L3–L4 Spine Care in Kuala Lumpur

At CSC, our L3–L4 spine care in Kuala Lumpur focuses on the mid-lumbar segment that carries load, guides bending, and safeguards nerve corridors to the thigh and knee. MRI reports at this level often mention disc bulge/protrusion/prolapse/extrusion, annular tear, facet hypertrophy, ligamentum flavum hypertrophy, foraminal narrowing, or low-grade spondylolisthesis. This guide explains what each finding means for the exiting L3 and traversing L4 roots, why direction matters, and how segment mechanics shape daily movement.

Care is non-invasive and gentle & focused—no twisting. You’ll get plain-English explainers, clear do-vs-don’t steps, and a corridor-aware plan pairing chiropractic with physiotherapy, calibrated spinal decompression, and segment-specific exercise to improve motion and day-to-day function. If you’re reviewing an MRI or comparing options for L3–L4 disc changes, start here.

Evidence: Bogduk N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum (4th ed.). Elsevier. • Adams MA, Dolan P. (2012). Intervertebral disc degeneration phenotypes. J Anat, 221(6), 497–506.

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Key Facts at a Glance

• Segment: L3–L4 mid-lumbar level — shares load and guides bending/extension.
• Nerve corridors: Exiting L3 (foramen) & traversing L4 (beneath the disc) → quadriceps strength, knee reflex, front-thigh/knee sensation.
• Common MRI phrases: disc bulge/protrusion/prolapse/extrusion, annular tear, facet hypertrophy, ligamentum flavum hypertrophy, foraminal narrowing, low-grade spondylolisthesis, synovial/Tarlov cysts.
• Direction = impact: Posterolateral changes tend to involve L4; far-lateral/foraminal changes can involve L3.
• Care style: Non-invasive, gentle & focused — chiropractic adjustment + physiotherapy, calibrated decompression, and segment-specific exercise (no twisting).

Evidence: Bogduk N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum (4th ed.). • Adams MA, Dolan P. (2012). J Anat, 221(6), 497–506.

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Understanding the L3–L4 Segment: Structure & Function

L3–L4 sits between the L3 bone above and L4 below. It’s a mid-lumbar link that carries upper-body load and passes it down to L4–L5, the sacrum, hips, and legs. The disc between L3 and L4 works like a cushion that shares force when you bend or extend. Two small facet joints (hinges at the back) guide movement and limit over-twisting. Ligaments—including the elastic ligamentum flavum—and deep back muscles (multifidus, erector spinae) add stability.

L3–L4 also contains two nerve corridors:

• the foramen (a side doorway) where the L3 nerve exits, and
• the lateral recess (a short tunnel under the disc) where the L4 nerve passes by (traverses).

If the disc loses height, facet joints thicken, or the ligamentum flavum folds inward, space can narrow in these corridors or the main canal. Many people notice this more in upright standing or when arching back. A slight forward lean often feels easier because it gently opens space.

Evidence: Bogduk N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum (4th ed.). • Adams MA, Dolan P. (2012). J Anat, 221(6), 497–506.

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L3–L4: Load Sharing, Stenosis Patterns & Nerve Root Involvement

L3–L4 shares day-to-day load with the levels below. L4–L5 and L5–S1 usually move more when you bend or lift; L3–L4 adds controlled motion. When the disc here loses height and the facet joints or ligamentum flavum thicken, the side opening (foramen) and the short tunnel under the disc (lateral recess) can narrow—that’s foraminal or lateral recess stenosis. In these positions, a nerve root can be compressed or abutted, most noticeably in upright standing or extension (some feel it with long sitting as well).

A “slipped disc” at L3–L4—meaning a bulge or protrusion—can add to this narrowing. Posterolateral direction tends to tighten the lateral recess and may involve the traversing L4 root. Far-lateral/foraminal direction can tighten the foramen and involve the exiting L3 root. Central thickening of the ligamentum flavum can also reduce central canalspace.

