A herniated disc at L5/S1 is an extremely common problem. So common, in fact, that 90% of people who suffer from a disc problem will have a herniated disc at L5/S1. Today, we’re going to talk about what a herniated disc L5/S1 is, the symptoms someone with this problem might get and the ideal treatment to get it better as fast as possible!
What is a Herniated Disc L5/S1?
When we refer to a herniated disc L5/S1, we are talking about a problem with the spinal disc at the lowest level in the spine.
To understand this better, let’s talk a bit about the anatomy of the spine. Once you can picture the area of the body affected by a herniated disc L5/S1, you’ll be able to understand why you’ve got your symptoms and what to do about it!
The Human Spine
The human spine is made up of 24 vertebra (your “back bone”) which are funny shaped bones stacked on top of each other. These vertebrae start in the lowest part of your back and run all the way to the top of your neck.
The top 7 vertebra in the spine are called the “cervical” vertebrae. These make up your neck. We call them C1, C2, C3 etc… All the way down to C7 at the base of the neck.
Your mid-back is made up of the 12 thoracic vertebra. These are called T1 to T12.
Your lower back is made up of 5 large lumbar vertebra. These are called L1 to L5. L5 is the lowest vertebra in the spine.
Below that is your sacrum. Your sacrum is the funny shaped bone that joins the right and left parts of your pelvis together. Although the sacrum is one individual bone, there are 4 sets of nerves that exit the sacrum. We call these levels S1-S4.
Below your sacrum is your coccyx – the little bone that forms your ‘tail’!
The Spinal Discs
Between each vertebrae is a spinal disc – a tough sac made up of strong cartilage, filled with fluid.
We name these discs based on the vertebrae above and below the disc. For example, if we are talking about the disc between L1 and L2, we would call it disc L1/L2.
So, when we are talking about disc L5/S1, we mean the final disc in the spine that sits between L5 (lowest vertebrae) and the sacrum (S1).
Although the discs are much stronger than a donut, it might help to imagine the design of the discs like a jam donut – made up of tough outer layers filled with fluid.
The discs are very important. They help the spine move normally. Without them, we couldn’t walk, stand or move our spines.
The Nerves and Spinal Cord
Inside the bones in the spine, there is a long hollow passageway. Through this passageway runs the spinal cord, which starts in your brain and runs right down your back – the origin of all the nerves in our body.
From each level in the spine, a tiny portion of the spinal cord splits off and becomes a nerve. This nerve then leaves the spine and runs to a limb or other part of the body.
The nerves are vital to human life – they allow us to move, feel, talk and digest food.
The longest nerve in the human body is the sciatic nerve. It leaves the spine near the bottom of the back and runs all the way down the back of the leg into the toes. It is around an inch in diameter and allows the legs to work normally.
Without the sciatic nerve, you wouldn’t be able to use the muscles in your legs and you would be completely numb in large patches in your legs and feet.
What is a Herniated Disc L5/S1?
Over time, the discs in the spine can suffer normal wear and tear that occurs from repetitive movements throughout our lives. This process happens to everyone and isn’t automatically painful. (Here’s a study that proves this fact.)
However, if one part of the disc has weakened more than others, it can lead to something called a herniated disc.
This describes the event where the strong outer fibres of the disc split (or “herniate”) and the fluid within the disc leaks out at the region where the injury occurred.
Because of how close the discs are to the nerves that we talked about earlier, some of the inner material of the herniated disc can touch the nerve, causing an array of symptoms along the course of that nerve.
If the fluid within the disc touches the sciatic nerve, the symptoms that follow are called “sciatica”. The term sciatica isn’t a disease in and of itself – just a word to describe the symptom of pain in the leg caused by the sciatic nerve.
If someone suffers from a herniated disc at L5/S1, because this disc is extremely close in proximity to the sciatic nerve, the inner material from the disc often touches the nerve and causes sciatica.
This is why a herniated disc L5/S1 is often one of the most problematic disc herniations that someone can experience.
