Herniated Disc - how does it heal?

Factual Questions
1

I injured my back last week and after a day of pain which wasn’t getting much better went to the hospital. ER doc says herniated disc and prescribes anti-inflammatories and painkillers. So far so good. The part I don’t get is when she says take it easy, let the anti-inflammatories do their thing and it will heal on its own. This confuses me since the disc had to have herniated for a reason - weakness on one side, pressure imbalance? I’m not sure about all that but wouldn’t it require pressure to be moved back where it belongs or am I thinking about this all wrong?

I don’t see my family doctor for another week and would like to be a bit informed about the issue before I go in but I can’t get my head around that part. I’m assuming physiotherapy would be required but it wasn’t suggested the last time I injured my back - back spasms, same location. I don’t want to go through this a third time.

I guess a simpler version of what I’m asking is how does the anti-infammatory medication help the disc? Will it just shrink the swelling away from the nerves or help the disc itself get back in the correct position?

2

The disk and the area become inflamed. This hurts. Inflammation is painful…and nerves transmit pain signals, so nerves are always involved. On top of that discomfort, there could be a specific nerve, like the sciatica, getting aggravated by the disk/inflammation and taking the pain up a notch.

Anti-inflammatories will control inflammation and block some pain signals from the nerve. You really want the nerve to settle down. The drugs will help do this, and take away inflammation that is aggravating it, too.

Like tendinitis, just the inflammation aggravating the nerves which send signals and is translated as “pain!” by the brain.

3

That all makes sense, thank you. I’m guessing that even when the injury heals though, that the underlying cause has still not been addressed in most cases. Or can a disc just ‘pop out’ in a normal back and then be fine once the inflammation and everything is back to normal? I realize there’s likely a lot of variation and my specific case will have to be addressed with my doctor. I just want to get an idea of what the usual situation would be.

4

>Will it just shrink the swelling away from the nerves

You were on to something right at the start, at least from what I hear. Your nerve may be in a cyclic situation where it swells because it is injured because the disk is pressing on it, and takes up more room, which makes the disk pressing on it more of a problem. One hope is that the antiinflamatories will reduce the nerve swelling to the point that the disk isn’t pressing on it any more. This may be realistic, because the disk herniation probably will shrink over time. It isn’t a sure thing, though. In any case the antiinflamatories will probably help reduce pain and long term nerve damage, at least somewhat.

The disk can heal in several ways. Disks are slow growing and don’t even have a blood supply, relying instead on the gradual movement of fluid into and out of them. Most of this movement happens as you lie down and reduce loading on them at night, when they swell, and stand or sit with load on them during the day, when they shrink again. In fact, when they are most swollen, during the first hour you are up, they are especially prone to herniation, because their soft middle pulp is the most hydrated and ready to leak.

Maybe they can pop back into place. Better to say, the bulges can be reduced, and perhaps pulp that has squeezed out of the inner layers of containment but not the outermost ones may get squeezed back to the center. There’s some physical therapist who made a mistake and had a disk patient lying on his belly on a table whose ends were elevated, which at the time was considered a no-no, but the patient felt better afterwards, and this has become a favored method amongst therapists, now named for the original mistake maker (Robin something). They think bending the spine this way may get the bulge to go back.

Good luck with it all, and if you have any other questions I’m happy to try to answer - I’m not a doctor or medical person, but went through several disk and spine problems and read up a great deal and remain interested.

5

Great info. Answers a few other things I was planning to ask my doctor about. Namely that the pain is worse in the morning usually and tends to get better as I walk around. Before this happened I had switched to working out in the morning after years of doing it in the afternoon.

6

I’m not a doctor, but I did have a herniated disc. I feel for you (literally, since I’mstill affected by it 3 years later). From what I understand an actual herniated disc has some disc material that has separated from the disc. The only way to heal that is to remove it, or hope it shrinks with time. Between the time of my injury and my surgery to remove the disc material, it had shrunk considerably but it still pressed against my nerve and I would occasionally have strange sensations in my leg, or outright pain.

