A herniated disc in the back at the L5-S1 level is common. The L5-S1 segment is where the lumbar, or lower, spine meets the sacral region. L5 is one of five vertebrae in the lower back. S1 is one of five bony segments in the sacral region that are fused together. The segments create the triangular bone that serves as part of the pelvis as well as the base of the spine. With an L5-S1 issue, you may also feel referred pain on the outside of your foot and have a diminished Achilles reflex. If you suffer a herniated disc in your lower back and your pain does not improve within a month, your doctor is likely to prescribe physical therapy exercises.
Identification
When you have a herniated disc such as the L5-S1, your doctor is likely to prescribe extension and isometric exercises first. Flexion exercises are allowed only after you gain strength and experience pain relief. One of the most common extension exercise programs prescribed is the McKenzie exercise program. This program emphasizes exercises that minimize radiating pain.
Precautions
The exercises within the McKenzie program need to be tailored to your needs by your doctor or physical therapist. Your doctor will conduct a trial to see if pain peripheralizes down your leg. If your leg pain centralizes, meaning it stays in your back, then the McKenzie program is safe for you. If it peripheralizes, you are not ready for this exercise program.
Process
One McKenzie exercise involves lying on your side near the edge of a bed or similar surface and pulling your knees toward your chest to stretch your lower back. Your bottom arm is placed behind your trunk and your top arm dangles toward the floor. Your knees and hips are flexed to 90 degrees and rest on the bed. Your lower legs go over the edge of the bed. You hold this position for five to 10 minutes.
Expert Insight
Work with your doctor to determine when to start doing any exercise for the L5-S1. If your pain is acute, exercise is unlikely to help. In fact, it may even cause further harm, cautions NYTimes.com. For example, flexion exercises apply the biggest load to the L5-S1 so are not appropriate to perform right away. If any exercise causes your pain to increase, stop immediately and consult your doctor.
It's important to work with a doctor who takes a complete medical history and performs a physical examination if you suffer this disorder because you need to be monitored for potentially significant complications. You also need a proper diagnosis because symptoms of a herniated disc are difficult to distinguish from simple back strain or other spinal disorders.
References
- American Family Physician: Clinical Evaluations and Treatment for Herniated Lumbar Disc; S. Craig Humphreys and Jason C. Eck
- NYTimes.com: Herniated Disk
- "Concise Guide to Sports Injuries"; Malcolm T.F. Read; 2008
- Dynamic Chiropractic: Williams' Flexion Exercises vs. McKenzie's Extension Protocol; Paul Hooper
- "Therapeutic Exercise for Musculoskeletal Injuries"; Peggy A. Houglum; 2010
- Spine-Health.com: "Normal Spinal Anatomy"; Pamela E. Verkuilen; 2005
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