Levels influence each other. If L1–L2 or L2–L3 are stiff or degenerated, L3–L4 often works harder. If L3–L4 becomes limited, L4–L5 or L5–S1 may compensate. Over time, this sharing can lead to multilevel disc and facet findings on MRI.

Common signs match this picture: a stiff lower back after standing, altered sensation at the front of the thigh or around the knee, and early leg tiredness on hills or stairs. A slight forward lean often eases symptoms because it increases canal and foraminal space.

Evidence: Jenis LG, An HS. (2000). Lumbar foraminal stenosis. Spine, 25(3), 389–394. • Genevay S, Atlas SJ. (2010). Lumbar spinal stenosis. Best Pract Res Clin Rheumatol, 24(2), 253–265.

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MRI Terms You’ll See for L3–L4

Facet Joint Hypertrophy (thickening of the small spinal joints)

What it is Facet Hypertrophy (in simple terms): Facet joints are the two small “guide-rails” at the back of each spinal level. With years of use, the smooth cartilage can thin. The body responds by thickening the joint edges and capsule (called hypertrophy).

What can it feel like to have an L3-L4 facet degeneration or hypertrophy? t some have Common descriptions include morning stiffness, a tight end-range when arching backward (extension), and early fatigue with standing or walking. Many people feel easier in a slight forward bend because it opens space.

Why it matters at L3–L4? At this level, thickened facets can narrow the lateral recess (the short tunnel under the disc) and the foramen (the side doorway). That means:

• Posterolateral thickening may crowd the traversing L4 corridor.
• Far-lateral/foraminal thickening can involve the exiting L3 path.

Evidence: Fujiwara A, Tamai K, An HS, et al. (1999). Relationship between disc degeneration and facet joint osteoarthritis of the lumbar spine. Spine, 24(14), 1476–1480.

Ligamentum Flavum Hypertrophy

Ligamentum flavum is an elastic ligament. It lines the back of the canal. With ongoing load and minor inflammation, it may thicken and buckle inward, reducing canal diameter. Thickening often coexists with facet enlargement and disc height loss. The combination is a common pathway toward spinal canal narrowing at L3–L4, especially in extension or prolonged standing.

Evidence: Sairyo K, Biyani A, Goel V, et al. (2005). Pathomechanism of ligamentum flavum hypertrophy. Spine, 30(23), 2649–2656.

Disc Hydration Loss (Degeneration/Desiccation)

A disc loses water with age and load. Disc height decreases or degenerates, the outer annulus stiffens, and load shifts to the facets. Hydration loss increases the chance of annular tears, bulging, and contact with nearby nerve pathways. Imaging may note “Modic changes” in adjacent bone—signals of altered load and micro-stress.

Evidence: Adams MA, Dolan P. (2012). Disc degeneration phenotypes. J Anat, 221(6), 497–506.

Annular Tear

A tear in the outer disc ring (annulus). Tears can sensitise local structures and are common where the disc is dehydrated. Lifting with a rounded back or sudden bending can worsen micro-tears. Management focuses on motion control, hip strategy, and graded loading while the tissue calms.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Lumbar disc nomenclature 2.0. Spine J, 14(11), 2525–2545.

Foraminal Narrowing (Foraminal Stenosis)

Reduced foramen size from disc height loss, facet enlargement, and posterior element thickening. The exiting L3 root is most affected. People may note anterior-thigh tingling with standing or walking, improved by sitting or gentle flexion.

Evidence: Jenis LG, An HS. (2000). Lumbar foraminal stenosis. Spine, 25(3), 389–394. • Genevay S, Atlas SJ. (2010). Lumbar spinal stenosis. Best Pract Res Clin Rheumatol, 24(2), 253–265.

Synovial Facet Cyst / Tarlov (Perineural) Cyst

A synovial cyst forms from a facet capsule that distends; a Tarlov cyst sits near the nerve root sleeve. Small cysts may be incidental; larger ones can narrow nerve space depending on position. Size, location, and motion sensitivity guide decisions.

