What is a torn disc? How do you fix or help it? Does it Heal? Is there a treatment? Let’s dig in.
What Is a Torn Disc?
The spinal discs are shock absorbers that live at each level between the vertebral bones (1). They have a tough outer annulus part and a soft inner gel part (nucleus pulposis). The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. These tears are called: a torn disc, a disc tear, an annular tear, and when seen on MRI a “High-Intensity Zone” or HIZ. They can cause pain, mostly through ingrown nerves (2).
What are the Symptoms?
There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. not painful) or can cause pain. Usually, the bigger and brighter they are on the MRI image, the more likely they are to cause pain (3). A reliable symptom of disc pain is an inability to sit. This is usually back pain with any sitting of more than 5-15 minutes (called sitting intolerance). While it’s possible to have a painful torn disc without sitting intolerance, this is one hallmark that many physicians look for. In addition, painful torn discs are also common in younger patients who are under 50 years of age.
Common Symptoms of a Torn Disc
Calf Muscle Twitching
A twitching calf muscle may seem like no big deal, and if it’s just a temporary annoyance that lasts a couple of days and then goes away, it may be. However, it can also be a warning sign of something bigger, especially if it continues. So, today, we’re going to explain a little about the calf and why it’s not a good idea to ignore calf muscle twitching. If there’s one muscle you’re likely familiar with, it’s the calf muscle. If you reach around and grab your calf and flex it, the muscle you are actually feeling just under the surface is called the gastrocnemius muscle.
After a long day on your feet sitting down is supposed to be way to relaxing. Unfortunately for some sitting for any length of time can be painful. Most people experience low back pain at some point in their life. The lifetime prevalence of low back pain is 85% (1). Let’s take a deeper look at the different types of pain and causes of low back pain when sitting.
Pain can present in many different ways. It can be intermitent or constant. The quality of the low back pain can also vary depending upon the actual source of injury. Common examples include:
Sharp and Stabbing, Dull and Aching, Throbbing/ Pulsating, Pins and Needles, Burning, Electrical
When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis. When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.
Combination of injury and degeneration (*most often the case)
How Is a Torn Disc Diagnosed?
There are two ways. The first and most common is MRI. The disc tear is seen as a bright spot in the darker disc annulus, called an HIZ or annular tear. Another major way these tears get diagnosed is by using discography (4). This is where the doctor places a needle into the disc by using x-ray guidance and injects contrast dye (that can be seen under x-ray) to pressurize the disc. The doctor is looking both to see if the patient’s typical back pain can be recreated (concordant) and whether the disc leaks (annular tear or torn disc).
Is a Torn Disc the Same as a Herniated Disc?
Not really. A herniated disc is when that soft inner gel squirts out a tear in the tough outer covering. A torn disc means that the outer covering is damaged (annulus) but the inner gel is still contained. In addition, a torn disc can be painful by itself, whereas a herniated disc is mostly painful because the gel that squirts out can irritate local spinal nerves.
How Long Does a Torn Disc Take to Heal?
A torn disc can take a few weeks to months to heal, but whether it heals at all depends on where it’s located. The outer part of the disc has a good blood supply, so tears here tend to heal (5). The inner parts of the disc annulus have a poor blood supply, so tears here tend not to heal well.
What Is the Treatment for a Torn Disc?
Many patients with a torn disc try physical therapy and if that fails they often try epidural steroid injections. However, none of this promotes healing, as the high dose steroids used can inhibit healing and cause disc degeneration. (6) If that doesn’t work, many surgeons will attempt to offer a low back fusion, which is where the disc is removed and hardware and/or bone is placed to make sure the level doesn’t move. However, large studies have shown this procedure to be ineffective and it can cause the levels above and below to begin to break down, leading to new problems (7,8). See my video below:
Another option is replacing the disc with a device (disc arthroplasty). However, the same ASD shown with fusion above is also a problem with this disc replacement surgery (9).
Perc-Orthobiologic Annuloplasty (POA) – A New Approach
What if it was possible to heal a torn disc? The patient’s own concentrated platelets, injected via x-ray guidance into the painful and torn disc have been shown to reduce pain (10). Similar research published by our group and others has also shown that the patient’s own bone marrow concentrate or stem cells can do the same (11-13). This procedure is called Percutaneous Orthobiologic Annuloplasty (POA).
How would this work? The goal of these injections is to heal the tear. If you take a look at the video below, you’ll see a disc tear before POA which is the bright spot in the dark disc annulus and then that same area on MRI after POA, which now shows no bright spot. This patient also reported significantly increased ability to sit for more than just 5-10 minutes and went back to working out.
