Do disc herniations go away?

🎙 Episode 61 – Do Disc Herniations Go Away?

Podcast: The Talking Rehab Podcast
Host: Dr. Fred Bagares, DO
Location: Virginia Beach, VA

Back pain can stop you in your tracks—sometimes literally. In this episode, Dr. Fred Bagares explores the often alarming diagnosis of disc herniation. Whether you've had an MRI that showed a large herniation or woke up one morning unable to move, the big question remains: Do disc herniations actually go away?

You’ll learn about the anatomy of disc injuries, why symptoms don’t always match the imaging, and how healing often happens even when things look scary on paper. Dr. Bagares also shares the clinical signs he watches for, conservative treatment approaches, and how to avoid unnecessary surgery.

⏱ Timestamps:

• [00:00] – Introduction to rehab and the episode's purpose
• [00:33] – Why back pain is so frightening and disorienting
• [01:34] – Focus of the episode: Do disc herniations go away?
• [02:00] – Three common ways disc herniations present
• [02:51] – Pain patterns: radiating pain, leg symptoms, and “the pop”
• [03:26] – Anatomy of a disc (jelly donut analogy) and what goes wrong
• [04:16] – When disc herniations affect nerves and cause radiculopathy
• [04:46] – Classic clinical sign: patients who prefer to stand
• [05:26] – Why sitting often worsens symptoms
• [06:01] – Typical treatments: PT, injections, massage, traction
• [06:44] – Can a disc herniation resolve on its own? (Yes – and here’s how)
• [07:38] – Improvement doesn't always mean the disc is gone
• [08:56] – Is treatment shrinking the herniation? (Not necessarily)
• [10:00] – What actually happens as the disc resorbs (bulge vs. blowout)
• [10:45] – The real role of treatment: symptom control while nature heals
• [11:26] – The risks of inactivity: joint issues, blood sugar, muscle loss
• [12:19] – Timeline matters: when is conservative care likely to work?
• [13:44] – When symptoms persist beyond 6 months, surgery may be considered
• [14:30] – The paradox: large herniations are more likely to heal
• [15:28] – Final thoughts: be patient, stay hopeful, stay informed

🗣 Call to Action:

If you're dealing with back pain or were recently diagnosed with a disc herniation, don't panic—get informed. Follow Dr. Fred Bagares on Instagram and Facebook (@drfredbagares), and subscribe to The Talking Rehab Podcast for more expert insights on musculoskeletal medicine.

Let this episode empower you with realistic expectations, practical advice, and hope for healing.

