--- title: "L4-L5 Disc Herniation: Symptoms and Treatment" description: "L4-L5 is one of the most common levels for lumbar disc herniation. Typical symptoms, examination and treatment options with and without surgery." date: 2026-10-24 lastmod: 2026-11-02 canonical: https://drmotiva.com/en/articles/l4-l5-disc-herniation/ lang: en --- # L4-L5 Disc Herniation: Symptoms and Treatment The L4-L5 level, between the fourth and fifth lumbar vertebrae, carries a large share of the load in the lower back and is one of the most common sites of disc herniation. Herniated disc material can irritate the nerve root and cause leg pain (sciatica). ## Typical symptoms - Low back pain, often with pain radiating down the leg - Pain, numbness or tingling on the outer side of the leg and the top of the foot, towards the big toe (L5 root) - Weakness lifting the foot or big toe in some patients - Pain worse with sitting, bending or coughing **Urgent warning signs:** numbness around the genitals or buttocks, new bladder or bowel problems, or rapidly progressing leg weakness need emergency assessment. Further reading: the [guide “Lumbar Disc Herniation”](https://drmotiva.com/en/guides/lumbar-disc-herniation/) and the articles [L5-S1 Disc Herniation: Symptoms and Treatment](https://drmotiva.com/en/articles/l5-s1-disc-herniation/) and [C5-C6 Disc Herniation: Symptoms and Treatment](https://drmotiva.com/en/articles/c5-c6-disc-herniation/). ## Diagnosis Diagnosis combines history, neurological examination and, when needed, MRI. Electrodiagnostic testing (EMG) can show whether the nerve root is affected. See [What does my MRI report mean?](https://drmotiva.com/en/articles/mri-report-protrusion-bulging/) ## Treatment Most patients improve without surgery [3]. Treatment may include activity adapted to pain, physiotherapy and exercise, pain medicines and, in selected cases, epidural steroid injections. Surgery can give faster relief of leg pain in selected patients, but in trials the long-term results of surgery and conservative care became similar [1, 2]. See [Disc herniation treatment without surgery](https://drmotiva.com/en/articles/disc-herniation-without-surgery/) and [When is surgery needed?](https://drmotiva.com/en/articles/when-is-disc-surgery-needed/) ## Anatomy in brief Each disc has a tough outer ring (annulus fibrosus) and a soft centre (nucleus pulposus). At L4-L5, a herniation most often presses on the L5 nerve root as it travels down; a herniation placed further to the side (foraminal herniation) can affect the L4 root instead. This is why symptoms can differ between people with a herniation at the same level. ## Causes and risk factors Disc herniation usually results from age-related disc changes combined with load, rather than a single event. Risk factors include repeated bending and lifting, prolonged sitting, smoking, excess body weight, low physical fitness and genetic factors. Often the pain starts after an ordinary movement such as bending forward. ## What the examination looks for - Strength of foot and big-toe lifting (L5) and of the knee extensors (L4) - Reflexes at the knee and ankle - Sensation along the leg and foot - Nerve tension tests such as raising the straight leg Findings help decide which root is involved and whether MRI or EMG is needed now or can wait. ## Rehabilitation Rehabilitation is progressed in stages. In the early phase the aim is to control pain and keep moving with comfortable positions and short walks. Later, mobility, trunk and hip strengthening, and fitness exercises are added, followed by a return to work and sport. The programme is planned by your physical medicine and rehabilitation specialist and the physiotherapist, and adapted to how symptoms respond. Epidural steroid injections can provide short-term relief of leg pain in selected patients; whether they are suitable is decided after examination. ## Home measures - Walk little and often; avoid long periods of sitting - Find relieving positions, such as lying on your back with the knees bent - Return to normal activities gradually - Keep doing the exercises after symptoms improve to help reduce recurrence ## Recovery time Many people notice substantial improvement within six to twelve weeks, although numbness may take longer to settle. Recovery varies, and a worsening course should be re-assessed. ## When to see your physical medicine and rehabilitation specialist Seek assessment if pain is severe, keeps getting worse, wakes you at night or does not start to improve within a few weeks; if numbness, weakness or any warning sign appears; or if you are unsure what your test results mean. Your physical medicine and rehabilitation (PM&R) specialist, a doctor trained to diagnose and treat musculoskeletal and nerve problems without surgery, examines you, explains the findings and plans treatment together with the physiotherapist. Whether injections or other advanced treatments are suitable for you is decided by a PM&R specialist after examination. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, please consult a PM&R specialist near you. To make the most of the consultation, it helps to bring: - A short timeline of your symptoms and what makes them better or worse - A list of your medicines and other health conditions - Previous imaging (the images themselves, not only the reports), test results and treatment summaries - Your questions and goals, such as returning to work, sport or a particular activity ## Frequently asked questions **Is bed rest recommended?** No. Staying as active as pain allows is generally better. **Can the herniation shrink?** Yes, herniated disc material often shrinks or resorbs over time. **Is foot drop permanent?** Not necessarily. Weakness often improves, but marked or worsening weakness needs prompt assessment because timing may matter for treatment decisions. **Can I drive or work?** Usually yes, adapted to your symptoms, with regular breaks from sitting. Heavy physical work may need temporary changes. ## Assessment and contact You can request an appointment or a second-opinion review of existing reports and imaging: [Contact & second opinion (WhatsApp)](https://drmotiva.com/go/wa?l=en&t=&loc=inline_contact&p=%2Fen%2Farticles%2Fl4-l5-disc-herniation%2F). This page is general health information. Diagnosis and treatment decisions are made individually after examination. ## Sources 1. Liu C, et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ. 2023. [PMID: 37076169](https://pubmed.ncbi.nlm.nih.gov/37076169/) 2. Peul WC, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007. [PMID: 17538084](https://pubmed.ncbi.nlm.nih.gov/17538084/) 3. Kreiner DS, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014. [PMID: 24239490](https://pubmed.ncbi.nlm.nih.gov/24239490/)