Disc herniation is well-known and well-blamed by most of the patients with low back pain +/- lower limb symptoms. But how much do you know about disc herniation? It is really the cause of your symptoms? Can a disc heal without surgery?
Disc herniation can be broadly classified into 4 stages as shown in the above figure. You may think that the more it protrudes or bulges out, the more severe the symptoms will be. In fact, it is not true. Let's look at the research findings below showing a systematic review of 3310 subjects without any symptoms but having different stages of disc herniation.
You can see from the above figure, that the prevalence of disc bulge/protrusion will increase with age. And this is the reason why we do not associate imaging finding with patient's symptoms. Everybody ages and everybody will eventually have some kind of disc bulge without symptoms. Therefore, why should we bother the imaging finding?
One more thing you should know is that disc herniation can be reabsorbed naturally by our body. The reabsorption rate from disc bulging to sequestration is 13.33%, 37.53%, 66.91%, and 87.77% respectively. In other words, the more severe the disc herniation is, the higher the reabsorption rate will be. For the 3 main proposed theories for natural disc reabsorption which are Mechanical traction, Dehydration, and Inflammation and neovascularization theory. (These theories will not be elaborated here)
However, with all I have said, disc herniation can be a source of symptoms if it matches your clinical presentation. Let me give you two examples. The first case is severe acute back pain with referred pain to the lower leg but not following a nerve dermatome pattern. This case turns out to be an acute disc annulus fibrosus tear (the ring surrounding the gel-like substance of the disc) and refers somatic pain in the lower limb.
Another case is disc sequestration which impinges the nerve root of the lumbar spine resulting in a radiculopathy clinical presentation, change in sensation, and muscle weakness of that nerve.
To conclude, please be reassured that your imaging findings of disc abnormalities may not correlate to your symptoms, and what you should focus on is improving symptoms and function.
If you are dealing with disc problems, reach out to Zion Physiotherapy Clinic to have a consultation and we will come up with a rehabilitation plan for you.