Symptoms of a herniated disc of the lumbar spine

Introduction and definition

Pain is one of the typical symptoms of a herniated disc, including in the lumbar spine.

In which Herniated disc of the lumbar spine (Prolapse) is a disease of the spine. The intervertebral discs consists of one Fiber ring (Annulus fibrosus) and the inner core (Nucleus pulposus) and lies as Shock absorbers each between two vertebral bodies.
By increasing wear the gelatinous core loses its original shape and the outer fiber ring tears. Parts of the gelatinous core and the fiber ring can now be applied to the Nerve roots or also nerve fibers press what is called Nerve root compression referred to as.
This creates many different symptoms. The type and severity of the symptoms depend on At what level of the spine the herniated disc occurs. Most herniated discs occur at the level of the lumbar spine. Accordingly, corresponding symptoms develop, especially the move and the lower extremities affect.

Figure intervertebral disc

Image of the intervertebral disc from above (A) and from the right (B)
  1. Intervertebral disc
    (Intervertebral disc) -
    Discus inter vertebralis
  2. Gelatinous core - Nucleus pulposus
  3. Fiber ring - Annulus fibrosus
  4. Spinal nerve - N. spinalis
  5. Spinal cord - Medula spinalis
  6. Spinous process - Spinous process
  7. Transverse process -
    Transverse process
  8. Upper articular process -
    Superior articular process
  9. Intervertebral hole -
    Intervertebral foramen
  10. Vertebral bodies - Corpus vertebrae
  11. Front longitudinal ligament -
    Lig.longitudinale anterius
    All medical illustrations

Appointment with a back specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

  • Lumedis - your orthopedic surgeon
    Kaiserstrasse 14
    60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Symptoms of a herniated disc at the L5 / S1 level

Of the Herniated disc L5 / S1 denotes the level of prolapse between the fifth Lumbar vertebrae and the first Tailbone vertebrae.
This area is located at Spine in the lower spine. This is where most of the weight of the body is borne, which is why it is rapid wear and tear on the vertebral bodies comes and therefore the Herniated discs increased occur.
A prolapse there is also called Lumbar spinal disc herniation designated. This height is often named after a nearby nerve, the sciatica.
Typical symptoms of a herniated disc at this level are sudden shooting painwhich is called sciatic pain because of the large nerve there. The pain especially moves from the injured area into the lower back. Depending on how strong through the bulging of the gelatinous core the Spinal nerves being trapped, the pain can also radiate to the legs.
Patients often report symptoms such as sudden Drawing and shooting pain from back to legs pulls. The pain is often localized more precisely and is located on the Thigh and the calf. In addition to pain, these areas of the skin can also be too Disorders of sensitivity come. This means that the patient can no longer feel a touch there.

L5 and S1 identification muscles and symptoms of damage

In the field of anatomy and also in neurology, identification muscles are muscles that are innervated by a specific individual segment of the spine.
The nerve fibers emerging from this spinal ganglion are responsible for the function of certain muscles. A very important role is assigned to these identification muscles, because their functional failure due to spinal injuries as well as herniated discs provide an indication of the height of the spine the injury is.

Conclusions can be drawn from the symptoms in various examinations. During the clinical examination there is a loss of function of the muscles.

This means that the patient can no longer perform a certain movement or that there is significant muscle weakness. In addition, certain reflexes can no longer be triggered due to the damage. The key muscle for lumbar segment 5 is the extensor of the big toe (Extensor hallucis longus muscle).
If this segment is damaged, depending on the severity of the injury, the patient is no longer able to consciously stretch the big toe.

The doctor can also test the function of this nerve tract with the tibialis posterior reflex (TPR). The doctor taps the corresponding tendon of the muscle on the inside of the foot below the protruding ankle with a special reflex hammer.

On the one hand, an internal rotation (supination) of the foot and also the extension of the big toe can be seen on the one hand. If there is pronounced damage to the nerve tract and thus to the characteristic muscle, this reflex cannot be triggered.

