Understanding L5 Disc and SI Joint Misconceptions

In this episode of 'Ask the Chiropractor,' Dr. Brant Hulsebus delves into common misconceptions about L5 disc issues and SI joint problems. Drawing on over two decades of experience, Dr. Hulsebus explains the anatomical and developmental intricacies of the L5 vertebra, discusses the differences between degenerative disc issues and normal growth variations, and highlights the importance of accurate diagnosis for proper treatment. He emphasizes the need for chiropractic expertise to differentiate between L5 disc problems and SI joint disorders, advising viewers to seek professional guidance from chiropractors for spine-related concerns.

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Transcript

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Hello, Dr. Brant Hulsebus here and welcome to another edition of Ask the Chiropractor. Ask The Chiropractor is my little podcast that I do when someone has a question about chiropractic or chiropractic care, I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic, and I'm happy to be the team chiropractor of the Rockford Ice Hogs. Let's dive into it. Thanks for tuning in for another episode of Ask the Chiropractor. Today I wanna talk about the very bottom disc, the L5. We have a lot of people committed telling us they have L5 disc issues, or I've been told I have an L5 situation, or I had X-rays taken somewhere else and they told me I have an L5 disc bulge or herniation, whatever you might have heard. Let's talk a little bit about the L5, 'cause I think the L5 is one of the more unique spots in the spine. So I've been a chiropractor now since 2002, and I'm recording this. It's 2025, so I've had 23 years plus my time in college looking at X-rays of people's L5 disc. And I'm gonna tell you a little bit what I've seen, what I've noticed, and a little bit just overall about the L5. So first of all, what is the L5? L stands for lumbar and lumbar are the five bones of your lower back, and the fifth one would obviously be the fifth one down the L one's the top one. Then 2, 3, 4, 5. Real easy math. So the L5's right before the sacrum, some people call it the tailbone, and the sacrum in the L5 have a disc usually in between them. Now I say usually because this is one of the most common places to have an abnormality of this disc in the spine. You see when you're a child, your sacrum isn't one bone, it's actually six. And as you go through puberty and you grow, the sacrum actually starts to grow together and the disc dissolve and diffuses into one giant bone. And right above it's the L5. Now the nerve that comes out there is the L5 nerve. Let's talk a little bit about this fusion of the bones. You see clinically, I've seen over the years that people, especially people that played hard outside or like myself, I was in high school and there was three brothers that lived a couple doors down from me and we played pretty hard and we, I played tackle football. I monkeyed around with my friends playing lacrosse and I was a wrestler in high school and we just played a lot of physical sports. Even in middle school and elementary school, I can remember getting in trouble for playing King of the Mountain on top of a snow pile at school. All of us boys that were playing, all of our mothers were called 'cause we're not supposed to play that game apparently. So I used to play a lot of rough stuff. A lot of people that do this stuff, or maybe had a motorcycle or horseback riding, when you go through puberty and these bones start to fuse, sometimes the L5 will actually start to fuse with the sacrum as if it's a larger sacrum Now. But usually right before it's done d fusing, it'll stop. Now, what happens here is it creates what we call a rudimentary disc. So the disc starts to flatten, go away, 'cause it thinks it's gonna fuse together, but for every reason at the last minute, it'll stop. Now when it stops, we end up with a rudimentary disc, a thin little sliver of a disc that you would normally have. But the backside of the vertebrae has a joint called the facet joint, F-A-C-E-T, facet joint. And a lot of times these facet joints will also start to fuse or come together or lock up in the sacrum area. Now, typically when I see this on the x-ray, I think to myself there's an L5 that's never gonna move because it's already trying to fuse with the sacrum, the backside of the joint where those facet joints are, those are starting to interlock more than normally would. And they're starting to really lock itself into place just through the bony structure. So how do we know if this is what happened? And you don't have a blown on L5 disc because you have to imagine that when a disc starts to dehydrate and starts to go away, it flattens. So how can we confidently say that this is a way you were born, raised, and groove, versus this is a really bad degenerative problem. A couple of the clues are simple. Whenever you have the misalignment like that and the vertebras get misaligned, we call it a subluxation. Now the subluxation is there. That means one or two bones are misaligned, affecting the nerve coming out. Wherever that nerve goes under stress. The stress response kicks in. So if it was your L5 nerve and you had a subluxation done there for a long time, that activates a lot of your foot and your lower extremity. You see the L5 nerve is part of the sciatic nerve. Several levels of the lumbar spine come out. They exit the spine individually, then they come together and they form a nerve about as big as your thumb, and that goes through the, around the piriformis muscle, down the back of your thighs, into your knee, down everywhere, knee down. That's the sciatic nerve. S So if you have hamstring problems, if you have anything knee down or thick in sciatica, so the part of the sciatic nerve, so if you had ATO station at L5 for a long time, you'd have issues with your sciatic nerve. So if we x-ray you and that disc is really thin and you've never had any kind of sciatica issues, then it's kinda hard for us to think that this is probably a SCIA issue and this is probably nerve de nerve from a subluxation causing the degeneration. Another huge clue is if it was really that thin, what happens is the body starts to undergo the arthritic process or to start