Last updated 02/04/2020 by The pain clinics - Interdisciplinary Health

Modic changes (type 1, type 2 & type 3)

Modic changes, also called modic changes, are pathological changes in the vertebrae. Modic changes are available in three variants / types. Namely type 1, type 2 and type 3 - which are classified based on what changes they cause to the vertebrae. Modic changes are normally detected via MRI examination and then occur in the vertebra itself and the end plate of the nearby intervertebral disc. Feel free to contact us on Facebook if you have comments or questions. We also really appreciate if you want to comment below the article so that other readers can also learn about what you are wondering.

What is the difference between the three variants of modic changes?

On a general basis, we can say that type 1 is the least serious and that type 3 causes the most serious changes. The higher the number - the more serious is found. Studies (Han et al, 2017) have shown an association between smoking, obesity and heavy physical work (which involves compression of the lower back) with a higher incidence of modic changes. It is especially the lower level of the lumbar spine that is most often affected - L5 / S1 (also known as the lumbosacral transition). L5 is an abbreviation for fifth lumbar vertebra, ie the lower level in the lower back, and S1 stands for sacrum 1. Sacrum is the part that meets the lumbar spine, and which is fused with the coccyx below.

Modic changes - Type 1

The most common form of modic changes. In modic type 1, there is no damage to the vertebral bone structure itself, nor change in bone marrow. On the other hand, one can detect inflammation and edema around and in the vertebra itself. One usually prefers modic type 1 as the mildest version, and the variant that involves the least change in the bone structure itself. Still, this may be one of the variants that, in some cases, causes more pain than others.

Modic changes - Type 2

In type 2 we see fat infiltration in the bone marrow with the replacement of the original bone marrow content. So the fat (of the same type we have around the stomach and hips) replaces the tissue that was supposed to be there. This type of Modic change is often associated with overweight and high BMI in the affected.

Modic changes - Type 3

The rarest but most serious form of Modic change. Modic 3 changes involve injury and small fractures / fractures in the bone structure of the vertebrae. It is therefore in type 3 that you see changes and damage to the bone structure, and not in types 1 and 2, although many believe it.

Modic changes and back pain

Research has found a link between Modic changes and low back pain (lumbago). Modic type 1 changes in particular are often linked to lower back pain.

Treatment of Modic changes

Patients with Modic changes and back pain can be significantly more difficult to treat, as this patient group often does not respond to regular back treatment - such as chiropractic, exercise guidance and physical therapy. However, biostimulatory laser therapy has proven to be a good and safe alternative (1).

It is important to stop smoking if you do this - as studies have shown that smoking can lead to changes in the bone structures in the vertebrae and thus a higher chance of degenerative changes. Weight loss, if you have an elevated BMI, is also very important to prevent further aggravation of this condition.

Many people with Modic changes also experience exacerbation during exercise and this increased discomfort often causes people in this group of back patients to drop out of training and treatment programs. Primarily due to lack of motivation because they get hurt from exercising and thus can't see how they can get better.

Part of the solution lies in an active lifestyle, adapted to exercise with a very gentle and gradual progression. Often one will need help from a knowledgeable clinician to get this done. Many also swear to yoga and exercise exercises such as said.

What is also known is that different types of modic respond differently to treatment and exercise. