Back pain: Can nature heal a disc prolapse?

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Hello I’m Dr George Ampat, I am a consultant orthopaedic surgeon and work in Liverpool in United Kingdom.
Today I will share a case report that we recently published about how a disc prolapse resolves naturally with exercises. I will also discuss how the body helps to naturally resolve the disc bulge/prolapse.

the case report that we recently published is titled - Immune-mediated resolution of a herniated lumbar disc prolapse aided by motor control exercises—a case report. This was published in the Oxford Journal of Surgical Case Reports.

A 64-year-old lady had presented with back pain and left-sided leg pain. MRI scans of the lumbar spine showed a left-sided disc prolapse at L3/L4 impinging on the left L4 nerve root. The red arrow on the image shows the disc bulge/disc prolapse.

She was asked to perform motor control exercises and take some simple painkillers to control the pain.

Her symptoms improved dramatically, and a repeat MRI scan performed about eight months following the previous MRI scan showed that the disc prolapse had completely resolved.

I have reproduced both images, showing how the bulge at L 3/L4 has spontaneously resolved with motor control exercises for the lower back.

If you are interested in reading the original article please follow the link provided on this QR code.

The important question is how and why disc prolapses resolve naturally.

Let me explain. This is the image of the vertebral column. The vertebral column consists of blocks of bones one above the other. In between two bones, the soft cartilaginous structure is called the intervertebral disc. This cartilaginous structure is made up an outer tougher substance called the “Annulus fibrosus” and the inner more softer substance called the “nucleus pulposus”.

The nerves from the lower part of the vertebral column join and form the sciatic nerve which travels in the back of the leg.

The structure of the disc is like a jam doughnut, with the dough being the annulus fibrosus and the jam being the nucleus pulposus.

A disc prolapse will only occur in a degenerate or dehydrated disc.

When a disc prolapses the nucleus pulposus comes through the annulus fibrosus and presses on the nerve that comes out from the spinal canal.

A disc prolapse can be very painful. The pain is usually worse in the leg. The pain may cause the body to tilt forward or to one side. Tilting to one side is quite common in disc prolapse.


Luckily, however, when the disc prolapses, the immune processes start. The body's warrior cells are called macrophages, and they arrive and collect around the disc prolapse.

Let us imagine that we accidentally leaked the jam out of the jam doughnut onto the kitchen table. If we had friendly ants in the kitchen, they would come and eat away the jam that leaked out of the jam doughnut. Similarly, the macrophages or the warrior cells in the body eat away the nucleus pulposus that has leaked out of the annulus fibrosus
.
As the prolapse resolves the pain decreases. Usually, the first part to obtain pain relief is the part farthest away from the body's centre. This means the leg pain resolves earlier. Sometimes some back pain may remain. The back pain is usually not severe and can be controlled by exercises.

All disc prolapses are not simple. Some may cause serious problems like cauda equina syndrome.

In cauda equina syndrome, the disc bulge is large and presses on the nerves to the waterworks and bowel. Passing urine and opening bowels may be affected. There may also be numbness in the saddle area. This requires emergency surgery.

So what are the exercises that one can do to help with disc prolapse and lower back pain

There are four stages for the treatment of disc prolapses or lower back pain. The four stages are synchrony, stability, strength and sustain. Synchrony involves getting the multifidus muscle to start working. As explained earlier, the multifidus weakens and is usually infiltrated with fat. The multifidus needs to be woken up first and it is important that the multifidus muscle contracts in synchrony with the other muscles. Hence the first stage is trying to get this synchrony. Once the synchrony has been established, then stability is important. Following stability, we need to build strength. This is all achieved in about 6 to 9 months' time. However, following that we need to sustain the benefit gained by regular exercises and keeping the muscles of the spine strong.

These exercises can be found on our website www.my-self-help.org.uk

It is important to note that strong muscles surrounding the back are like strong soldiers that protect the back.

Thank you so much for listening. This QR code will provide the link for the lower back exercises. If you have found this video helpful please like the video and subscribe to the channel.