L5 Nerve Root Compression Evaluation with Paul Marquis PT
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- čas přidán 23. 09. 2018
- In today's video I break down the evaluation for an L5 nerve root compression. I talk about the common signs and symptoms and pearls from experience.
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If only I could give multiple thumbs up for this video! You clarified the missing piece to what's been puzzling me. I see my doctor this coming Friday, but have been struggling to understand what might be happening. I'm 5 years fused at L5-S1, but slipped on ice 3-4 weeks ago. In the last week or so, I've developed CRAZY, constant, thigh pain that fits with your l4 video, but also CRAZY hip pain. I had FAI repaired 2 years ago & this hip pain is different & hurts when I straighten my leg & feels better when bent at my hip! I've been baffled by this until seeing this video along with your l4 one. Thank you so much for them!
You are welcome Tee. Best of luck with your appt!
Great explanation and diagnostic testing, simple, but quite informative. Nice job.
Great Video...Keep it up.
What about Hamstring Reflex and EDB Atrophy as a signs of L5 Radiculopathy?
I’ve been dealing with L5S1 compression for a couple of years now. I’ve had some successful (6 months or more of relief) nerve blocks, however the last one (4th in two years) failed to reboot me. I’m having my 5th block in a couple of weeks. This sciatica is a beast to deal with.
Suffering from the same thing for 2 years nowand on the verge of a mental breakdown from Jesus 6 years 😣😣
You're a hero in my eyes
I hope you feel better soon 💪🤢
Suffering for 41 years with bilateral radiculopathy that has been called fibromyalgia, restless leg syndrome and have been told it's all in my head! Can't even find a PCP after 3 surgeries! Not that I can stand doctors after the hell I've been put through over the years not to mention the expense and not being able to work makes a girl angry 🥵
Been dealing with sciatic pain for more then 10 years, just had fusion march 31. Im in as much pain now as i was before they did the surgery,,, i,m at the end of my ropes.oxicodonx helps but not a cure...do not know what to do after 5 back surgery’s , scar tissue can be a problem also ....i was told by my surgeon it takes a year for the fusion to be healed and i could have some nerve issues that will go away. I doubt it there gettin worst,,, we,ll see . You cannot exspain the pain we have with this , you have to experience it. My wife i love to death is tired of hearing me complain i,m sure but laying in the bed everyday gets old...
@@johnnystieferman6527 hang in there Johnny. I take oxycodone and lyrica and yeah, sure they “help”, but as you said, no cure. My pain specialist doesn’t want to go above 10mg doses on the oxycodone because “it can be hard to get off of”. Yeah, ok, deal with what I’m dealing with 24/7/365 then tell me “getting off of oxycodone” is your primary concern. We do have a battle on our hands. The DEA is making it hard for doctors to write scripts, and even then, they’re just a bandaid. Sigh. I’m gonna have to go under the knife eventually and I’ve heard about and even know a couple people personally who have had bad outcomes.
Same exact symptoms for L5s1 from 2 months no relief from anything 🥺
Good to know
This dude maxed out the 'Articulateness' stat when he created his character
S1 Nerve root compression happened post my MRI showing my L4 being the issue causing my sciatica. It's like my sciatica and a lumbar steroid shot led to me compressing my S1 nerve root. I can't use my calves and my glutes are gone also. The original sciatica is gone for the most part from the two shots I had. The second shot was to fix the s1 issue I believe. It did nothing for it since they did it in the l4 area. I just read up on this issue since it came to my head that hmm I think I'm experiencing entirely different symptoms. Btw I'd gladly take back L4 for this. I can barely walk and using stairs is terrible.
I have surgery scheduled to fix my L4 in two 3 days and just figured this out!
