Can a herniated disc heal on its own over time?

[Brovane]

snip.

Thank you I appreciate your insight. Right now we are waiting to see how the physical therapy goes. Her Pain Management DR still recommends that we see a surgeon just to get on their radar and discuss what are the options. Luckily living in South Orange County it seems like we have several good back/spine people in the area that we can see.

I am not sure really what to push for at this point. Right now my wife doesn't have much of a life. She has always stayed home to take care of or two children and was originally looking at possibly going back to school to eventually get a career. She is only 34 and still has a lot of things she wants to do. However over the last year medical problems have really floored her and this back one has really gotten ugly. She started with back issues after she delivered or first child. Right now she takes 60 MG of Oxycontin every day for the pain and a good part of the day she is laying on the couch because of the pain. At least the PT has got her up and moving some for part of the day. She can barely take care of or two children and get them off to school. Now that the Hysterectomy is behind us hopefully we can concentrate on the back issues and maybe come up with some good options. I also want to get a good feel from the DR how bad her back is in the L4-L5 area. I believe last time we had a appointment he said basically the disc was gone in that area which isn't a good thing. Several months ago the DR burned the nerves in that area of the Lumbar to alleviate some of the pain. This has worked some but we are both not happy with the amount of pain meds she still has to be on.

I do really appreciate your input on this. We have some tough decisions ahead of us.

 

[SilthDraeth]

I didn't read all the posts, or your follow up posts.

I just had L4 L5 S1 fusion in April.

Started about 8 years ago, had a slipped disk caused me to become immobile, couldn't get off the floor on my own. They gave me some direct inject muscle relaxers due to muscle spasms, and sent me on my way.

Happened again a year or so later, was working out at gym, and on lunch break from work, stepped over a child safety gate and it slipped again.

Several years later, car accident...Had about 3 months of physical therapy.

Then was good for a year or 2. Then was lifting some heavy stuff again, and back went bad again, couldn't get up. More therapy, then happened again a year later, more therapy, but after last time I had constant pain down leg.

Had injections over 6 months, no improvement. Just temporary relieve from pain in hips.

Sciatica was causing a constant pain/numbness down my right leg and into foot.

This was with 2 herniated disks.

Finally had surgery, and my overall pain is less, but then my mobility is pretty limited now.

I still can't sit for to long, definitely can't sit on the floor to play with kids.

Laying down still causes issues and it is hard to get up.

If you aren't having the bouts of pain so severe you vomit, and your back muscles spasm, knocking the wind from you, and you can't stand up without assistance... (I spent a month in bed during one of my incidents, doped up on percocets and muscle relaxers, and taking laxatives...

Anyways if your back doesn't do all that, I would live with the sciatica, and not get surgery. Find some exercises you can do.

Heck I could scan up my stuff from my therapist post surgery and email it if you want.

One that I found that helped that isn't officially recomended, is laying on my couch, face down. But my thighs are on the arm of the couch hanging off the couch and rest of the body is on cushions.

 

[SociallyChallenged]

One that I found that helped that isn't officially recomended, is laying on my couch, face down. But my thighs are on the arm of the couch hanging off the couch and rest of the body is on cushions.

PTs actually utilize a technique like that all the time - it's called the McKenzie technique for the lumbar spine. Essentially, it repositions the jelly part of the disc anteriorly (on the front side) so it doesn't push back into the nerves. If that helps you, you may want to google some videos on how to officially do the McKenzie technique. It might actually help. Thanks for your input though. I know chronic back injuries can be painful and debilitating. I'm sorry that you've had to go through so much. Also, to improve your mobility, you really need to optimize your hip motion. Lots of hamstring and hip flexor stretching might help you feel like you can move more.

 

[SilthDraeth]

PTs actually utilize a technique like that all the time - it's called the McKenzie technique for the lumbar spine. Essentially, it repositions the jelly part of the disc anteriorly (on the front side) so it doesn't push back into the nerves. If that helps you, you may want to google some videos on how to officially do the McKenzie technique. It might actually help. Thanks for your input though. I know chronic back injuries can be painful and debilitating. I'm sorry that you've had to go through so much. Also, to improve your mobility, you really need to optimize your hip motion. Lots of hamstring and hip flexor stretching might help you feel like you can move more.

Yep. Well, I used the McKenzie technique but doing it the way I stated actually helped a bit more than the way my PT showed me.

