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How To Treat L4 L5 Back Pain

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L4 L5 Disc Bulge Treatment Without Surgery -How To Relieve L4 L5 Back Pain | Dr. Walter Salubro

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Conservative Care For A Herniated Disc Why It May Not Work For You

This is why many doctors will recommend many and varied courses of conservative care before recommended spinal surgery.

Here are our articles on conservative care for herniated disc:

  • epidural steroid injection. In this article, back pain treated with epidural steroid injections and Prolotherapy is compared. We will answer common patient questions such as: Do epidural injections help herniated, slipped, bulging discs?
  • Chiropractic care, physical therapy, and various spinal and muscle stimulators.

Minimally Invasive Microendoscopic Discectomy

Minimally invasive microendoscopic discectomy is a bit more complex surgery that is being used more and more often these days. A small incision is still made at the back of a patient. A doctor will use small tubes in order to make the tunnel to the vertebra larger. A part of the bone is removed in the procedure. Ruptured disc is removed as well. This surgery is less-invasive and requires a shorter recovery.

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What Causes Lumbar Strain

Injury can damage the tendons and muscles in the lower back. Pushing and pulling sports, such as weight lifting or football, can lead to a lumbar strain. In addition, sports that require sudden twisting of the lower back, such as in tennis, basketball, baseball, and golf, can lead to this injury. Certain risk factors, such as excessive lower back curvature, forward-tilted pelvis, weak back, or abdominal muscles, and tight hamstrings, can increase the risk for this injury.

Research: Latest Information On Conservative Care For Herniated Discs Outdated

L4 L5 Disc Bulge Treatment Without Surgery

While many people will find great pain relief from the above conservative care measures, some will not. Some doctors feel that conservative care failures are based on outdated information about what will work, for whom it will work, and when it will work for these people indicating as we did above that there is a window of opportunity when these treatments or any treatment will be most effective in helping the patient avoid surgery.

Lets look at the first choice of herniated disc treatment through the eyes of a Canadian research team who reviewed the current concepts and clinical guidelines for the management of low back pain to assess their quality of care.

In this February 2017 study published in the European Pain Journal, doctors and researchers found according to high-quality guidelines:

  • All patients with acute or chronic low back pain should receive:
  • education,
  • reassurance,
  • and instruction on self-management options
  • Patients with acute low back pain should be encouraged to return to activity and may benefit from:
  • paracetamol,
  • Patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation.
  • This new study found some of these guidelines to still be in practice but outdated, specifically the use of paracetamol for acute low back pain and other herniated disc symptoms.

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    Muscle & Ligament Disorders At L4

    Injury, damage, or disorders of the ligamentum flavum are common muscular and ligamentous issues that cause concern. Muscular and ligamentous issues involving the L4-L5 segments are relatively common. They are present in almost all persons over the age of 40. However, having muscles or ligament issues alone will not cause significant pain. A muscular or ligamentous source of back pain occurs when they are damaged. Ligamentum flavum is a ligament with muscle characteristics. In other words, it has contractile abilities. Damage to ligamentum flavum leads to hypertrophy of ligamentum flavum that compresses the nerve and spinal cord.

    More Detailed Procedure Does Not Necessarily Mean More Effective

    In the surgical approach for a patient with a spine problem, the general rule is that the preferred surgical intervention is the one with the least invasion and greatest benefit. A complex detailed surgery is not necessarily more effective. Performing a long complicated operation, such as transforaminal lumbar interbody fusion with pedicular screw and rod fixation for simple LDH not associated with Modic endplate changes, can be inappropriately complex for the intended goal . The procedure of choice for simple LDH is partial microscopic discectomy, preferably with minimally skin incision. Performing additional measures like posterolateral or interbody fusion and instrumentation in order to obtain additional surgical outcome have only been proposed for those herniated discs accompanied with Modic endplate changes and predominantly LBP .

    A 32-year-old man with low back pain and left sciatic pain. Sagittal and axial magnetic resonance imaging scans showed extruded left sided simple L5S1 lumbar disc herniation. Plain postoperative lumbosacral radiographs of the same patent underwent transforaminal lumbar interbody fusion and fixation.

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    How To Treat Bulging Disk L5

    Treatment for a Bulging Disc L4/L5 Cobra Pose. Only go as far as is comfortable no need to get to full extension for a benefit! Knee Rolls. This sciatica exercise is great for relieving any tension in tight muscles in the lower back. McKenzie Side Bends. Start standing next to a wall. Standing Extension. Start standing normally.