Evidence: Khan AM, Girardi FP. (2005). Lumbar synovial cysts. Spine, 30(12), 144–149. • Lucantoni C, Than KD, Wang AC, et al. (2011). Tarlov cysts review. Neurosurg Focus, 31(6), E14.

Spondylolisthesis at L3–L4

Spondylolisthesis or a forward slip (usually low-grade) occurs when stabilizers fatigue and disc height drops. Subtle translation plus facet and ligament changes can reduce lateral recess space for the traversing L4 root. Lifting, extension, or long standing may be provocative.

Evidence: Kalichman L, Hunter DJ. (2008). Degenerative lumbar spondylolisthesis: conservative management. Eur Spine J, 17(3), 327–335.

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Damaged Spinal Disc Types at L3–L4 

Readers often hear “slipped disc.” MRI reports use more specific labels. The terms below are commonly used for L3–L4. At this level, the exiting L3 root sits in the foramen, and the traversing L4 root passes beneath the disc. In the sections below we have provided additional informative content on each type of spinal disc disorder that often impact the L3-L4 segment, starting with the first stage of disc damage known ad degenerative or the desiccated stage. 

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Lumbar disc nomenclature 2.0. Spine J, 14(11), 2525–2545. • Brinjikji W, Luetmer PH, Comstock B, et al. (2015). Imaging features in asymptomatic populations. AJNR, 36(4), 811–816.

Degenerated / Desiccated Disc (DDD) at L3–L4

An L3–L4 degenerated or desiccated disc has reduced water and height. The annulus stiffens and load shifts toward the facet joints. These shifts may increase the likelihood of a bulge or small annular splits. At this segment, height loss can narrow the foramen and lateral recess, changing space for the exiting L3 and traversing L4 roots—often more noticeable during extension or long standing. Co-findings like annular tear, facet hypertrophy, ligamentum flavum hypertrophy, or facet joint inflammation can compound narrowing.

Evidence: Adams MA, Dolan P. (2012). J Anat, 221(6), 497–506. • Brinjikji W, Luetmer PH, Comstock B, et al. (2015). AJNR, 36(4), 811–816.

L3–L4 Disc Bulge (Broad-Based)

An L3–L4 disc bulge extends beyond the usual disc margin over a wide arc while the outer wall stays intact. A bulge may reduce foraminal height or the lateral recess—especially with disc height loss or facet hypertrophy. Posterolateral bulges can approximate the traversing L4 root; far-lateral components can involve the exiting L3 root. Effects increase when annular tears, ligamentum flavum hypertrophy, or facet joint inflammation coexist.

Video: L3–L4 Disc Bulge (60s)

This YouTube short clip explains what a disc bulge is and how it may cause back issues as it impacts the nearby nerve corridors

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545. • Brinjikji W, Luetmer PH, Comstock B, et al. (2015). AJNR, 36(4), 811–816.

L3–L4 Disc Protrusion (Contained Herniation)

An L3–L4 disc protrusion is a focal outpouching where the nucleus remains contained by the annulus. A protrusion can center or a posterolateral protrusion that often pinch or compress the L3 nerve that exits at the L3-L4 segment or the traversing (passing by) nerve of the L4-L5 segment known as the L4 nerve.

Protrusions results from excessive load bearing activities like prolonged sitting, lifting heavy objects, or degenerative changes in the disc that has resulted in a bulge. Daily activities often feel limited during extension or loaded side-bend toward the involved side, especially when annular tears, facet hypertrophy, or ligamentum flavum hypertrophy reduce available space.

Video: L3–L4 Disc Protrusion (60s)

In this YouTube Short, we show how a focal protrusion narrows cause nerve impingement a source for back issues resulting from nerve compression.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545. • Genevay S, Atlas SJ. (2010). Best Practice & Research Clinical Rheumatology, 24(2), 253–265.

