What Happens To Herniated Discs?

Being told that you have a herniated, ruptured, or bulging disc can sound very bad. In fact, when we look at the picture of an MRI, it does look bad at times. In this article, I want to talk a bit about what happens to these bad looking things that are seen on MRIs over time. Are we really doomed with one of these diagnosis?..........

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If you have had back pain, or back pain with leg pain,  you have likely at some point had an MRI on your back.  The MRI is a great machine because it can show a lot of things in great detail. It is also a bad thing because it can show things in great detail! By this I mean that many of the things seen on an MRI of the spine are just normal parts of aging and are likely not the cause of your pain. I have written about this previously here:
www.promotiongb.com/blog/low-back-imaging-how-useful-is-it.

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Basically, what we have to realize with MRIs is that the older we are, the more likely the MRI is going to find "something." The graph to the right shows this. The important thing to remember is that all of these things were seen in people without pain! So, it appears that, much like the greying of our hair or the wrinkles on our skin as we get older, our spine changes as well. And, just like we don't expect our head to hurt because our hair is turning grey, or our face to hurt because we are getting wrinkles, we shouldn't expect our back to hurt just because it is showing some normal, age-related changes!

Now, there are definitely some times when what is seen on MRI does correlate with the symptoms a person may be experiencing. In someone who is experiencing leg pain (with out without back pain) and has a disc herniation on MRI at the level or the spine that corresponds with where their pain is, the MRI finding is likely relevant. In these situations, the disc problem may be large enough to be irritating a nerve that goes down the leg. These situations can be very painful-I know, I have had this! 

The purpose of this article then is to discuss what happens to these disc herniations with time. In an article published in 2017, Zhong and colleagues, reviewed a bunch of studies that took before and after MRIs of disc herniations. What they found is that the percentage of these disc herniations that went away with time (resorbed) varied between 62%-83% depending on the study which was looked at. It seems that with these bigger disc problems, the body sees it as a problem, and will do something (send an inflammatory response) to help fix the problem! This is good news for anyone currently experiencing leg pain from a herniated disc. The authors conclude that conservative treatment (non-surgical) may be the first choice of treatment for lumbar disc herniation since many of these will get better with time. 

The picture above shows a disc herniation that resolved with conservative care. 

The key here is getting through the initial phase of the episode of pain, which can be very painful and limiting. Getting the right care early so the symptoms can be helped with some manual therapy, education about the problem, and some exercise to help diminish the pain in the leg is important. If a person can get past this initial phase, it is likely the body will take care of the herniation with time. 

The other thing I want to point out is that the studies are showing that the bigger the problem (herniation, rupture, sequestration), the more likely the body will heal the problem. For simple disc bulges, the body does not see these as a problem and likely just leaves them alone. Again, look at the high incidence of disc bulges in pain-free people from the graph I posted above. Given how common these are in pain-free people, a disc bulge is likely not anything to be concerned about!

In summary then, there is no doubt that a disc herniation can at times cause a lot of pain in the leg and cause you to be quite limited in your function. But, if you are patient, get the right conservative treatment, try to stay active, and give it some time, many of these can get better without having to take the drastic step of a surgery. 

Please reach out if you have questions about what the right treatment is and to see if your problem is something that I can help with.

Thanks for reading,

​Bob