The surgery was a great help to me, but I continue to have issues with my left leg due to the nerve damage. My back also still gets soar from time to time, as well. But everyone is different, and all injuries are different. Trust your doctor for now, but if you aren’t getting the help you need, go see a neurosurgeon.

Also, I’ll put a plug in for traction. Oh, mama! I could feel all the stuff in my back pop back into place, and it felt soooooo good. I was in there for 30 minutes or so, and I’d fall asleep every time despite the pressure and not so perfect laying position.

7

Did you lift or pull something the wrong way? The soft disks between the vertebrae are each composed of a slightly harder outer shell with a jelly-like center. When you strain your back, the little ligaments holding the sides of the disk into place may tear on one side, and the jelly like center releases a little of itself through the tear in the shell of the disk. When that happens, the nerve that runs nearby sometimes gets irritated, because this jelly-like center is a little bit corrosive. When I looked at my own mri, it wasn’t a bulging disk that impressed me, but rather this material that got “squished” out. The doctor explained to me that eventually the body may resorb that jelly like material and the ligaments will probably heal up. The disk does not “slip out” of place, it just extrudes material. Meanwhile, the nerve irritation and swelling makes it harder for the area to heal. So anti-inflammatories are very important to help reduce the irritation.

Believe it or not, there are many people out there with such herniations that have no pain or symptoms. It’s such a highly individual thing.

I had 9 months of unmitigated pain with my herniated disk. The pain was worse when I was lying down and I think I took about 24 advil tablets just to get me through the night. I couldn’t sit in a chair at all. I would sleep for 2-3 hours and then the pain would wake me up when the advil wore off, and I had to take more pills. I had sciatica and even numbness in my foot. I got all this from lifting a shovel the wrong way.

The orthopedic surgeon I saw assured me I was better off taking the conservative route and that the pain would get better eventually. I think surgery ends up putting people in a worse condition more often than not. Nowadays, it seems doctors are acknowledging that the herniation may heal on its own.

I tried everything: physical therapy, accupuncture, pain medication. The only constant was anti-inflammatory medication. The thing which finally fixed my problem for good was a procedure where a steroid epidural was injected into my spine near the inflamed nerve. Epidural administration - Wikipedia I went through that three times. Blessedly, it worked like a charm and I healed over a couple of months. (I envy the osteopathic doctor specialist that did the procedure. She works only one morning a week, and charges $900-$1000 per procedure for her personal fee. The whole thing takes 30 minutes. She works 5 hours, and books one patient after the other. You do the math. This is all she does!)

The oddest thing is, I’d had on and off back pain for years from a previous herniated disk injury in the same spot. It was the type of back pain where some mornings you wake up with your “back out” and you feel like something is crooked or twisted out of joint. It felt like I had hit my “funny bone” except that it was in my lower back. After I did a number on my back a second time, and healed from that, I never had those chronic “my back’s out today” issues again.

I hope some of this info. helps.

8

FWIW some more info:

The reason the herniation hurts a nerve is that the nerve passes through a narrow bony opening called the foramen, formed by the butterfly-shaped bone sections to the rear of the disk. Your spine is a stack of cylinders (the heavy part of the vertibrae) with disks between them, plus these butterfly extensions. The extensions interfere with one another to limit twisting and bending backwards and to anchor many of the tendons and ligaments that create your back’s stability. The spots where the butterflies rub against their upper and lower neighbor are called the “facet joints”. If you look vertically through this bony assembly you see a canal bounded by the cylinders and disks in front, the butterflies in back, and the posts that bridge between cylinders and butterflies on either side. Your spinal cord runs through the canal. Nerve roots branch off of it and go out through the foramen on each side. When your disk herniates into these tight spaces, the nerve is crushed in there. When your disk herniates elsewhere, you may never notice.

