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Can slipped discs heal by themselves?

Orthopaedic Surgery Sport Medicine

My dad has a slipped disc. I've heard conflicting advice from friends on whether he needs to get treatment or not. Is it possible for slipped discs to completely "heal" by themselves, or is treatment required? Thank you!

DOCTOR’S ANSWER (2)

It is very common to be told we have a "slipped" disc whenever an MRI scan is done for our back or neck pain.

However its a "misnomer" layman's term as only a minority (less than 10%) of discs actually ruptured or "slipped out".

This can cause dire consequences of compressing the adjacent spinal nerves or spinal cord, which usually necessitates open spinal surgery (not injections or disc-plasty "laser") to remove the offending EXTRUSION disc fragment.

This helps to decompress and "free" the nerve or cord (like removing a "burst" car tyre in a car workshop).

However, the majority of "slipped" discs in us (>90%) are actually degenerated disc PROTRUSION (like an old bulging worn-out car tyre).

This is because as we age, our cushioning spinal discs wear out naturally - see pictures below:

These natural aging processes do not reverse, heal or "cure" back to "normal" (like my white hair and creaking knees).

As such, the disc protrusions will remain forever in your MRI images even after the pain has recovered.

So unless the disc has unfortunately ruptured causing nerve pain in the arms/legs, all treatment is for the back/neck pain from wear/tear/overuse/injury of these already pre-existing but "painless" degenerated disc protrusions now suffering from inflammation resulting in pain.

In short, pain from an inflammed/injured discs must be treated not only to prevent worsening of your dad's pain, but more importantly to reduce the build up of the disc inflammation "pressure" leading ultimately to disc rupture, necessitating surgery.

Hence majority of this "discogenic" pain will slowly gradually recover with:

  • anti-inflammatory medications (including steroid nerve injections) together with
  • regular physical therapy (physio, tcm, chiro, osteo, etc) to reduce the intradiscal pressure ("stretching out the tight disc") and
  • strengthening the protective spinal core muscles (e.g. swimming, planking, yoga, pilates, etc)

However no more pain does not mean "cure", as recovered patients subjecting their discs again to repeated wear/tear/overuse/injury will very soon find out.

Another repeat MRI will confirm their degenerated disc STILL permanently there (hopefully the disc protrusion not becoming bigger) and if they don't wise up and practise good back/neck care and hygiene, they will eventually encounter worsening recurring relapsing back/neck pain attacks finally ending up with surgery.

Hence the common but important advice "prevention is better than cure".

0 172 views 10 Jan 2019
Contact Doctor

Thanks for your question.  Dr Fong has given you an excellent answer so I won’t repeat what he has said, but I would certainly advocate assessment and treatment for back pain symptoms.  Having had personal experience of it, I know that it can be frustrating and limit your activity. 

While there might be a degenerative element to things, often symptoms settle with physiotherapy, activity and lifestyle modification and other treatments such as acupuncture or cupping.  Although degenerative changes might not self resolve, symptoms do tend to improve and invasive treatments are often not required.
 
I would suggest that your dad sees a MSK/Sports Physician it physiotherapist in the first instance for an assessment.  This will include a clinical history and examination and appropriate investigations.
 
Hope things get better for your dad.
Bw
Dr Dinesh 
0 92 views 13 Jan 2019
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