Who is a candidate for POA? Patients with painful discs who have significant sitting intolerance. Generally, an MRI or discogram is performed. We also tend to use “Biologic Discography” which means that instead of injecting a bunch of contrast dye which has been shown to harm disc cells (14), we inject your own concentrated blood platelets to pressurize the disc. That way we’re combining a treatment that may heal the tears with a test.
The upshot? A torn disc can be a big concern but realize that steroid injections and surgery are no longer your only options. There are newer treatments for back pain that aim to heal the disc tear.
Doctors Who Help with Torn Disc
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery
This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.
Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.
“Cracking” the back is a safe and effective way to stretch the joints of the spine. This exercise also relieves pain and discomfort in the joints. You’ve probably done it just after waking up or at the end of a long day without really thinking about it. The Benefits Of Cracking Your Lower Back There … Continued
It started as a dull ache and now has progressed. It feels like a knife in the back of your neck and is preventing you from daily activities. Medications, rest and conservative treatments have failed. Your doctor noticed on x-ray that the bones are out of alignment. He thinks you may have suffered a ligament … Continued
If you have had an MRI of your spine, you are probably like most patients. You read the MRI report and then google every term on your MRI report from the Radiologist trying to figure out what it all means! Alternatives to Laminectomy should be an important part of that search. Today you’re in luck, … Continued
The multifidus muscle is an important stabilizer of the lumbar spine. Dr. Schultz discusses what the multifidus muscle is, its importance, what muscle atrophy is, the association between multifidus atrophy and low back pain, and a new, exciting study at the Centeno-Schultz Clinic using PRP injections.
A herniated disc can stop you in your tracks. Dr. Schultz reviews what a disc herniation is, how it is diagnosed, whether it can heal on its own, current treatments, and a natural way to treat a herniated disc.
Dr. Pitts discusses PRP for Herniated Disc, Disc Bulge, and Disc Protrusion Transcript Hello, everybody. This is Dr. John Pitts of the Centeno-Schultz Clinic, where we are the leaders and inventors of much of the field of interventional orthopedics, which is basically treating and diagnosing musculoskeletal, orthopedic-type problems using injections and regenerative agents rather than … Continued
(2) Ito K, Creemers L. Mechanisms of intervertebral disk degeneration/injury and pain: a review. Global Spine J. 2013;3(3):145–152. doi: 10.1055/s-0033-1347300.
(3) Teraguchi M, Yim R, Cheung JP, Samartzis D. The association of high-intensity zones on MRI and low back pain: a systematic review. Scoliosis Spinal Disord. 2018;13:22. Published 2018 Oct 20. doi:10.1186/s13013-018-0168-9
(4) Ito K, Creemers L. Mechanisms of intervertebral disk degeneration/injury and pain: a review. Global Spine J. 2013;3(3):145–152. doi: 10.1055/s-0033-1347300
(6) Aoki M, Kato F, Mimatsu K, Iwata H. Histologic changes in the intervertebral disc after intradiscal injections of methylprednisolone acetate in rabbits. Spine (Phila Pa 1976). 1997 Jan 15;22(2):127-31. https://www.ncbi.nlm.nih.gov/pubmed/9122791
(7) Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech. 2014 Jul;27(5):297-304. doi: 10.1097/BSD.0000000000000072.
(8) Okuda S, Yamashita T, Matsumoto T, et al. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Global Spine J. 2018;8(7):722–727. doi:10.1177/2192568218766488 torn disc
(9) Zigler JE, Blumenthal SL, Guyer RD, Ohnmeiss DD, Patel L. Progression of Adjacent-level Degeneration After Lumbar Total Disc Replacement: Results of a Post-hoc Analysis of Patients With Available Radiographs From a Prospective Study With 5-year Follow-up. Spine (Phila Pa 1976). 2018;43(20):1395–1400. doi: 10.1097/BRS.0000000000002647
(10) Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, Harrison JR, Gribbin CK, LaSalle EE, Nguyen JT, Solomon JL, Lutz GE. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R. 2016 Jan;8(1):1-10; quiz 10. doi: 10.1016/j.pmrj.2015.08.010.
(11) Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop. 2017 Oct;41(10):2097-2103. doi: 10.1007/s00264-017-3560-9.
(12) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi: 10.1186/s12967-016-1015-5
(13) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi: 10.1186/s12967-017-1300-y
(14) Chee AV, Ren J, Lenart BA, Chen EY, Zhang Y, An HS. Cytotoxicity of local anesthetics and nonionic contrast agents on bovine intervertebral disc cells cultured in a three-dimensional culture system. Spine J. 2014;14(3):491–498. doi: 10.1016/j.spinee.2013.06.095
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