ABOUT RESORPTION
This web page is intended to provide you with answers to the questions on how and why disc herniation may be reduced without a surgery. We will try to address the issue in a comprehensive manner, analyze several examples of MRI images, and discuss whether we can influence the process and whether there is any sense in it.
Table of contents
BRIEF INTRODUCTION TO ANATOMY
Our spine is a hard skeletal structure consisting of 33 vertebrae
Each vertebrae has a hole in the center and when the vertebrae are joined together in the spine, these holes form the spinal canal which contains the spinal cord and nerve roots. Between the vertebrae, there are intervertebral discs, they act as shock absorbers and are responsible for spine flexibility. Each vertebrae also has 2 sets of facet joints, as intervertebral discs, they also provide stability and flexibility to the spine.

An important thing to remember is that the disc has a poor blood supply, it does not have its own vessels, and nutrients are absorbed by diffusion (from the surrounding tissues).

Overtime in the course of life, these structures are prone to degenerative changes and aging.

Each disc consists of a hard outer fibrous ring and soft inner core, nucleus pulposus.
The fibrous ring is so hard that it can withstand pressure of up to 20 atmospheres. Normally, the pressure inside our intervertebral discs is similar to the pressure in a car tire.

When the fibrous ring wears down, tears out causing the nucleus pulposus to budge out, this is spinal disc herniation. Hernias are classified into 2 types: common (pic.1) and sequestrated, when hernia breaks off from the disc and has no continuity with it (pic.2).
YOU HAVE DISC HERNIATION – WHAT IS THE PROBLEM?
The main problem is that hernia presses the nerve root mechanically and as a result of active inflammation.
Acute lumbar disc herniation may manifest as back pain that radiates into your arm or leg. You may feel weakness in some muscles, stiffness, numbness, and some other symptoms.
HOW TO DIAGNOSE HERNIATED DISC?
A herniated disc may be found during clinical neurological and orthopedic examination and by the results of magnetic resonance imaging (MRI).

This is what a large lumbar hernia of one of my patients looks like. Later it disappeared.
HERNIATED DISC RESORPTION
Resorption is reduction or complete disappearance of disc herniation without any surgical intervention. In other words, a patient had a herniated disc, but as a result of treatment or due to body defense mechanisms, it disappeared. Let us have a look at this situation on an MRI scan.

On this scan, you can see complete resorption, which means that the disc structure is actually restored. But is it really useful and important for a patient to have herniated disc reduction?
SCIENTIFIC INQUIRY
The first scientific papers to mention spontaneous resorption of the herniated disc appeared at the end of 1984 and the beginning of 1985.

Currently, only few exceptional cases of resorption are described in the published papers and several large reviews including 2 meta-analyses – they are large scientific papers that study all existing information concerning the issue and give conclusions based on the information.

The total number of scientific papers on the issue is more than several hundred.

Many papers share the same key conclusion – resorption is real and the future of regenerative medicine is of great promise.
The first scientific papers to mention spontaneous resorption of the herniated disc appeared at the end of 1984 and the beginning of 1985.

Currently, only few exceptional cases of resorption are described in the published papers and several large reviews including 2 meta-analyses – they are large scientific papers that study all existing information concerning the issue and give conclusions based on the information.

The total number of scientific papers on the issue is more than several hundred.

Many papers share the same key conclusion – resorption is real and the future of regenerative medicine is of great promise.
IS RESORPTION MAGIC?
Resorption is a physiological process inherited by our body.

It would be strange to assume that the regeneration mechanism of damaged discs had not been developed in the process of evolution, because such damages occurred in ancient people and 10.000 years ago, but not only after we have created MRI and found herniated discs.

Basically, resorption is a local disc regeneration that is accompanied by herniated disc absorption. If we look at this like that, then it seems to be a normal physiological process, but not magic or even some native healing.
Resorption is a physiological process inherited by our body.

It would be strange to assume that the regeneration mechanism of damaged discs had not been developed in the process of evolution, because such damages occurred in ancient people and 10.000 years ago, but not only after we have created MRI and found herniated discs.