Why is a herniated disc L5/S1 so common?
We now know that the disc L5/S1 is the lowest disc in the spine. It sits at the junction between the lowest vertebrae and the sacrum.
Because of the way our spines are designed, they have special curves at the top, middle and bottom. When we walk and move, the areas that have a more dramatic curve tend to suffer from more stress than the areas that don’t curve.
In addition to this, the discs that sit at a junction between two different types of vertebrae (i.e. cervical and thoracic (C7/T1) and lumbar and sacrum (L5/S1)) tend to suffer even more stress through normal movement.
We think of this as a minor “fault” in the way human spines are created – unfortunately, there isn’t much we can do about this design fault!
Anyway, the disc at L5/S1 is both at the point of a curve in the spine AND at the junction between two types of level. This places it at double the risk of the other vertebra and this is why a herniated disc L5/S1 is so common.
What are the Symptoms of a Herniated Disc L5/S1?
There are a number of symptoms that can occur following a herniate disc L5/S1. They can be alarming and scary for anyone who first experiences them.
Luckily, with this article, you’ll understand what’s normal and why you are going through these issues which will hopefully alleviate some of your concern.
Common symptoms of a herniated disc L5/S1:
- Back Pain: Perhaps the most common symptom of a herniated disc L5/S1 is back pain. Now, although this may surprise you, not everyone experiences back pain with a herniated disc, but most people do. I was shocked at first when I would get clients who had a herniated disc yet no back pain whatsoever, but it is certainly possible. Most people who suffer a herniated disc L5/S1 will experience an aching to sharp pain right across the lower back. It may be tender to touch and feel like the muscles are in spasm too.
- Sciatica: A herniated disc L5/S1 is the most common cause of sciatica. Sciatica is the word we use to describe the sensation of pain the runs down the back of the leg. It is usually shooting and can be severe – sometimes described by my clients as feeling like “being stabbed by a hot poker”.
- Pins and Needles/Numbness: A herniated disc L5/S1 can cause sensory changes in the leg and foot. Usually, the funny sensations will be present in the foot and toes and for some people this symptom can be worse than the pain. This symptom happens because the herniated disc is pressing against the nerve in the spine which stops the nerve from doing its job correctly. This means that some signals don’t get through properly and sensation isn’t felt normally.
- Weakness in the Legs: Now, this symptom can be alarming and you should definitely head to your doctor if you feel weakness in one or both legs along with any of the other symptoms on this list. Weakness in the legs (particularly calf weakness with a herniated disc L5/S1) indicates a severe nerve compression from the herniated disc. If this sounds like you, it needs addressing as soon as possible.
Uncommon symptoms of a herniated disc L5/S1:
- Leg shaking/spasms: Often confused with sciatica, these spasms cause the muscles to tense up and go into spasm. The best way to deal with this symptom is through a short course of muscle relaxants.
- Problems with the Bladder and Bowel: This is an alarming symptom that needs addressing as quickly as possible by a doctor. This occurs when the nerves that allow the bladder and bowel to do their job are compressed by the herniated disc at L5/S1. If you suffer from incontinence (accidents), not being able to “go” or not being able to feel when your bladder/bowel are full, you need to speak to your doctor as soon as you can. If you cannot contact your doctor, a trip to the emergency room should be your next step.
- Numbness in the Private Areas (or “Saddle” Region): This is another symptom that needs immediate investigation. Again, this indicates the lower nerves are compressed to the point that they can’t function properly. If this isn’t fixed soon, you might end up with a permanent problem. Again, a trip to the emergency room should be your next step.
What to Expect from a Herniated Disc L5/S1
When I worked in professional football, we would usually be able to tell the manager with reasonable accuracy exactly how long a player would be out for, depending on the injury he had.
For example, a mild ankle sprain would almost always be recovered by 3 weeks, while a hamstring injury might take 6 weeks.
However, with a herniated disc L5/S1, it isn’t possible to accurately predict how long someone will suffer for.
Almost always, the healthier you are in general, the faster you will get better.
