Pinched Nerve Lower Back – Lumbar Nerve Compression

Pressure on the nerve roots as they leave the spine produce symptoms of nerve compression, and the nerve roots in the lumbar region of the spine are most liable to be pinched or compressed as a result of maximum movement of the vertebrae in this region. Lumbar nerve compression is commonly known as sciatica, which is the most frequent of all the pinched nerve conditions.

Anatomy

The lumbar parts of the spine bears the weight of the lower part of the body and is more prone to wear and tear due to a number of causes, such as improper bending and lifting with pressure on this area, apart from normal wear and tear associated with age. This causes early degeneration of the intervertebral discs in the lumbar area, which puts pressure on the nerves, resulting in lumbar radiculopathy.

The nerves that leave the lower lumbar spine join to form the sciatic nerve, the longest nerve in the body, which controls the muscles of the lower leg and provides sensation to it. Pressure on the nerve roots of the lumbar spine causes pain and numbness in the area supplied by the sciatic nerve and may lead to muscle weakness and loss of reflexes.

Symptoms of Lumbar Nerve Compression

  • Shooting pain along the distribution of the sciatic nerve, running from the buttocks, thigh and legs and may radiate to the feet.
  • Tingling or “pins and needles” sensation in the buttocks, leg and calf.
  • Numbness or decreased sensation.
  • Muscle weakness in the leg.
  • Muscle spasm.
  • Symptoms may aggravated  while walking.

The most common symptoms related to a pinched nerve at different levels  are :

  • Nerve compression at L3, L4, and L5 results in symptoms of sciatica, caused by pressure on the sciatic nerve. Shooting pain may be felt at the lower back, radiating down to the buttocks, thigh and legs.
  • Nerve compression at L5 causes muscle weakness of the foot and big toe since the L5 nerve controls the muscles involved in lifting the foot and big toe.
  • Compression of the S1 nerve results in weakness of the muscle at the back of the calf, with difficulty in foot push off and numbness along the outer side of the foot. There may be low back pain, which continues down the buttocks, to the thigh and legs, to the outer side of the little toe.

Conditions Related to Nerve Compression in the Lumbar Region

1. Sciatica

Refer to the article on Sciatic Nerve Pain.

2. Herniated Intervertebral Disc

Repeated injury may weaken the outer layer of the intervertebral disc so that it breaks and the inner gelatinous layer protrudes out and produces herniation of the disc. Often a sudden movement may cause rupture of the outer layer with resulting herniated disc. If the nerve root gets compressed by the herniated disc, there may be pain, numbness, and weakness of the region supplied by the nerve.

3. Degenerated Intervertebral Discs

Due to age-related wear and tear of the lumbar vertebrae and the intervertebral discs, there is gradual and progressive degeneration of the discs, leading to compression of the nerve as it exits through the foramen, giving rise to symptoms of nerve compression.

4. Lumbar Stenosis

Narrowing of the spinal cord at the level of the lumbar vertebrae is called lumbar stenosis and this may occur due to various causes.

  • Spondylosis. The most common cause of lumbar stenosis is degeneration of the spinal cord as a result of age, or osteoarthritis-related bone changes, and this is known as spondylosis.
  • Spondylolisthesis. Either due to degeneration or trauma, one vertebra may slip over the other, causing misalignment and narrowing of the spinal canal, resulting in features of lumbar stenosis.
  • Congenital. There may be a narrow spinal canal present as a congenital defect, which is a defect that is present since birth.
  • Bone spurs. In late stages of spinal degeneration bone spurs form, which further narrow the spinal canal.
  • Spinal tumors. Abnormal growths inside the spinal cord, within the meninges or membranes covering the spinal cord, or in the space between the spinal cord and vertebrae. Metastasis or spread of malignancy to the spinal cord from other parts of the body may occur too.
  • Injury. Such as in car accidents or other type of trauma.

Diagnosis of Lumbar Nerve Compression

Diagnosis is based mainly on the history and physical examination but associated tests may need to be done and these include :

  • X-ray
  • Myelogram
  • Nerve conduction study or nerve conduction velocity test
  • Electromyography
  • Magnetic resonance imaging or MRI
  • Computed tomography or CT scan

Treatment of Lumbar Nerve Compression

Treatment will be guided by the cause of nerve compression, but may include :

  • Bed rest with or without traction.
  • Exercises to strengthen the muscles of the affected area.
  • Avoiding activity that aggravates the condition.
  • Wearing a support or brace.
  • Medication to relieve pain, such as ibuprofen, or muscle relaxants. Corticosteroid injections into the affected area often help.
  • Surgery will depend on the type of compression and if the symptoms are not relieved by conservative treatment.
  • cheang

    I have occasional pain on my right lumbar. The pain can cause numbness on my right hip. i guess this is lumbar stenosis. please give advice how to avoid such pain.