My latest set of PT is focusing on all my hip stuff, and using an exercise ball. I am still in a better place than I was pre surgery, but I can't help but dream of when I wasn't messed up.

Was just mainly trying to add a bit of anecdotal experience to the OP's question, vs "medical knowledge".

So back to the OP good luck.

 

[Schfifty Five]

Yep. Well, I used the McKenzie technique but doing it the way I stated actually helped a bit more than the way my PT showed me.

My latest set of PT is focusing on all my hip stuff, and using an exercise ball. I am still in a better place than I was pre surgery, but I can't help but dream of when I wasn't messed up.

Was just mainly trying to add a bit of anecdotal experience to the OP's question, vs "medical knowledge".

So back to the OP good luck.

Thanks for your input as well as everyone elses.

I'm not going to immediately do anything as I have some other priorities I need to take care in the next few weeks, but I am going to carefully weigh my options and see which is the best bet for me.

I appreciate everyone's input/responses.

 

[Sixguns]

The biggest thing is to stay positive if you can. I know when I was dealing with my back, I would give up all the time. Depression set it and things got really bad.

 

[SociallyChallenged]

Yep. Well, I used the McKenzie technique but doing it the way I stated actually helped a bit more than the way my PT showed me.

My latest set of PT is focusing on all my hip stuff, and using an exercise ball. I am still in a better place than I was pre surgery, but I can't help but dream of when I wasn't messed up.

Was just mainly trying to add a bit of anecdotal experience to the OP's question, vs "medical knowledge".

So back to the OP good luck.

Ah, ok, I gotcha. Thanks for the input. It's nice to know what the experience is like first hand before any decisions are made.

 

[spinejam]

This is my brother's L spine MRI showing an L IVD herniation. Onset was following lifting some heavy furniture back in December 2011. Treatment to date has consisted of rest and he has undergone a week of oral steroids and physiotherapy / chiropractic spinal decompression w/ significant progress. He is not totally asymptomatic at this time, but can function w/ much less discomfort and minimal radicular pain. Of course each person is different and what may work for some may not for others -- therefore having options is imperative. I am a Chiropractic Physician and certainly advocate trying some of the recommendations presented by SC. He's got a good head on his shoulders and I have never seen him give poor/bad advice.

Normal L MRI:



Uploaded with ImageShack.us


My brother's L spine:



Uploaded with ImageShack.us



Uploaded with ImageShack.us

 

[Schfifty Five]

Just thought of another question, since my disc is herniated in the lower back, why does my buttock's and hamstring area hurt the most? The pain I get is 95% right in the middle of my ass cheek, no joke. I assume it's just the nerve that runs through there that's causing the pain?

Why wouldn't the pain radiate from the lower back where the disc bulge pressing on the nerve is?

 

[offnote]

I Recently had an MRI which revealed I had a herniated disc (L5-S1). I can either get injections or go for surgery.

First of all almost each adult has some kind of degeneration at L5 area.
Second read those two books and you'll know excatky what to do, all by yourself. No surgery no injection necessary. First book is "Trigger Point Therapy Workbook" and the second "Healing Back Pain: Mind Body Connection". I had similar problem and thanks to these books and my research I have "fixed" myself good luck.



p.s.
It's really sad how little most doctors know about human body...

 

[offnote]

Just thought of another question, since my disc is herniated in the lower back, why does my buttock's and hamstring area hurt the most? The pain I get is 95% right in the middle of my ass cheek, no joke. I assume it's just the nerve that runs through there that's causing the pain?

Why wouldn't the pain radiate from the lower back where the disc bulge pressing on the nerve is?

exactly like trigger points work - they send often pain to other areas of the body. Get yourself a deep tissue (trigger point) massage, the good part is you can do it on your own with tennis ball.

 

[SociallyChallenged]

snip

Holy smokes, that spine is not lookin' very good. Tons of anterior disc herniation as well (which is not typical considering the anterior longitudinal ligament is much wider and thicker then the posterior longitudinal ligament). Not to mention, he's got Schmorl's nodes protruding into the vertebral end plates in all of the lumbar spine. It never ceases to amaze me how little or how much the radiology can be paired with the pt's symptoms. I've seen much nicer spines on MRI/CT and the pt CANNOT get out of their symptoms. It's also impressive that individuals with these degenerated spines can find significant relief. Conservative care results impress me quite a bit sometimes.