Transcript

0:00

What is rehab or rehabilitation? My name is Fred, be Garris, a board certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. I. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge, dogma, and share my experiences in musculoskeletal medicine. Welcome to The Talking Rehab Podcast. I. One of the most common conditions that I see people for is your common back pain, there are several things that can cause back pain, and it can be pretty scary for people because back pain is fairly debilitating when you've ever experienced it, you. wake up one morning, can't get outta bed, or you get outta bed and you're doing something, bend over to try and, fill the dog bowl and then all of a sudden your back locks up and you can't straighten out. it can commonly cause a panic, if you're there by yourself, it's certainly very scary because you're starting to wonder how am I gonna get outta the house? Can someone help me? So it's, it can be pretty, pretty scary. naturally people jump to what's going on? Did I just herniate a disc? And so there are other things that can cause back pain, but for today's episode, I'm gonna focus primarily on disc herniations. the question that I'm gonna focus on is really. Do disc herniations go away?'cause ultimately that is what people really want to know. It's not always the just the pain that I have to address, but I do have to address that particular question. So over the years I've seen the presentation of back pain a number of different ways. So just like the two scenarios I described, sometimes it can come on suddenly, sometimes related to something that you did. But often it is just waking up, getting outta bed, and all of a sudden having fairly severe back pain. sometimes it's related to doing something you've done a million times, and then it's from doing something that you haven't done before. let's say if you're in the gym, and you're going for a new squat or deadlift record, and then all of a sudden, boom, something happens. So sometimes you can actually associate it with a particular event or particular episode. And then there's the last presentation, whereas that sometimes people will just have disc herniations on an MRI. They're getting an MRI for some other reason. And then lo and behold, there's this massive disc herniation. And that's a whole, that's a whole different discussion. But, Sometimes disc herniations don't actually cause symptoms, but when they do, it can be fairly uncomfortable. it can start off as back pain, but then it can also radiate into buttock and leg pain. Sometimes one leg, sometimes both legs. And I've even had people say that when they. They heard when it actually happened, they actually hurt or felt a pop in their back and then a sudden sh jolt of pain. That's. I can't even imagine what that might feel like. But it, essentially it sounds like they can, they can actually experience the pop or the herniation itself and that, the way I look at disc, the disc itself, the disc is a shock absorber, and your spine is organized, is a series of building blocks separated by the shock absorber called the vertebral disc. And inside of the vertebral disc there is. A gel, gel-like substance called a nucleus pulsus. So in my mind, I think of it is like a, almost like a jelly donut. Now this jelly donut, is reinforced in a circular manner, with annular fibers. And so it does serve as a dynamic structure can absorb shock, but again, Physics always applies, and when there is excessive force or repetitive trauma or motion, you can actually stress the fibers and that can create a very small focal defect where a disc herniation can take place. Now, aside from pain symptoms, the disc herniation can actually touch the nerve fibers, causing a radiculopathy. So you can actually have tingling, numbness, sometimes weakness, and in the emergency sense you can actually have a loss of the power in your legs and even your bowel and bladder. But typically it comes on with back pain, with some radiation of symptoms. Now, another thing that I've noticed is that it usually has a directional preference, meaning that people with a disc herniation have a preference to not flex or they prefer to stand. So in my clinic, I would notice people would. wait for me and as soon as I knock on the door, I walk in and they're standing and pacing in the room, and almost immediately I can put disc herniation to the very top of the list because, conditions act a certain way in people. It's not, it's not everybody, but you know that one particular. clue or hint seems to hold true over the years. disc herniations are very uncomfortable and when you go into a seated position, that actually puts more pressure on the disc. With, just in general, they've done many studies of this and being in a flex position or seceded position, tends to put a lot of pressure on the disc. So naturally, when you have a disc herniation, you know you have a focal wall defect. When you go into a seated position, it makes it worse. That increased pressure can sometimes also push on the nerves. and. As a result, people tend to prefer to stand, stand and walk. So very uncomfortable condition. if you've ever had a disc, herniation can be fairly debilitating. Some people have to go to the emergency room, some people have to call the ambulance because they literally can't get into the car. or I've even had patients, essentially fall to the ground and they just could not move. So can be pretty bad. And the treatment options are fairly typical what you guys would expect. things are. injections, medication, the treatment options, usually physical therapy, massage, chiropractic care, if we're talking about disc herniations, epidural injections, sometimes trigger point injections. You can also use traction. So there's a whole host of different things, and this kinda gets to the heart of. Like today's topic is the, aside from what can be treated, does the disc herniation actually go away? and from a research standpoint, even clinically, disc herniations actually tend to improve. And we're talking well, for the purposes of our discussion, I'll focus on the lumbar spine. But for the, but typically disc herniations, if you can, Ima take that analogy of a jelly donut losing its jelly. the jelly donut actually with time starts to go back into the disc. And I ironically, the larger the disc herniation, the more likely the disc is about to go, is going to go back into the disc. But this whole process can take, somewhere between, in my experience it can be somewhere between. Two months to even to about six months. From a clinical standpoint, disc herniations don't actually have to completely go back in for the symptoms to resolve. So from a clinic standpoint, it's fairly common for people to have acute symptoms, but then they have. pain that eventually improves to treatment. by about that sixth week or so, the whole episode should actually, be, let's say 80% improvement. So pretty much almost done. That doesn't necessarily mean that the disc, her herniation has resorbed or that the, particular episode is over. That I'm just highlighting the fact that the resolution of symptoms does not always mean that the disc herniation has resolved itself. And that's a really very