Basically, resorption is a local disc regeneration that is accompanied by herniated disc absorption. If we look at this like that, then it seems to be a normal physiological process, but not magic or even some native healing.
DRAWING ANALOGIES
Now let us step aside from a herniated disc for a while and take a broader look at the regeneration process. For better understanding, let us compare resorption with a bone fracture. Further, we are going to use the same comparison as it is very demonstrative and helps to better understand treatment approaches.
  • When a bone fracture or some other trauma occurs, our body initiates a regeneration process at the site of the injury. The regeneration process always goes through inflammation. You may recall, for example, when being a child you got scrapes or bruises, the site became swollen, and then a crust containing fibrin and platelets formed; then the swelling reduced and the wound healed. The same is happening with fractures or herniated discs.
MECHANISMS OF HERNIATED DISC RESORPTION
  • 1
    Inflammation
    at the site of a herniated disc
  • 2
    The formation
    of new blood vessels as a result of growth factors release
  • 3
    Hernia absorption
    by the cells body own immune cells, predominantly macrophages
  • 4
    Loss of water
    in the disc and its gradual drying out (which consequently causes a reduction in size).
Here we should make a brief note about the mechanisms. The nucleus pulposus is foreign to our immune system, and when its fragment gets into the epidural space (this is a space in the spine where hernia migrates to) immune response is triggered because hernia cells come up against the immunity. And the regenerative process is triggered through inflammation.
Nature initially created this smart mechanism. For example, a primitive man had a herniated disc. As a result of this condition, they could not move anymore and died because they were not able to get food. Consequently, such mechanisms are necessary for saving the human race.
Now let us try and answer the question of how long does it take resorption to occur?
PERIOD OF RESORPTION
There is no easy answer to this question. While some authors say that they observed resorption to happen from 3 to 21 months, the majority come to the conclusion that the average period of resorption is 12-15 months without any stimulating treatment.

Proper treatment and medical screening may reduce this period to 3-6 months.

This difference can be explained by many factors such as the size of a hernia, its degree, location, and patient's condition.

How can we predict the process?
PROGNOSIS AND POSSIBILITY OF RESORPTION
Attention! Any prognosis is based on MRI scans (not MRI description).

Currently, there is several criteria that allow estimating probability and time of resorption. Naturally, MRI should be associated with current deterioration, i.e. it should be done after the pain syndrome occurred and the scans should be done not later than 3 months (preferably, not later than 1 month).
MRI scans show the state of the disc, hernia size, its MRI signal intensity, degree of inflammation of surrounding tissues, state of muscles, and some more parameters. A set of criteria allow to make a prognosis but does not guarantee that resorption will occur because resorption depends on many other factors.
You can send your MRI scans to our e-mail
FACTORS INFLUENCING RESORPTION
Size does count. From the results of research, it is known that large hernias are better resorbed than smaller ones. If a hernia is displaced and has no continuity with the disc, then such sequestrated disc herniation has a great potential for resorption (more than 90%).
How acute the process is. The more acute the process, the stronger the pain. On the other hand, the more acute the process, the faster resorption. Why is it so? The basis of the process is inflammation which directly depends on the damage degree and the speed with which this damage has been developing. So, this correlation seems perfectly logical. The larger acute hernia, the stronger inflammation consequently, resorption is happening more actively as well.
Important:
While it may seem logical (large hernia = severe inflammation), the size of a hernia and how acute is the process are not always interrelated. True, it is often the case, but an old hernia that has not been resorbed under the load continues each time to bulge out. And each time a patient suffers aggravation of the condition and pain like an electric shock.

However, it does not always result in severe inflammation.

For example, in the picture you can see a small protrusion and a sequestrated hernia. A sequestrated hernia has a better chance for resorption but a clinical picture and pain syndrome will be much more severe.
Disc nutrition: Disc has a poor blood supply and disc metabolic processes are very slow. It is a myth that the disc gets nutrition from surrounding muscles. It is not so. All the nutrients are absorbed by diffusion from vertebral bodies and it normally happens during walking. And vertebral bodies receive necessary nutrients from the arteries that branch from the aorta.

Our opinion: Correct tactic doubles the chances for resorption. As for the clinical management of patients with a herniated disc, it is not such a sure thing.

When we say tactic, we do not mean drugs and injections, because a herniated disc is a biomechanical and degenerative condition, so drugs are not our best choice. We would also like to underline the phrase management of a patient.