COMPLETE REMOVAL OF L2 L3, rods and pins,replaced with Rods and pins L2 S1 rods and pins stabilization and fusion 8 weeks ago. Severe drop foot and calf pain progressively improving! This was my 4 th. Back surgery,every time I was told it would fix everything,it just kicked it down the road. No guarantee it will eliminate or relieve SIATIC PAIN OR CORRECT DROP FOOT !
That is correct. Once you fuse a level, there is a slight increased chance of developing an issue above or below the fusion
I have scoliosis (big curve around thoracic, and a small one around lumbar). Thoracic curve is aimed towards my right. Have the same issue here. Sciatica and everything on my left hip and numbness in both feet but mainly in the left. And a plus to all these when my back hurts so much, my feet begin to swell. I’ve seen a couple of doctors, they told me the swelling couldn’t be due to any spinal cord compression. But I’ve seen a doctor on the internet telling he studied a case just like mine. Would really appreciate it if you’d answer. Thanks doc.
I’ve been dealing with L4 L5 holding this and pain numbness big toe curling it also has been affecting my hamstrings and my thighs but I also have MS but I’m trying to find somebody to give me some advice on what to do. I had a test done on my lower leg and my perennial nerve is fine but no one has ever tested the nerves in my lower back they have only given me MRIs to determine bulging discs
If a nerve on the outer thigh is compressed can it cause pain on the inner thigh and not the site of the compression?
Initially my pain started at right hip which wss radiating down my foot, after 2 months pain started in left side also,since then ots alternating sides,sometimes on both
sides.some physiotherapist said its bilateral tronchenteric bursitis. Sime say its l4 l5 s1 root compression. Im still having lots of pain since 18 months. I took bursa injection which did not work. Doing physiotherapy, im etill in constant pain. What will help tecover from pain and does it take so long to heal
Who can I go to to find out if I have these compressions of my nerves I have severe back pain I do have an L for L5 S1 bulging disc but then I also have hip flexor pain in my right leg that shoots down into my thigh and my big toe is weak all on my right leg and it starts from my lower back
Whenever we sit on bike I get pain the same area where he pointed.
It's like serious cramp.
I cannot lift my fingers of left leg 😭
What's the treatment.....
Even if I tried hard to lift the fingers I get cramp in my leg 😭
i have only part of my big toe a bit numb (sometimes better or worse)... why only there and why no symptoms (never) in other region in leg? if there is about bigger nerve compression in spine why it's so selective?
I've had a sequestrated hernia and left thumb weakness for 6 month now.
According to MRI hernia is no more there and it's not pressing on the nerve, but the weakens have remained the same. Does it mean it's a permanent nerve damage and it will not go away?
I have L5 nerve root compression, diagnosed by both an MRI (L4-L5 bulging disk) and EMG (+1 positive waves seen when the needle was inserted into the tibialis anterior). What I find interesting is that you said you should only have trouble raising your big toe but with me it's the opposite. I can raise my big toe all the way but the other 4 toes only lift up about half way. Have you ever seen this with an L5 nerve root compression?
How are you now ?
@@Fajjerinho_ Pretty much the same. Big toe is strong as an ox but other four toes still only go up half way. I've been offered physical therapy for the herniated disc at L4-L5 but haven't done it yet due to a lot of other health problems I have.
I have the same problem bro! Have you had any surgery to release the nerve
Unfortunately, no. I have consulted with multiple neurosurgeons and all of them say the herniated disc is not bad enough to be operated on. They just want me to try physical therapy or epidural injections. I don't know if you are in the U.S., but most surgeons here will not operate unless the disc is touching the spinal cord (myelopathy) or you have severe, unbearable pain. @@paulsmith-qu9ul
That is extremely uncomfortable No doctor has ever did that test. Now I know what my pain is. How is it treated.
chiropractor no doctor will tell you that
Great video, Paul! Sorry for the long post here, but would love to get your thoughts on my issues. I'm a relatively healthy, 40-year old male. For over a year now, I've had tingling/numbness/tightness in my lower right leg - all day/every day. No pain in low back, glutes, or hamstring. Symptoms originally started over one year ago - I literally woke up one day with light tingling/numbness in both feet and both hands. I originally thought it was due to a combination of horrible stress, excessive caffeine consumption, and not enough sleep.
