Can a Herniated Disc Cause Degeneration? Or Did the Degeneration Come First?

If you have been diagnosed with a herniated disc and degenerative disc disease, you may have been given a simple explanation:

“The disc was already worn out. That is why it herniated.”

But is it always that simple?

This becomes especially important when back or neck pain begins after a car accident, lifting injury, fall, sports injury, or other physical trauma. Patients often want to know whether degeneration caused the disc to fail—or whether an injured disc can actually begin or accelerate the degenerative process afterward.

The answer is important: a spinal disc does not necessarily have to be significantly degenerated before it can herniate. Mechanical loading and acute trauma can injure a disc, and that injury can contribute to structural and biological changes within the disc over time.

That makes disc degeneration and disc herniation something of a chicken-and-egg question.

At Elite Family Chiropractic in Charleston, SC, I evaluate these cases by looking at the patient's history, examination, biomechanics, symptoms and available imaging together—not simply assuming that every degenerative finding explains why someone hurts.

Let’s look at what happens when a disc is injured, why some damaged discs become painful while others do not, and how the entire spinal motion segment can change after a disc injury.

Can a Healthy Disc Herniate?

An intervertebral disc works somewhat like a pressurized hydraulic system.

The center of the disc, called the nucleus pulposus, contains water-rich proteoglycans that help the disc distribute force. Surrounding it is the annulus fibrosus, a strong outer wall made of concentric layers of collagen that help contain the nucleus and stabilize the motion segment.

For many years, disc herniation was often described primarily as the end result of a disc gradually drying out, weakening and degenerating.

Degeneration certainly can make a disc more vulnerable. But it is not the only pathway. Biomechanical research has demonstrated that sufficient mechanical loading or physical trauma can injure or rupture a disc even without advanced pre-existing degeneration.

That distinction matters.

A disc injury may occur during a significant lifting event, sports injury, fall or traumatic event. What happens to the disc afterward can then contribute to additional structural changes.

What Happens to a Disc After It Herniates?

When the annulus tears and nuclear material escapes its normal pressurized environment, the biology and mechanics of the disc begin to change.

The Herniated Material Changes

Once nuclear material is no longer contained inside the disc, its physical properties change. The displaced tissue can swell and gradually lose some of the water-binding proteoglycans that gave the nucleus its normal gelatinous consistency.

Researchers have even described chronically herniated nuclear material as having a dry, fibrous appearance resembling “crabmeat.”

The Disc Loses Pressure

The intact disc relies partly on internal pressure to distribute mechanical load.

When its outer wall has been disrupted, that pressure can decrease. The remaining disc tissue must then handle forces differently, behaving more like a fibrous structure and less like the highly hydrated cushion it was designed to be.

Degenerative Changes Can Follow

Over time, those mechanical and biological changes can contribute to further breakdown of the injured disc.

This is why the relationship between disc herniation and disc degeneration is not always one-directional.

Degeneration can increase susceptibility to injury, but an injury to the disc can also initiate or accelerate degenerative changes afterward.

Does Disc Degeneration on an MRI Mean It Is Causing Your Pain?

Not necessarily.

This is one of the most important things patients should understand about spinal imaging.

Many people have degenerative changes visible on MRI without significant pain.

That means seeing phrases such as:

• degenerative disc disease
• disc desiccation
• loss of disc height
• disc bulge
• facet arthropathy
• spondylosis

does not automatically identify the structure generating someone's symptoms.

The MRI matters, but it has to make sense when compared with the patient's symptoms, examination and overall clinical picture.

This is similar to the question I discussed in “I Have Arthritis in My Spine — Is That Actually What’s Causing My Pain?”

Finding degeneration is one part of the puzzle.

Determining whether that structure is actually producing pain is another.

What Is Discogenic Back Pain?

Discogenic pain refers to pain arising from the intervertebral disc itself.

One mechanism researchers have identified involves a biological process called hyperinnervation—the growth of pain-sensitive nerve fibers deeper into injured or degenerative disc tissue.

This helps explain why two people can have seemingly similar degenerative findings on MRI yet experience very different symptoms.

Healthy Discs Have Very Few Pain Fibers

A healthy intervertebral disc is largely aneural, meaning most of the disc does not normally contain sensory nerves. Nerve endings are generally concentrated in the outer portions of the annulus fibrosus.

Healthy disc tissue also contains high concentrations of large proteoglycan molecules called aggrecans, which appear to inhibit nerve growth into the deeper portions of the disc.