It is critical to not let the patient make fatal mistakes and manage him helping to overcome the diseases and become healthy.
TACTIC. WHAT SHOULD A PATIENT DO?
Here is the situation that I see almost in every patient with a herniated disc.
Tkachev A.
You suddenly have severe pain, you decided to visit a doctor and did an MRI just in case. Your doctor prescribed you pain medications, myorelaxants (to relax your muscles) and recommended that you should strengthen the core and do gymnastic exercises. Being a responsible patient, you did everything you were told, but the pain is still there. You visit the doctor again.

Now massage or manual therapy is added to the treatment, you still should take the drugs and strengthen your muscles. In case the pain is intolerable, you are recommended an intradiscal injection of Diprospan to alleviate the pain. You agree to do everything because you lost the ability to sleep as a result of pain. 3-4 weeks after you can work, at least. You keep on with the exercises and massage.

This is not the worst scenario, by the way.

Now let us go back to what I have said earlier – acute disc herniation is similar to fracture or trauma.
Some more analogies.

You were walking on the street and learned good news – "all restrictions are lifted, coronavirus is stopped!"
You were so overwhelmed by the news that you fell and broke your arm. So, your arm is broken, what will be the tactic? In the first place, we need to make sure that the pieces of bones are lined up correctly to avoid deformity. Then we fixate the arm and pain medications may also be prescribed.

Nobody in their right mind would:

  • knead the arm
  • set a bone
  • strengthen the core
  • stretch the arm
  • massage the arm
  • crack the joints
  • swim with the broken arm
Some more analogies.

You were walking on the street and learned good news – "all restrictions are lifted, coronavirus is stopped!"
You were so overwhelmed by the news that you fell and broke your arm. So, your arm is broken, what will be the tactic? In the first place, we need to make sure that the pieces of bones are lined up correctly to avoid deformity. Then we fixate the arm and pain medications may also be prescribed.

Nobody in their right mind would:

  • knead the arm
  • set a bone
  • strengthen the core
  • stretch the arm
  • massage the arm
  • crack the joints
  • swim with the broken arm
You need time and rest for the arm to heal. It is necessary for a fracture site to go through all the stages of inflammation. Th swelling will be present but it will reduce; immune cells will migrate to this sire and as a result of very active inflammation, the site may be warm to touch. This is absolutely normal. This is how it should be.

And what if one manipulates the broken arm as I mentioned above?

Well, the union will be delayed or malunion may occur; in the worst-case scenario, it may be nonunion.

So the approach to treating acute (I stress the word acute!) disc herniation should be similar to fracture treatment. This is fundamental for healing and adequate regeneration (resorption) processes.

Acute disc herniation lasts for 4 weeks. During this period you want to avoid certain physical exercises, especially forward bent exercises. Daily home routine is allowed, distance walking is also fine if you feel well.

Some people need detailed explanations about everything, herniated disc is not an exception. Let us play a game "Home and daily routine is not..."
  • This is NOT:
    • digging up potatoes and pulling weeds
    • lifting and carrying a 15 kg child
    • driving or sitting in front of the computer for 10 hours a day
    • using your own weight to exercise in a gym
    • going to sauna with further swimming in an ice hole
    • changing a car tyre
    • papering the walls or renovating your apartment
    • moving a new table up the stairs to your apartment
    • dancing tango
These are all real-life examples. Our patients did each and every of these things and they all had a reason why they could not stop doing it.

There are 2 scenarios, please choose:
  • WRONG SCENARIO
    You do as you think is right and you do not have any complaints about your back pain.
  • CORRECT SCENARIO
    You play the game by boring rules, laying the foundation for adequate rehabilitation and further normal activity and working ability.
TREATMENT
This is a very interesting topic. Do we have to treat disc herniation? What type of hernia does require treatment? Can we treat a herniated disc in such a manner to speed up/maintain resorption? When and what should we do?
WHO TREATS BACK PAIN?
A huge number of different specialists (though not all of them can be considered specialists) deal with back pain. Let us try and remember all those noble people who contribute to this demanding undertaking: neurologists, general practitioners, orthopedists, neurosurgeons, rheumatologists, chiropractors, osteopaths, manual therapists, bone setters, needle reflex therapy specialists, occupational therapists, kinesiologists, hirudotherapy specialists, homeopathists and even wise-women.