After the first month experiencing these symptoms, the tingling/numbness in both hands and left foot eventually subsided, with just the right leg/foot being affected. Eventually went to see a neurologist who ordered EMG, nerve conduction, and MRIs of brain/neck (looking for MS lesions) and low back (looking for herniated disk, etc.). All bloodwork came back normal. Was diagnosed by neurologist as having a pinched nerve at L5/S1, although MRI report only showed mild/moderate disc bulge at L4. Primary care doctor said my MRI was pretty typical of most 40 year olds and wouldn't be causing my symptoms (especially tingling in hands and feet, with onset at same time). Regardless, I followed my neurologist's advice and did 8 weeks of PT - no improvement. I also routinely saw my chiropractor for decompression therapy, with no improvement in symptoms.
To this day, the tingling/numbness/tightness in lower right leg is still present, yet I have no weakness/balance issues as I can run/walk/exercise just fine. I do get occasional cramps and muscle twitching in right leg, although nothing too severe. Typically, sitting in a chair does make the symptoms worse, as does stress/anxiety, and oddly enough - taking a shower (cold or hot). Recently went to see a second neurologist for another opinion - did another EMG, nerve conduction test, skin biopsy, and more bloodwork. This new neurologist tells me my symptoms are not caused from a pinched nerve at L5/S1, but rather a condition called peripheral nerve hyperexcitability. Not sure which neurologist to believe or how to move forward in treatment. Been a stressful and frustrating process to say the least.
Any thoughts/suggestions? Thanks!
Thanks BH Adam! First of all, an L5/S1 nerve root impingement does not typically cause problems on both sides and certainly not I the hands. MS was my first thought but if that is ruled out then I would agree more with the second neurologist. I assume they tested your reflexes and did a Hoffman's test where they flick your middle finger?
Thanks for the quick reply. Yes, the second neurologist did a Hoffman's test, which I assume came back negative.
My experience is similar to yours with symptoms and professional opinions. I have L5 herniated disk. I've gone to 5 different specialists in the last 18 months and still have no definitive answers with the neuropathy in my feet.... mostly my right foot and now spreading to my left. I'm very troubled by it. I have avoided health issues for most of my life by eating healthyand exercising. Losing feeling in my feet and now get bounced around the medical system is awful. 😢. It seems there are no distinct answers for treatment.
But is possible to have it on both sides? Also, can stenosis cause these types of symptoms, or only herniated discs?@@OrthoEvalPal
Same numb tingling right foot, all the way up my calf sometimes. The tightening and loosening of my lower right leg when I am just sitting down, for 6 years. My lower back hurts all the time. Doctor cant figure it out. Ever move kind of funny and you feel like the pain goes away just for a second or to, then you move back and it hurts again. Thats a lower back. I have seen a many a doctors. Nobody can pin point exactly where the problem is. My buddy has had this problem for 20 years. Last year they said he had a broken hip. Got it replace and now is pain free. No lower back issues and no feet issues. Foot doctor said L5. Sensitive situation for sure. He said to work out more and build muscle cause your gonna need it. I don't like my doctor much.
I have a spinal fusion of L1-3 from car crash 13 years ago. I have been suffering from “nerve pain” in my right foot/big toe since the accident despite there being no injury in those areas. The pain is intense and it is more profound when I lay down.
I have had a recent ablation done and now two epidurals to attack this issue. It’s worse now than it has been in 13 years.
I am able to walk and work but the lack of sleep and constant pain is at the limit of my strength.
What can I do?