L3–L4 Disc Prolapse (First Stage of a Non-Contained Herniation)

An L3–L4 disc prolapse means disc material has moved beyond its normal boundary more than a simple bulge or a protrusion—often used for a pronounced protrusion or early extrusion. Disc prolapse is the first stage of a potential non-contained slipped disc, a progressive stage that occurs following a protrusion.

In spinal disc prolapse, the space for the nearby nerves can tighten, compressing the exiting nerve of L3 or the passing by nerve that exits at the l4-l5. Co-findings like annular tear, facet hypertrophy, ligamentum flavum hypertrophy, or facet joint inflammation can further reduce corridor room, especially during extension or loaded side-bend.

Video: L3–L4 Disc Prolapse (60s)

In this 20-second walkthrough Youtube Shorts, we show you what a disc prolapse is and how it may impact the nearby nerves.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545. • Brinjikji W, Luetmer PH, Comstock B, et al. (2015). AJNR, 36(4), 811–816.

DIsc Herniations at L3–L4

An L3–L4 disc herniation means there’s a focal tear in the disc wall (annulus) with inner material (nucleus) pushing outward. What it affects depends on direction and remaining space. Posterolateral herniations tend to narrow the lateral recess and can involve the traversing L4 nerve root. Far-lateral/foraminal herniations can narrow the foramen and involve the exiting L3 root. Size, shape, and position—not the label alone—decide how it feels in daily tasks like standing tall, arching back, or climbing stairs.

Video: L3–L4 Disc Herniation

This 40-second clip shows what a herniation may look like. It also informs you of what happens and why it is a progressive disc disorder and what you can do.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Lumbar disc nomenclature: version 2.0. Spine Journal, 14(11), 2525–2545. • Macki M, Hernandez-Enriquez M, Bydon M, et al. (2014). Spontaneous regression of lumbar disc herniation: meta-analysis. World Neurosurgery, 82(6), 1357–1366.

L3–L4 Disc Extrusion (Non-Contained Herniation)

An L3–L4 disc extrusion extends beyond the disc space where the center of the disc is forced outwards extending into the nearby areas reserved for the spinal nerves and the spinal canal. An extruded disc is the progression of a disc herniation or other stages discussed earlier. Compared to protrusions, prolapses, and bulges an, extrusions have a higher likelihood of nerve impingement and canal stensosis, depending on size and direction.

Posterolateral extrusions reduce lateral recess (side opening for the nerves) and it also reduces the space allowed for the traversing L4 nerve roots; foraminal/far-lateral extrusions can crowd the exiting L3 path. Risk increases when annular tears, facet hypertrophy, or ligamentum flavum hypertrophy coexist.

Video: L3–L4 Disc Extrusion

In this Short, we help your understanding of what happens in an extruded disc and when it occurs as well as what you can do.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545. • Ishimoto Y, Yoshimura N, Muraki S, et al. (2013). Osteoarthritis & Cartilage, 21(6), 783–788.

L3–L4 Fragmented Disc (Fragmentation)

An L3–L4 fragmented disc means portions of disc material have broken into pieces near the canal. Fragments may remain adjacent to the parent disc or move short distances. Corridor space can become more sensitive when facet hypertrophy, capsular inflammation, or ligamentum flavum hypertrophy are present. Direction and size determine whether the traversing L4 or exiting L3 pathway feels tighter during extension or loaded side-bend.

Video: L3–L4 Fragmented Disc

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545.

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L3–L4 Sequestered Disc (Free Fragment)

An L3–L4 sequestered disc is a fully detached fragment that may migrate within the canal or lateral recess. Posterolateral fragments more often relate to the traversing L4 corridor; far-lateral fragments can involve the exiting L3path. Coexisting facet/capsular inflammation or ligamentum flavum hypertrophy can compound space loss and motion sensitivity.