putting more calcium down on these bones. I always describe. This degeneration, kinda like bony calluses. You see the disc goes away and the bones get closer together and there's rubbing and friction. So the body starts putting down more and more calcium in this area to help straighten the bone. Unfortunately, this calcium grows sometimes we don't want to grow. It actually hits the nerve and irritate the nerve constantly. So when you get this thin disc, we expect to see calcium build up. Now on the x-ray, you can actually see when there's more calcium build up, 'cause the spot's actually whiter. The calcium will build up on the x-ray. We'll see the bone, we'll see a big brim around the bone, where the calciums build up. That's wearing a tearing. So when I see that, then I suspect it's been a disc problem for a long time. When I see a thin disc like that, I don't see any changes. Then I know this hasn't been a long-term issue 'cause the bone hasn't changed. Yeah, but you can't have that thin of a disc happen overnight. It takes time for that disc to thin out. So if the disc is really thin and there's no extra calcium put down there, I'm thinking more and more. This is probably just a change of the way you grew more than a degenerative real bad disc issue. The other clue is if I look at the sacrum itself from the side on the x-ray and I see Lou rudimentary disc in there too, then I know there's another clue that the normal puberty changes of the sacrum in the lumbar spine weren't as typical, meaning that you probably played hard and tackled each other, fell down, and it's more likely this is a disc that never fully grew. Now it's really easy for me to use a fear tactic or a sales tactic to look at you and say, you have a really bad L5 disc. There's no height here. But if I don't have any complaints of sciatica ever, if I don't see any issues with the bowels, 'cause the nerves also go to that area and we don't see any extra calcium deposits there, and maybe we see some sacral changes, then I have to suspect that's just the way your disc grew, that this what's going on. You see a lot of people that come in, they complain about their L5 or they've been diagnosed with having a bad L5. When they're really having SI problems, I tell 'em, why don't you point where it bothers you if they don't point at the L5? They're pointing at the SI joints and what are the SI joints? Where the SI joints is where the sacrum, the tailbone and the hip, the ileum come together and they're right next to the L5. So when someone says, that hurts over here, it hurts right here. And they, I put my thumb right where they're touching and I realize it's an SI problem. I've done many videos on SI issues, where a lot of times it's nothing to do with the si, it has to do with the upper lumbar. It might be an L one problem actually. And they're being told they have an L5 issue. I've had many patients over the years that have had shots and they've had nerve ablations at the L5 for this issue, and they don't get any relief. But then I find out it was actually an SI problem and I go up and adjust the upper lumbars and they finally get relief and I don't even touch the L5, even though it's, they've had shots, they've had nerve ablations, everything going on there. We get good relief by looking higher up. So how do we know this? If you come in the office, what your situation is? There's only one way to know and that's to take films of your spine. So if you have films of your spine, you could bring them in with you. We can always look at those films. We don't always have to take new ones. X-ray of your lower back is an x-ray of your lower back, regardless of who took it as long as you were standing up in the x-ray. If you were laying down on the x-ray, then your chiropractor cannot use those x-rays. To determine a lot of the chiropractic issues that we look for and evaluate. We can still use 'em to diagnose the fact that you don't have a fracture, you don't have a tumor, you don't have this, that they're good for that. But what they're not good for is looking at your posture and seeing how you cure yourself for the simple fact you're not carrying yourself, you are laying down. So if you've been told you have an L5 disc problem or an L5 issue, it might be beneficial to ask a chiropractor. Now you can ask whoever told you have an L5 problem, whether or not you should ask a chiropractor. And that's a really bad idea because medical doctors, nurse practitioners, family doctors, orthopedic surgeons, they don't study chiropractic like we study chiropractic. They don't know what we know or know how we know what we do. Just like I wouldn't know how to perform back surgery on you. I might know the spinal anatomy. Very good. Matter of fact, I went to Palmer College of Chiropractic, had Mr. Mortor, one of the hardest teachers Palmer College ever had, and I passed this class. So I know the spinal anatomy as well as anybody else, but I have no idea how to do a surgery. So if you ask me how the surgery. Works. I don't, I have an idea, but I don't know enough to give you solid medical advice for you to make medical decisions about. No more than your family doctor knows anything about chiropractic. So ask a chiropractor and if you went to a chiropractor that took an extra of your lower back and tells you have an L5 disc problem, but you haven't had some of the things I'm describing, it's okay to get another opinion too. So make sure you don't spend too much time working on the L5. If the L5 is really not the issue, again, if there was one disc that people come in and tell me they have a disc problem with that, I would bet that's probably gonna say the L5. They probably really don't. It's probably something else. I'm always thinking L5. So if you have questions about your L5 disc or anything else about. Chiropractic, the only person qualified to answer these questions is a chiropractor. Make sure yourself, find yourself a chiropractor. Ask them, and if you have a question about chiropractic or chiropractic care that I might be able to answer for you, leave a message or a comment wherever you're watching or listen to this, and maybe next week you'll be the question of the week. Thanks for tuning in. Make sure you like, share, subscribe, and all that other good stuff. Thank you.