L4 L5 Instability Treatment

The L4 and L5 spinal segments are the lowest vertebrae of the lumbar spine. They’re crucial to the spine’s flexibility and bear more impact than most other vertebrae. Despite their importance, L4 and L5 are also particularly susceptible to injuries and chronic conditions, including instability. 

In this article, we’ll review spinal conditions involving L4 L5 instability and how they’re treated.

L4-L5 Pain Symptoms

L4-L5 pain symptoms include sharp, burning, and/or shooting pain that may radiate into the legs and feet. 

Pain symptoms from the L4-L5 spinal segment may be accompanied by neurological symptoms, including, tingling, numbness, and weakness that extends to the lower extremities. 

It can be challenging to determine if lower back pain is caused by a spinal condition or soft tissue injury, such as a sprain, strain, or back muscle tear. Here are a few differences to consider:

  • Spinal back pain usually develops gradually, while sprains, strains, and tears tend to occur suddenly. 
  • Muscular pain tends to be described as soreness, stiffness, or achiness, while spinal pain can trigger sharp, burning, or shooting pain.
  • Unlike muscular pain, pain from a spinal condition can cause pain, numbness, weakness, or tingling that radiates to the extremities. Pain from soft tissue injuries is typically confined to a limited area of the back, such as a specific muscle or muscle group. 
  • Muscular pain is more likely to cause lower back cramps and spasms than spinal pain. 

How Can I Improve My L4 and L5 Instability?

You can improve L4 and L5 instability by building strength in the abdominal and deep back muscles. 

By strengthening these muscle groups, you can reduce the impact of daily movements on the spine. 

What Muscle Stabilizes the Lumbar Spine?

The transverse abdominis, oblique abdominals, quadratus lumborum, erector spinae, and multifidus muscles stabilize the lumbar spine. 

  • The transverse abdominal muscle is the deepest abdominal muscle. It extends horizontally across the abdomen, which is why it’s often referred to as the “cumberbun” muscle. This muscle is often considered the most important to stabilize the spine and prevent back pain. 
  • The oblique abdominal muscle is located on the lateral side of the abdomen. It extends from the bottom half of the ribs around the torso and to the pelvis. This muscle allows you to twist your torso. 
  • The quadratus lumborum muscle is the deepest muscle in the back. It’s positioned in the posterior, anterior, and lateral regions of the spine. This muscle is considered “postural”, meaning that it stabilizes the body in minor movements, like sitting. 
  • The erector spinae muscle is a deep muscle of the back that allows the back to straighten and rotate. It consists of three muscle groups (spinalis, longissimus, and iliocostalis) that extend parallel to the spine. 
  • The multifidus muscle is located on either side of the lumbar spine. Its primary function is to strengthen and stabilize the lower back, directly helping to prevent lumbar instability. 

What Causes L4-L5 Instability?

L4-L5 instability may be caused by:

  • Lumbar spondylolisthesis
  • Spinal disc degeneration or a herniated disc
  • A genetic spinal defect
  • Scoliosis
  • Spinal fractures

How Do I Build Stability in My Lower Back?

You can build stability in your lower back with lumbar stabilization exercises, such as:

  • Knee side plank
    • Begin seated on one hip with bent legs stacked beside you. Bend your elbow and lower your forearm to the floor next to you.
    • On an exhale, press your forearm into the floor to lift your hips upward, toward the ceiling. 
    • Inhale, lowering your hips halfway to the ground.
    • Exhale to lift your hips back up, making a straight line from your knees to your shoulders. 
    • Repeat for 10 sets, then repeat on the other side. 
  • Bridges
    • Lie on your back with bent knees and feet flat on the ground, hip-width apart. 
    • On an exhale, engage your abdominal muscles and glutes to raise your hips upward, making a straight line from your knees to your shoulders.
    • Inhale to lower your hips back to the floor. 
    • Repeat for 10 sets.
  • Quadruped (Bird Dog)
    • Begin on all fours, positioning your knees under your hips and your hands under your shoulders with a neutral spine. 
    • On an exhale, engage the abdominal muscles. Lift one leg behind you and lift the opposite arm in front of you, making sure to not shift your weight or arch your back.
    • Remain in this position for a slow count of three. Keep breathing while you hold the pose. 
    • Inhale to slowly return to the starting position. 
    • Repeat for 8 sets, then switch sides. 

Why is it Important to Stabilize the Spine?

It’s important to stabilize the spine because, left untreated, instability can trigger spinal degeneration. In younger patients, instability may accelerate spinal degeneration. In older patients, instability can exacerbate age-related spinal degeneration and increase the risk of chronic pain. 

What Are the Best Treatments for Diseases That Affect L4 L5 Vertebrae?

The best treatments for diseases that affect L4 L5 vertebrae include:

  • Physical therapy

The first line of defense against L4 L5 diseases is usually physical therapy. Especially for lumbar instability, which can benefit greatly from strengthening exercises, physical therapy facilitates recovery while preventing future injuries.

Your physical therapist can provide stretches and strengthening exercises to complete at home for improved lumbar stability. Your PT will adjust your exercise routine as your recovery progresses. Additionally, your PT may provide in-office treatments (like heat/cold or electromagnetic therapy) to provide further relief from pain and inflammation. 

  • Chiropractic care

Chiropractors improve spinal alignment, reduce inflammation, and stimulate the body’s healing process with manual adjustments. This may help you recover faster from L4 L5 spinal conditions, especially if a spinal misalignment is present.

  • Anti-inflammatory medications

While not a permanent solution, anti-inflammatory medications can help treat diseases of the L4 L5 vertebrae. These drugs can help you manage pain and reduce inflammation in the spine. 

  • Surgery

When L4 L5 conditions don’t improve after 6 to 12 months and cause a significant decline in your quality of life, surgery might be necessary. Depending on the condition, the surgeon may recommend spinal decompression procedures (such as laminectomy or discectomy) and stabilization (such as spinal fusion). 

If L4 L5 Surgery Is Recommended

If L4 L5 surgery is recommended, make sure to speak with an experienced spinal surgeon about the latest available treatment options. 

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While spinal fusion is the conventional option for L4 L5 instability, it involves certain risks and complications. Permanently fusing the L4 L5 vertebrae is unideal for many patients, as it eliminates motion at the affected segment. Additionally, fusion involves a lengthy recovery period of up to one year and speeds up degeneration of the adjacent spinal segments. 

Non-fusion implants for the L4-L5 segments, like the TOPS System, stabilize the spine without irreversibly fusing the vertebrae. The TOPS System is FDA-approved for degeneration spondylolisthesis at one level from L3 to L5 with lumbar spinal stenosis. It can resolve L4 L5 instability while preserving the spine’s natural motion in all directions. 

If you’re struggling with symptoms of L4 L5 instability, contact a spinal specialist in your area to learn more about available treatment options.