Evidence: Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545. • Genevay S, Atlas SJ. (2010). Best Practice & Research Clinical Rheumatology, 24(2), 253–265.

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Symptoms & Functional Changes Linked to L3–L4

A L3-l4 disc and joint presentations vary. Common descriptions include lower back discomfort or stiffness, anterior-thigh tingling, a sense of heaviness or early fatigue in the leg, and reduced knee reflex on testing. Quadriceps work—stairs, rising from a chair, or long uphill walks—may feel less steady. 

Some with and L3-L4 disc or joint issues may notice movement difficulties. Tilting back or extension may result in discomfort when standing or arching back. while it may feel easier in a slight forward bend. Always remember: the degree of MRI change does not always match how someone feels day to day.

Evidence: Ishimoto Y, Yoshimura N, Muraki S, et al. (2013). Stenosis prevalence & performance. Osteoarthritis Cartilage, 21(6), 783–788. • Bogduk N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum.

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Why L3–L4 Gets Overloaded: Common Causes

Prolonged sitting with a rounded posture shifts force to the disc and facets. Repetitive bending or lifting with the load away from the body multiplies segment stress. Deconditioned trunk endurance and tight hips increase lumbar shear. Past low-back episodes, high-load sports, and long commutes compound exposure. Over months or years, these factors accelerate disc dehydration, facet thickening, and ligament buckling—especially at mid-lumbar levels like L3–L4.

Evidence: Adams MA, Dolan P. (2012). J Anat, 221(6), 497–506. • McGill SM. (2016). Low Back Disorders (3rd ed.). Human Kinetics.

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If Left Unmanaged: Likely Progression Paths

Without targeted changes, stiffness increases, disc height continues to drop, and the lateral recess/foramen can narrow further. Adjacent levels may compensate, contributing to overload below at L4–L5. People often limit walking time or stand with a flexed posture to feel easier. Early attention to movement quality, segment motion, and endurance can interrupt this trend and keep daily activities practical.

Evidence: Brinjikji W, Luetmer PH, Comstock B, et al. (2015). AJNR, 36(4), 811–816. • Ishimoto Y, Yoshimura N, Muraki S, et al. (2013). Osteoarthritis Cartilage, 21(6), 783–788.

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What Not to Do (Keep It Safe & Practical)

• Avoid high-force twisting or long-lever manipulations.
• Avoid heavy lifting with a rounded back or sudden jerks.
• Avoid one-size-fits-all routines that ignore MRI and motion findings.
• Do not ignore progressive thigh weakness, night-time tingling, or reduced knee reflex—seek an assessment.

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What Helps Most at L3–L4 (Evidence-Aligned, Non-Invasive)

The aim is smoother motion, safer load-sharing & steady daily function—without twisting or high force.

• Gentle & focused mobilization to restore segment motion without force.
• Targeted spinal decompression parameters to encourage disc mechanics & hydration.
• Physiotherapy modalities such as high-intensity laser, therapeutic ultrasound & electrotherapy for tissue recovery.
• Segment-specific exercise: trunk endurance, hip strategy, posture resets & graded load.
• Ergonomics & movement cues for sitting, driving & lifting.

Evidence: Qaseem A, Wilt TJ, McLean RM, Forciea MA. (2017). Ann Intern Med, 166(7), 514–530. • Chou R, Deyo R, Friedly J, et al. (2016). Ann Intern Med, 165(7), 493–505. • McGill SM. (2016). Low Back Disorders (3rd ed.).

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Contact CSC Locations 

For information on types of care & services, or to discuss L3–L4 segment-specific options, please contact our main center in Bukit Damansara. Fell free to Call Us: +603 2093 1000 or SMS / WhatsApp: +60 17 269 1873. The team will guide you to the nearest CSC location & help schedule a session.

