L5S1 Disc Herniation
I’ve already covered what a herniated disc is at a high level, but I’d like to dig in to one of the more common areas for a disc herniations.
What is the ‘L5S1’ spinal disc?
There are five main sections of the spine: the cervical, thoracic, lumbar, sacral and coccygeal. The cervical spine supports the head and makes up the neck. The thoracic spine supports the ribs. The lumbar spine composes the lower back. The sacral section sits at the base of the spine, and is composed of 5 fused vertebrae which fits between the hip bones. The coccygeal spine is the very bottom tip, and is also known as the tailbone.
L5S1 refers to the spinal disc that connects the 5th vertebrae in the lumbar spine to the 1st vertebrae of the sacral spine. This region is also known as the L5S1 motion segment, and helps to distribute loads from the spine to the legs and pelvis.
Injuring the L5S1 Disc
The L5S1 spinal disc has particular biomechanical properties that make it a hotspot for pain and injuries. In many ways, it’s a focal point when the body is engaged in some sort of load bearing activity that involves bending forward. The L5S1 disc sits between and extremely flexible part of the back (the lumbar spine) and a very inflexible sacrum. This means that when the lumbar spine is in flexion (moving or bending in some way), the part of the disc attached to the sacral vertebrae is held in place. This tension can cause pressure on the disc, which can result in herniation, bulging or tearing. For this reason, an L5S1 disc herniation is a common injury for weightlifters, as well as unconditioned individuals engaged in heavy lifting when not utilizing proper lifting form. It can also be injured if the lumbar spine is in a vulnerable position (bent, twisted or both) when someone sneezes.
However, many injuries to the disc occur more gradually over time. Though many people suffering from an L5S1 disc herniation experience a single event that precedes pain and symptoms, many others will sustain injuries to the disc over time. These small injuries here and there can add up to cause a bulge or a tear. Many people with bulging discs are not aware of their conditions, and for a large portion of these people, they may go their whole lives without realizing their condition. This is not an uncommon scenario, and life for such individuals can go on as normal. For those who do begin to experience symptoms however, whether through a gradual onset or a sudden occurrence
Symptoms of L5S1 Disc Herniation
The symptoms of an L5S1 disc herniation can manifest in a number of ways. Some people will be completely asymptomatic, while others will experience one or more of a variety of unpleasant symptoms.
Pain
Pain is an early and obvious sign of an L5S1 disc herniation, though it is not a guarantee that you’ve sustained such an injury, and can also be associated with back pain or strain
Numbness or weakness
Numbness occurs from muscle impingement, but rather than causing pain, the impingement is cutting the nerve off from sending signals back to the spine, and thus the brain. An L5S1 herniation in particular can impinge the S1 nerve, and cause numbness or weakness in the toes, soles or outside of the feet. If you suffer any numbness or weakness in these areas, seek medical attention immediately. Otherwise, the impacted areas of your lower body may atrophy, and you may lose some or all function of the limb.
Loss of bowel or bladder control
This symptom, along with numbness or weakness, is a cause for immediate concern. If you experience this symptom as well, make sure to go to a doctor as soon as possible. These symptoms indicate that the L5S1 disc is impinging on one or more of the nerves that regulate these bodily functions. If these nerves are impacted for too long, you could experience lasting issues with bowel or bladder control.
Managing, treating and overcoming your L5S1 herniated disc
So you’ve learned you have a herniated or bulging disc. First of all, read this article. The advice contained within is a great general approach to dealing with a herniated disc, and should take you through the immediate days and weeks following your injury. The advice from my earlier article can be summarized in the points below:
- Make an appointment with a doctor
- Rest, Ice, NSAID
- Manage pain
- Plan accordingly
In addition to the above advice, you may come across more extensive treatment options for an L5S1 disc herniation. These options may seem intimidating and invasive, but it is best to understand them as you set out to overcome this challenging injury.
Injections
In the event that you herniate your L5S1 spinal disc and subsequently suffer from pain, tingling, numbness or sciatica, a doctor may suggest injections to help alleviate symptoms. With this option, a physician will inject a combination of pain relievers (such as novocaine) and corticosteroids. The role of the steroid is to help with inflammation. After an L5S1 herniation, you may have muscle inflammation in addition to the protruding spinal disc. The corticosteroid will reduce the swelling from both of these issues, which may help alleviate symptoms like sciatica, tingling or numbness.
