Introduction
Modic changes are pathological alterations in the vertebral endplates and adjacent bone marrow, detectable through magnetic resonance imaging (MRI). They are closely associated with degenerative disc disease and are frequently observed in individuals experiencing chronic low back pain (LBP) (1). The classification of Modic changes is divided into three distinct types, each representing different pathological and radiological characteristics.
Types of Modic Changes
The classification of Modic changes includes three primary types as demonstrated in the image below:
1. Modic Type 1 (Vascular Development):
This type indicates bone marrow oedema and inflammation. MRI scans reveal decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Histologically, Type 1 changes are associated with fissuring of the endplates and vascular granulation tissue, suggesting an ongoing inflammatory process (1).
2. Modic Type 2 (Visceral Fat):
Characterised by fatty degeneration of the bone marrow, Type 2 changes appear as increased signal intensity on both T1- and T2-weighted MRI images. These changes represent a more chronic and stable phase of vertebral degeneration (2).
3. Modic Type 3 (End Plate Sclerosis):
This type signifies subchondral sclerosis, showing decreased signal intensity on both T1- and T2-weighted images. It is considered the most advanced stage of Modic changes, indicating significant bone sclerosis (3).
Clinical Significance of Modic Changes
The presence of Modic changes, particularly Type 1, has been strongly linked to chronic LBP. Patients experiencing these changes often report heightened pain intensity, nocturnal pain, and morning stiffness, which can significantly impair daily activities and overall quality of life (2). The exact pathophysiological mechanisms underlying the association between Modic changes and pain remain under investigation, with hypotheses including mechanical stress, inflammatory processes, and low-grade bacterial infections (3).
Osteopathic Approaches to Managing Modic Changes
Osteopathy offers a holistic and patient-centred approach to managing LBP associated with Modic changes. Osteopathic manual treatment (OMT) encompasses a range of techniques aimed at improving spinal mobility, alleviating pain, and enhancing overall function (4).
Common Osteopathic Techniques
• Soft Tissue Techniques: Relieve muscle tension and improve blood circulation.
• Joint Mobilisation: Enhance spinal mobility and reduce pain.
• Exercise Prescription: Customised exercise plans aimed at improving strength and flexibility.
At Cruz Osteopathy, we specialise in using these techniques to provide personalised care for patients with Modic changes.
Efficacy of Osteopathic Interventions
Research into the effectiveness of OMT for patients with Modic changes is ongoing. assessed changes in biomechanical dysfunction following OMT and its correlation with LBP reduction (4). The findings suggested that OMT may lead to improvements in spinal biomechanics and a reduction in pain intensity (4). However, the study did not specifically focus on patients with Modic changes, highlighting the need for further research.
Integrative Treatment Strategies
Since Modic changes are multifactorial, a comprehensive treatment plan is often recommended.
Additional Treatment Options
• Pharmacological Interventions: Use of analgesics and anti-inflammatory medications to manage pain and inflammation (2).
• Physical Therapy: Structured exercise programmes designed to strengthen muscles and improve posture (5).
• Lifestyle Modifications: Ergonomic adjustments and weight management strategies to reduce spinal stress (5).
Osteopaths at Cruz Osteopathy work closely with patients to ensure their treatment plans are tailored to their specific needs.
Conclusion
Modic changes are significant MRI findings strongly associated with chronic LBP. While the pathogenesis of these changes is complex and not fully understood, osteopathic care offers a promising approach to managing related symptoms. At Cruz Osteopathy, we are dedicated to providing personalised osteopathic care aimed at alleviating pain, improving function, and enhancing overall well-being.
References
1. Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17(11):1407-1422.
2. Kuisma M, Karppinen J, Niinimäki J, et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine. 2007;32(10):1116-1122.
3. Albert HB, Manniche C. Modic changes following lumbar disc herniation. Eur Spine J. 2007;16(7):977-982.
4. Licciardone JC, Kearns CM, Hodge LM, Minotti DE. Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: results from the OSTEOPATHIC Trial. Man Ther. 2014;19(5):411-418.
5. Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Manniche C. Rest versus exercise as treatment for patients with low back pain and Modic changes: a randomized controlled clinical trial. BMC Med. 2012;10:22.
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