Written by Dr. Matthias Wiederholz, MD | Last Updated: July 2025
L4-L5 nerve damage refers to compression or injury of nerves between vertebrae L4 and L5, often causing radiating pain, numbness, or muscle weakness—prompt evaluation by a spine expert is crucial.
Recognizing the symptoms of L4-L5 nerve damage early empowers you to act before pain and weakness limit your independence. Immediate understanding helps protect mobility, prevent nerve complications, and improve long-term daily comfort—even when symptoms seem minor or slow to progress.
As a board-certified interventional pain physician and specialist in Pain Medicine and Physical Medicine & Rehabilitation with over 20 years of experience, I've helped countless patients overcome debilitating spine conditions in Houston.
My expertise as a nationally recognized leader in non-surgical spine care—and as the first physician in Houston to offer the Discseel® Procedure—enables me to diagnose and treat the complex symptoms of L4-L5 nerve damage with confidence. If you're interested in targeted therapies for lumbar issues, you may also want to review our comprehensive guide to L5-S1 bulging disc symptoms and treatment.
L4-L5 nerve damage occurs when the nerve root between the fourth and fifth lumbar vertebrae is compressed or injured, leading to radiating pain, muscle weakness, numbness, or tingling in the back, leg, or foot. This type of lumbar radiculopathy often disrupts daily life and can progress rapidly if not addressed. Key clinical signs include difficulty lifting the foot (foot drop) or sensory changes over the top of the foot, impacting patients’ independence and safety. These hallmark symptoms have been described in detail by medical authorities such as the characteristic presentation of L4-L5 nerve involvement in lumbar radiculopathy.
In this article, I’ll guide you through the warning signs, diagnosis, and the most advanced treatment options for L4-L5 nerve damage—so you can take the next step toward relief and recovery.
Used source: https://www.cedars-sinai.org/health-library/diseases-and-conditions/l/lumbar-radiculopathy.html
L4-L5 nerve damage, resulting from compression or injury between the fourth and fifth lumbar vertebrae, can manifest through various symptoms that may significantly impact daily activities. For patients dealing with lower back problems, our Houston back pain treatment specialists provide comprehensive options to address these symptoms.
Early recognition of these symptoms is crucial. If you experience any of the above, especially the severe symptoms, seek medical evaluation promptly to prevent potential complications.
Let me break these down further. Radiating pain often starts in the lower back and shoots down the leg, sometimes described as a burning or electric sensation. Numbness and tingling follow the nerve’s path, making it feel like your foot is “asleep” or buzzing. Muscle weakness can make it hard to climb stairs or keep your balance. Foot drop is a classic sign—if you find yourself tripping or unable to lift your toes, this is a red flag for what are the symptoms of l4-l5 nerve damageherniated disk symptoms.
In my 20 years of treating spine conditions, I’ve seen how these symptoms can disrupt everything from walking the dog in Memorial Park to simply getting out of bed. If you notice any combination of these signs, especially sudden weakness or changes in sensation, it’s time to consult a spine specialist in Houston. To learn more about similar nerve issues, you may find our article on S1 nerve root compression symptoms helpful.
Glossary callouts:
For more on how these symptoms present, see the detailed breakdown below and consult with a Houston spine doctor if you’re experiencing any of these issueslumbar spine conditions and treatments.
Pain from L4-L5 nerve compression typically radiates from the lower back, through the buttock, down the side or front of the thigh, and into the top of the foot. This pain can feel sharp, burning, or electric. Numbness and tingling—often described as “pins and needles”—commonly affect the area between the first two toes and the top of the foot. In my Houston practice, I see how these symptoms can make walking or standing for long periods especially challenging in our active city. These patterns are classic for lumbar radiculopathy and are well-documented in medical researchlumbar radiculopathy symptoms.
If you’re curious about other conditions that may mimic sciatica or lumbar radiculopathy, explore our resource on everything you need to know about new treatments for ruptured discs.
Muscle weakness is a hallmark of L4-L5 nerve damage. Patients often struggle to lift the front of the foot or big toe—a movement called dorsiflexion. When this weakness is severe, it leads to foot drop, where the foot drags or trips during walking. Even mild weakness can make daily activities difficult, while severe cases may require assistive devices. In my experience as a master instructor, early recognition of foot drop is critical for preventing long-term disabilityfoot drop and muscle weakness.
