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Modic changes refer to the 3 different types of change in the trabeculae. that were first identified and examined by Dr. Michael Modic in 1988. Dr. Modic is the Institute Chair at the Cleveland Clinic Neurological Institute.
Modic pain is very hard to diagnose as it can only be detected with an MRI scan. The pain is either caused by fractures in the trabeculae or in rare cases, a build up of scar tissue.
However, the purpose of this article is not to discus the details of the causes of Modic pain, but to look at some therapies to help treat it. We shall look at some recent research carried out by Region Syddanmark and published in BMC Medicine.
Manifestation of Modic Back Pain
Modic changes cause relatively severe and persistent low back pain. This type of back pain tends to lead to reduce mobility, more time absent from work and a reduced quality of life.
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While exercise is considered to be the best way to treat low back pain, when Modic Changes are present this course of treatment may not be the best practice as it could aggravate the condition more. This is why the recent study was carried out, to test a new approach of treating back pain resulting from Modic Changes – the treatment method is called “load reduction and daily rest”.
The Study
In the study a group of people who suffer from Modic Changes and lower back pain were split into two groups – a “rest and reduced load” group and an “exercise and staying active”.
One group participated in rest therapy with 2 hours of planned rest each day and the other group used a flexible lumbar bely or exercise therapy once a week.
The rest group was instructed to avoid hard physical activity and to rest twice daily for one hour, by lying down.
The exercise group were given a set of exercises for the stabilizing muscles in the low back and
abdomen as well as some dynamic exercises, exercises for postural instability and light
physical fitness training.
The study lasted 10 weeks with a an initial follow up at the end and then another examination one year later.
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Neither Approach is Best
The study showed that neither resting or exercising worked better to reduce pain. However, although exercise did not fair significantly better than rest, it was suggested that if rest is encouraged it could lead to some bad practices and also kinesiophobia, the fear of exercise / movement. While rest may not be better, any prescription that may encourage a total avoidance of exercise should be avoided unless there is a very good case for not be active at all.
Also, while the body mass index of the patients was not examined specifically, around 50% of all those suffering from Modic Changes or lower back pain were overweight or obese. Losing weight is recommended to reduce pressure on the spine and again, any prescription that encourages inactivity is likely to lead to increased weight gain and further problems.
This study did not have a control group, so it is not known if exercise therapy and rest therapy are better than nothing at all. All subjects in the study wanted to undergo some form of therapy to try to alleviate their back pain.
Other studies have shown that slouching is good for your back. The advice to sit up straight may well be doing more harm than good.
References
“Rest versus exercise as treatment for patients with low back pain and Modic changes. A randomised controlled clinical trial.” by Rikke K Jensen, Charlotte Leboeuf-Yde, Niels Wedderkopp, Joan S Sorensen and Claus Manniche. BMC Medicine 2012, 10:22 doi:10.1186/PREACCEPT-2076984228657971 Published: 29 February 2012
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