I have similar nerve pain and paralyzed from having my sciatic nerve severed in surgery and a right hemipelvectomy to remove cancer 15 years ago. Nerve pain for me strikes like electrocution in either the big toe/second toe area like right now, or the outer side of the foot by the pinky toe. Rarely do I have the nerve pain in the buttocks or side of the leg. I have a lower lumbar fusion as well.
From looking at a chart, it appears that right now I may have a bulging disc or pressure on the L5-S1 discs.
The nerve pain comes as often as hiccups and usually lasts half a day or longer. I end up losing my voice from screaming and all my muscles are exhausted from flinching and holding the pain while it strikes. It is the most painful experience I’ve had and the most brutal because it keeps occurring over and over and over and throughout years of time. My worst days are about 1-2 days a month (screaming pain) with much of the rest of the month with mild irritating nerves, but even one day of my life of this is more pain than anyone should ever have to feel.
Right now it’s 5am and I have a rolled towel placed at the bottom of my spine and I am leaning back into my wheelchair to arch back “hoping” to help it relieve pressure. I have taken pregabalin, my pain medicine (methadone), an oral steroid, and naproxen, hoping to decrease inflammation. From experience, the pregabalin and NSAIDS (aspirin or naproxen) helps with inflammation. Or an ice pack on the lower back. I also try laying on my stomach with the pillows under my pelvic or get on all fours to change the gravity of my spine.
What you do throughout the day matters. Do you lift things? Do you lay down too long? Do you overwork yourself? (When I clean or sweep the whole house too much, I always get nerve pains…or lifting my wheelchair too much). Sometimes we can’t help that rainy days and a drop in barometric pressure causes pain. I have to pay attention to weather and make sure I avoid extra work and take NSAIDS when it’s going to rain or drop in temperature. Sometimes distracting my brain helps too with playing games or typing right now or talking to someone. Check the position you sit in throughout the day and remind yourself to have good posture. They have back braces that help with that and the braces also help with back pain. We need a happy medium of movement and rest, good posture, and the proper medications. Pregabalin is the best thing I take. Sounds like we have lived with this for an equal amount of time so you may know all this already but I’m reaching out anyway in case there’s new info. At the very least, someone who understands your pain. You’re not alone. Hope you get relief. ~Christina
4 lumbar surgeries including an L3-S1 fusion and then a C5-6 fusion and I'm hurting worse today and now have lumbar arachnoiditis and a thoracic syrinx causing me a true HELL!! It only gets worse for some people unfortunately 😢
I had 2 surgeries 6 weeks apart on the L4/L5 disk due to that I have suffered some L5 nerve damage. What you have described in this video is EXACTLY what I am feeling serioud pain in my hip area, cannot flex the big toe for very long or at all. I saw my surgeon yesterday and depending on what the xrays and MRI says we may be looking at Fusion (TLIF) What can I do in the mean time??
Please help to about this . because my father was same problem
Please send your mobile number I will call you
Been suffering with pain from that area for about 8 months, been doing all forms of massage / Physiotherapy but still any kind of straight leg movement I get severe pain in that area. Physio seems happy with my improvement but after 8 months I’m wondering if surgery can solve this ?
You may consider an interventional pain physician for an injection and/or meet a neurosurgeon. Should have improved by now. Good Luck! Paul
i had sciatica pain down my lower left side of back and hip. lasted about 12-14 days then went away. felt great. could sit comfortably, could put on shoes + socks, get dressed with no issues. bend down touch my toes, bend and twist. 3 days later right foot feel asleep / went numb while driving and never woke up/ returned nerve feeling. cant lift toe or curl foot up at all for past 72 hours. theres no pain at all. is nerve compressed ? will feeling come back or could damage be permanent ? very concerned
It is not uncommon to start with a lot of pain, and then lose sensation and strength later. You definitely should seek medical attention to find out the severity of nerve root compression.
