Why you may not need to worry about disc herniations in my opinion …..

Working as a musculoskeletal physiotherapist I often see people walk into the clinic room with large envelopes in their hands housing their “latest” MRI or CT scans. I am always eager to look at these, I mean I am not ashamed to admit that I love anatomy and seeing the images is a tad exciting.

An interesting thing I’ve noticed though is that I often get shown imaging of previous disc injuries in the spine that can be up to 4 years old. I often wonder if people bring them in because they think they are still walking around with the same old disc pathology they once had 4 years ago.

When you think about it, it makes sense… I mean have you noticed that when a friend, colleague or family member has a back injury they often say “I’ve done my back in” and use terms like “I’ve got a slipped disc” or “I have a bulging disc”. These terms sound quite sinister in nature and if a disc has “slipped” or “bulged” out it seems impossible to think it can slip back in.

So what is a disc herniation? I often think of the discs in the spine like Chinese steam buns, firmer on the outside with a soft filing on the inside. In reality the filling on the inside is like the consistency of tooth paste. When there has been a disc herniation there is a displacement to the disc material which then at times causes changes to the nerve root or spinal canal (kjaer, 2016).

Kjaer (2016) studied 140 herniated discs over an 8 year period and found that herniated discs spontaneously resolve without treatment. As well as this they found that most of them were stable in nature and would not get any worse or better. If you are wondering how they just resolve on their own well keep wondering because there are some theories but no-one knows for certain.

As well as this a Meta-analysis by Zhong et al (2017) found that overall there is a high incidence of disk reabsorption to 66% of the patients who received conservative treatments which consisted of anything that was not surgery or injections.

Resolution of Lumbar Disk Herniation without Surgery
Hong, J.and Ball, P DOI: 10.1056/NEJMicm1511194

Now I don’t want to create a sense of triviality to disc injuries because they sure can be painful and alter your normal routine for a few weeks… but next time a friend, family, colleague or even yourself suffers from a disc injury perhaps you can remember this article and the recent statics that show a large amount of herniated discs spontaneously resolve and that your body is a self healing mechanism. I mean it is constantly trying to find it’s homeostasis, give it the right environment conducive to healing and you will be surprised how well it heals injuries.

References

  1. Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, Xue RR. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017;20(1):E45–E52. PubMed #28072796.
  2. Kjaer P, Tunset A, Boyle E, Jensen TS. Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population: a longitudinal MRI study using quantitative measures. BMC Musculoskelet Disord. 2016 Jan 15;17(1):26. PubMed #26767364

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