Another bit: the probability that the patient feels long term relief from surgery depends on why the surgery was done. If it is supposed to fix pain in your back itself caused by a herniation, the success rate is only about 50% - and indeed it is not clear how disks cause pain locally, one theory being that the disks, which have no nerves in them, may open up cracks and tears which let nerves grow into them, nerves which don’t like being crushed as part of the normal function of disks.

But if the surgery is intended to fix pain felt in the limb served by the nerve the disk is crushing, success rates jump to 85%. I think this situation is like having your hand slammed in a car door, and people are offering pain killers and ice and special exercises, and all you want is for them to open the damn door.

My story: I herniated my L5S1 disk with massive pulp extrusion on 2/1/05, crushing my right sciatic nerve root and causing great pain that migrated around my right foot and leg, and some paralysis, leaving me walking with a cane for a few weeks. By a few months later some of the trouble had spread to the left leg (as a nurse said, “Oh! You’re going bilateral!” like it was the hot trend in GQ). I had 6 months of physical therapy, 3 stearoid injections, two MRIs, one of those nerve studies where they put needle electrodes into various leg muscles, 1200 Percocets, and finally surgery on 7/18/05 to cut away disk, undercut the spinal column itself 15%, and cut out some of the bone in the foramen to increase the size of the opening. I got much relief right away, and then they started me on gabapentin, a nerve med (best known by the trade name Neurontin). A few months of this gave me even more relief. Now I’d say the problem is at least 95% fixed and I am happy. I still can’t wiggle my toes on the right, and can’t stand on my heel on that side, and often fail to clear steps with my right toe; I have a drop foot. And my sensations are compromised somewhat. If I cut my foot or toes I often can’t feel it. The top of my foot feels very slight sensations as very strong, so that if one of the cats walks over my bare foot and the soft soft fur of their belly just slightly brushes it, I feel great burning pain. Yet, I can scrub the area with a stiff brush without discomfort. But I have my life back and am thrilled about that.

I guess my spine has other problems too. I had to get my bottom 3 neck vertebrae fused last summer (an even more rewarding trip than the back surgery), and am going to get an artificial disk next to the 4th one some time soon, having pain and difficulty with my arms and hands getting clumsy and weak, especially on the left. Doc says I chose my parents badly.

Last but not least, remember the motto of orthopedic surgery: “We may not make you better, but we’ll definitely make you different!”

9

The first time I injured my back I was reaching to pick up a shovel off the ground. That time was much worse in terms of pain because I had spasms, this time around the pain was much more bearable. no spasms. This last time I was at the gym performing deadlifts. It wasn’t a heavy weight though - 205 lbs, barely a warm-up but my lower back went weak and rounded over. I knew it was bad right away but hoped I had stopped the movement in time but I hadn’t. Again, at least no spasms.

Early in my lifting career I had an ongoing pain in my lower back. Very mild but enough for me to see a physiotherapist. She found I had inflamed facet joints (I think that was how she put it, my doctor has a report from her). The physio treatment didn’t really help that much but the strengthening exercises they gave me helped a lot. I don’t know if that will be a clue about what happened recently but I’ll remind the doctor of it just in case

Very very much. I didn’t want my doctor to have to explain how everything works and then forget half of it because it’s too much to take in at once. I want to be able to focus on this not happening again and follow everything that comes up regarding that whether that means, physio, nothing, or whatever course he recommends.

Napier, I really owe you, not only did you give a nice explanation in this thread but one of the things I passed the time doing while I couldn’t sit up much was reading about Kelvin wiring and related topics. Thanks for that too. :slight_smile:

10

This is why I’d advise seeing a neurosurgeon before letting anyone near your spine with a scalpel.

Between the orthopedic surgeon and the neurosurgeon that I saw before my surgery, the ortho guy just came across like a carpenter and the neuro guy made it sound like art.

