Before we all go rushing to the operation theatre for our injured discs let’s look at some interesting research on disc healing. In 2010 Chiu et al carried out a systematic review, which basically means he looked for all research on the topic and compiled the results. His study demonstrated some very positive results for anyone that has a disc injury. Look at this.
Sequestration, extrusion, protrusion, and bulge are the terms used when discussing the severity of disc injury. Sequestration is the most significant, with bulge the least. These results show spontaneous regression (the disc healing itself) was 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. This demonstrates how amazing our body is at healing itself. For the worse type of disc injury 96% of the time it will be able to heal itself. This healing is demonstrated on repeat MRI scans.
The exact mechanism behind the process is unclear, however, Chui reports a likely mechanism. He theorizes that the disc herniation into the epidural space causes an inflammatory reaction and neovascularization, resulting in absorption of herniated disc by phagocytosis and enzymatic degradation. These are big words which basically mean that the body removes the debris and reabsorbs the collagen. This would make sense as the larger the disc injury the more likely it is to cause an inflammatory response in the surrounding tissue, increasing the removal of debris resulting in regression of the disc material.
This proves a very important point, that not a lot of people will be aware of. Our discs can heal themselves! It means that a disc injury does not mean a life sentence to back pain, or that because you injured a disc you must stop the sports you love, or that you constantly need to be worrying about your back.
The thing is, this is not a sudden revelation that we are just finding out about. It has been reported in scientific research for the past 20-30 years. The important thing is that this is not a standalone study, it has significant scientific backing.
So now that we know that discs can heal, we can start looking at our back injury through a different lens and start to get things back on track.
Types of Disc Injuries
Disc injuries can be classified related to the level of disruption to the annulus fibrosus, (the thick outer layer of the disc), and whether there is involvement of the nucleus pulposus (the inner gel like matrix of the disc). But we must remember that the type of disc injury does not directly correlate with the level of pain or dysfunction that is experienced.
Although we don’t know exactly how the disc heals its self (we discussed a likely mechanism/idea), we do know that they can often heal without the need for surgery. We also know that the bigger the disc herniation the more likely your body is to heal itself. This is worth repeating, the worse the disc injury the better your body is at healing it.
This is our take home message, if you have had a significant disc injury in the past it does not mean you are stuck with it for life. This should help to reframe the way we think about our old disc injuries.
If you missed last weeks blog you can check it out here. Keep an eye out for next week where Rich discusses why a slipped disc might not be the cause of your pain.
(1) Stemper, B. D., Board, D., Yoganandan, N., & Wolfla, C. E. (2010). Biomechanical properties of human thoracic spine disc segments. Journal of Craniovertebral Junction and Spine, 1(1), 18–22. http://doi.org/10.4103/0974-8237.65477
(2) Chiu, Chun-Chieh & Chuang, Tai-Yuan & Chang, Kwang-Hwa & Wu, Chien-Hua & Lin, Po-Wei & Hsu, Wen-Yen. (2014). The probability of spontaneous regression of lumbar herniated disc: A systematic review. Clinical rehabilitation. 29. 10.1177/0269215514540919.
Richard Linley is a senior Sports Lab Physiotherapist. He has extensive knowledge in major trauma, and both acute and chronic care. Rumour has it, Rich delegates his Fat Friday responsibilities to his wife.