Have you recently been diagnosed with a disc bulge or herniation? Like most patients after the first visit you've probably already seen it described on your X-ray or MRI, been offered pain pills, steroid injections, and maybe even surgery. This is an overwhelming experience for any patient to feel that their anatomy is now "broken." It can be hard to navigate the next steps appropriately unless you have a unbiased understanding of what's actually going on in your body.
To begin, a review of your imaging should always come with a caution provided by your physician that "many people have this condition and have zero pain or dysfunction."
Consider this STUDY by Brinjikji and colleagues in 2014. Out of over 3,000 asymptomatic people, greater than 50% of individuals 30–39 years of age had disk degeneration, disc height loss, or disc bulges. The authors concluded that even in young adults, degenerative changes may be incidental and not related to presenting symptoms.
This can make you begin to wonder if the problem on the imaging is actually the root cause of your pain symptoms...which is where some of our key questions to ask your provider begin...
Another topic that it isn't discussed much by providers is that there is strong evidence that discs can regress or resorb (heal) on their own. The exact mechanism isn't known and probably differs based on the severity of the bulge or herniation, but some theories represented in the literature include:
-The disc retracts back into the intervertebral disc space, aided by movement of the surrounding vertebrae, muscles, and ligaments, as well as intra abdominal pressures.
-The disc segment that is herniated may gradually dehydrate and shrink, allowing easier retraction (movement back towards midline) or degradation (breakdown).
-The disc segment may degrade due to specific enzymes released from an inflammatory reaction triggered by presence of unfamiliar “debris” outside of the annulus
-The disc may undergo some “neovascularization” (process of growing new blood supply)
Confused yet? Don’t worry about all the specifics - we only included this section to show just how much your body is doing to help you heal! One interesting note is that gradually returning to movement and activities can potentially aid all of these mechanisms no matter which may be working the hardest.
Also, though it can be overwhelming to hear from your provider that you have a “large” disc bulge or the “worst kind” of disc herniation, extrusion, or sequestration, the worse it is, the more likely it is to heal very well on it’s own. This is likely due to the significant increase in blood flow and cascade of chemicals available to the disc to help it recover.
Consider this STUDY by Chiu and colleagues in 2015. The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. In simpler terms, the worse the problem with the disc, the more likely it would completely resolve. The authors concluded that spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment.
You can find dozens more studies, the specific questions to ask your provider to avoid unnecessary procedures, and much more in our eBook "Clinical Precautions For Low Back Pain Patients."