My MRI Shows a Disc Bulge or Herniation, So Why Do I Still Have Pain?

A disc bulge or herniation on MRI doesn't automatically explain your pain, since research consistently shows a large share of pain-free adults have the same findings on their own scans. Many herniations also shrink or get reabsorbed by the body naturally over time, sometimes disappearing almost entirely. The more useful question usually isn't what a single still image shows, but what's actually happening functionally in your spine day to day.

If seeing the word "herniation" on a report made your back feel more fragile, even though the pain hasn't really changed since before you got the scan, that reaction makes complete sense, and it's worth separating from what the finding actually means for your recovery.

What the Scan Shows, and What It Doesn't

Disc bulges and herniations are common structural findings, and studies of people with no back pain at all consistently find them present at high rates, particularly as people get into their thirties and beyond. A structure showing up on a scan and that same structure actively generating your pain are not automatically the same thing. There's also a genuinely encouraging piece of biology most patients are never told: a meaningful proportion of herniated disc material is naturally broken down and reabsorbed by the body's own immune response over the following months, often shrinking significantly or resolving entirely, even for herniations that initially looked large or alarming on imaging. Your MRI report is describing what your spine looked like on the day of the scan, not a permanent, unchanging condition.

The second reason the scan often doesn't explain your ongoing pain connects directly to the rest of this cluster. MRI captures a still image of your spine at rest. It cannot show the multifidus inhibition or the thoracic-lumbar coupling pattern covered in our piece on recurring low back pain, the functional, movement-based drivers that are frequently what's actually generating day-to-day symptoms, independent of whatever the disc itself is doing. This is a major reason two people can have nearly identical MRI findings and completely different pain experiences. The scan captured the same structure in both of them. It didn't capture which one has a spine that's still compensating for an inactive stabilizing muscle and a restricted thoracic spine.

When It's Something More Serious

Most disc bulges and herniations respond well to conservative care and don't require surgery. Get evaluated promptly, however, for loss of bladder or bowel control, saddle numbness, progressive leg weakness, or pain accompanied by fever, unexplained weight loss, or a history of cancer, since these fall outside a typical disc finding and need prompt attention.

How This Gets Addressed

Because the functional driver behind your pain usually isn't visible on the scan that prompted the question, addressing it well starts with an evaluation of how your spine actually moves, not the imaging report alone.

Chiropractic care assesses your spine's movement directly, identifying the specific restricted joints and compensation patterns an MRI can't capture, and mobilizes them accordingly.

Massage therapy addresses the muscle tension that's built up around those restrictions, tension that often correlates far more closely with your actual pain than the disc finding does.

For deep, persistent tension that doesn't fully resolve with massage, dry needling reaches those areas with more precision.

Two additional pieces complete the picture. Physical therapy builds in the same multifidus reactivation and thoracic mobility work covered elsewhere in this series, the functional pattern the imaging never measured in the first place.

And because inflammation and blood sugar regulation both affect how well disc tissue heals and how quickly herniated material gets reabsorbed, naturopathic medicine evaluates those contributors through targeted lab testing when recovery is slower than expected.

You can learn more about our full approach to low back pain here.

Most patients get more useful, actionable information from a hands-on functional evaluation than from the imaging report alone, since the scan shows what your spine looks like at rest, and the exam shows what's actually happening when it moves.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

Should I be worried about my disc herniation? 

Most herniations are a manageable, common finding rather than a cause for alarm, and a significant share improve or resolve on their own over time as the body reabsorbs the disc material. What matters more is whether it's actively correlating with your specific symptoms, which a physical exam can clarify far better than the scan alone.

Do herniated discs need surgery? 

The large majority of disc herniations, even ones causing real symptoms, improve with conservative care and do not require surgery. Surgical evaluation becomes appropriate mainly when there's progressive neurological loss, significant weakness, or symptoms that don't improve after a genuine course of conservative treatment.

Can a disc herniation actually heal on its own? 

Yes, in many cases. The body's immune system can gradually break down and reabsorb herniated disc material over months, often reducing its size substantially, which is part of why so many people recover fully without ever needing surgery despite an initially concerning-looking scan.