--- title: "L5-S1 Disc Herniation: Symptoms and Treatment" description: "L5-S1 disc herniation is a common cause of sciatica. Symptoms, diagnosis and treatment options, including whether the herniation can shrink." date: 2026-10-24 lastmod: 2026-11-02 canonical: https://drmotiva.com/en/articles/l5-s1-disc-herniation/ lang: en --- # L5-S1 Disc Herniation: Symptoms and Treatment The L5-S1 disc lies between the last lumbar vertebra and the sacrum. Together with L4-L5, it is the most common level of lumbar disc herniation. A herniation here usually affects the S1 nerve root. ## Typical symptoms - Pain radiating from the buttock down the back of the leg to the calf, heel or sole - Numbness on the outer edge of the foot and little toe - Weakness standing on tiptoe in some patients - A reduced ankle reflex on examination Numbness in the saddle area, bladder or bowel problems or rapidly increasing weakness require emergency assessment. Further reading: the [guide “Lumbar Disc Herniation”](https://drmotiva.com/en/guides/lumbar-disc-herniation/) and the articles [Disc Herniation Treatment Without Surgery](https://drmotiva.com/en/articles/disc-herniation-without-surgery/) and [What Does My MRI Report Mean? Protrusion, Bulging, Extrusion](https://drmotiva.com/en/articles/mri-report-protrusion-bulging/). ## Diagnosis History, examination and, when needed, MRI and electrodiagnostic testing are used [1]. ## Treatment Most patients improve with conservative treatment [1]. Herniated disc material can shrink or disappear spontaneously; a meta-analysis found spontaneous resorption in a substantial proportion of patients [3]. Options include: - Staying active, physiotherapy and exercise - Pain medicines - Epidural corticosteroid injections, which can give short-term relief of leg pain in selected patients [2] - Surgery when there is severe or progressive weakness, emergency signs or persistent disabling pain despite treatment See [When is surgery needed?](https://drmotiva.com/en/articles/when-is-disc-surgery-needed/) ## Anatomy in brief The L5-S1 disc sits at the junction of the lumbar spine and the sacrum, where the load and movement of the lower back are concentrated. Each disc has a tough outer ring (annulus fibrosus) and a soft centre (nucleus pulposus). A herniation at this level usually presses on the S1 nerve root; a herniation placed further to the side (foraminal) may affect the L5 root. ## Causes and risk factors Herniation usually develops from age-related disc changes combined with load, rather than one specific injury. Risk factors include repeated bending and lifting, prolonged sitting, smoking, excess body weight, low fitness and genetic factors. ## Assessment in practice The examination checks calf strength (for example standing or hopping on tiptoe), the ankle reflex, sensation on the outer foot and the sole, and nerve tension tests such as raising the straight leg. MRI is recommended when symptoms persist beyond several weeks, when weakness is significant, or before an injection or surgery. EMG (a test of nerve and muscle electrical activity) can help when the clinical picture and MRI do not match, or to assess the severity of nerve-root involvement. ## Rehabilitation In the early phase, the aim is to calm pain while staying active with short walks and comfortable positions. As symptoms settle, mobility, trunk and hip strengthening, calf strengthening and general fitness exercises are added, then a gradual return to work and sport. The programme is planned and progressed by your physical medicine and rehabilitation specialist and the physiotherapist. Injection suitability is decided after examination. ## Home measures - Walk little and often, and break up long periods of sitting - Use relieving positions, such as lying on your back with the knees bent - Avoid heavy lifting in the early phase, then build up gradually - Continue your exercise programme after recovery to reduce the risk of recurrence ## Recovery time Leg pain often improves substantially within six to twelve weeks. Numbness and a reduced ankle reflex may persist longer, and a reflex change alone does not usually require surgery. ## Red flags Seek emergency care for numbness in the saddle area (genitals, buttocks, inner thighs), new problems controlling urine or stool, weakness in both legs, or rapidly progressing weakness. ## 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 **Which herniations are more likely to shrink?** Larger, extruded and sequestered herniations show resorption more often. **Is walking good?** Walking within pain limits is generally recommended. **Does the herniation need to disappear on MRI for me to recover?** No. Symptoms often improve before, or without, visible change on MRI, so repeat imaging is not routinely needed if you are improving. **Can a calf muscle weakness recover?** Often yes, gradually. Marked or worsening weakness should be assessed promptly. ## 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%2Fl5-s1-disc-herniation%2F). This page is general health information. Diagnosis and treatment decisions are made individually after examination. ## Sources 1. 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/) 2. Oliveira CB, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020. [PMID: 32271952](https://pubmed.ncbi.nlm.nih.gov/32271952/) 3. Zhong M, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017. [PMID: 28072796](https://pubmed.ncbi.nlm.nih.gov/28072796/)