Article Rundown

• Why large disc herniations may heal faster than small ones
• The role of inflammation in disc recovery
• How repeated flexion and endplate damage contribute to injury
• Key insights from McGill-backed research on spinal healing

Why Bigger Disc Herniations Sometimes Heal Better

When people get their MRI results back and see the words “massive disc herniation,” it usually sends them into a tailspin. Understandably so. The word “massive” sounds catastrophic—but here’s the paradox: in some cases, those large herniations actually resolve faster and more completely than smaller ones. This isn’t just wishful thinking—it’s grounded in solid science and clinical experience, as I recently discussed with Dr. Stuart McGill.

Inflammation Is Not the Enemy

One of the first concepts Dr. McGill emphasized was the critical role of inflammation in healing. Contrary to popular belief, suppressing inflammation too early—especially with anti-inflammatories like NSAIDs—can actually delay the resolution of disc issues.

There are now multiple studies showing that allowing the body’s natural inflammatory process to run its course can help the body “clean up” disc debris, reabsorb herniated material, and ultimately reduce the size and symptoms of a disc bulge. In other words, inflammation isn’t something to immediately fight—it’s something to manage wisely, especially in the early stages of healing.

Disc Injury Mechanics: How It Starts

To understand how disc herniations develop—and how they can resolve—we need to look at how the spine behaves under stress. Decades of spine research, including McGill’s own cadaver and animal model studies, show that repeated flexion under load—especially with poor form—can gradually damage the endplates (the top and bottom cartilage plates of a disc) and lead to delamination of the disc’s collagen fibers.

That repeated motion, especially when combined with compression (think: heavy deadlifts with a rounded back), causes the nucleus—the soft center of the disc—to slowly push outward, working its way through the weakened collagen layers. Eventually, this leads to a bulge or herniation, typically posterior (toward the precious nerves and thecal sac) in the lower lumbar spine.

Genetics vs. Mechanics: The Two Pathways

What’s fascinating is that not all disc herniations occur for the same reason. Dr. McGill explained that Mike and Trish Adams—respected researchers in spine biomechanics—identified two phenotypes or patterns of endplate failure.

1. Inherited/Upper Spine Variant – More common in the upper lumbar and thoracic spine, these cases often involve the bone breaking behind the cartilage endplate, which may run in families. These lead to issues like Schmorl’s nodes (discs bulging into superior and/or inferior vertebral bodies).
2. Mechanical/Lower Spine Variant – More common in the lower lumbar spine (where most disc herniations occur), this type is clearly caused by repeated loaded flexion. It’s less about genetic predisposition and more about training habits, postures, and accumulated stress.

For lifters like me, who’ve had massive disc bulges and even endplate fractures from years of heavy spinal loading, the good news is that recovery is possible. With a long-term strategy of removing provocation, allowing the spine to adapt, and progressively reloading with proper form, it’s entirely possible to rebuild resilience, just like I did on the way to setting all-time world records.

The Shrinking Disc: How Resolution Happens

So, how does a massive disc herniation “vacuum back in”?

One key study from a Chinese research group led by Pengfei Zhang (often cited in spine literature as Peng Fei) shed new light on this. Their work confirms what clinicians like McGill have observed for years: larger disc bulges are more likely to spontaneously reduce, especially when the inflammatory process is allowed to proceed and the endplates are intact.

Here’s how it works:

• When an endplate is damaged, it creates edema (swelling) in the adjacent bone. This is often seen on imaging and referred to as a Modic change by radiologists. But what it really represents is a bone bruise—and a change in the local chemistry.
• That change in chemistry can inhibit the vascular and immune responses that help break down and reabsorb the herniated material.
• In contrast, if the endplates are still healthy and the inflammation is allowed to do its job, vascularization of the herniated disc tissue can occur, promoting shrinkage of the bulge over time.

So, a large herniation with an intact endplate and an active inflammatory response? That’s actually a good setup for spontaneous healing.

The Takeaways for Lifters and Clinicians That I Live by: Always Follow the Advice of Your Practitioner

Here are some key lessons from all of this, especially for lifters dealing with disc injuries:

• Don’t panic if you hear “massive herniation.” Bigger doesn’t always mean worse.
• Avoid anti-inflammatories, particularly in the early stages of a disc injury, unless prescribed for a specific reason. They may make you feel better short term, but they could slow down the natural healing process.
• Respect flexion under load. Repeated rounding of the spine with heavy weights is a major contributor to disc damage. Use good form, brace appropriately, and train smart.
• Endplate health matters. If your imaging shows Modic changes or bone edema, spontaneous healing may be slower or less likely. That’s where medical (injections, medications)/ surgical or more structured conservative interventions might be needed.

Give the body time. As my own story proves, healing from a significant spinal injury is possible, but it takes consistency, proper loading, and patience. Gift of Injury will help you understand the cascade of bone damage.

Final Thoughts

This conversation with Dr. McGill was a reminder that spinal injuries—and their recovery—are far more nuanced than the MRI report suggests. Instead of fear or rushed decisions, lifters and clinicians should lean into the science, respect the body’s healing process, and take the long road to building back resilience. YOU ARE NOT YOUR MRI! 

I’ve been there. I’ve had massive herniations, endplate damage, vertebral body (sacrum split) and the crippling pain. But with the right plan, I came back stronger. If you’re in that hole now, there’s a path forward—you just need to understand it and commit to it.

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