If you’ve ever been diagnosed with a lumbar disc herniation, you might have been told surgery is the next step after conservative treatments don’t work. But what if I told you your body could resorb that herniated disc material naturally—and that physical therapy plays a starring role?
In their 2024 systematic review, Xie et al. show that about 76.6% of lumbar disc herniations (LDH) shrink without surgery (PubMed). Let’s dig into what this means—and why PT can not only capitalize on this natural process but help rebuild resilient, pain-free spines.
1. How Common Is Spontaneous Disc Resorption?
Xie et al. analyzed 34 studies, representing 2,199 patients treated non-surgically for LDH. The average resorption rate was 76.6%, though individual studies ranged between 20 % and over 96 % (Orthopedic Reviews).
Key takeaways:
- Most disc herniations decrease in size during the first 3–6 months of conservative care .
- Larger herniations, especially those that are “prolapsed” or sequestered, tend to resorb faster (Orthopedic Reviews).
- Certain MRI features—like rim enhancement and exposure to epidural vessels via a ruptured posterior longitudinal ligament—increase the likelihood of resorption (Orthopedic Reviews).
2. Why Does the Body Resorb Herniated Discs?
The review identified several mechanisms through which the body naturally clears disc material:
- Inflammatory response – Herniated nucleus pulposus (NP) material triggers cytokine release (e.g., TNF‑α, IL‑6) (Orthopedic Reviews).
- Neovascular growth – New blood vessels invade the herniated tissue, bringing in reparative cells (Orthopedic Reviews).
- Macrophage infiltration – These immune cells phagocytose NP material, essentially “eating” the herniation (PubMed).
- Matrix degradation – Enzymes like metalloproteinases (MMP‑3, MMP‑7) break down the extracellular matrix, aiding resorption (Orthopedic Reviews).
The most prevalent mechanism: macrophage-driven inflammatory resorption (PubMed).
3. Clinical Predictors: Who Is Most Likely to Resorb?
Xie et al. identified imaging features linked with higher spontaneous resorption rates:
- Sequestration/prolapsed disc material—especially when outside the posterior longitudinal ligament—tends to resorb more readily (Orthopedic Reviews).
- Larger herniation size – counterintuitively, larger herniations show quicker shrinkage (ResearchGate).
- Rim enhancement on gadolinium-enhanced MRI, indicating vascular invasion and inflammation (Orthopedic Reviews).
- Posterior longitudinal ligament disruption, which allows NP material to access the epidural vasculature (Orthopedic Reviews).
- Absence of Modic endplate changes—likely due to less structural impediment to resorption (Orthopedic Reviews).
Still, there’s individual variability, and imaging findings don’t perfectly align with patient symptoms.
4. What It Means For You—and What PT Can Do
a) Respect the Body’s Natural Healing
Since most herniations shrink naturally in 3–6 months, rushing to surgery isn’t always necessary. Conservative care—including PT—should be your first line of defense, especially when no red flags (like progressive weakness or bowel/bladder issues) are present.
b) Support Resorption & Improve Function
Here’s how PT can complement the body’s healing process:
- Tailored load management – structured activity progression encourages neovascularization and immune engagement without overloading passive tissues.
- Mobility optimization – improving spinal, hip, and thoracic mobility reduces stress on neural tissues and helps distribute load.
- Motor control training – reactivating deep stabilizers (multifidi, transverse abdominis) supports the spine and reduces aberrant movements.
- Progressive strengthening – reinforcing posterior chain muscles balances spine loading dynamics.
- Body mechanics education – teaching proper lifting, bending, and movement prevents re-herniation and compensatory pain.
5. Anatomy & Physiology Refresher
Understanding why PT matters begins with anatomy:
- Nucleus pulposus (NP) – gel-like core that can herniate through the annulus fibrosus.
- Annulus fibrosus – tough outer ring that resists NP protrusion.
- Posterior longitudinal ligament – runs along the spine’s back and often ruptures during herniation.
- Spinal nerve roots – vulnerable to compression and irritation when NP protrudes.