To learn more about exercise strategies that support recovery, see our guide to herniated disc exercises.
If you experience any of the following, seek emergency care immediately:
These are emergency symptoms that may indicate cauda equina syndrome. Prompt evaluation by a physician is essential to prevent permanent nerve damageemergency symptoms of lumbar herniated disc.
Diagnosing L4-L5 nerve damage starts with a thorough evaluation. I begin with a detailed history and physical exam, checking reflexes, muscle strength, and sensation. Imaging studies—like MRI or X-ray—help confirm the diagnosis and pinpoint the exact location of nerve compression. In complex cases, I may order nerve conduction studies (EMG) to assess nerve function. Houston patients benefit from access to advanced diagnostics and expert review at my clinic, ensuring an accurate diagnosis and tailored treatment plandiagnosis of lumbar disc herniation.
If you’re looking for a deeper dive into surgical approaches, review our detailed L5-S1 herniated disc surgery overview.
During the physical exam, I test your reflexes, muscle strength, and ability to sense touch or vibration. MRI is the gold standard for visualizing nerve compression at L4-L5, while X-rays can reveal structural changes. In some cases, EMG or nerve conduction studies help clarify the diagnosis, especially if symptoms are complex or don’t match imaging findings. My board certification in Physical Medicine & Rehabilitation guides my approach to these evaluations, ensuring no detail is misseddiagnostic approach to lumbar radiculopathy.
Treatment for L4-L5 nerve compression is highly individualized. I always start with conservative options and progress to advanced interventions if needed. Here’s how I structure care:
Conservative Treatments:
Minimally Invasive Treatments:
Surgical Options (last resort):
Comparison of Minimally Invasive vs. Surgical Options:
For a closer look at herniated disc treatment advancements, see our overview of effective treatment options for L5-S1 disc herniation pain.
In my two decades of practice, I’ve found that most patients improve with a stepwise approach, reserving surgery for those who do not respond to other treatments. If conservative care fails, consider advanced options like Discseel® or other minimally invasive procedures. For more information, see our Houston back pain specialist resource.
As the first physician to bring the Discseel® Procedure to Houston, I offer this advanced, minimally invasive option for patients who have not found relief with standard treatments. The Discseel® Procedure uses a biologic fibrin sealant to repair damaged spinal discs and stimulate natural healing, often providing long-term pain relief without the need for surgery. Having performed hundreds of these procedures, I’ve seen firsthand how it can restore mobility and quality of life for patients with L4-L5 nerve damage.
Discseel® is performed as an outpatient procedure, with no incisions or hardware, and most patients return to daily activities within days. Compared to traditional spinal fusion, Discseel® preserves spinal motion and has a higher reported success rate—82% versus 31% for fusion, according to published data. My experience as one of only three master instructors worldwide allows me to train other physicians in this technique, ensuring the highest standards of care for Houston patients.
To expand your understanding of this innovative approach, read more about Discseel® procedure reviews and back pain relief.
For additional background about the Discseel® approach, refer to official Discseel® procedure information.
If you’re struggling with persistent symptoms of L4-L5 nerve compression, see if you are a candidate for the Discseel® Procedure—schedule a consultation with me in Houston. For those in the area, visit our Houston location for expert care tailored to local patients.
★★★★★ “My Discseel procedure is an unqualified success... I knew immediately this was unlike the ESI. I had alternating swings from some numbness and pains for the first 8 weeks but by the 12th week, it settled out totally... the arm is now pain-free. I started minor physical therapy exercises and I hope to be playing tennis in another few months.” — L., Houston patient Read full review
In my experience, Discseel® offers a unique, regenerative approach for patients who want to avoid surgery. To find out if Discseel® is right for you, schedule a consultation with a back pain specialist in Houston.
Patient experiences are at the heart of my practice, especially as someone who trains physicians nationally in advanced spine procedures. Hearing directly from those who have undergone treatment helps me refine my approach and ensure the highest standards of care.
