“Slipped disc” or “disc herniation” are very scary words that usually don’t mean much in evidence-based clinical practice.

As a pain sufferer, however, being told that you have a disc herniation or disc protrusion can be a very scary experience.

Perhaps you have been told a intervertebral disc in your lumbar spine is pressing on your spinal nerves and causing your leg pain, numbness or tingling, or even muscle weakness?

Perhaps you have been recommended for steroid injections or an orthopaedic surgery but you just aren’t sure if that’s the right treatment plan for you.

Don’t worry, you are not alone in feeling this way.

This morning a client of mine just texted to inform that he just did a MRI with his GP as part of the annual examination.

He was concerned because they found TWO DISC PROTRUSION in his lumbar MRI scan and his doctor suggested that a surgery may be necessary for him.

The good news? According to best clinical practice guidelines, he has nothing to worry about.

MRI of lower back pain patients were twice as likely to go for surgery

I am not pulling rabbits out of thin air.

Over the past few years, research and medical organsations have consistently advocated against routine MRI scans.

It is unclear why the medical doctor referred my client for a MRI in the first place.

Even if you have back pain, the latest clinical guidelines assert MRI imaging is not necessary in the absence of red flags:

“The labeling phenomenon of patients with low back pain has been studied and shown to worsen patients’ sense of well-being. In addition studies have linked the increase rate of imaging with the increase rate of surgery. A study by Webster et al showed that patients with occupation-related back pain who had early magnetic resonance imaging (MRI) had an eightfold increased risk of surgery. A study by Jarvik et al showed that patients with low back pain who had an MRI were more than twice as likely to undergo surgery compared with patients who had plain film imaging.”

American Academy of Family Physicians, Choose Wisely Campaign

This is almost like a ‘if all you have is a hammer, go find a nail’ situation.

The medical doctor referred my client for a lumbar spine MRI to find two disc protrusions. From there, he was recommended to consider going for surgery to remove them.

Before we even talk about why that is poor clinically recommendation, we should understand that MRI has poor — to be exact negative — value for most low back pain patients.

According to the American Academy of Family Physicians, one of the most authoritative organisations for general practitioners in the WORLD:

• Early imaging (MRI, lower back) of the spine INCREASES cost without improving recovery outcomes (i.e. lose-lose)
• There is strong evidence to avoid CT/MRI imaging in patients with non-specific low back pain

So if you have been referred for a MRI and you are feeling unsure about forking out hundreds of dollars for a MRI, don’t go for it. The only exception this is if you have a red flag (more on this later).

If you have already had your MRI and you are freaking out over the disc herniations or degeneration the doctors have found on your scans, take a couple deep breaths.

We are going to discuss why you are going to be okay.

Majority of slipped discs will start to go away within eight weeks

herniated disc, disc herniation, spine mri
Before and after MRI scans of a lumbar disc herniation (grey lump) regressing on its own without treatment. The white region is spinal canal where the CSF fluid and the spinal cord are.

So I think the scary-ness of slipped disc, apart from its terribly misleading name, is in that it sounds like permanent damage.

The good news is that it isn’t.

Since most people without back (or neck) pain would not go for a MRI, most people first discover their disc herniations upon further investigation of their pain. This lead them to believe that their back pain is from their slipped disc.

Since it’s a structural issue, it’s going to be there forever!

“I need surgery!”

Well, hang on a minute.

First of all, you do not know how long you have had the herniated disc for. Remember, you don’t have a pre-pain can to show that these MRI findings are new.

The truth is a lot of people do have “abnormal” imaging findings in their spinal MRI without any pain or symptoms at all. There is no evidence to suggest a relationship between your pain and slipped disc (more on this later).

Secondly, The Lancet published that there is insufficient evidence to support discectomy for acute lower back pain and that it’s at best an adjunctive treatment option in chronic cases.

We think that there’s “something wrong” with our spine so we have to remove that defect to get back to normal daily living. However, clinical studies are suggesting that removal of these “abnormal” MRI findings are not necessarily useful at improving your pain experience.

Thirdly, and perhaps most important of all, most disc herniations disappear on their own! Even without treatment!

I know that sounds ridiculous because it goes against every fibre of our belief. But hey, this is science.

According to the study:

“The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging.”

The probability of spontaneous regression of lumbar herniated disc, Clinical Rehabilitation (2015)

In short, the worse your slipped disc (i.e. disc sequestration), the more like it is to go away (regression) by itself.

This is not some kind of natural healing junk science where I’m telling you to bathe in moon water so you can heal yourself. These are research studies from established medical organisations telling us that your disc bulge or disc protrusion is not scary and is likely to go away by itself.

They are also saying that you don’t need surgery and that surgery doesn’t seem to be as effective as we assume it to be.

What if my slipped disc doesn’t go away?

We did say that majority of disc herniations will resolve on their own.

You are right in thinking that you may be one of the minority whose slipped discs aren’t going away. What happens then?

First, do not worry.

Science tells us that you still have nothing to worry about.

