Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial

Abstract

BackgroundClinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design.MethodsParticipants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking.ResultsIn total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome.ConclusionsNo differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes.Trial RegistrationClinicalTrials.gov: NCT00454792

Answer to the Editorial of J. O’Dowd and A. Casey

“…The follow-up study on our paper [1], where MIC are being explored, indicates that possibly other antibiotics should be used instead of amoxicillin (study in press). The lack of spontaneous change in clinical outcome measures in this study in the controlled group with untreated Modic changes has been seen before [2]. We agree that it would also be interesting to see if the results could be replicated in back pain sufferers who have Modic type 1 changes, but have not had a documented disc herniation.…”

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients

“…Our findings of pain on the same side as inflammatory changes seen on MRI, exacerbated pain during back extension and sedentary work as a protective factor can highlight this hypothesis. Starting from this theory, rest therapy (load reduction and daily rest) has been proposed for patients with Modic 1 changes, but does not seem effective [20].…”

The Pilates method in the rehabilitation of musculoskeletal disorders: a systematic review

“…Intervertebral discs, joints, ligaments, fasciae, muscles and nerve roots were identi ied as tissues capable of transmitting low back pain (43). Therapeutic exercise is currently the irst-line treatment recommended in clinical guidelines for non-speci ic chronic low back pain (44). Evidence indicates that Pilates based exercises are superior to minimum interventions for reducing non-speci ic low back pain, although they are no more effective than other forms of pain reduction exercise (45).…”