Age also plays a role – people under 40 tend to recover a bit quicker than those over 40. However, other than that, herniated disc recovery time is difficult to predict.
As a general ball-park figure for you, most people SHOULD feel significantly better after 12 weeks following a herniated disc L5/S1.
However, many don’t. And when you’ve been in pain for a long time, the body undergoes some changes which make recovery slower and more difficult.
That’s why ACTION is key – when you make a commitment to getting better, and do all the right things each day, you can usually accelerate herniated disc recovery significantly.
Timeline following a Herniated Disc L5/S1
Day 1 – Day 14
- Expect to be in a LOT of discomfort. Even though staying active as much as possible is key, you’ll need plenty of rest… And that is OK!
- You’ll need to look at HOW the problem started – were you lifting and shifting with poor technique? You’ll need to address this later in the process.
- How’s your diet and sleep? The more sleep you get and the “cleaner” you eat (click HERE for info on the RIGHT foods to eat), the faster you’ll get better from here.
- You may need a short course of pain killers to get through the worst bit.
- It’s worth getting an assessment from a doctor, especially if you are worried about any of your symptoms.
Day 14 – Day 28
- The pain may have started to ease a bit by now, but you’ll likely have incredible stiffness in the lower back. We need to start addressing that soon!
- This is the stage where gentle movement is key – in the back, in the leg and getting out for a few walks if you can manage.
- Make sure to stay hydrated here – when you aren’t fully hydrated, the discs don’t function or recover as well. Drink more water than usual.
Day 28 – Day 56
- Keep going with your rehab, keep walking as much as you can.
- Start a stretching program for your legs – click for a simple stretching program you can use for sciatica relief at this stage.
- Now’s a good time to address the problem that caused the herniated disc at L5/S1 – was it weakness in your back? Was it terrible technique? Was it your lifestyle and the fact that generally you’ve been unhealthy? Start addressing these things now.
- Click here for a complete program that can help you address all the above and get back to normality!
Day 56 – Day 90
- Now, you should start to be getting back to some normality, although you’ll still be feeling fragile.
- You’ll need to take things easy – don’t rush back to anything. You should have someone who can help you at work when the pain starts to nag.
- Don’t worry if you get occasional bad days – it’s normal! Recovery is hardly ever straightforward and few set backs aren’t uncommon.
- Keep addressing the problem areas. If it’s weakness in your spine, you need to strengthen it. Don’t try and do this without guidance! Find a professional or invest in a proven system that works!
Treatment for a Herniated Disc L5/S1
So, when we talk about treatment for a herniated disc L5/S1, we need to split this category into two parts: Lifestyle and Exercise.
Before we dive in, if you’d like more help recovering from a herniated disc L5/S1, sign up for my 30-Days of Sciatica Relief Coaching below to get tips, techniques and strategies that are proven to get you better faster:
Treatment for a Herniated Disc L5/S1 Part #1 – Lifestyle
It’s crucial that you optimise your diet for a recovery from a herniated disc L5/S1.
This involves maximising anti-inflammatory foods: click HERE to learn more about anti-inflammatory foods for a herniated disc L5/S1.
You’ll also need to minimise pro-inflammatory foods: click HERE to learn about which foods to AVOID when you have a herniated disc L5/S1.
You need to keep generally active. This means not taking too much time off work.
You should try to walk as much as you can within the realms of comfort. Stop when pain starts, have a break, then get back to it.
One of my clients used to leave his house, walk up the road 100 yards, then come back. That was it for each day. But even those few hundred steps made a huge difference over a number of weeks.
Little and often is key – don’t overdo it. Make sure you stop as soon as your pain starts to worsen. Each day, you’ll be able to build your activity level gradually.
Drinking plenty of water is absolutely crucial. When you have a herniated disc L5/S1 compressing a nerve, any dehydration in that disc will make the compression worse.
This means that drinking 3-4 litres of water each day is critical to your success and a highly undervalued facet of recovery.
