💣 Herniated disc: when it really is a hernia and what actually helps
“I have a herniated disc” is one of the most common things I hear in the clinic. People come in scared, holding an MRI, after someone has told them the hernia needs to be “put back” or “realigned”. The truth is that not every disc problem is a hernia, and many findings on the scan are not the cause of the pain at all. Watch the video – below I have summarised the most important points.
Table of contents
💡 Herniated disc or disc protrusion?
Between the vertebrae there is a disc with a strong outer ring, the annulus fibrosus, and a gel-like fluid inside. The two conditions people most often confuse are:
- 🔸 Disc protrusion – the disc bulges, but the ring is intact. This is extremely common, and in most cases it is exactly this rather than a hernia.
- 🔸 Herniated disc – the annulus fibrosus ruptures and the fluid from the disc leaks out. This is what herniation means.
Many people with no back pain at all also show protrusions and even hernias on an MRI. That is why a finding on the scan is not a diagnosis by itself.
🧪 Why does a real hernia hurt so much?
The fluid that leaks from the disc is chemically active. The covering of the spinal cord and the nerve roots are right next to it, so it causes a chemical inflammation. For this reason, in the acute phase a herniated disc is managed mainly with medication prescribed by a doctor.
🔍 How to tell a hernia from a protrusion by the symptoms
🔹 With an active herniated disc
- the pain is constant and severe
- it hurts no matter how you lie down
- it is hard to find a position that brings relief
🔹 With a disc protrusion
- it hurts today and not tomorrow
- two very bad days, then two good weeks
- the pain changes with movement and load
If your pain comes and goes like this, it is most likely not an active herniated disc.
⏳ The nine months: the natural course of a disc hernia
A herniated disc hurts from the moment the disc ruptures until the body deals with the leaked fluid. This process takes up to about 9 months and is called spontaneous regression. During this time the body absorbs part of the material and the disc stabilises.
This matters, because lately some people claim they can “reduce” or completely “remove” a herniated disc with massage or special exercises. Please don’t fall for it. When a hernia is no longer visible after a few months, that is the work of your own body, not of a particular massage or exercise. Our body is very smart.
🦴 Spinal manipulation (“cracking”) with a herniated disc: yes or no?
- 🔸 With an active herniated disc, manipulation is not a good idea.
- 🔸 Once those roughly 9 months have passed, something else is most likely bothering you, such as a disc protrusion. Then exercise is helpful, and manipulation can be used when needed.
- 🔸 Exception: with osteopenia or osteoporosis, manipulation is not appropriate. Extra care is needed for older women in particular.
Recently a patient came to me after a chatbot had told her that, based on her symptoms, she should go to a chiropractor. When I asked whether she had osteoporosis, the answer was “yes”. In that case it is not a good idea at all.
🤖 Artificial intelligence does not make a diagnosis
If you don’t know what is wrong, you can ask ChatGPT, but rather which specialist to see, not which treatment to do on your own. Only an examination with movement testing can show whether the problem is a hernia, a protrusion or something completely different.
🚨 When to see a doctor immediately
- numbness around the buttocks and groin
- problems controlling your bladder or bowels
- rapidly increasing weakness in the leg or foot drop
These symptoms need emergency medical care – do not wait.
🩺 How we work at Omni Health
We start with a physiotherapy assessment: we talk about the pain, test your movements and find out whether it is a hernia, a protrusion or another problem. Then we choose a therapy just for you, most often kinesiotherapy and manual therapy, and re-test the result so you know it works.
❓ Frequently asked questions
What is the difference between a hernia and a protrusion?
With a protrusion the disc bulges but the outer ring (annulus fibrosus) is intact. With a hernia the ring ruptures and the fluid from the disc leaks out, causing chemical inflammation and severe pain.
How long does it take to heal?
The acute pain from a true hernia usually settles within about 9 months. During this time the body absorbs the leaked material on its own – a process called spontaneous regression.
Can massage or exercise “put back” a herniated disc?
No. A hernia cannot be realigned or made to disappear with massage. When it is no longer visible on an MRI months later, that is your own body at work. Therapy helps with pain, movement and recovery.
Is spinal manipulation dangerous with a hernia?
With an active herniated disc, manipulation is not a good idea. Once the acute phase is over it can be used, but not in people with osteopenia or osteoporosis.
When does lower back pain need emergency care?
If you have numbness around the groin and buttocks, problems controlling your bladder or bowels, or rapidly increasing weakness in your leg, seek emergency medical care.
Time for action
Don’t delay – book an appointment now and take the path to full recovery!
Contact us by phone for a free consultation
References:
The probability of spontaneous regression of lumbar herniated disc: a systematic review – PubMed
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations – AJNR