In other words, pain fibers normally have little reason or ability to grow deep into the center of a healthy disc.

Injury Changes the Environment Inside the Disc

When disc tissue becomes damaged, inflammatory signaling changes.

Disc cells and inflammatory cells can release cytokines including TNF-alpha and IL-1 beta. These signaling molecules can then influence the production of neurotrophins, including Nerve Growth Factor, or NGF.

The process can be thought of like this:

Disc Injury or Trauma
↓
Inflammatory Signaling
↓
Increased Nerve Growth Factor
↓
Nerves and Blood Vessels Grow Deeper Into the Disc
↓
Potential Discogenic Pain

NGF appears to encourage pain-sensing nerves and small blood vessels to grow farther into damaged disc tissue than they normally would.

These newly established sensory fibers can also express pain-related chemicals such as Substance P and CGRP, potentially making the injured disc much more sensitive to mechanical and chemical irritation.

This is one reason I do not believe spinal pain should automatically be reduced to the phrase “wear and tear.”

There is often much more happening biologically and mechanically.

A Disc Injury Can Affect More Than Just the Disc

The spine functions as a connected mechanical system.

One way we evaluate spinal biomechanics is through the Functional Spinal Unit, or FSU.

A functional spinal unit consists of:

• two adjacent vertebrae
• the intervertebral disc between them
• the surrounding spinal ligaments
• the facet joints behind the disc

These structures work together to control movement and distribute load.

If the disc loses height, pressure or structural integrity, the mechanics of the entire motion segment can change.

The facet joints may begin carrying forces differently. Ligaments may be subjected to abnormal loading. Motion at the segment can change.

Over time, these changes may contribute to conditions such as:

Facet joint osteoarthritis: Increased or altered loading can contribute to joint narrowing, hypertrophy and osteophyte formation.

Ligament changes: Spinal ligaments, including the ligamentum flavum, may thicken as degenerative changes progress.

Spinal stenosis: Enlargement of the facet joints, loss of disc height and ligamentous hypertrophy can collectively reduce the available space around the spinal canal and nerve roots.

That is why I rarely look at a herniated disc as an isolated structure.

The disc is part of an entire motion segment.

Understanding what is happening throughout that segment can be just as important as identifying the herniation itself.

How Do We Determine Whether a Disc Is Actually Causing Your Pain?

There is no single MRI phrase that answers this question.

A proper evaluation begins by determining whether the patient's symptoms, examination findings and spinal mechanics reasonably correlate with the disc abnormality.

At Elite Family Chiropractic, my evaluation of a suspected disc problem may include:

• the history and mechanism of injury
• location and behavior of the pain
• neurological symptoms
• orthopedic and neurological examination
• spinal movement and biomechanics
• review of available X-rays or MRI studies
• whether symptoms follow a particular nerve-root pattern
• how the patient has responded to previous treatment

This is particularly important when someone has been told they have degenerative disc disease but still does not understand why they hurt.

The objective is not simply to find an abnormality on an MRI. The objective is to determine which findings actually matter.

Can a Chiropractor Help With a Herniated Disc?

For the right patient, conservative spine care may play an important role in managing symptoms associated with a herniated disc.

But treatment should begin with diagnosis—not simply an adjustment.

As a herniated disc chiropractor in Charleston, my first goal is to understand what structure appears to be involved, whether neurological compromise is present, what the imaging shows when imaging is available, and whether conservative treatment is appropriate.

Some patients may be managed conservatively.

Others may require additional imaging, pain management, orthopedic evaluation or neurosurgical consultation.

The treatment should match the problem.

Conservative Treatment for Discogenic Pain and Herniated Discs

When conservative care is appropriate, there is rarely one treatment that solves every disc problem.

Our approach is based on the patient's specific presentation.

Chiropractic Care and Spinal Biomechanics

When abnormal movement or mechanical loading appears to be contributing to a patient's condition, chiropractic care may be used to improve motion and address mechanical dysfunction within the spinal region.

The technique, location and intensity should be selected according to the individual patient rather than applying the same adjustment to everyone.

Spinal Decompression Therapy

For selected patients with disc-related back or neck pain, non-surgical spinal decompression therapy may be incorporated into the treatment plan.

Motorized decompression applies controlled traction to the spine with the goal of changing mechanical loading across the affected spinal segment and reducing irritation around painful disc and nerve structures.

Research examining spinal traction and decompression has also demonstrated changes in intradiscal pressure under certain conditions.

Decompression is not appropriate for every patient, which is why determining the diagnosis and reviewing the patient's neurological status comes first.