However, one thing to keep in mind with injections is that their effects can be temporary. The pain reliever and steroids will last for anywhere from a week up to a year. An injection shouldn’t serve as a primary solution to an L5S1 disc herniation; rather it should be used to help an individual with this injury resolve their most acute and immediate pain, while enabling them to begin a therapeutic routine, some options of which I list further below in this article.
Surgery
Surgery can sometimes be an option for those with herniated L5S1 discs. However, this is usually a last resort, or reserved for the most severe cases of herniation. Check out my article on whether you need surgery for a herniated disc. Such severe cases include when an individual is suffering from symptoms such as total numbness or loss of bowel/bladder control. In these cases, surgery is needed to take the pressure off the nerve upon which the herniating disc is pressing. There are several options for surgery, which I summarize below.
Laminotomy
In a laminotomy, the surgeon will remove a piece of the vertebrae in order to relieve pressure on the impacted nerve clusters.
Discectomy
In a discectomy, a portion or the entirety of the protruding L5S1 spinal disc will be removed. This of course relieves the immediate symptom of the nerve compression, however not having a spinal disc can cause issues in its own right. In these cases, and artificial disc will be added.
Artificial disc replacement
In cases where an entire L5S1 spinal disc needs to be removed (usually if the disc is severely herniated or compromised), a new artificial disc will be added in its place. This can be a risky procedure, and is not right for everyone. In addition, artificial discs are not nearly as durable as natural ones, so the new disc may degrade over time, necessitating repair or replacement down the road.
Spinal fusion
In particularly severe cases where the L5S1 disc is removed, the L5 vertebrae may be fused with the S1 vertebrae. This adds stability to the lumbar spine, though at the expense of mobility. People with spinal fusion surgery may experience a loss in their range of motion and flexibility. However, this downside may be worth it in especially severe circumstances.
However, if you really want to make great strides in treating or overcoming your herniated discs without resorting to surgery or injections, you may need to take your therapy into your own hands.
Seek out a physical therapist
Having a good physical therapist can be a game changer as you seek to recover from your herniated disc. Soon after I injured my back, I was referred to a physical therapist by a cross country teammate. After one session, I was feeling 95% better. After several sessions, I was feeling almost back to normal. My physical therapist had taught me a number of exercises to do on my own, after which I was able to manage my own therapy. My therapist also did some hands on manipulation, such as myofascial release. Although this wasn’t directly related to my herniated disc, the body is a highly interconnected system. A physical therapist may identify other areas in your body that may be contributing to your overall condition. Although many therapists may not accept insurance, or your insurance may refuse to pay for therapy, I found that going in for physical therapy was worth every penny I spent.
Stay active, or begin a healthy exercise routine:
Some people injure their lower backs through some sort of physical activity. In these situations, sustaining a disc herniation can certainly be both painful and demoralizing. However, it is important not to completely cease physical activity in the mid to long run. Take a few days off, or however long your doctor recommends, then start back up with a gentle routine.
Other individuals who may lead more sedentary lives may also herniate discs in their backs. Such individuals should start forming better habits for long term health and well-being. For such individuals, lower back pain should serve as a wake-up call for what the future may look like if they continue to lead an inactive lifestyle. Below are a number of great activities you can pick up to begin a healthy lifestyle, or things you can start doing as a supplement to your already active routine.
Build a strong core
A strong core is the best foundation to overcoming lower back pain from disc bulging or herniation, and will help you stay pain free in the future. There are a number of great core exercises which I will cover briefly here, and expand on in future articles. A strong core will support your lower back and spine. This is useful in minimizing pain with your current injury, as welling as reducing the risk of future injuries.