  • Dr. Chris

    Hi Cheang

    First get an orthopedic surgeon to confirm the diagnosis. You may need an x-ray and ct scan.

    Depending on the cause, pain may be unavoidable unless you consider surgery. But this will depend on your individual case and your doctor will advise you accordingly. Avoid certain trigger factors – positions and activities that aggravate the pain. It can only be managed to some degree and you will likely need surgery if it persists.

  • vinay sianarian

    i am getting shocking pains on my lower back when bending and sitting a sudden movement with experience these shocking pains.when i get these pains i just fall to my knees.i cannot stand or walk for long i have to sleep on my back.

  • ken

    Hi,I’m ken,21,male,UK. At present ,I have got severe and chronic pain in my left buttock,which goes all the way down to left foot. I do feel pins and needles,weakness in my foot and leg.I cannot walk straight,cannot stand straight,I could hardly walk for 5mins,because as I walk,then I sweat as pain gets worse.While,I walk,I cannot face straight as my neck faces down due to some reason.2years ago,this pain started as I was working in a heavy lifting job,got physiotherapy for 3 months, then pain went away but not 100%. 4 months ago, got MRI,it shows l5-s1 disc bulge.The part of disc has come out and is compressing the nerve.,got ct guided nerve root injection(anaesthesia and steroid),but didnt effect.
    Shall I get a new MRI, again as 4 months ago,when I had mri,then I was walking fine,but now I could hardly walk,as the pain is really severe.I cannot sleep at night as the pain gets worse,when I lie down.Its very hard for me to lie on my back or to lie on my stomach as pain down the left leg makes me restless,if i lie on back or stomach, so I have to lie side -ways. If i go for a latest mri,then I wonder how would I lie in the mri tube machine as I cannot lie on back or stomach for not more than a minute.Please Help!!!!!!!!!!!

  • Dr. Chris

    Hi Ken

    From what you are describing, you most likely have sciatica. This is nerve root compression of the sciatic nerve as a result of a bulging disc (most probably arising from your job 2 years ago). However, you must remember that there could be other possible causes of the compressions. It is advisable to return to your doctor, or preferably a neurologist, and discuss your case. There are other causes of the brain, spinal cord and even vertebral column that may be responsible for your case and would explain why the nerve root injection was not effective (although it is not effective in every case). These serious, although rare causes, may have to be considered if your case presentation does not correlate with the findings upon conducting the MRI. Other investigations may be warranted at this point. You posted this question on another article on Leg Weakness and a further response from that writer may be forthcoming. Nevertheless, see your doctor.

  • Barely

    I have been waiting to see a doctor for an appt for an MRi it has been six days since I went for a (what I thought burning pain in Knee) The orthopedist gave me a cortisone shot and the pain went away almost immediately but about 3 days later it started to return along w/numbess in the ball of my foot. This was my left leg now my right leg is reacting the same and i have numbness in my lower legs and pain in the side of my thighs in the evening …what do you think it might be.. I am awaiting my dr.appt.

  • Dr. Chris

    Hi Barely

    Considering that both legs are now showing symptoms, the cause is very likely stemming from the lower back at the nerve root (sciatic, femoral). This could be related to a lower back injury, bulging disc and so on. However, there is a possibility that you placed additional weight and strained the other leg to compensate for the original affected sites. You don’t mention any event that preceded it, your age or medical history so it is difficult to provide much information beyond this. An MRI will prove useful in identifying the possible cause

  • TinaB

    Hi there, was Googling and came across this page. I have a long history of disc problems, originally stemming from an injury when I was 30. (I’m 53 now) I had surgery about a year after the injury. I have periods of discomfort on and off, and a few years ago it was so bad I couldn’t walk. My dr. sent me for an MRI and wanted me to get the steroid shots, but I opted for stretching machine (they used to have infomercials). Either it really helped, or I got better on my own. I still get on and off problems, but if I’m patient and take it easy, it gets better in a day or two. Pain down my left leg comes and goes.