• Chiropractic Specialty Center – KL (Bukit Damansara) — main center for service information
• Chiropractic Specialty Center – Sri Petaling & Bukit Jalil
• Chiropractic Specialty Center – Bandar Sri Damansara 
• Shah Alam — Setia Alam & Kota Kemuning
• Bangi

Prefer a call-back or message? Tell us your location & a convenient time; our main center will route your query to the right team.

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Our Segment-Specific Care in Kuala Lumpur: Chiropractic + Physiotherapy + Rehab

At Chiropractic Specialty Center®, L3–L4 care begins with a detailed history and motion testing. We identify whether the priority is disc height, foramen space, facet stiffness, or endurance. Plans combine gentle & focused chiropractic mobilization, manual physiotherapy and myofascial work, device-assisted rehab (including decompression where indicated), and exercise therapy tailored to the segment. We avoid twisting or high-force methods.

Registered physiotherapists and our CSC chiropractors in KL will review progress together and adjust loading, positions, and exercises as tolerance improves. The goal is clear: smoother motion, steadier legs, and day-to-day tasks that feel manageable—achieved through non-invasive, segment-specific steps.

Evidence: Qaseem A, Wilt TJ, McLean RM, Forciea MA. (2017). Ann Intern Med, 166(7), 514–530. • Chou R, Deyo R, Friedly J, et al. (2016). Ann Intern Med, 165(7), 493–505. • Brinjikji W, Luetmer PH, Comstock B, et al. (2015). AJNR, 36(4), 811–816.

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Meet the Author: L3–L4 Spinal Joint & Disc Care in Kuala Lumpur

Written by Y. Zafer, (D.C.), this article on L3–L4 Spine: Joint, Disc & Nerve Care in Kuala Lumpur draws from decades of experience blending chiropractic with physiotherapy for safe and effective lumbar recovery. Scope of practice: Non-invasive spine & joint care; segment-specific lumbar protocols (L3–L4 focus); gentle chiropractic mobilization; physiotherapy co-management; calibrated spinal decompression; exercise therapy and ergonomics education.

Last Updated: L3–L4 Spine: Joint, Disc & Nerve Care in Kuala Lumpur

This page was last clinically reviewed by Yama Zafer, D.C. and last updated on August 13, 2025, to provide the most accurate, up-to-date information on L3–L4 care.

FAQ – L3–L4 Spinal Joint, Disc & Nerve Care

Conclusion

L3–L4 matters because it shares load and protects nerve paths that influence the thigh and knee. Direction and location of change (posterolateral vs far-lateral; foramen vs lateral recess) explain why some positions feel tight and others feel easier. Most L3–L4 findings can be managed with a non-invasive, gentle & focused plan that respects space for the exiting L3 and traversing L4 roots.

What to do next

• Use the do-vs-don’t list to match positions to comfort (short walks, posture resets, hip-hinge for lifts).
• Build capacity in small steps: graded exercise for trunk endurance and hips; desk and driving ergonomics.
• Seek a segment-specific review if you notice progressive thigh weakness, reduced knee reflex, or night-time tingling.
• If you want help planning next steps, contact our KL (Bukit Damansara) main center; we’ll map your MRI wording to a corridor-aware plan.

Evidence: Qaseem A, Wilt TJ, McLean RM, Forciea MA. (2017). Ann Intern Med, 166(7), 514–530. • Chou R, Deyo R, Friedly J, et al. (2016). Ann Intern Med, 165(7), 493–505. • Fardon DF, Williams AL, Dohring EJ, et al. (2014). Spine Journal, 14(11), 2525–2545.

