What is a disc herniation?
A disc herniation is when the nucleus pulposus, the middle gelatinous material within a spinal disc, migrates (typically) posteriorly towards the cord or nerve roots. If compression of a nerve occurs, sciatica is a common presentation with a potential symptom distribution of pain, numbness, tingling, or weakness along the pathway of that nerve.
How Does a Ruptured Disc Heal?
Various studies have, interestingly, shown that the larger the disc bulge, the higher the likelihood of spontaneous regression...meaning the body will reduce the herniation over time, ridding the person of the any longstanding issues. Several theories have been proposed, with the most commonly believed reason for this being: "disc herniation into the epidural space causes an inflammatory reaction and neovascularization, resulting in gradual resorption of the cartilaginous tissue through enzymatic degradation and phagocytosis"¹
This of it this way. The spinal canal is like an Operating Room. It needs absolute sterility. The fluid that runs within our spinal canal also bathes our brain, therefore it needs to be completely clean. So while a disc sequestration ( a piece that breaks off into the canal) is technically still not a foreign invader like a bacteria or virus, it is still perceived as a massive threat to the immune system, just as an unwashed surgeon is to an OR.
DISC SEQUESTRATION ILLUSTRATION
What are the Chances of my Disc Herniation Healing Soon?
A fantastic 2015 study found that "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. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs."²
In Layman's terms: the larger or extruded torn discs will recover at a higher percentage than small or less severe bulges on their own, without any interventions at all. The good news, as long as you aren't one of the ~10% of people that may need surgery for more serious disc herniations, is that if you have a large herniation or torn leaking disc it will most likely heal with time, despite the horrible symptoms you may currently be experiencing. The down side is you may lose some disc material in the long run, which decreases the space between the spine bones, possibly leading to some earlier disc degeneration...which to a point, is normal but if in excess can lead to complications later on.
The good and bad with the more typical average or small disc bulges is that although they can still cause pain and sciatic like symptoms they are rarely emergencies or serious. The down side is they have a much lower chance of just "going away". They tend to linger and be annoying. Some people will eventually opt for surgery just to get rid of the minor symptoms that seem to never expire.
What Can You Do to Increase Your Chances of Resolving a Disc Herniation and Sciatica?
Anecdotally, from 10 years of clinical experience there are two main ways to help resolve your disc pain:
1) Stop Irritating the Disc! If sitting gives you sciatica, you need to sit less. If sneezing shoots pain into your foot, you need to find a pain free way to sneeze (hint: look up 45 degrees).
2) Rebuild Your Low-Back! All tissues of the body respond to stress and load. If you can safely and effectively load your low-back over time, you may help speed up the health of the tissues around and within your spine. Recently, studies have shown that even the spinal disc can change with load and pressures in a positive manner. Previously this was unconfirmed and many experts doubted its ability to recover/change.
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