In the resorption process, immune cells access the NP via epidural vessels, especially when the PLL is breached. Enzyme-driven breakdown reduces NP size, and vascular ingrowth helps clear debris.
PT steps in to restore dynamic balance, encourage mobile and controlled movement, and address structural compensations.
6. Here’s What a PT Plan Might Look Like
A thoughtful rehabilitation plan often spans 3–6 months, aligning with the typical resorption timeline.
🗓 Phase 1: Inflammation Control & Load Tolerance (Weeks 0–4)
- Pain relief modalities – modalities like heat, ice, or gentle manual traction.
- Isometric core drills – low-dose activation of inner core muscles:
- Brush breathing (diaphragm and TA activation)
- Quadruped abdominal bracing
- Gentle mobility – hip and spine rotations, pelvic tilts.
- Early non-impact movement – walking, aquatic therapy.
- Education – posture, positioning, activity pacing, and technique.
Phase 2: Stability, Motor Control & Movement Quality (Weeks 4–12)
- Dynamic core progression – bird-dogs, dead bugs, chops and lifts.
- Posterior chain activation – glute bridges, hip hinges, banded sidesteps.
- Controlled loading – progressive deadlifts, suitcase carries.
- Thoracic mobility – foam roller extension, open-book stretches.
- Functional integration – sit-to-stand with load, hinge patterns.
Phase 3: Strength, Resilience & Return to Activity (Weeks 12+)
- Heavy posterior chain work – squats, Romanian deadlifts.
- Loaded carries – farmer’s walks, suitcase variations.
- Explosive drills – medicine ball chops, jumping variations.
- Work-specific training – lifting mechanics, bending strategies.
- Ongoing education – self-management, movement hygiene, long‑term strategies.
7. When to Partner With Medical Teams
While conservative treatment is effective, PT isn’t a substitute for medical assessment. Consider follow-up if:
- Progressive neurological changes
- Severe worsening pain
- Symptoms persist beyond 3–6 months
- Imaging identifies structural risk (e.g., large sequestration)
Your PT can collaborate with your spine specialist or physician to determine need for imaging (MRI/CT) or surgical consultation. But in many cases, PT evolves into “prehab” ahead of possible surgery—improving outcomes (Wikipedia,Orthopedic Reviews).
8. Why PT Makes a Difference Even Without Imaging Changes
Yes, disc resorption is happening—but symptom relief and functional return often don’t match image changes directly. Here’s why PT remains key:
- A resorbed disc doesn’t guarantee improved movement.
- You may develop stiffness, poor mechanics, or compensations during healing.
- PT helps retrain coordinated movement that supports long-term spine health.
- Functional recovery depends on building resilience, not just finding a smaller bulge on MRI.
9. Key Guidance From Research
✅ 76.6% of patients experienced some level of spontaneous resorption (ResearchGate,PubMed).
✅ MRI predictors like extrusion, rim enhancement, and PLL exposure increase resorption odds (ResearchGate).
✅ The main biological mechanism is macrophage-mediated inflammatory absorption (PubMed).
✅ Conservative treatment guidelines advocate for 3–6 months of PT before surgery unless red flags are present .
10. Simple Tips While You Heal
- Stay active in a controlled way—walking, gentle movement is better than bed rest.
- Embrace progressive challenges—a little more movement builds tolerance.
- Focus on spine-friendly mechanics—bend at hips, brace your core, avoid twist and load combos without control.
- Partner with a PT—get strength, stability, and custom strategies based on your MRI and symptoms.
Final Takeaway
The Xie et al. (2024) review confirms a powerful truth: disc herniations often shrink naturally, driven by inflammation, vascular remodeling, and macrophage action (Orthopedic Reviews). Physical therapy supports this natural healing while building the movement system’s strength, coordination, and resilience—transforming a risky spine into one that thrives through everyday life.
If you’re navigating a lumbar disc herniation, PT shouldn’t be an afterthought—it should be the frontline defense, aimed at helping your body heal itself and creating a robust foundation for long-term wellness.
Wondering if Physical Therapy can help your specific issue? Book a FREE Discovery Call with one of our experts and start your recovery today.