A lot of people without lower back pain or any type of symptoms (we call them asymptomatic) also have slipped discs. That is a lot of people with herniated discs actually don’t feel pain in their low back!

protrusion, slipped disc, low back pain

A study of 3110 subjects published in American Journal of Neuroradiology found that most people without any pain or symptoms actually shows signs of disk degeneration and disk protrusion. The more interesting thing to note here is that these findings increase with age.

According to the authors, “many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”

My point is: it doesn’t matter that you have a slipped disc. For some of you, it may be “pressing” against a nerve to give you sharp shooting pain. The good news is most of these radicular/neurological symptoms would resolve within weeks (American Academy of Family Physicians).

Because the imaging findings on MRI are not associated with age, you can return to pain-free living without having to make your herniated disc go away.

How does that sound to you?

Research is telling us that disc bulge, disc protrusion, loss of disc height, etc are normal age-related changes that do not seem to be related to pain.

Just think of grey hair or wrinkles. These are also natural age related changes.

Do you get face pain from wrinkles or headache from grey hair?

If you are a chronic headache sufferer with grey hair, do you think dying your hair black is going to resolve your head symptoms?

This is why science is important. It tells us what is true and what is not true. From there, we are able to make better decisions to lead us to the outcomes we desire.

Sure, some of these may not be common sense.

However if common sense worked, then all of us should be doing the right thing for our recovery and, by extension, 100% pain-free.

You can’t pop a disc with exercise, okay?

Bro, this is 100% your daily gym broscience talk.

I cannot repeat this enough: You CANNOT pop a disc with exercise. Even if you are lifting heavy objects.

A study investigating the biomechanical properties of our spinal disc found that it took 740lbs (335kg) of force to compress the disc height 1mm in young people and 460lbs (208kg) of force to compress the disc height 1mm in seniors.

This works out to 335kg of force to compress it by ONLY 1mm.

Let’s not forget you have 23 of these spinal discs. You also have ligaments, tendons, and muscles to provide stability to this area.

So, to “slipped” a disc, you probably have to deadlift a small building.

You keen?

The current understanding is that herniated disc occurs when the outer ring (annulus fibrosus) of the spinal discs “weakens” and inner portion (known as the nucleus pulposus) herniate through the outer ring of annular fibres.

At the same time, current scientific understanding is also suggesting that you need a lot more force than a few 1RM deadlifts to “burst” a disc. They are really not your regular jam-filled donuts.

When should I consider MRI for lower back pain?

That is not to say MRI has zero value for low back pain patients. In a very small group of back pain patients with the following symptoms, MRI may be useful.

  • Loss of bowel or bladder function
  • Loss of sensation around the groin region
  • Trauma
  • Medical history of cancer, osteoporosis, prolonged steroid use
  • Progressively WORSENING neurological symptoms (i.e. leg numbness)

If you have any of the above, do seek immediate medical attention.

A study published in June 2020 looking at 1,000 low back pain patients in a Melbourne hospital found that although 67% patients who presented at an emergency department had a red flag symptom, only 3.3% had a serious pathology.

Yes, MRI is highly valuable at helping us find serious pathology. However, these cases are rare even in the presence of a red flag.

The current clinical guidelines suggest that you do not seek a MRI scan without a red flag. Even if you do have one, remain calm and seek immediate medical advice. Remember, serious pathology is rare.

Got it, so what do I do with my lower back pain then?

Find a healthcare provider who knows his stuff. By ‘know his stuff’, I mean somebody who follows evidence based practice.

“In God we trust, all others must bring data.”

It really comes down to being able to make the best clinical decision in times of uncertainty.

It doesn’t sound like much but someone who rationalises his clinical judgement with hard data is going to lead you to more favourable results.

A chiropractor who is trying to “pop” your slipped disc back in place is as good as a hair stylist trying to dye your hair black for your headache. It just simply doesn’t work.

The Lancet (2018), still the largest and most authoritative back pain clinical guideline ever published in the history of healthcare, points to exercise, education, and advice to keep active as solutions for chronic lower back pain.

Other health organisations around the world from United States, United Kingdom, Australia, Canada, Norway, all independently echo the same clinical recommendations.

When it comes to numbness or weakness relating to disc hernation, exercises or movements such as neurodynamic mobilisation has been demonstrated to be helpful.

While narratives around such symptoms have been traditionally around pressure on nerve or pressure on spine, it is important to note that exercises can help regardless of the affected nerves.

This is important for you to know because there is hope and there are treatments besides surgery or anti-inflammatory medication that can help.

For more evidence-based awesomeness, check out my other content at:

If you have been diagnosed with a disc herniation and your past or current treatments is simply not giving you the results you are after, book in an appointment via the form below to discover the difference the right care can make.

At Square One Active Recovery, I use a combination of evidence-based exercise, education, and coaching to co-create long-term pain solutions with my clients. My solution-focused approach is aimed at making my own services redundant to you. Let me help you find your true freedom from pain.

Your Recovery Journey Begins Now

Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, chiropractor Jesse Cai founded Square One Active Recovery to deliver recovery goals in just 4 to 7 visits.

Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment to discover the difference the right care can make.

*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.

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