    Which Nerve Is Your Bulging Disc Pressing On

    how to relieve l4 l5 back pain

    The symptoms you experience will vary depending on which nerve root is compressed by the bulging disc

    There are 5 bones in your lower back or lumbar spine. These are known as L1 L5

    On top of getting lower back pain symptoms, the most common places to get symptoms from a lumbar disc are:


    This refers to the disc that is situated between Lumbar bones 3 and 4. Learn more about L3L4 Symptoms.

    Pain: You may feel sharp shooting pain on the inside of the lower leg usually from below the knee to the top of the big toe.

    Weakness: You will experience weakness when straightening your leg from a bent positionLoss of Sensation: You may experience altered or loss of sensation in the area just above your knee


    This refers to the disc that is situated between Lumbar bone 4 and 5.

    Its the 2nd most common place to get a disc in the lower back.Pain: You may experience pain on the outside of the leg start near your hip and running down the side of your leg to your 3 middle toes.

    Weakness: Weakness is usually felt if you try to raise your big toe on the side of painLoss of Sensation: You may experience numbness or a loss of sensation in between the webbing of your big toe and second toe.


    Refers to the disc that is situated between Lumbar bone 5 and the sacrum.

    This is the most common disc bulge in the entire body because its the very bottom bone in the spine.

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    Certain Sleep Positions Help Relieve Herniated Disc Pain

    Pain from a lumbar herniated disc can worsen during the night. You may find comfort sleeping in a position that relieves pressure from the spine. A couple good options include:

  • Use a pillow under your knees to help relieve tension in the lower back.4
  • Lie on your side with a pillow between your knees to keep your spine straight and hips balanced.4
  • Your preferred sleeping position and pillow placements will likely be determined by the location of your herniated disc. Try a few different pillow and positions to see what works best for you.

    See Best Pillows for Different Sleeping Positions

    What Is The Prognosis

    In general, the clinical course of an episode of acute low back pain seems favourable, and most pain and related disability will resolve within a couple of weeks. This is also illustrated by the finding that about 90% of patients with low back pain in primary care will have stopped consulting their doctor within three months. Croft suggests that in many patients low back pain symptoms fluctuate over time.w5 Most patients with back pain will have experienced a previous episode, and acute attacks often occur as exacerbations of chronic low back pain. So recurrences are common. Pengel et al estimated the cumulative risk of at least one recurrence within a 12 month period to be 73% .w2 The severity of these recurrences, however, is usually less and does not always lead to a new visit to the general practitioner., Only a small proportion of people with an acute episode of low back pain develop chronic low back pain and related disability.

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    Nonsurgical Treatments For L4

    Nonsurgical treatments of the L4-L5 motion segment include:

    • Medication. Both prescription and over-the-counter medications are used to help relieve pain from L4-L5. Typically, non-steroidal anti-inflammatory drugs are usually tried first. For more severe pain, opioids, tramadol, and/or corticosteroids may be used.
    • Self-care. To promote healing and/or prevent an L4-L5 injury from becoming worse, a few tips include avoiding:
      • Repeated bending of the spine
      • Sudden, abrupt movements, such as jumping
      • High-intensity exercise and lifting heavy weights

    It is important to use correct posture while standing, sitting, walking, lying down, and lifting items off the floor to maintain a normal spinal curvature and minimize stresses on the spine.

    Additionally, staying active, following an exercise-routine, quitting smoking, and reducing weight in overweight individuals can help lower the risk of problems stemming from L4-L5.

    Should You Opt For L4

    L4 L5

    L4-L5 lumbar fusion or minimally invasive spine surgery is not as effective as some would have you believe. Spine surgery is just that: surgery! So, when they use terms such as minimally invasive spine surgery, they decrease your surgical fears by making it sound minimalistic. In other words, it is a play-on-words. Ye, it is not as intense as fusion surgery , bone graft, discectomy, foraminotomy, or laminectomy, but invasive. Even the most minimally invasive spine surgery carries risks and, as such, is better avoided, especially when effective conservative measures are available right here in town. It is just that simple!

    We are even opposed to an l4-L5 spinal injection, such as steroidal injections at the L4-L5. Steroidal injections or any other type of injection into the spine have complications. Besides, under the best scenarios, spinal injection only provides limited improvement. But, the failure rate and risks of complications are even higher when it comes to spine surgery. Steroidal injections, facet joint injections, and spine surgery are invasive means that offer short-term gains. Our advice is to opt for nonsurgical treatments from our clinical experts.