The identification muscle for the vertebral body segment S1 is one of the superficial lying calf muscles, the Triceps surae muscle.
This muscle consists of three sub-muscles, all of which have their common point of attachment to the Achilles tendon. These muscles cause the foot to bend towards the sole of the foot (Plantar flexion). The nerve tract can be checked using the Achilles tendon reflex.

The doctor taps the Achilles tendon with the reflex hammer. In a healthy person, the foot would bend down. If there is a herniated disc, it may be that the movement stops when the Achilles tendon is hit. Accordingly, the doctor can suspect damage in the corresponding segment.

Not sure what is causing your back pain? Find out more in our article:

  • How do I distinguish a herniated disc from a lumbago?

Figure herniated disc

Figure slipped disc (A), (B) and healthy disc (C)

Disc prolapse -
Nucleus pulposus prolapse

A. - Herniated disc from the left
B. - Herniated disc from above
C. - Healthy disc
a - Neck and chest area
b - lumbar region

  1. Fiber ring - Annulus fibrosus
  2. Gelatinous core - Nucleus pulposus
    1. + 2. Intervertebral disc
    (Intervertebral disc) -
    Discus inter vertebralis
  3. Spinal nerve - N. spinalis
  4. Spinal cord - Medula spinalis
  5. Vertebral bodies - Corpus vertebrae
  6. Spinous process - Spinous process
    All medical illustrations

Symptoms of a herniated disc at L4 / 5 level

The designation L4 / L5 refers to lumbar vertebrae four and five and the intervertebral disc in between.

If a herniated disc occurs at this level of the spine, the nerve bundles and spinal roots located there can be affected.

In the case of a herniated disc L4 / 5, the 4th and 5th nerve roots of the lumbar spine can be damaged.

These are responsible for specific movements on the leg and the sensitive innervation of certain skin areas. In the case of an injury at level L4, sensory disorders can occur on the outside of the thigh, on the kneecap and on the inside of the lower leg.

This means that the patient there may no longer feel a touch as symptoms or numbness and tingling caused by the herniated disc of the skin.

Furthermore, the failure of various movements can occur as symptoms. Since L4 is also used for the four-headed thigh muscle (Quadriceps femoris muscle) is responsible, it can happen that due to the damage the patient can no longer straighten the knee properly and the lifting of the foot can also be restricted.

The doctor can also test the loss of function using the patellar tendon reflex. The doctor taps the tendon underneath the kneecap with the reflex hammer.
If the reflex is intact, the loosely hanging leg shoots forward, if there is nerve damage, this movement does not take place or is significantly weakened.

If the nerves from L5 are damaged, symptoms of the herniated disc are disorders of sensitivity on the inside of the thigh, the back of the foot and the big toes. The disorder can also manifest itself here as numbness or tingling.
If this segment is severely damaged, the toe lifter may lose its function, which typically corresponds to a large L4 / 5 herniated disc.

Read more on the topic:

  • Herniated disc L4 / 5
  • Bragard test

Symptoms of a herniated disc at the L3 / L4 level

Everyone feels pain and therefore it is part of every herniated disc. Usually the pain has a stabbing quality.

In addition to the pain, abnormal sensations can be noticed. These include feelings of tingling or numbness. In serious incidents, muscle paralysis - primarily in the thighs - can occur.

You can find out more about this at: Disc herniation of L3 / L4

Pain in the lumbar spine herniation

The localization the pain depends on the Amount of damage at the Spine.

In addition, the correlates mostly Strength the pain with the Severity the damage. At the level of the herniated disc, the nerve roots and also the annoy become trapped in the spinal canal.

The pain and failure symptoms then occur in the Coverage area this nerve on. This type of pain is also known as radicular pain.

Herniated discs in the lumbar spine area are often expressed Pain in the leg and foot. This is often the case Sciatic nervewho is impaired. The pain is then called sciatica or Lumboischialgia designated.

The symptoms can also radiate into the abdomen or back. The back pain will also be low back pain or lumbago called. Patients often report one aggravation of pain when you Cough, sneeze or otherwise increase the pressure in the abdomen.

In the case of severe intervertebral disc damage, the initial severe pain and symptoms can after a certain time again slowly go back. That can be a bad sign. Because then there could possibly already be advanced damage to the lumbago in the spinal cord. The Nerve fibers can die due to entrapment and no longer perform their function. As a result, paralysis and Numbness.