One review from a Houston patient who chose the Discseel® Procedure stands out for its honesty and detail. I have specialized training in this procedure as one of only three master instructors worldwide, and feedback like this is invaluable:
“My Discseel procedure is an unqualified success. I suffered C6/C7 disc herniation in 2014 and have lived in pain. I tore a neck muscle during cervical traction in 2020 and it made things even worse. Later in Jan 2023, I suffered another herniation at C4/C5.
I wrote to Dr Kevin Pauza in June after my 3rd ESI injection and fourth Methyldose pack treatments in six months. The Orthopaedic Surgeon had just reviewed my case and for the first time recommended surgery if the pain in my right arm returned. However, the pain was already there and could not use my right arm for anything. The Diclofenac capsules did little and the Prednisolone tabs could hold the pain at bay for just few days.
I set up further reviews with DeukSpine but found Discseel a lot more realistic and with less logistical issues.
Amy Barrett wrote back and also followed up with calls. She recommended Dr Weiderholz in Houston. I shared the research and scientific documents with my Primary Doc.
I met Dr Widerholz circa Aug 20 and immediately set up the eventual procedure.
Amber and others treated me nicely and helped with onboarding and after at the Houston facility.
I knew immediately this was unlike the ESI. I had alternating swings from some numbness and pains for the first 8 weeks but by the 12th week, it settled out totally. I followed all the instructions to load the arms lightly. I applied ice packs whenever I feel uneasy but the arm is now pain-free. I started minor physical therapy exercises and I hope to be playing tennis in another few months.” — L., Houston patient
Read more Google reviews here.
Stories like this reinforce why I am committed to offering innovative, minimally invasive options—among several advanced treatments available—to help patients regain their quality of life. Curious about disc tears and spinal disc disease? See our explanation of spinal disc tears: causes, symptoms, and treatment options.
Living in Houston means staying active, whether it’s walking in Memorial Park or enjoying the city’s vibrant lifestyle. L4-L5 nerve damage can disrupt these routines, making timely, expert care essential for our community.
As the first physician to bring the Discseel® Procedure to Houston, I’ve seen how local patients benefit from advanced, minimally invasive solutions that preserve mobility and reduce downtime. Houston’s diverse and active population often seeks alternatives to traditional surgery, and research shows that early intervention with the right treatment can prevent long-term disability.
My practice is dedicated to providing comprehensive evaluations and a full spectrum of care for lumbar radiculopathy and related conditions. If you’re experiencing symptoms of L4-L5 nerve compression, I encourage you to connect with a spine specialist who understands the unique needs of Houston residents.
*This content reflects current medical guidelines and Dr. Wiederholz's 20+ years of clinical experience.*
Drawing from my quadruple board certification and two decades of practice, I know that recognizing what are the symptoms of l4-l5 nerve damage—such as radiating pain, numbness, tingling, and muscle weakness—is the first step toward lasting relief. Early diagnosis and a tailored treatment plan, whether through physical therapy, injections, or advanced options like the Discseel® Procedure, can help you regain mobility and protect your independence in Houston.
As Houston’s first Discseel® provider and a nationally recognized spine specialist, I offer a comprehensive, patient-centered approach to care. If you’re ready to address your symptoms and explore all available solutions, see if you are a candidate for the Discseel® procedure.
For more information on appointments and advanced spine care in Houston, contact us for a consultation.
*This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.*
The most common symptoms include radiating pain from the lower back down the leg, numbness or tingling on the top of the foot and between the first two toes, and muscle weakness—especially when lifting the foot (foot drop). Severe cases may involve loss of bladder or bowel control, which requires immediate medical attention. These symptoms are well-documented in clinical research and patient education resources.
You can find advanced, minimally invasive treatments—including the Discseel® Procedure—at specialized spine clinics in Houston. My practice offers comprehensive evaluation and a full range of options, from conservative care to regenerative procedures. For more on evidence-based treatments, see the latest clinical guidance on lumbar disc herniation.
Early recognition allows working professionals to seek prompt care, reducing the risk of long-term disability and missed workdays. Addressing symptoms like muscle weakness or foot drop quickly can help maintain mobility, prevent complications, and support a faster return to daily activities. Timely intervention is especially important for those with active or physically demanding jobs.