Summary Table – L3–L4 Spine

Feature	Details
Segment	L3–L4 mid-lumbar; shares load and guides bending/extension.
Role	Passes upper-body load to L4–L5, sacrum, hips, and legs; adds controlled motion.
Nerve corridors	Exiting L3 via the foramen; traversing L4 in the lateral recess.
Typical MRI terms	Disc bulge/protrusion/prolapse/extrusion, annular tear, facet hypertrophy, ligamentum flavum hypertrophy, foraminal narrowing, low-grade spondylolisthesis, synovial/Tarlov cysts.
Direction → involvement	Posterolateral change → often the traversing L4 corridor; far-lateral/foraminal change → often the exiting L3 corridor.
Functional clues (non-diagnostic)	Lower-back stiffness after standing, front-thigh/knee tingling, early leg tiredness on hills or stairs; slight forward lean often feels easier.
Helpful positions & cues	Short walk bouts, posture resets, slight forward lean when needed, hip-hinge for lifts, keep loads close.
Non-invasive care (CSC)	Gentle & focused mobilization (no twisting), calibrated spinal decompression, physiotherapy modalities, segment-specific exercise (trunk/hip endurance), ergonomics coaching.
Avoid	High-force twisting/long-lever methods, rounded heavy lifts, one-size-fits-all routines, ignoring progressive weakness/tingling.
When to get assessed	Ongoing thigh heaviness/tingling, reduced knee reflex, or changes in quadriceps steadiness.
Contact	Main center: KL (Bukit Damansara) for service info and routing. Also: Sri Petaling & Bukit Jalil; Bandar Sri Damansara; Shah Alam (Setia Alam & Kota Kemuning); Bangi for and L3–L4 back issue.

References – L3–L4 Spine & Non-Invasive Care (Alphabetized)

• Adams MA, Dolan P. (2012). Intervertebral disc degeneration: evidence for two distinct phenotypes. Journal of Anatomy, 221(6), 497–506.
• Bogduk N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum (4th ed.). Elsevier Churchill Livingstone.
• Brinjikji W, Luetmer PH, Comstock B, et al. (2015). Imaging features of spinal degeneration in asymptomatic populations: systematic review. AJNR American Journal of Neuroradiology, 36(4), 811–816.
• Chou R, Deyo R, Friedly J, et al. (2016). Noninvasive treatments for low back conditions: a systematic review. Annals of Internal Medicine, 165(7), 493–505.
• Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Rothman SLG, Sze GK. (2014). Lumbar disc nomenclature: version 2.0. Spine Journal, 14(11), 2525–2545.
• Fujiwara A, Tamai K, An HS, et al. (1999). Relationship between disc degeneration and facet joint osteoarthritis of the lumbar spine. Spine, 24(14), 1476–1480.
• Genevay S, Atlas SJ. (2010). Lumbar spinal stenosis. Best Practice & Research Clinical Rheumatology, 24(2), 253–265.
• Ishimoto Y, Yoshimura N, Muraki S, et al. (2013). Prevalence of symptomatic lumbar spinal stenosis and association with physical performance: a population-based cohort. Osteoarthritis and Cartilage, 21(6), 783–788.
• Jenis LG, An HS. (2000). Lumbar foraminal stenosis. Spine, 25(3), 389–394.
• Kalichman L, Hunter DJ. (2008). Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal, 17(3), 327–335.
• Khan AM, Girardi FP. (2005). Spinal lumbar synovial cysts: diagnosis and management. Spine, 30(12), 144–149.
• Komori H, Shinomiya K, Nakai O, et al. (1996). The natural history of lumbar disc herniation with radiculopathy. Spine, 21(2), 225–229.
• Lucantoni C, Than KD, Wang AC, et al. (2011). Tarlov cysts: pathophysiology, clinical features, and outcomes (review). Neurosurgical Focus, 31(6), E14.
• Macki M, Hernandez-Enriquez M, Bydon M, et al. (2014). Spontaneous regression of lumbar disc herniation: a meta-analysis. World Neurosurgery, 82(6), 1357–1366.
• McGill SM. (2016). Low Back Disorders (3rd ed.). Human Kinetics.
• Qaseem A, Wilt TJ, McLean RM, Forciea MA. (2017). Noninvasive treatments for acute, subacute, and chronic low back conditions: ACP guideline. Annals of Internal Medicine, 166(7), 514–530.
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