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    What Is A Disc Herniation

    The bones in your back, called the vertebrae, are stacked one on top of another and are separated by discs. These discs contain a tough outer layer, known as the annulus, and a jelly-like inner layer, known as the nucleus.

    In the case of a herniation, the nucleus of the disc begins to push through the annulus and, in some cases, goes into the spinal canal. When this occurs, it can contact the nerves along your spine and cause numbness, tingling, pain and weakness down the legs.

    Drop Foot Or Numbness In Big Toe Due To Slip Disc

    • With severe compression to the lower fibres of the L4 nerve due to L4-L5 disc herniation can cause the drop foot. Majorly the big toe stops responding to the neural commands. And its activities are reduced.
    • This condition shows that nerve fibres are not in a good shape inside the spine and treatment should be planned properly.

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    What Are The Risks For Lumbar Disk Disease

    Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.

    Other Treatment Options For A Bulging Disc L4/l5

    L4 L5 Back Pain Surgery, “How I Ended up Here”

    Very rarely, surgery is required for a bulging disc. This intervention is reserved for those who have tried everything else and are still suffering.

    Its important to exhaust all non-surgical methods first, as you cant 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 is an injection, 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.

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    Rest And Lifestyle Change

    The simplest and very effective treatment. You will need to rest at least 2 days first. After that, start with simple physical activity, dont rush, and take your time. Regular walks are the best type of activity to use at this time. Lifestyle changes are mandatory as well. You need to consume more anti-inflammatory foods. The best examples are tomatoes, nuts, spinach, kale, and also fruits such as oranges, blueberries, cherries and etc. try to find foods with anti-inflammatory properties that suit you the most. At the same time, avoid food that is known to cause inflammation.

    Other changes you will want to make is to drink plenty of water. Consume 3-4 liters per day. This is essential for the condition due to the fact dehydration will have a negative effect and can worsen your symptoms.

    Sleep is essential for recovery. Your bulging disc will recover when you sleep. Sadly, sciatica can make sleep almost impossible. Try to find a position in which you can fall asleep and stay asleep for at least 8-10 hours. During the day, take a 30-minute nap. These are known to provide impressive benefits.

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    Make Fitness Part Of Your Life

    Never underestimate the value you’ll get from some weights and a treadmill. Take care of your health and fitness to prevent lower lumbar back pain.

    Resistance exercises build the muscle groups in both your back and your core. The stronger these muscle groups are, the less they tax and wear on each other.

    Many back injuries happen because the person had a weak core. When the back has to overcompensate for the weak core, you’ll tear muscles and hurt your spine.

    Invest in some home gym equipment that can help you build your strongest body. Pullups are incredible total-body exercises that strengthen your neck, back, core, and legs.

    These exercises also require you to hold your own bodyweight steady, which teaches you control and coordination. The stronger your back, the less likely you are to suffer from pesky injuries.

    Invest in some kettlebells that give you a full range of motion with your resistance exercises. Holding a heavy kettlebell at your chest adds the resistance you need to build your back with some deep squats.

    Holding a light kettlebell over your stomach during situps and crunches will build both your back and your abs.

    Getting some quality cardio in every week will also improve your back pain. A healthy heart circulates blood effectively, which will reduce the inflammation in your lumbar area.

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    What Is The Treatment For A Herniated Disc

    Occasionally, disc herniation is incidentally detected when a test such as an MRI is performed for other reasons. If no symptoms are present, no particular treatment is necessary.

    Depending on the severity of symptoms, treatments for a herniated disc include physical therapy, muscle-relaxant medications, pain medications, anti-inflammation medications, local injection of cortisone , and surgical operations. In any case, all people with a disc herniation should rest and avoid reinjuring the disc. Sometimes, even people with relatively severe pain early on can respond to conservative measures, including physical therapy with an exercise regimen, epidural cortisone injection, and/or oral cortisone medication , without the need for surgical intervention.

    There are now a variety of surgical approaches to treat disc herniation. Each type of operation is customized to the individual situation and depends a great deal on the condition of the spine around the disc affected. Surgical options include microdiscectomy using small surgical instruments and open surgical repair . The urgent operation can be necessary when cauda equina syndrome is present .

    More Advanced Care Options

    Lumbar Spinal Stenosis L4 L5 S1 Home Remedies

    Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

    Implanted nerve stimulators

    • Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
    • Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
    • Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

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