Can a herniated / prolapsed disc heal itself?

Yes, a herniated / prolapsed disc can heal itself.  There, I’ve said it.  Now, let me explain.  First I’ll answer the questions “What is the difference between a herniated disc and a prolapsed disc? And the difference between a slipped disc and a bulging disc?”  Then I’ll explain how a herniated / prolpased disc can heal itself.  And how you can optimise that process.

Herniated, Prolpased, Bulged, Slipped Discs

Medical professionals can’t even agree on these terms.  What hope do you have?!  Here’s what I was taught when training to be an osteopath (30+ years ago).  Note that there’s no more agreement now than there was then.

Slipped Disc

This is a term we were encouraged to avoid.  It is used by non-medical people to describe when a disc goes wrong. However, it is very misleading. Because it gives the impression that the whole disc can slip out (and back into) place.  It can’t.  It doesn’t.  Wipe that idea from your mind.  Because it is very unhelpful.  And as you’ll see, the anatomy of the disc will not allow that.  So, slipped disc is a meaningless, and misleading term.

Bulged Disc

We’re getting closer to reality.  I was always taught that “bulged disc” was the layman’s term for a herniated disc.

Herniated Disc

Your intervertebral discs – to give them their full name – are largely fibrous (the blue bit in the image).   In a young, healthy disc the periphery of the disc is called the Annulus Fibrosus.  In that same young disc, the central portion is gelatinous (the yellow bit).  It’s called the Nucleus Pulposus.  But I’ll refer to it as the jelly part from here on.  As the disc ages, the jelly part oozes through the fibrous parts of the disc.  And you get tears in the fibrous perimeter.  If enough of the peripheral fibres tear, the pressure from the jelly can cause the outer perimeter of the disc to bulge. And that’s a bulged disc.  But I call it a herniated disc. Your disc bulges outwards, but your jelly hasn’t escaped yet.

Despite what the image shows, about 80% of the disc is the Annulus Fibrosus.  There isn’t a lot of the jelly stuff, and it gets less as you get older.

Prolapsed Disc

You guessed it.  When enough of the fibers tear, some of the jelly comes out.  That’s a prolapsed disc.  The jelly can escape up, down, backwards, forwards or to the side.  It depends where the tear is.  The most common tears are in the back corners.  Unfortunately.  Because that’s where your spinal nerves exit the spinal column.  And that can lead to nerve irritation and compression.

When your disc prolapses up or down it can push into the boney end plates.  That’s the bits of the vertebra that are next to the disc.  If they push out to the sides or front, they may not contact anything terribly crucial.  But when they push backwards, and especially into the back corners, they are much more likely to cause irritation.  Because, that’s where your spinal nerves are.  The above image shows that discs generally get thinner as we age.  And there can be related splaying out of the bones above and below.  That’s called spondylosis. But, please don’t worry about that.  That’s just like getting grey hair.  It’s a normal process of ageing.

How can a herniated / prolapsed disc heal itself?

Stage 1 of healing – Inflammation

Unfortunately, a herniated / prolapsed disc heals slowly.  But it does happen. The disc has no direct blood supply. There are no blood vessels that penetrate the disc.  So it’s nutrient supply, and drainage of waste products, is very slow.  Interestingly, that’s also why it is slow to become inflamed.  And why most people find the pain of a damaged disc takes a day or two to peak.

You might think inflammation is a bad thing.  It isn’t in the short term.  It’s essential.  Inflammation is the first stage of healing.  It becomes a problem when the inflammation lasts more than a few days.  In some people the inflammation can go on for weeks or months. This is termed chronic inflammation.  That’s a bad thing.

Inflammation brings vital nutrients into your injured disc.  Without this stage, you simply won’t start the healing process.  It takes quite a long time for your immune system to remove the piece of prolapsed disc. Inflammation mobilises your immune system.  Your immune system includes cells called macrophages.  They literally eat the prolapsed disc material.  The other mechanisms leading to the herniation reducing over time are dehyrdration and retraction.

Dehydration is exactly what it sounds like.  Retraction is only possible when the jelly has not escaped the annulus entirely.  So, it only works where the outer fibres of the annulus remain intact – the difference between herniation (in this case) and prolapse.  The jelly can retract back to the central portion of the disc.  In some people.  There are things you can do to assist this process.

In this study, involving large disc herniations/prolapses, 8 out of 10 people had a “sustained and complete recovery” without any surgery.

Stage 2 of healing – scar tissue formation

All tissues (except nerves) can regenerate themselves.  If you cut your skin, it grows back.  If you break a bone it heals.  Why wouldn’t discs be the same?  They are.  Herniated and prolapsed discs can heal themselves. I have guided hundreds of people through this process.

It’s worth repeating this… Your disc has no direct blood supply.  And so the repair process is slow.  Much slower than you would like. And you can re-tear it while it’s healing.  Think about a cut on your knee.  In the first few days you know not to stretch that scab don’t you?  Because if you do, it’ll tear.  And the cut will bleed again.  And you have to start forming a scab all over again.  Why do we put broken bones into a cast?  To allow time for the union of bone to strengthen.  One of the phrases I most often repeat to disc patients is, “Stop picking the scab”.  If you stretch the scar tissue before it’s strong, you’ll damage it.  Then inflammation kicks in again.  And you’re back to stage one.  Inflammation starts all over again. And that’s painful, demoralising and depressing.

Can a herniated / prolapsed disc heal itself? Further complications

Nerve supply of normal and degenerate discs

The young, healthy disc only has sensory nerves in the outer 3mm.  Which is probably why a lot of people don’t experience any significant pain when they damage the disc.  Most of the damage is not on the surface.  So, if you tear the inner portion of the annulus, you may not feel anything at the time.  It’s also why you may not know when you’re stretching the scar tissue.  But, you MUST avoid stretching that scar tissue.

As your discs wear, developing degenerative changes, the sensory nerves grow deeper into the disc. This may be why some people have more low back pain as they age.  Bummer.  But, there’s always hope.  Remember, even large disc prolapses can heal themselves.

Action steps:

  • Find out where the tear in your disc is.  Most people have their tear in the back corner of the disc.  So, don’t stretch that bit i.e. STOP PICKING THE SCAB.  Allow time for it to heal.
  • Use medication to reduce the pain in order that you can sleep.  Don’t use it to do things that would otherwise be painful to do.
  • Stay mobile (but don’t pick the scab remember).

If you want more tailored help in rehabilitating a herniated/ prolapsed disc, I can help right now.  Sign up to our free Best Back Pain / Sciatica Online Course now.

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