Btw, always nice to see another practitioner around here. Eits is also a chiropractor. It's good to have others around here to keep me on my toes. And I know I can always learn more from those with more experience in the field so feel free to share if you feel I'm getting anything wrong.

 

[SociallyChallenged]

Just thought of another question, since my disc is herniated in the lower back, why does my buttock's and hamstring area hurt the most? The pain I get is 95% right in the middle of my ass cheek, no joke. I assume it's just the nerve that runs through there that's causing the pain?

Why wouldn't the pain radiate from the lower back where the disc bulge pressing on the nerve is?

Well, there are several reasons. The simplest place to start is by talking about the spinal nerve roots and how they form peripheral nerves. Essentially, a bunch of the spinal nerve roots come together and form the sciatic nerve. If one spinal nerve root is angry, it can modify the activity (membrane permeability, threshold level, etc) of the sciatic nerve itself. In addition, the piriformis muscle is right there, which can frequently put excess pressure on the sciatic nerve, causing more dysfunction.

In addition to this, there's the theory of the facilitated segment, which suggests that muscles innervated by a given nerve root (in your case S1 if it's truly caused by the disc, L5 if it's caused by entrapment due to the vertebra itself) can act abnormally. Since the nerve root is so angry and active, the theory is that the muscle becomes hypertonic (excessively active at baseline) and potentially spastic. Muscles are designed to contract and relax, but if they don't relax, they can become tight and symptomatic. That then causes pain, which causes a lot of other physiologic reactions that make the pain worse (inflammation, scarring, etc).

Lastly, there is a large joint in that region (called the sacroiliac joint) that can actually cause nerve impingement and buttock/low back pain as well. Typically, a rotation of one side occurs, putting excess tension on one side of muscles and ligaments. That can cause the piriformis to be irritated, but it can also lead to sacrospinous, sacrotuberous, posterior/anterior sacroiliac, and iliolumbar ligaments to become irritated. All that is in the area between your low back and the bottom of your buttock so it's no wonder that this area can become painful. This can be fixed (IMO) more easily that lumbar disc herniation and should be something your physical therapist considers.

I've had patients that present like you with the same prescription of lumbar disc herniation. With one patient, I couldn't get him out of symptoms with treatment of his lumbar spine, sacroiliac joint, soft tissue around the area. With one patient, it took a mix of treatment to the lumbar spine and piriformis to reduce his symptoms. With another, I had to work mainly on piriformis and hamstring stretching. I can't tell you which your's is, but I can tell you there are several things that should be done during your physical therapy other than just exercise. The PT should be putting his/her hands on you to fix your position and improve your mobility.

 

[SociallyChallenged]

First of all almost each adult has some kind of degeneration at L5 area.
Second read those two books and you'll know excatky what to do, all by yourself. No surgery no injection necessary. First book is "Trigger Point Therapy Workbook" and the second "Healing Back Pain: Mind Body Connection". I had similar problem and thanks to these books and my research I have "fixed" myself good luck.



p.s.
It's really sad how little most doctors know about human body...

When it comes to low back pain, there is no blanket book that can magically fix the pain. With some, trigger point may very well help. With disc herniation, that is not likely the case. Trigger point therapy, in itself, is typically only a temporary fix to alleviate symptoms. It may improve mobility, but it does not alleviate issues like abnormal joint position, ligament tightness, postural issues, etc. This is not the cure for everybody (and will be for hardly anyone).

 

[SociallyChallenged]

exactly like trigger points work - they send often pain to other areas of the body. Get yourself a deep tissue (trigger point) massage, the good part is you can do it on your own with tennis ball.

This is a very one-sided view. A deep tissue massage may actually increase his symptoms if his piriformis is irritated and inflamed. You don't deep tissue a truly painful region. In addition, muscle is only one segment of treating low back pain. There are many, many joints and dozens of ligaments in the area. Those will need to be addressed as well.

 

[offnote]

This is a very one-sided view. A deep tissue massage may actually increase his symptoms if his piriformis is irritated and inflamed. You don't deep tissue a truly painful region. In addition, muscle is only one segment of treating low back pain. There are many, many joints and dozens of ligaments in the area. Those will need to be addressed as well.

I'm sorry but you abviously know very little about trigger points, muscles and spine correlation so I'm not going to waste my time here arguing. Been studing that subject for last 5 years FYI. Reaad some books, practice and we can talk more some day.

