Herniated lumbar discs are a serious concern in cases of low back pain. The L5 intervertebral disc sits between the L5 and S1 spinal segments, and the nerves that exit at that level contribute to lower extremity muscle movement and sensation. Recognising the signs and symptoms of a herniated disc will allow proper care to be provided sooner, and that offers a better prognosis.
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Low Back Pain
Low back pain can originate from the L5-S1 spinal level. This level corresponds to the area of the back directly above the buttocks. Pain may be centrally located or biased to the left or right, depending on the location of the herniation. Back pain due to herniation is often increased by lifting or sitting; both actions increase the pressure on the herniated disc.
The hallmark symptom of an L5 disc herniation is a sharp pain down the back of the leg, below the knee or into the foot. Pain is often described as shooting, burning or electric-like, and the patient can often trace the path of the pain with her finger.
Muscle weakness may be present depending on the severity of the herniation. In the case of an L5 herniation and nerve root compression, weakness of the big toe extensors, ankle extensors or ankle flexors may be present. This may present as an inability to extend the ankle while walking, resulting in a foot drop. It may otherwise be mild and only discovered by a thorough neurological examination.
Numbness and Tingling
Hernation of the L5 disc can cause nerve compression and feelings of numbness or tingling in the posterior leg and foot. Descriptions of pins and needles, tingling or lack of sensation may be present depending on the severity of the herniation.
More severe L5 disc herniations may present with a diminished Achilles tendon reflex.
Red Flag Signs and Symptoms
Red flags that require immediate referral to a neurologist or neurosurgeon include the following: any changes in bowel or bladder control (loss of control, difficult urination), saddle parasthesia (numbness or tingling of the skin that would be in contact with a saddle if riding a horse) and progressive neurological losses (progressive loss of muscular control, reflexes or sensation).
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