L4-L5 Nerve Root Compression Symptoms

The L4 and L5 nerve roots are located in the lumbar spine. They’re commonly affected by lumbar spine conditions, like spinal stenosis and spondylolisthesis. If these conditions trigger L4-L5 nerve root compression, you may experience a variety of symptoms, including chronic lower back pain. 

In this article, we’ll outline the most common L4-L5 nerve root compression symptoms and what you can do to achieve lasting relief. 

Table of Contents

What Does the L4-L5 Nerve Root Control?

The L4-L5 nerve roots control the thigh and knee muscles. They also provide sensation to the lower legs and the upper portion of the foot. 

The L4-L5 nerves join with other sacral nerves to form the sciatic nerve, which extends from the lower back through the legs. 

What Are the Symptoms of L4-L5 Damage?

The symptoms of L4-L5 damage include:

  • Sharp, burning, or shooting pain that begins in the lower back and travels down the legs
  • Weakness and/or numbness in the thigh, foot, or knee
  • Tingling and/or a pins-and-needles sensation from the lower back to the lower extremities
  • Numbness in the lower extremities

These symptoms are commonly referred to as sciatica, the condition involving pain along the sciatic nerve. The sciatic nerve is the largest nerve in the human body, encompassing the L4, L5, S1, S2, and S3 nerves. 

What Does a Pinched Nerve at L4-L5 Feel Like?

A pinched nerve at L4-L5 is often described as feeling like a sharp, burning, or aching pain from the lower back to the lower extremities. Some people with an L4-L5 pinched nerve also struggle to stand or walk for extended periods. 

What Causes L4-L5 Damage?

L4-L5 damage can be caused by:

  • Herniated disc
  • Degenerative disc disease
  • Lumbar spinal stenosis
  • Lumbar spondylolisthesis

With these conditions, a damaged spinal disc, bone spur, displaced vertebra, or the spinal canal can impinge on the L4-L5 nerves.

Additionally, poor posture, being overweight, high-impact activities, and overextending the lumbar spine can increase your risk of L4-L5 damage. 

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Can L4-L5 Cause Hip Pain?

L4-L5 nerve compression can cause hip pain. 

The sciatic nerve, which extends through the hips, includes the L4 and L5 nerves. So, if the L4 or L5 nerves become compressed, it can cause a sharp or burning pain through the hips. Hip pain from L4-L5 nerve root compression is often accompanied by lower back pain and neurological symptoms (like tingling and weakness) in the legs. 

Does L4-L5 Cause Buttock Pain?

L4-L5 nerve compression can cause buttock pain. 

According to clinical research, the L4-L5 spinal level is the primary spinal level responsible for buttock pain in people with a lumbar herniated disc. Buttock pain from the L4-L5 level is generally categorized as sciatica, as the sciatic nerve extends through the buttocks. 

Can L4-L5 Cause Pain in Both Legs?

L4-L5 damage can cause pain in both legs, although it usually causes pain in one leg. 

Whether L4-L5 compression affects one or both legs depends on the severity and location of the damage. 

How Do You Treat L4-L5 Nerve Root Compression Symptoms?

You can treat L4-L5 nerve root compression symptoms with physical therapy, medications, and activity modifications. If these methods fail, your physician may recommend spinal decompression surgery. 

Physical Therapy for L4-L5 Nerve Root Compression Symptoms

Physical therapy is often used as the first line of defense for lumbar nerve root compression. It’s safe, non-invasive, and drug-free, making it a risk-free option for individuals with nerve pain. Your physical therapist will work with you to reduce pressure on the L4-L5 nerves with:

  • Targeted exercises (particularly core strengthening exercises)
  • Lifestyle suggestions, such as avoiding certain activities that put undue pressure on the lumbar spine
  • Manual therapy, such as joint mobilization and massage
  • Heat and cold therapy
  • Pulsed electromagnetic fields therapy 

Medications for L4-L5 Nerve Root Compression Symptoms

Prescription or over-the-counter medications may alleviate L4-L5 nerve root compression symptoms. If your symptoms are relatively mild, your physician may recommend over-the-counter NSAIDs, like ibuprofen. NSAIDs (non-steroidal anti-inflammatory medications) can help with lumbar nerve compression by reducing inflammation and swelling. 

If over-the-counter medications don’t work, prescription medications are the next option. Prescription medications that can be used for lumbar nerve pain include:

  • Corticosteroid injections reduce inflammation by inhibiting the immune response in the affected area. 
  • Certain antidepressants, like tricyclic antidepressants, can help with chronic pain caused by L4-L5 nerve root compression. 
  • Anticonvulsants help block pain signals in the nerves. 

While medications can help alleviate L4-L5 nerve root compression symptoms, they’re not a lasting solution. They simply block pain and inflammation, rather than addressing the cause of the compression. So, while your physician may recommend medications for temporary symptom relief, they’re not a permanent solution. 

Activity Modifications for L4-L5 Nerve Root Compression Symptoms

Activity and lifestyle adjustments are a natural way to alleviate lumbar nerve root compression symptoms. These changes are usually recommended alongside physical therapy and/or medications for lasting pain relief. 

The most common activity modifications for L4-L5 nerve root compression symptoms include:

  • Quitting smoking: Nicotine restricts blood flow throughout the body, which can inhibit the nerve-healing process. Smoking also contributes to artery damage and increases the risk of osteoporosis, which is known to worsen back pain. While quitting smoking can be very difficult, it’s a worthwhile challenge to take on for your health. 
  • Managing stress: Stress, anxiety, and depression can contribute to lumbar nerve compression symptom flare-ups. Stress triggers the release of cortisol, a hormone that can lead to excessive inflammation throughout the body. Cortisol can also hamper the immune system, which may sabotage your body’s ability to repair damaged nerve tissue. 
  • Practicing proper posture: Your posture when you’re standing and sitting can significantly affect your spinal health. Ensure that you stand up straight with a natural curve in your lumbar spine and choose a chair with adequate lumbar support. This can prevent irritation of the L4-L5 nerve roots. 
  • Reaching a healthy weight: Shedding excess pounds reduces the impact on your lumbar spine. If you’re overweight or obese, making this change may improve your lumbar nerve compression symptoms while boosting your overall health. 
  • Choosing supportive footwear: Swapping high-heels for supportive shoes (ideally with orthopedic inserts) can protect your lumbar spine with every step. You can talk to your physician or even an orthopedist to learn more about the best shoes for back pain. 
  • Avoiding high-impact exercise: If you experience lumbar nerve compression symptoms, take a step back from high-impact activities like running, weight lifting, and contact sports. These activities can worsen the problem and may even lead to serious complications. Wait for your doctor’s approval to return to these activities. 
  • Remaining active with low-impact exercise: While it’s important to avoid high-impact exercise with nerve compression, don’t avoid exercise altogether. Low-impact exercise like walking, swimming, and yoga prevents lost mobility and keeps blood flowing to the injured nerve tissue. 

Surgery for L4-L5 Nerve Root Compression Symptoms

When conservative methods fail to alleviate L4-L5 nerve root compression symptoms after several months, surgery may be the only remaining option. Surgery generally involves spinal decompression to remove the tissue impingement on the nerve roots. 

Innovations like the TOPS System have revolutionized surgical procedures for lumbar spine conditions. Contact a spine specialist in your area to learn more about your treatment options.