A Ruptured Disc Can Shrink on Its Own

If you've been told your disc has ruptured

Key points in 30 seconds

1. A disc that has pushed out often shrinks on its own over time. When studies were pooled, it was about two in three.
2. The more severely ruptured it is, the more likely it is to shrink. Being told "it's badly ruptured" doesn't mean "you need surgery."
3. But if you can't lift your foot or your bladder or bowel control changes, it's not for our treatment. A surgical evaluation comes first.
4. In a Korean study following 260,000 people with low back pain, those who received acupuncture were less likely to go on to have surgery.
5. We start by checking imaging and measuring how long you can walk. If that doesn't increase, we don't repeat the same treatment.

What we often hear

• "They said my disc ruptured. They say I need surgery, and I'm scared."
• "They looked at my MRI and said it's on the bad side."
• "One place tells me to have surgery, another tells me to put up with it."
• "I'm only OK while I'm on painkillers. When they wear off, it's back."
• "I heard that if you have surgery, you end up having it again later. Is that true?"

Many people who come in with lower back and leg pain have already been to several places. And most are stuck at the same point: whether or not to have surgery.

Ruptured discs shrink

Here's something worth knowing first.

A disc that has pushed out doesn't stay that way. It often gets smaller over time, and that isn't a guess. It's been confirmed by MRI scans of the same people taken several times.

When these studies were pooled and analyzed, about two-thirds shrank on their own.

Zou et al., Clinical Spine Surgery, 2023

And the worse it is, the more it tends to shrink

This is the surprising part.

How far a disc has pushed out is divided into several stages: slightly bulging, pushed out, broken through its outer layer, and a fragment broken off.

The rate of shrinking goes up in that order.

Condition	Rate of shrinking
Slightly bulging	Low
Pushed out	Medium
Broken through the outer layer	High
Fragment broken off	Highest

If you've been told "it's badly ruptured," that doesn't automatically mean "it's bad."

Here's how it's explained. When disc material breaks through its outer layer, the body recognizes it as something that shouldn't be there and starts to clear it away. If it stays inside the outer layer, the body doesn't recognize it, and it stays.

But this is the explanation so far, and it doesn't happen the same way for everyone. How long it takes to shrink also varies from person to person.

That doesn't mean you should just wait, no matter what

If you have these signs, it's a different story.

• Weakness that keeps you from lifting your toes or the top of your foot
• Changes in bladder or bowel control
• Numbness on the inner buttocks

If you have even one of these, it's not for our treatment. We won't start treatment, and we'll refer you right away to a place that can do a surgical evaluation. It's the kind of problem that becomes hard to reverse if you skip steps.

When we say "let's wait and see," it's when these signs aren't there.

People who received acupuncture had less surgery

There's one large study from Korea.

Using National Health Insurance Service data, researchers selected people newly diagnosed with low back pain and compared those who received acupuncture with those who didn't, matching 130,000 people in each group. As a result, those who received acupuncture were less likely to go on to have back surgery. The direction was the same in almost every age group except people in their 20s, and the older the group, the bigger the difference.

Koh et al., PLoS One, 2018

But there are limits to what this study can tell us. This kind of study can't tell whether people avoided surgery because they got acupuncture, or whether people who weren't going to need surgery anyway were more likely to get acupuncture. So we don't tell you "if you get acupuncture, you won't need surgery."

What does herbal medicine do?

One paper pooled clinical studies from several countries on a single herbal prescription used for lumbar disc herniation. It reported that using herbal medicine together with other treatment improved pain and difficulty with daily activities more than the other treatment alone.

Sun et al., Medicine, 2020

We use herbal medicine to calm inflammation and swelling and create the conditions for recovery. Herbal medicine doesn't push the disc back in.

Here's what happens when you visit us

First, we work out which it is. Whether it's a herniated disc or spinal stenosis changes what we need to look at and the order of treatment. We start by asking whether bending forward is hard, or whether your legs go numb the more you walk until you have to stop.

We check imaging. We look at X-ray, CT and MRI in partnership with the radiology clinic on the 2nd floor of the same building. We don't make a treatment plan without checking imaging.

We look for emergency signs first. If you have even one of the three listed above, we tell you what to do right then.

We measure how long you can walk. A back pain score alone makes it hard to tell whether you've improved. We measure how long you can walk without stopping and compare it at every follow-up visit. If that number is going up, the treatment is working. If it doesn't go up, we don't repeat the same treatment.

We don't tell you not to walk. Together, we work out how to use a back brace, how to rest before the numbness starts and then walk again, and how much to walk each day.

Come in when

• Leg numbness has lasted more than 6 weeks
• You've been advised to have surgery but can't decide
• The days you take painkillers are increasing
• You have to stop and rest more and more often while walking

On the other hand, if you've just tweaked your back a few days ago, it usually passes. Until then, we won't recommend treatment.

And let us say it again: if you can't lift your foot or your bladder or bowel control has changed, go to a place where you can get a surgical evaluation before coming to us.