This means that there is no one-size-fits-all approach to treating back pain.

Every specialist looks at it from their own angle and does what they want. But the biggest concern is that it is all absolutely legal (in most cases).

Everyone is ready to do their best to advocate for their truth fighting with those who believe or think differently.

P.S. Presently, worldwide there is no consensus on managing this condition.
A huge number of different specialists (though not all of them can be considered specialists) deal with back pain. Let us try and remember all those noble people who contribute to this demanding undertaking: neurologists, general practitioners, orthopedists, neurosurgeons, rheumatologists, chiropractors, osteopaths, manual therapists, bone setters, needle reflex therapy specialists, occupational therapists, kinesiologists, hirudotherapy specialists, homeopathists and even wise-women.

This means that there is no one-size-fits-all approach to treating back pain.

Every specialist looks at it from their own angle and does what they want. But the biggest concern is that it is all absolutely legal (in most cases).

Everyone is ready to do their best to advocate for their truth fighting with those who believe or think differently.

P.S. Presently, worldwide there is no consensus on managing this condition.
DOES HERNIATED DISC REQUIRE TREATMENT?
Shortly, not in all cases.

Now we will explain in more detail: disc herniation is not always accompanied by a pain syndrome. It was proved many times. Research, in which 100 randomly selected people at the age of 30-50 years old took part, showed that almost half of them had disc herniation. However, not all of them reported back pain. It means that the appearance and disappearance of disc herniation is a normal thing and it is not always associated with back pain.
WHAT TYPES OF HERNIA REQUIRE TREATMENT?
The one that is associated with a typical pain syndrome radiating into the arm or leg and its association with pain is confirmed by medical history and the results of neurological examination. This condition is called radiculopathy when a nerve in the spine is compressed.

In the picture you can see types of lumbar radiculopathy. Those areas where a patient can feel pain are marked in pink.
The question of an accurate diagnosis for back pain remains open. The common diagnosis is still non-specific back pain. However, the results of proper neurological and orthopedic examination almost always may help to find the cause of pain.
IS THERE ANY SENSE IN REDUCING HERNIA (RESORPTION)?
Shortly, yes, there is sense if there are clinical findings. In case, pain is caused by facet joint damage, then disc herniation reduction will not bring you any physical or psychological relief. And this research showed a close connection between disc herniation reduction and symptoms alleviation.
The National Center for Biotechnology Information
Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome
CAN WE INFLUENCE RESORPTION?
Yes.
General points and approach:
  • competent work with a patient, explanation of mechanisms of intervertebral disc regeneration
  • correct stereotypic movements and general exercise regimen
  • physical rehabilitation: adequate pain management from acute period to healing
  • early estimation of probabilities for resorption and the need in it based on MRI results
Consequently, if a patient with a disc herniation does not make serious mistakes, then they will have a better chance for resorption. I will repeat the example with the broken arm for illustration purposes: train, strengthen or set a bone immediately after you break your arm and you can forget about a proper union.
IMMEDIATE TREATMENT
Pain management. It is necessary to relieve pain syndrome. Everything that pharmacology can offer may be used from common pain medications to anti-epileptic drugs and antidepressants.

Now almost any pain syndrome can be tolerated due to medications and then regenerative processes will come into the game and the pain will cease.
RESORPTION STIMULATION
Resorption is a normal process that leads to healing. We can speed up and stimulate this process by improving blood supply, metabolism, and alleviating acute pain.
There are several options:
  • Robotic MLS laser therapy
    Laser helps to improve blood supply and stimulate the process of tissue regeneration. Its depth of penetration is 7-8 centimeters, so this procedure is safe for a patient. If we follow protocols, then the effect will be observed in a short time.
  • Needle reflex therapy
    This therapy proved its efficiency in reducing chronic acute pain as some research showed. The mechanism of action is based on a neurohumoral theory for pain management. Such treatment speeds up the healing process.
SURGICAL TREATMENT. WHEN IS IT REQUIRED?
While the main aim of this guide is to explain what resorption is, we believe it is important to say a few words about surgical treatment as well.