If you have already been diagnosed with a herniated disc and are trying to decide between conservative treatment and surgery, I break that decision down further in “Do I Need Surgery for a Herniated Disc, or Can I Try Spinal Decompression First?”

Class IV Laser Therapy

We may also incorporate Class IV laser therapy, or photobiomodulation, to address pain and inflammatory processes surrounding injured tissues.

Photobiomodulation interacts with cellular and mitochondrial activity and has been studied for its potential effects on inflammatory signaling, including pathways involving cytokines such as TNF-alpha and IL-1 beta.

Because discogenic pain can involve both mechanical and biological factors, addressing only one side of the problem may not always be enough.

Exercise and Movement Restoration

Improving movement, strength and the patient's ability to tolerate normal daily activity is also an important part of conservative spine care.

The goal is not simply to make someone feel better temporarily.

It is to help them return to work, exercise, recreation and normal life with better function.

Knowing When to Refer

Conservative treatment is only one part of spine care. When a patient needs additional diagnostic testing, pain management, orthopedic spine evaluation or neurosurgical consultation, referral should be part of the plan.

I regularly collaborate with other healthcare providers because the right answer is not always chiropractic care.

Sometimes the most important thing a chiropractor can do is recognize when another specialist needs to be involved.

Can a Herniated Disc Cause Degeneration? The Bottom Line

Yes—a disc does not necessarily need to be significantly degenerated before it herniates.

Degeneration can increase a disc's susceptibility to injury, but sufficient mechanical loading or trauma can also injure a disc that did not previously have advanced degeneration. Once the disc has been damaged, changes in pressure, hydration, inflammation and spinal mechanics can contribute to additional degeneration over time.

That is why simply seeing “degenerative disc disease” on an MRI does not tell the entire story.

The better questions are:

• What happened?
• What structures were injured?
• Do the imaging findings correlate with the patient's symptoms?
• How is the spinal segment functioning now?
• What treatment—or referral—does this patient actually need?

For patients dealing with a herniated disc, sciatica, degenerative disc disease or persistent back pain in Charleston, SC, that is where a thorough spine evaluation should begin.

At Elite Family Chiropractic, my goal is not to force every patient into the same treatment.

It is to figure out what appears to be causing the problem and help determine the most appropriate path forward.

Frequently Asked Questions

Can a healthy spinal disc herniate?

Yes. Although degeneration can make a disc more susceptible to injury, biomechanical research demonstrates that sufficient mechanical loading or trauma can injure a disc without advanced pre-existing degeneration.

Can a herniated disc lead to degenerative disc disease?

A disc injury can alter the pressure, hydration and mechanical behavior of the disc. These changes can contribute to a degenerative process following injury.

Does degeneration on an MRI automatically mean it is causing my back pain?

No. Degenerative findings are common, including in people without significant pain. Imaging findings should therefore be considered together with the patient's symptoms and examination.

What does discogenic back pain mean?

Discogenic pain refers to pain arising from the intervertebral disc itself. Injured and degenerative discs can undergo inflammatory and neurological changes, including growth of pain-sensitive nerve fibers deeper into the disc.

Can chiropractic care help a herniated disc?

Some patients with disc-related pain can be managed conservatively with chiropractic care, spinal decompression, exercise and other therapies. The appropriate treatment depends on the patient's diagnosis, neurological findings, imaging and overall clinical presentation.

When should a herniated disc be referred to another specialist?

When examination findings or the patient's progression indicate the need for additional diagnostic testing, pain management, orthopedic evaluation or neurosurgical consultation, referral should be considered. Good spine care includes knowing when conservative treatment is appropriate—and when another specialist needs to be involved.

Ready to Get Answers About Your Spine?

If you are dealing with persistent back pain, sciatica or a herniated disc in Charleston, SC, schedule a spine evaluation with Brad Gorski DC, at Elite Family Chiropractic in West Ashley.

Author

Brad Gorski DC, FSBT At Elite Family Chiropractic in Charleston, South Carolina, Dr. Brad Gorski is a top-ranked chiropractor offering effective treatment options for back pain, knee pain, neck and shoulder pain, sciatica, migraines, pinched nerves, herniated discs, and more. Dr. Gorski received his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, Iowa in 2008. He has completed extensive post-graduate training, becoming qualified in Hospital Based Spine Care, MRI Interpretation Review, and Trauma while also completing a Fellowship in Spinal Biomechanics and Trauma. He provides chiropractic care and helps his patients achieve their goal of optimum health and wellness.