Hey man can you please help!I recently got MRI done and it said disc buldge at L4-L5 compressing the L5 nerve.The pain is only around the buttocks not in the whole leg.But it is really really severe and I find it hard to get up from the bed or lay on the bed.I feel comfortable in one position only.What should I do now?I really don’t want surgery to be done.I’m visiting a chiropractor but no relief it’s been 2 weeks.Please help😔
Hi Siddhant, it is so hard to give advice without actually evaluating you. L5 compression is classic for buttock pain. Have you tried laying on your stomach and getting up on your elbows? if you do that and you feel a little relief then keep doing it for 2-3 minutes at a time a couple times a day. It could make it worse though if the disc is herniated enough. Have you tried getting an injection or taking prednisone? those are questions you could ask your doctor. If you have weakness on the big toe, you definitely need to get checked.
I've been evaluated for this but I don't feel I'm getting good advise for what to do. "He does have L5-S1 extruded disc compressing the left-sided S1 nerve root". My issues is not pain. My issue is I cannot while standing raise to my toe on the left foot (too weak). This affects my walking stride. I've been doing "nerve floss exercises" and core strengthening for 2+ months as prescribed in PT sessions. I've been adding 30 to 40 minutes of elliptical time recently. Less numbness in the foot but still can't raise to my toe on left foot. Keep doing what I'm doing? Other suggestions?
Hi Tom, If you can't raise your big toe, it is probably an L5 nerve root problem. S1 causes calf weakness and inability to press the foot down and lift the heel up.
@@OrthoEvalPal I can lift my toe up. I cannot lift my heal on the left foot from standing. I can lift up with help from the right side. One of the exercises suggested was to stand up, lift up both heals and slowly transfer weight to the left side and try to stay on the left toe. I've been doing that with several other PT directed exercises and don't seem to be building any strength on the left foot.
@@TomDixonMN did you manage to recover completely? Can you lift your heal on the left foot?
So what should be done for treatment
Like to try to strengthen the core, teach proper body mechanics, cardio
@@OrthoEvalPal I know an exercise makes my L5 symptoms go away almost immediately. I used to have the shooting pain of sciatica. 2 years on the shooting pain is gone but ive been left with a permanent numb little toe, and sometimes tingles that spread over the top of my left foot and a simultaneous dull unpleasant ache in my left SI Joint area. A chiropractor said i didnt respond to the reflex test on the ankle and diagnosed me with an L5/S1 disc problem. I work as a window cleaner so im forever bending down and twisting which aggravates the symptoms. The more i bend, twist and especially lift the pole off the glass to rinse the window, the more intense the symptoms will be, especially felt at the end of the day when i stop. I will share however that something ive tried gets rid of the L5 tingling like magic within a few seconds, and thats performing the deadlift with no or very low weight (bar only). I find that focusing on keeping my back straight, and sticking my butt out as far as possible while also going as low as possible seems to do the trick. I'm doing that as well as a calesthenics program which is proving great provided i avoid exercises like crunches and strangely dips which seem to aggravate it. I would love to know if there is an exercise to release the S1..Hope this information helps someone.
chiropractor
I have no nerves in my right thigh so my foot is not working at all from last 5 years. What can i do sir? Leg is totally weak .
You should see a PT or orthotist. you may need a brace
Hello, thanks for the video. Would true piriformis syndrome cause these same symptoms? I have that characteristic pain between the hip joint and sacrum. I have almost no feeling in my right foot and calf, have had instances of "foot drop," and the sciatic nerve does flare up and cause pain...some bad "pin prick" nerve pin in the foot and toes on occasion. Neurologist did not think it was disk compression. Chiropractor thinks piriformis syndrome. Thanks for your reply.
Hi David, Foot drop is more likely to be L4 but L5 could be a contributor. Lay on your back and do a straight leg raise. If the hip becomes painful with some tingling down the leg, it is more likely a nerve root compression. Good luck!
what was that? piriformis or disk harniation?
Sir I am having foot drop since 15 days due to L5-S1 disc herniation..I am going have surgery tomorrow..plz let me know when I will v normal. I had L5-S1 LEFT side laminotomy in 2010.this time it's right side.