    What concerns me now is numbness in my left thigh, and up into the bottom part of my left buttock. This happened in the grocery store, and I thought it was a panic attack (I have bad panic disorder), but now it’s happening often. The last few days, it happens every time I cook dinner, because I’m standing in the kitchen, chopping vegetables, etc. I have to stretch out and relax in order to get the numbness to leave, then go back and forth. I was Googling to make sure this wasn’t some kind of stroke or something, but it’s the same leg I had/have the sciatic pain, in fact the same area. But now instead of shooting pains, it’s numbness, and it’s creepy.

    I’ll post my MRI results from before (about five years ago), if that helps. Sorry it’s all caps, that’s how it was sent to me.

    Any thoughts on what I need to do and what I’m in for? I just mainly don’t want to mess around with this and end up paralyzed or something. I can go to my GP, but she has said my next step was the shots. Or I can seek out a specialist. Obviously, if this is caused by the nerve compression, I can’t ignore it. (Or can I? Would the compression perhaps shift on its own?)

    Even though I know surgical techniques have improved since I had surgery (I was in hospital for about a week), I’m still hesitant to even consider it, unless it’s the only thing standing between me and paralysis.

    Thanks for listening. MRI below.

  • TinaB

    Here’s what my MRI said…remember it’s a few yrs old. LOL

    L4-L5: MILD TO MODERATE INTERVERTEBRAL DISC SPACE NARROWING IS
    SEEN. THERE ARE DISC DESICCATION CHANGES. THERE IS MODERATE TO
    MARKED CIRCUMFERENTIAL DISC BULGE WITH MODERATE CENTRAL CANAL
    STENOSIS. THERE IS FACET HYPERTROPHIC OSTEOARTHRITIC CHANGE.
    THERE IS MINIMAL COMPROMISE OF THE INFERIOR RECESS OF THE RIGHT
    MRI LUMB SP W\O & W CONTRAST) NEUROFORAMINA WITHOUT NERVE ROOT COMPRESSION.

    L5-Sl: THERE APPEARS TO BE RIGHT LAMINECTOMY CHANGES. THERE IS MILD DISC SPACE NARROWING AND DISC DESICCATION CHANGES. THERE IS CIRCUMFERENTIAL DISC BULGING ECCENTRIC TOWARDS THE LEFT SIDE WITHOUT CENTRAL CANAL STENOSIS. NEUROFORAMINA APPEAR PATENT WITHOUT SIGNIFICANT NERVE ROOT COMPRESSION. EXITING NERVE ROOTS APPEAR TO COME INTACT WITH THE PERIPHERY OF THE BULGING DISCS LEFT GREATER THAN RIGHT. THERE IS MILD DEGENERATIVE HYPERTROPHIC OSTEOARTHRITIC CHANGE POSTERIOR FACETS.

  • Dr. Chris

    Hi TinaB

    Based on the information provided, here are some answers to your questions. Please note that on an online platform like this, it is difficult to conclusively answer any question and your doctor will be in the best position to advise you further. If you are still uncertain, then you should consider seeking a second opinion.

    1. Yes, you should consult with a specialist. Considering your history, an orthopedist (orthopedic surgeon) and neurologist should be consulted with. They will work together to find the best possible solution.
    2. Yes, you cannot ignore it but apart from surgery, your options are limited. The ‘steroid shots’ will not offer permanent relief.
    3. It is highly unlikely (I don’t want to say impossible) that this will shift and ease the compression on the nerve. The traction machine that you used for stretching (this is what I assume it is) will ease pressure on the nerve root temporarily. Given the degeneration reported in the report, the problem is unlikely to go away.
    4. Paralysis is unlikely but the pain can be debilitating enough to hamper walking.
    5. The numbness does indicate that the condition is progressing although it could be related to complications of other conditions like diabetes but in this case it wouldn’t ease with just a little stretching.

  • TinaB

    Dr. Chris,

    Thank you for such a quick and thorough answer. Not what I wanted to hear, but at least I know what to do. I’m bad about just tolerating pain, but the numbness really threw me for a loop. Today it’s turned to actual pain, so I can’t continue to ignore this. Thanks again.

  • Dr. Chris

    Sorry I couldn’t give you better news TinaB.

    However, my assessment is based on the information your provided (as well as limitations to what I am able to comments upon due to the editorial guidelines of this website). The outlook may be much better.

    Nerve root compression does present with both severe pain and sometimes numbness. This can fluctuate depending on the extent of the compression which may account for your change in symptoms. Hopefully there are no other underlying complications.