Absolute indications for surgery:

  • Compression of cauda equina spinal roots. (This condition causes numbness of the genital area and muscle weakness)
  • Pelvic floor dysfunction (mostly, urinary and fecal incontinence)
  • Intractable pain syndrome after adequate long-term treatment.
That is. There are no other absolute indications for surgery.

Operative interventions are often offered to patients without a reasonable basis. On average, the successful outcome of surgeries is 70-90%. The effectiveness of surgeries compared to conservative treatment of patients with a disc herniation in the long-term is equal and does not have any additional advantages. The risk of recurrence after microsurgical treatment is 5-30%.

Narrowing of the spinal canal (stenosis) occurs in 10-30 % of cases. Damage of the upper spinal cord segment occurs in 58% of cases, the secondary stenosis of the spinal cord and the damage of facet joints occur in 45 % of cases. There are also some other complications that can be classified as failed back surgery syndrome.

Summary: surgery is not a is not a silver bullet. In the long-term, conservative treatment may prove even more effective. Surgery should be offered only if medically required and this is a measure of last resort. Any competent neurologist and neurosurgeon is well aware of it.
FREQUENTLY ASKED QUESTIONS AND ANSWERS
Does resorption exist?
Absolutely.
What are the chances?
It depends. We need to see a recent MRI scan (not later than 1-3 months), examine a patient, and analyze their medical history. Sometimes we can say for sure only by having MRI results.
How long should I wait before having a second MRI examination?
Again, it depends. 1-3 months is fast resorption, 6-12 is standard resorption.
Will I suffer back pain all this time?
Of course, not. Normally, adequate treatment helps to reduce pain by 50-70 % during a week. Doctors do not allow their patients to live with ongoing pain and they should do their best to prevent the development of chronic pain syndrome.
Then why should I wait for 3-6 months to have the second MRI examination?
This is because pain is normally alleviated earlier than resorption occurs, and this can be explained by the stages of inflammation. Typically, not only disc damage but also muscle spasms, tissue, and nerve swelling contribute to pain syndrome. If we eliminate these problems, we get rid of pain. But the process of resorption is not that fast.
Can it be that treatment does not help\resorption does not occur?
Anything can happen. Sometimes there are absolute indications for surgery when conservative treatment is not successful. Medicine is not math and no one can predict the results with 100% guaranty.
"There is no magic in the process of resorption. We have learned about so many incidences of herniated discs just recently with improved access to MRI. It would be unreasonable to assume that nature and evolution did not instill mechanisms of healing for a disc herniation. We just help nature in this process".
CLINICAL EXAMPLES
Patient: Woman, 40 years old
Diagnosis: big sequestrated herniaеted disc L4-L5. Size - 1,2х2,3 cm
Result: after the 1st 12-days treatment session. Usually such type of herniated disc responds to our treatment very well. Mostly it takes 1-2 months for full resorption in such cases
Patient: Man, 50 years old
Diagnosis: sequestrated herniated disc L3-L4 with the right cranial migration. Size - 2х1 cm
Result: complete sequester resorption and partial hernia resorption. Here it is 2,5 months between MRI examination before and after (Nobember 5, 2018 - February 2, 2019)
Patient: Woman, 35 years old
Diagnosis: sequestrated herniated disc
Result: No more complaints. The patient came back to full-quality life. Here it is 2,5 months between MRI examination before and after (March 26, 2018 - June 15, 2018)
Patient: Woman, 35 years old
Diagnosis: huge herniaеted disc L4-L5. Size - 1,2х2,3 cm
Result: after the 1st 12-days treatment session
Patient: man, 36 years old
Diagnosis: very huge sequestrated herniated disc
Result: it took only 1 course of our resorption therapy to reduce this herniated disc. No more complaints. The patient came back to full-quality life
Patient: woman, 34 years old
Diagnosis: huge herniaеted disc L4-L5. Size - 1,3х1,7cm + sequestration 1,0х09 cm
The MRI results showed full spinal stenosis. It is surgical indication in 99%.
Result: after the 1 st course of our treatment. The small light part of the herniated disc is awaiting the 2nd course to dissapear at all
How to get a treatment
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