Getting as much sleep as possible is incredibly important when you have a herniated disc L5/S1 (although, sciatica can make sleep more difficult unfortunately).
Sleep is one of the key parts of a recovery from a herniated disc L5/S1 – sleep is when healing occurs. It’s impossible to get better without ample sleep each night.
One helpful tip to remember is that you can make up for lost hours of sleep as a nap if your pain tends to be worse at night. A 20-minute nap has been shown to be as effective as two hours of extra sleep in the morning in terms of restoration, some research shows.
Minimising Discomfort to Speed Up Recovery
Getting better from a herniated disc L5/S1 is just as much about avoiding making the problem worse as it is about doing extra things.
As a general rule of thumb, if an activity or position is making your pain worse, you need to change it or you run the risk of delaying your disc recovery time.
Products That Can Help
For a herniated disc L5/S1, there are a number of products that can help you go about your day with less pain and more comfort. Here are a few of my top recommended products for herniated disc relief:
#1 – TENS Machine for herniated disc L5/S1
TENS machines are useful for providing relief from pain and muscle spasms in the back and legs. They are a safe and effective way of relieving your symptoms without any effort on your part.
Below are 3 of my top recommended TENS machines for relief from a herniated disc L5/S1:
TENSCare Perfect TENS Pain Relief Machine
This TENS machine for sciatica has 8 preset programs so you don’t need to “tune it” yourself – just pick a setting and off you go! There is an option to purchase a ‘Value Pack’ which includes spare pads which I would definitely recommend.
TPN 200 Plus TENS Machine
A super-simple yet sleek design, this TENS machine is perfect for those who want a highly effective model and are confident with using a TENS machine for sciatica pain relief. This unit doesn’t have a fancy display, so you can customize the settings to best suit your needs, tweaking and changing the frequency until you find one that works best for you.
#2 – Lumbar Roll
A lumbar roll is a specially designed cushion that goes behind your lower back when sitting.
It increases the curve in the lower back, which many people find takes pressure off a herniated disc L5/S1 when sitting (which can be the worst position for a lot of people).
Here is a great option for a lumbar roll for the office, car and home:
#3 – Muscle Rub
A muscle rub or topical anti-inflammatory is a great first-line treatment for a herniated disc L5/S1. Although it won’t affect the actual disc itself, it will ease tension and pain from the muscles in the lower back and legs and can help to relieve symptoms associated with a herniated disc.
Here are the muscle rubs that my clients find most useful (I provide these Tiger Balm rubs to some of my clients as they are so effective in the first few weeks following a disc herniation):
Home Treatment for a Herniated Disc L5/S1 Part #2 – Exercise
The most important thing to understand when it comes to herniated discs and exercise is that everyone is different; a suitable exercise regime for one person with a herniated disc L5/S1 will be different for another with the same problem.
However, there are some exercises that are commonly useful for many people with herniated discs. Only choose the ones from the following list that are non-painful and don’t make your symptoms worse during and after you finish the exercise.
Always go gently at first and build up slowly.
#1 – Cobra Pose
- Begin laying face-down on a firm surface like a mat on the floor or a hard mattress
- Place your hands in line with your shoulders and gently push up, raising your torso off the floor
- Keep your hips down on the floor
- Only go as far as is comfortable – no need to get to full extension for a benefit!
- Gently lower yourself to the starting position and repeat up to a maximum of 10 times.
- Do a set of these 3-4 times per day
Who this is for:
Usually, people suffering with a herniated disc L5/S1 find this exercise one of the most useful for improving their symptoms. However, regardless of what is causing your sciatica, you should only persist with this exercise if it is comfortable to perform this movement. This exercise is a good place to start if you have trouble bending forward.
Why this sciatica exercise works:
This sciatica exercise works because it involves movement of the lower back which encourages blood to flow to the injured area so healing can occur. Some researchers also believe this exercise causes a disc bulge to “centralise” into the disc where it can’t pinch on a nerve root.