 

[SociallyChallenged]

I'm sorry but you abviously know very little about trigger points, muscles and spine correlation so I'm not going to waste my time here arguing. Been studing that subject for last 5 years FYI. Reaad some books, practice and we can talk more some day.

Lol, I know what research shows about the efficacy of trigger points and I use them daily in practice. I do understand that there are multiple limiters of function and mobility, muscle being only one of them. You may have anecdotal evidence, but I know what randomized controlled trials published in legitimate journals say. And you're telling me to read books? I probably have 10 textbooks and 100 research articles on rehabilitation and the spine. I also have a degree in exercise biology and am pursuing a doctorate in physical therapy. We can talk now if you'd like to have a mature conversation and provide some reasonable evidence, other than subjective experience. The burden of proof is in your hands since you are the one making all these claims.

 

[Sixguns]

Lol, I know what research shows about the efficacy of trigger points and I use them daily in practice. I do understand that there are multiple limiters of function and mobility, muscle being only one of them. You may have anecdotal evidence, but I know what randomized controlled trials published in legitimate journals say. And you're telling me to read books? I probably have 10 textbooks and 100 research articles on rehabilitation and the spine. I also have a degree in exercise biology and am pursuing a doctorate in physical therapy. We can talk now if you'd like to have a mature conversation and provide some reasonable evidence, other than subjective experience. The burden of proof is in your hands since you are the one making all these claims.

Ooohh.

For the massage stuff. Before my surgery, I had several and they all seemed to make things worse. But again, every body is different and will react different to things like this.

 

[SociallyChallenged]

Ooohh.

For the massage stuff. Before my surgery, I had several and they all seemed to make things worse. But again, every body is different and will react different to things like this.

Exactly. I know some people who respond very well to deep tissue work because their limitations are primarily muscular in nature. However, there are a LOT of things massage therapists don't take into mind when working with patients. They don't as about numbness and tingling, they don't take position into mind (considering they do most massages prone, which causes narrowing of the neural foramina and loading of the facets), they aren't trained in pathology. They're trained to massage indiscriminately. For all they know, they think they could be massaging your piriformis and they're actually on your sacrotuberous ligament. That's not ok.

 

[Sixguns]

I should dig up my old MRI's and upload them. I still cant believe how crappy my spine looked and how I lived like that. Even the doctor who did the surgery said he had never seen a spine so jacked on somebody so young.

 

[SociallyChallenged]

I should dig up my old MRI's and upload them. I still cant believe how crappy my spine looked and how I lived like that. Even the doctor who did the surgery said he had never seen a spine so jacked on somebody so young.

They're always interesting to see. As radiology stuff is a huge thing still held over our (PTs') heads by MDs and chiropractors, I'm particularly fond of it. We learn it now in doctoral programs, which is nice, but I don't see as many films as I'd like. I'd definitely take a look at your's if you posted them. Perhaps another thread might be warranted so as not to take away from the OP's specific topic. Or maybe you could post it to show him what you're looked like and what relief you got. Whatever you feel is best.

 

[spinejam]

I'm sorry but you abviously know very little about trigger points, muscles and spine correlation so I'm not going to waste my time here arguing. Been studing that subject for last 5 years FYI. Reaad some books, practice and we can talk more some day.

Differences of opinion are always welcomed here, but your comments were certainly insulting and immature. They do however, provide insight as to your current knowledge base. Let's try to keep this thread civil and professional -- it lends to one's credibility and helps others w/ difficult decisions to make.

 

[Eos]

Fun fact: I have a L6 vertebrae.

 

[SociallyChallenged]

Fun fact: I have a L6 vertebrae.

Yeah, that happens occasionally Do you know if you have a full L6 transitional vertebra or do you have a hemivertebra? If you have a full one that isn't sacralized (essentially attached at one or multiple points), it can just act like a normal vertebra and not cause any problems unless you experience the normal pathologies.

 

[Eos]

Yeah, that happens occasionally Do you know if you have a full L6 transitional vertebra or do you have a hemivertebra? If you have a full one that isn't sacralized (essentially attached at one or multiple points), it can just act like a normal vertebra and not cause any problems unless you experience the normal pathologies.

Not sure. I know about the L6 because I herniated L3-4, L4-5, L5-6 when I was 19. Laminectomy cleared it right up.