Read more causes that can trigger leg pain under our topic: Pain in the legs

Lumbar disc herniation and abdominal pain

Symptoms like stomach pain are not always associated with one Herniated disc of the lumbar spine brought. But the pain caused by a Entrapment of the sciatic nerve in the lumbar region, often radiate also in the abdomen out.

The sciatic nerve is a very large nerve. He starts at the height of the Lumbar spine (lumbar spine) and then pulls down the lower abdomen to the buttocks. There it divides into different branches. Due to its course, it is obvious that the pain can also radiate into the abdomen and mistakenly indicate a disease in the abdominal cavity.

Occurrence of tingling and numbness with a herniated disc of the lumbar spine

In addition to the pain, numbness in the leg can also arise in the skin areas that are supplied by the pinched nerve.
Those affected often report tingling of the skin or it feels like pins and needles. The symptoms can occur continuously or are triggered by certain movement or only temporarily.

A typical disorder was the so-called breeches anesthesia. This leads to sensitivity disorders with pronounced numbness on the back of the thighs, around the rectum and on the inner lower legs.

There is an urgent need for action here so that permanent damage with lasting symptoms can be avoided.

If you suffer from tingling or numbness, we recommend the following topics:

  • Is a tingling sensation a sign of a herniated disc?
  • Is numbness a sign of a herniated disc?

Appearance of muscle weakness and paralysis

When a Herniated disc of the lumbar spine is already very advanced, so that there is already enormous damage to the nerve roots and pathways, can over time severe complications occur.

A first sign This is often the reason for greater damage to the nerve tracts The pain subsides. It could be a sign that the nerves are damaged to the point that they die and no charmsso also the pain, hand off.

Likewise, no more excitement can pass to the Musculature to get redirected. The consequences are initially one Muscle weakness.

Patients have a decreased feeling and also problems moving the parts of the body that are supplied by the damaged nerves.
Here should be a treatment as soon as possible in which usually a Pressure relief of the annoy he follows.

Otherwise it can result in a irreversible damage come to the nerve root.
The signs and symptoms can then no longer be remedied and paralysis can also occur in the corresponding muscles in the further course. So can result from one Herniated disc in the lumbar spine develop a loss of function of the leg. The patient can no longer feel one or both legs and also loses control of any coordination.

Discomfort of the legs with a herniated disc of the lumbar spine

The sudden herniated disc is often accompanied by one as well sudden shooting pain, the Sciatic pain. From the back, the pain shoots over the buttocks into the leg and causes a Pull in the calf and foot. Since in most incidents, the intervertebral disc slips sideways, are from the complaints usually only one leg affected. In addition to pain also occur tingle (Ants running) and Muscle weakness on. Often those affected cannot stand on tiptoe.

Paralysis of the bladder and rectum as a result of a herniated disc of the lumbar spine

In addition to the known complaints such as pain and paralysis, a herniated disc can also lead to the loss of function of some internal organs, as the supply via their nerve tract can also be restricted.

Another possible symptom is bladder and bowel disorder. The urine leakage can possibly no longer be controlled by the patient and is therefore involuntary. Often this is a very stressful situation for many.
Read more on the topic: Urinary incontinence

Furthermore, a feeling of Residual urine arise. The patient often feels the need to go to the toilet because a small amount of urine always remains in the bladder. In addition, residual urine in the urinary bladder always carries the risk of ascending infections.

Controlled bowel movements can also be disturbed: fecal incontinence is also possible. In addition, it can lead to sensitivity disorders in the genital and anal area.

If these symptoms occur, there is already severe damage to the nerves (so-called cauda equina symptoms) due to the slipped intervertebral disc. It is an emergency situation in which an operation is urgent. The nerves must be relieved as quickly as possible if the symptoms are to be avoided permanently.

The herniated disc in the lumbar spine can also trigger a so-called cauda equina syndrome, which should be recognized urgently and, if left untreated, can lead to permanent paraplegia. We therefore recommend our website for further information: Cauda equina syndrome - do I have paraplegia?