#2 – Knee Rolls
- Lie on your back on a mat or a firm mattress
- Bend your knees up halfway
- Slowly and gently, allow both knees to roll over to one side only as far as is comfortable
- Bring your knees back to the start position, then allow them to roll over to the opposite direction
- Repeat for 30-seconds total, don’t rush the repititions and try to find a rhythm
- Try to find time to do this exercise every 2-3 hours if you can
Who this is for:
This sciatica exercise is great for relieving any tension in tight muscles in the lower back. It is also a great way to begin to regain any lost rotation in the lower back following a herniated disc L5/S1.
Why this sciatica exercise works:
By gently encouraging a slow, controlled rotation of the lower back, the muscles in your lower back will realise that it is OK to relax a little. This will bring about herniated disc pain relief.
#3 – McKenzie Side Bends
- Start standing next to a wall. Most people prefer to do this exercise with their painful leg being the one FURTHEST AWAY from the wall. However, try both sides and see which one is most comfortable for you – stick with that one.
- Use your elbow and forearm to support yourself so you are leaning on the wall (1st picture)
- Slowly and gently, let your hips “glide” towards the wall while keeping your feet in the same position.
- Only go as far as is comfortable, then return to the start position.
- Repeat this 10 times, have a break, and do 3 sets total.
- If this exercise has worked for you, you may feel rapid relief in the painful leg and possibly slightly worsening back pain – rest assured this is a normal phenomenon.
Who this is for:
This exercise works really well for disc problems and is a mainstay for a treatment approach called “McKenzie”. If you have pain in one leg only from a disc bulge or prolapse, try this exercise. It brings significant sciatica pain relief to many people and can work rapidly.
Why this sciatica exercise works:
The McKenzie approach claims to work by encouraging the disc material called the “nucleus pulposus” to re-centralise into it’s inner middle. Whether or not this actually occurs hasn’t been proven in scientific literature but I have seen this exercise provide relief for many. Be sure to choose the direction that is least painful when performing this sciatica exercise.
#4 – Standing Extension
- Start standing normally.
- Gently try to lean back. Only go as far as is comfortable.
- If you feel able to, use your hands to provide support in the lower back allowing you to extend further (3rd picture)
- Slowly return to the start position
- Perform up to 10 repetitions, every few hours or so. Cut your set short as soon as you reach the first signs of pain.
Who this is for:
This is a great sciatica exercise for a herniated disc L5/S1 as well. It works especially well for people who have trouble leaning forward and is a more user-friendly/convenient version of #1 on this list. However, I find it to be slightly less effective compared to the Cobra pose as I find people tend to rely more on pelvic rather than spinal movement with this one. You should AVOID this exercise if you suffer from arthritis of the lower back or spinal stenosis.
Why this sciatica exercise works:
This exercise works in a similar way to #1 – it involves movement of the lower back, encouraging blood to flow to the injured area so disc healing can occur. This exercise may help a herniated disc to “centralise” into the inner disc where it can’t pinch on a nerve root.
Other Treatment Options for a Herniated Disc L5/S1
Very rarely, surgery is required for a herniated disc. This intervention is reserved for those who have tried everything else and are still suffering.
It’s important to exhaust all non-surgical methods first, as you can’t reverse a surgery and the results from surgery are often underwhelming. Occasionally, surgery can make someone worse which is obviously devastating to hear about.
Another option includes injections, which can give pain relief down the course of the sciatic nerve. From my experience, these have very underwhelming results for most people. However, they can occasionally be effective.
My Final Recommendations for a Herniated L5/S1
If you’re currently suffering with a herniated L5/S1, don’t try and go through it alone!
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I hope you’ve found this article helpful. I think it’s useful to understand exactly why you’re suffering the way you are right now from that herniated disc L5/S1, so the symptoms make more sense. I also hope you find some of the exercises in this article useful.
Remember, getting better from a herniated disc is just as much about managing your day in a way that doesn’t make the symptoms worse as it is about doing exercises to fix it.
What did you think of this article? Was it useful? Leave me a comment below and let me know!