Key takeaways
- Disc degeneration and bulges are common in people with no back pain, and become more common with age.
- Many disc herniations shrink on their own over time, and the larger ones are the most likely to.
- Most people with sciatica from a herniated disc improve with conservative care.
- Imaging is most useful when warning signs are present or surgery is being considered.
Reviewed by Dr. Manan Patel, PT, DPT, TPS. Updated October 17, 2026.
What the words on your report mean
- Disc degeneration or desiccation: the disc has lost some water and height. This is a normal age change, much like gray hair.
- Bulge: the disc extends a little beyond the edges of the vertebrae over a broad area.
- Protrusion or extrusion (herniation): some of the disc's inner material pushes out through the outer wall in one area. An extrusion pushes out farther.
- Sequestration: a piece of disc material has separated from the disc.
- Annular fissure (tear): a crack in the disc's outer layer, common in people without pain.
- Stenosis: narrowing of the space around the spinal cord or nerves.
These terms come from standard spine imaging definitions.1
These findings are common in people without pain
A large review of spine imaging in people with no back pain found that disc changes become more common with every decade of life:2
| Finding in people with no pain | Age 20 | Age 40 | Age 60 | Age 80 |
|---|---|---|---|---|
| Disc degeneration | 37% | 68% | 88% | 96% |
| Disc bulge | 30% | 50% | 69% | 84% |
| Disc protrusion | 29% | 33% | 38% | 43% |
In other words, a disc bulge on an MRI is often an incidental finding. Whether it explains your pain depends on your symptoms and examination.
Herniated discs often shrink on their own
A systematic review found that herniated discs frequently regress without surgery. The chance of regression was about 96 percent for sequestrations, 70 percent for extrusions, 41 percent for protrusions and 13 percent for bulges.3 The larger, more dramatic-looking herniations were the most likely to shrink.
So what causes the pain?
Pain from a disc problem usually comes from inflammation and irritation of a nearby nerve root, along with protective muscle guarding and a more sensitive nervous system. That is why two people with identical scans can feel completely different, and why pain can improve while the scan looks the same. Our guide to pain science explains this in more detail.
When imaging is useful
Guidelines advise against routine imaging for low back pain without warning signs.4 Imaging makes sense when there are signs of a serious problem, when nerve weakness is getting worse, or when symptoms have not improved and an injection or surgery is being considered.
Questions to ask about your MRI
- Which finding, if any, do you think explains my symptoms, and which are normal age changes?
- Do my symptoms and examination match the level shown on the scan?
- Is there anything that needs urgent treatment, or can I try conservative care first?
- What would change the plan, such as worsening weakness?
When surgery is considered
Surgery for a herniated disc is usually considered when there is cauda equina syndrome, severe or worsening leg weakness, or leg pain that remains disabling despite several weeks to months of good conservative care. For many people, surgery and conservative care lead to similar results over the longer term, so the decision often comes down to how severe the symptoms are and personal preference. A good physical therapy plan does not rule out surgery later; it often makes recovery from surgery easier.
What helps sciatica and disc pain
- Staying active within comfort, rather than bed rest
- Exercise and movements that ease or centralize leg symptoms
- Manual therapy as part of an active plan
- Pain neuroscience education to reduce fear of movement
- A gradual return to sitting, lifting and work
UK national guidance recommends exercise for low back pain and sciatica, with manual therapy only as part of a treatment package that includes exercise.5 Most people with sciatica improve over weeks to months.
Myth or fact?
Tap each statement to see what the evidence says.
Myth or fact?A herniated disc means I will need surgery.
Myth. Most people with a herniated disc improve without surgery. Surgery is considered for severe or worsening weakness, cauda equina symptoms, or pain that stays disabling despite good conservative care.
Myth or fact?Degenerative disc disease means my spine is crumbling.
Myth. Disc degeneration is a normal age change seen in most adults over 50, many with no pain. It describes the scan, not your future.
Myth or fact?The worse the scan looks, the worse the pain.
Myth. Scan findings and pain levels often do not match, and large herniations are actually the most likely to shrink on their own.
Keep reading
- Neck and back pain from desk work: what actually helpsWhy perfect posture is a myth, which desk changes help, and a simple daily plan.3 min read · Patients
- Early physical therapy for neck and back pain: a referral guideGuideline points for neck pain, whiplash, radiculopathy, back pain and post-op spine rehab.3 min read · Clinicians
- All guidesBrowse the full learning center.
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References
- Fardon DF, et al. Lumbar disc nomenclature: version 2.0. The Spine Journal. 2014.
- Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015.
- Chiu CC, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. 2015.
- Chou R, et al. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine. 2011.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, updated 2020.
- George SZ, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021.
This guide is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor.