  • nirajdugar

    Hi,
    I am getting a very unusual shocks on my left thigh. Mostly it happens when I am ssitting and working on my laptop. first time i felt it, I though some insect has bitten me but it was from inside. Now , I am getting this frequently. Allthough it remains less than a second, but its not a good feeling. I dont know what it cud be. can you tell?

  • Dr. Chris

    Hi Nirajdugar

    It may be actual shocks – static electricity or from a short when the laptop surface (if uninsulated) touches your skin. Read up on electrostatic shocks and what clothing you could wear or not wear to ease it. Some people do have these experiences where they get these shocks due to static electricity many times in a day. If it is only happening on the thigh, even without computer use and so on, then it may be a paresthesia. Speak to your doctor just to verify.

  • Nikki

    Hi, I am a 20 year old female and have been experiecing sciatic nerve pain for almost 3 months. It started with my right leg; i couldn’t sit nor stand for more than 10 mins.

    I went to see an orthopedic surgeon and chiropractor for this. But I did not go for any scans. About a month and a half later, the pain in my right leg subsided.

    But then my left leg started hurting. The pain felt different from the right leg, felt like my muscles were strained. With this new pain, i found it hard for me stand straight and lie on my back.

    So i went to see another orthopedic surgeon. This time i went for X-ray and CT scans. It came back saying i had a ‘slipped disc’ in L4/L5. According to the doctor, it was quite a big disc.

    The doctor gave me an injection to help shrink the disc. For the next 2-3 weeks, the pain away by alot. I could walk and stand straight.

    But this did not last long as the pain in my left leg returned. It is not that bad during the day, i could walk, but when night comes, it starts hurting more and i find myself unable to walk again.

    Although it isn’t as painful as before, i find myself considering if i should go for surgery. My parents aren’t too eager about it. But i don’t know if i can go on like this, especially when i have to return to college in a few months for my semester. Dr Chris, please do advise.

  • Dr. Chris

    Hi Nikki

    Surgery should always be considered on a case by case basis. It is imperative that you discuss the risks and possibilities of complications with the orthopedic surgeon. You mention this inflammation of the disc but you have not stated the cause. It is imperative that this is established. It could be related to injury and autoimmune cause and so on. Unless there was degeneration of the disc and nerve root entrapment due to compression between the two vertebrae.

    There is no denying that surgery is often undertaken with haste these days. However in this case, if it is the only therapeutic option to give you a better quality of life then it may have to be considered. The fact is that you are young and all therapeutic options should be considered before forging ahead with surgery. Possibly seek a second opinion from another orthopedic surgeon and speak to your family doctor for further advice as he/she has monitored/treated you for years.

  • Nikki

    Thank you Dr Chris for your reply.

    Earlier this week I went for an MRI and it shows a herniated disc compressing on my nerve which causes the pains running down my left leg.

    I’ve seeked a second opinion and have started treatment called DTS or disc decompression therapy. I am sure you have heard of this. I go to the centre five days a week for a 15-minute DTS session followed by 20 minutes of rehab exercise.

    Ideally, I will have to follow this program for 3 months. But during the middle of it there will be a reassement, if my condition is not responding well to it then I may have to proceed to surgery.

    According to the doctor, it would be an open surgery as the protrusion is quite large. About 80% out.

    I would like to know Dr Chris, do you think this DTS will work for me? My doctor told me as well that surgery at my age is not encouraged, may I ask what implications may be present if I do go for surgery.

    Thank you.

  • Nikki

    As for the cause of my disc injury, I am not very sure. According to my scans, the doctor said it looked like an old injury, possibly 5 or more years ago.

    I do not recall having a very bad fall or accident. So, I’m unsure of its causes as well.

  • Dr. Chris

    Hi Nikki

    You doctor is right. Surgery at your age is usually not advisable. We are here to guide you to the appropriate health care professional. We do not generally advise on prognosis or complications as each case is an individual consideration. What may be a consideration in one case, may not be a risk in another. I would advise that your direct these questions at your orthopedic surgeon because he/she is familiar with your case and has seen you actual scans and evaluated your condition. If you are not comfortable with your current practitioner, seek advice from another who also has access to your records.

  • lori

    Hi I had back surgery 2 years ago in April and now I’m just a mess. I have been having so much pain its nuts and had a new MRI just this week. My test showed compression on the nerves and some other things and I’m wondering how you fix it pain shots do not work an neither did therapy help I can’t feel my legs other than pain