The foot drop may never get better but most of the time it will improve in 3-6 months. it varies with everyone.
I have a loss of grip or sense of weakness/numbness in my pinkie and ring finger in both hands...and in the last toe fingers of my feet...need help..No serious pain associated..but last fingers of feet and hand feels weak
You should see a neurologist.
Recent back injury from lifting furniture. Back healed about a month later but then I developed nerve pain down my left hip, butt, tailbone, thigh, and calves. I want to get back in the gym asap. What’s the best action I could take?
Dude I have the same problem. How did it improve?
@@AmanSharma-om8cn it gradually improved with time. It naturally healed enough to where I went back into the gym. And then the gym really helped me get back to 100%. I fell great now and I’m lifting everyday. It just takes time for the nerve to not be compressed anymore. And lifting helped speed that process up
All of that applies to me, except that it's on the other side. Is that still the L5?
Hi Diego, yes you have an L5 on each side.
@@OrthoEvalPal hi doc .I just stumbled on your video .I'm already diagnosed with weak lumbar from L4 to S1.But I had a foot drop subsequently now it is my hip my knee all in the left side ,but there is an interesting thing it is my left butt toward my hip that hurt not my hip I can touch the area .I was searching is my sudden big toe pain has to do with arthritis or SCIATICA. Because I have both.
@@OrthoEvalPal thank you the short video I wish you said more or give suggestions on how to decompress the nerve. Yet thank you.
Heyy pls connect for 2 min just we have an patient their leg not working and losting sensation slowly wanna disscus something pls connect
I would like to know what could cause pain after L4/L5 fusion 6 months post op, with spacer. They went in through the back small scar maybe 4 or 5 inches. All Sciatic pain was gone, I could stand and walk where a week before surgery I could not. They removed the whole disc and put in a spacer. What could cause pain when I am in the act of standing up. Once up I am ok. but shocking pain as I stand in lower back. Also anytime my spine flexes or is not straight. Sex hurts, pelvic tilts hurt. Twisting if seated hurts as well. Not a constant pain but in those positions. Could it be I am not fused? Could it be L5/S1 is bad? could it be the spacer is digging into my spine? I am pulling my hair out trying to figure out what is going on. My spine feels very weak if I try to do anything like bend down to reach for something on a shelf. Or reach out lower than my wait for something. carrying groceries kills.. trying to sweep hurts.. any ideas would be great. I assume you have had people with post fusion with this same issue. Thanks. I used to be super athletic and active, now I am living like I am 80 years old. Thanks for any advice. Also no pain at all when I lay on my back.
Welcome to the living Hell of spine problems!! I wish I could say it gets better but I've had it since 2009 and multiple surgeries and techniques and it seriously just gets worse for a lot of folks!! Sorry😢
@@pache2112 My first fusion must not have fused. I had a revision Fusion at L4/L5 in April of 2023 and feel much better now. I still have a disc issue at L5/S1 but I can tell a big difference in the L4/L5. I can sleep walk with no pain most days and can move around much better. I will probably end up having something done at L5/S1 but waiting as long as possible for another surgery.
Sir ,can I surgery after 3 years of injury
You can always have surgery at any number of years. the question is...is there a true indication for surgery and what is the predicted outcome?
Sir
What's the healing process please
There are too many variables. Some can resolve without surgery over time (1 year+) A straight up herniated disc pushing on one nerve only, surgery can help right away. Again, lots of factors to consider.
@@OrthoEvalPal thanks
What’s the treatment?
chiropractor
Hi dr my mother cant even stand due to nerve compression her right leg is no responding she fell when ever she try to stand
Sorry I can't evaluate on CZcams
Oooh I need relief
chirpractor
My pain is in my right butt
L5 --> posterior tibial reflex, inconsistent. Soooo...maybe take the video down?