I had a nearly 3/8" diameter extrusion of disc material at L5-S1 and had the usual problems - pain, numbness, tingling, foot drop, absent reflexes, etc. One microdiskectomy later (done by the neurosurgeon four weeks ago) and the back pain itself is gone, and the sciatic issues are sorting themselves out. It will take a while - nerves repair and regenerate very slowly, but there are occasional days when everything’s perfect.

And yes, I chose my parents poorly as well.

11

Gotpasswords, I didn’t mean to suggest an orthopod isn’t as good a choice as a neurosurgeon. I guessed the joke probably didn’t originate regarding spines in particular, but because getting your frame modified generally has more remarkable results than most kinds of medical treatment.

I actually prefer the idea of an orthopedic surgeon to fix spinal interference with nerves. I imagine people entering orthopedic surgery because they like thinking about subtly shaped mechanisms in 3d and getting them to interact properly, and I imagine people enter neurosurgery because of their interest in nerve tissue and its transport of information. Somebody once told me a neurosurgeon is better for fixing disk-nerve issues because they really understand the importance of not cutting that nerve. This is supposed to appeal to me because I myself understand the importance of not cutting that nerve. I think an orthopedic surgeon working on the spine would understand plenty well that the nerve shouldn’t get cut. In fact, orthopedic surgery is about cutting bone, and anybody cutting bone right next to a nerve should be good at that. In fact, I doubt any other surgeon cuts as much nerve in their career as a neurosurgeon.

To pick on the carpenter reference itself, if the frame of my house was shifting around and crushing my wiring, I would want the frame fixed by a carpenter, not an electrician. If the wiring got severed, well, then, we would call in an electrician, too, but after the carpenter is finished. When neurosurgeons can fix severed nerves, then the analogy will get me to calling on them.

I do have to say that as a layperson I don’t think I am in a good position to make a valid determination about this. But, appearing to be arguing the opposite side does seem worth clarifying.

FWIW I did all the research I could looking for a surgeon to fix my back, including chatting with physical therapists in the area who help rehabilitate all these patients after their surgery, and talking with friends and relatives and friends of relatives and relatives of friends who are in medical trades in the area (whom I hope feel like leveling with me about patients they meet, scuttlebut they hear, and whom they would pick), and web searching for things like lawsuits. I found a guy who has a better reputation than anybody else around here, much better than several of the others. He’s done both my surgeries and I had good results, and while spinal surgery is scary, I feel great about going back to him. He’s an orthopedic surgeon, though I had about equal numbers of them and neurosurgeons on my list when I started the process.

12

HongKongFooey, you are perfectly welcome. I also suggest you get “Low Back Disorders: Evidence-based Prevention and Rehabilitation” by Stuart McGill. This is a technical book though it is often used for training physical therapists. He studies pig spines in Instron machines, has watch weightlifter spines on fluoroscopes, all sorts of great things. You’re apparently a technical professional and would understand the material, though it is certainly not aimed at the patient.

Oddly, I posted this recommendation not long ago, and thought I saw it appear, but it isn’t there now - don’t know why, or if it will reappear or something.l

13

Another not-a-doctor-but-I’ve-got-the-same-problem weighing in. I herniated two discs in my back in a scratch (what Americans would call a “pick-up”) game of rugby league at university. That was in 1994. I’m constantly in a low level of pain, but it flares up once every couple of months. If I get the anti-inflammatories and painkillers onto it quickly, I can usually gut it out to go to work that day. If I don’t, I’m usually laid up for the better part of a week and need daily traction for a couple of weeks thereafter.

I’ve had my fair share of MRIs over the years, and the degree of herniation varies pretty greatly. It’s usually pressing on the nerve from the rear-right, but when it flares it blocks about half the spinal column.

The specialists recommend against disc replacement because it’ll need to be re-done roughly every 5-7 years and if I keep playing the averages eventually one’s likely to go wrong.

In short, the problem will never go away, so it’s all about management. If you’re having a flare-up. look after it quickly and well. The anti-inflammatories relax not only the nerves, but also the muscles around the site that are squeezing the hernia even tighter. Traction certainly helps me - it may help you as well.