- Planks
- Spinal erector exercise
- Leg raises
Swimming
Swimming is a great, low-impact way to stay in shape. There are numerous benefits to swimming. It’s a low impact activity, so you won’t put a lot of wear and tear on your body. When you move through water, you face more resistance than when moving through air so you naturally burn more calories. You improve your endurance and cardiovascular system, so you use energy more efficiently. And very importantly for a herniated disc, you decompress your spine. When you float in water, your spine is not under the same kind of pressure it is when you’re upright on land. As such, it is able to stretch out lengthwise more than it can on land. Because of that, the load is taken of the vertebrae and spinal discs. This can help with immediate pain relief, and over time, this may also help a herniation heal, as the negative pressure caused by the expansion can help draw the protruding portion of the disc back in. There is a reason that I consider swimming to be the number one best exercise that you can do for your lower back!
Running
Running is a great exercise in general, and it can be when you have injured or herniated a disc in your lower back as well. However, you should certainly be cautious if your are just starting to run after a lower back disc herniation. As with any physical activity, you should start slow and ramp up. A good rule of thumb for a healthy person is to start at 5-10 miles a week, and add about 10% distance every week. However, you may want to be even more cautious if you suffer from an L5S1 disc herniation. Unlike swimming, you run upright. Because of this, your spine is under some amount of pressure. Add to this the up-down movement of your upper body during running, which compresses and expands your spine like a spring, and you get an activity that may make your lower back pain worse.
If you experience more pain after you start running, take a break, and try it again after several weeks. However, this very same up-down movement in your upper body may actually feel good, and help with your recovery. This compress-expand cycle of your spine during running can increase blood flow to your spine. The reason that herniated discs take so long to heal is that there is relatively little blood flow to spinal discs. Some gentle running can increase this, and potentially help you recover more quickly. If you are an experienced runner and suffer from a herniated disc, continuing to run at similar mileage after a few days of rest may be just fine. However, if you have never run before and want to start a routine after injuring your lower back, think about running on soft surfaces. Begin with 400 meters (one lap around a standard track), see how it feels, and up your distance slowly and gradually.
Yoga
I usually say that swimming is the absolute best exercise that you can do for lower back pain or a herniated disc, but yoga is definitely a close second. I really like Yoga because there are a lot of different kinds of practices, and you can pick and choose the kinds of yoga you do based on your own needs. In every variety, you can usually make the pose as easy or as challenging as you would like, and since you’re being mindful the whole time, you can figure out what hurts and what doesn’t. Really at its core, yoga is a series of movements combined with mindfulness. You can really develop your mind-body connection, and many of the poses can help stretch tight muscle groups while strengthening others. While more energetic and active yoga classes are popular, there are also varieties of yoga such as Yin and restorative yoga. Yin yoga focuses on the connective tissues of your body. Poses are held for longer periods of time to help really loosen the fascia, or scarred/tight connective tissues. In restorative yoga, you hold very gentle poses for up to 10 minutes, while in a mindful and meditative state. Both varieties are great for individuals who have recently injured themselves, while regular, or vinyasa yoga, is a great way to push yourself physically once you have built a solid foundation of flexibility and strength.
Weightlifting
Weightlifting is an activity that you can do after herniating a disc in your lower back, however, there are a number of caveats to this. To begin with, if you injured your lower back by weightlifting to begin with you should certainly take time off from lifting, and only return to this activity under the guidance of a doctor or physical therapist. You should pair this weightlifting with the above exercises and routines, especially the core strengthening activities. Use and learn the best form for lifting, especially for lower body exercises such as deadlifts and squats. When performing such exercises, you need to make sure that you are not bending your back, as this can put tremendous strain on the part of your back that you injured to begin with! Check out my article on how to properly perform heavy lower body lifts when you have a herniated disc.
Weightlifting with a lower back injury or disc herniation can be risky, but if performed correctly, it can have very positive benefits. Exercises such as squats and deadlifts can greatly strengthen your core. You’ll put on muscle mass, which can help you in your day to day life. With your additional strength and conditioning, you will move in a more healthy and efficient way. You won’t need to bend your back when lifting heavy objects, because your body will have the strength to do so without contorting or moving in a risk-prone manner.
Conclusion
Learning that you’ve herniated your L5S1 disc can be disappointing news indeed. The spine is a critical part of the human body. For those who lead active lives, the news of such an injury can be demoralizing. For those who are not active, the diagnosis of a disc herniation can serve as a wake up call to improve poor habits and lifestyle choices. Most often in both circumstances, this injury can be overcome, and many people, myself included, end up stronger and healthier than before the injury!
