Modic changes can be seen on MRI Scans and are represented by inflammation/infection in the vertebral body adjacent to the disc – either above/below or both –  this happens with patients that have experienced a disc herniation. Sometimes the cause of the inflammation is bacterial while in others it is likely to be of mechanic injury. Modic change types 1 and 2 are the types most closely associated with lower back pain.

Inflammatory changes are visible in the vertebral bodies above and below discs that have been damaged. Modic changes are also known as bone oedema (swelling). They include microfractures in the vertebral bodies as well as blister like fluids in Modic type 1 and fat deposits in Modic type 2.

Putting pressure on these vertebrae will increase pain. Patients with Modic changes do not respond to exercise programmes which are the most commonly prescribed treatment for chronic low back pain.

Exercise plays an important role in the management of most chronic lower back pain. A thorough case history is vital for all patients experiencing severe and chronic lower back pain. This would establish whether Modic changes are the cause of the pain. This would indicate an entirely different course of treatment.

Our Journal contains a fuller analysis of why exercise increases symptoms in modic patients.