important point, to emphasize to my patients is that, I've seen disc herniations almost overnight, just dramatically improve. And if you're still within that six week period. if you re-image the person, the disc herniation is likely still there. It doesn't always make a lot of sense, but it, that's just the way that it is that sometimes disc herniations don't hurt. Similar to what I said in the beginning is that, I've had MRIs of people that have incidental disc herniations, fairly large ones, and they have no symptoms. There's not really, I don't have a great answer for that. It's just that sometimes that's just the way that it is, and Trying to slow people down, even though they feel really good is one of the things that I need to screen for now. The treatment options, the, one of the more common things I'll get asked is. Does, things are working? Does that mean that the disc hernia, does that mean that the treatment is making the disc go back? And the short answer is not? No. It doesn't mean that necessarily from a patient standpoint, I think, and even from a clinician standpoint, this is one of those things that I think just fits nicely into our brain, that what I'm actively doing is actually making the condition go back. Yeah, from a technical standpoint, that's not always the case. But from a, motivation and a day-to-day standpoint, I think we all need that mental win sometimes of knowing that what we're doing is actually making things better or preventing things from occurring. But from a research standpoint, they have done studies where they will. Re-image people, basically every three months. And the disc herniation does resolve not in everybody, and it doesn't always go back in perfectly. Sometimes the herniation is more like, like a bulge versus a blowout. So again, using a different analogy, sometimes you can have a complete blowout of the. Disc herniation, but then when it actually resorbs itself, it looks more like a bulge or almost like a slightly flat tire. As a result, sometimes that makes a difference, sometimes that doesn't. Now, why I think that's important is that when I counsel people and tell them what is the benefit of the treatment is that the treatment doesn't necessarily hasten. The timeline for the disc herniation to resolve. It doesn't necessarily decrease the potential of recurrence. What it does is that it makes you comfortable so you can live your day-to-day life until the disc finally heals on its own. Because outside of the fact that people have. debilitating pain. I've had people essentially just opt to do nothing and just wait it out for one reason or another. And it does improve in a lot of, in a lot of my patients. So you don't have to necessarily do something, it does go away. it really comes down to what you can tolerate. And does this treatment option make it easier for you to sleep, work, play? And also very important aspect of the rehab process is to stay physically active, because as I said, one of the positions of comfort for people with disc herniations is just to stand. And that's good. I would say standing is a good physical activity, but if you're limited to that. For, from a pain standpoint or fear standpoint, you can create secondary problems. you can, if you have underlying knee arthritis, you can flare up your knees because now you're standing all the time and the knees are taking are definitely starting to feel it. so the purpose of this treatment is also to help make sure that you don't develop secondary problems, the muscle atrophy, developing joint contractures. if you have like diabetes, sometimes the way that we control our blood sugar. So I've, I've seen patients, have a fairly acute pain episode, can't do much, and then all of a sudden the blood sugars are all over the place. And that sometimes presents again, a secondary problem as a result of the disc herniation indirectly. But it is a factor. Knowing, knowing the timeline and of when the disc herniation happened versus when the symptoms started is something I also try to tease out because, from a counseling standpoint, if someone has a fairly severe disc herniation and, it's two weeks in, three weeks in, assuming you, you can get an MRI that quickly. the chances you have a lot of time to improve. you have, you do have to manage the symptoms, but from a technical standpoint, you don't necessarily have to jump straight to surgery. And if you can help that person essentially survive and get through it, the chance of the disc discrimination from a probability standpoint will improve. but let's say that you have a massive disc herniation, and I happen to see them, let's say in their 10th, 11th month. You know that the chances of that disc improving or moving back in are fairly low. Now, the, again, the main question is what symptoms are you experiencing with a disc herniation that has. Essentially moved back, but only this far or maybe didn't move at all. Because if you have a massive disc herniation in your 10th month, but you have no symptoms, a lot of people will just essentially leave that alone. But if you're the opposite person where the disc herniation is, fairly severe, it hasn't moved back. That, within that six month timeframe and your pain is not well controlled, despite conservative treatment, your prognosis isn't as great for conservative management and that might be somebody that I, essentially I. Would recommend for potential surgery because you know it, it's a structure problem. if the disc herniation in the beginning is a structure problem, but if it goes away, then no harm, no foul. But if the structure problem persists, plus the symptoms persist. then I think we tend to have to get a little bit more aggressive, in terms of no longer just doing therapies and injections, but actually recommending them to be seen by surgery, recommending they be seen by, spine surgery. so that being said. Disc herniations can be really bad, and just because they hurt really bad doesn't always mean that you have to have surgery. It doesn't always match that way, even from an imaging standpoint, as I said. the larger the disc herniation, the more likely it actually goes back in. So it can be not only just, mentally draining for my patients, I do try to set that expectation that, hey, even though it's this bad, that chancers are still in your favor, if you're presenting with the right. Timeframe. and even if you're outside of that timeframe, I use the same, in same type of information to counsel them in their next step and to make sure that they're not acting too hastily.'cause that's, I think, another concern is that some people are in a lot of pain. They don't want to jump into an aggressive surgery, but sometimes you have to. And I'm happy to get that counseling, but, Anyhow, I want, this is a super common question I get. I thought this would be a great time to, to talk about it. hopefully you guys, enjoy this particular episode. Everybody's got their own opinion, certainly this one is mine. but, I've been doing this for 10 years and I'm fairly, this methodology and how I've interpreted literature seems to have, held up pretty well. if you have any questions, to find me. Thanks again. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.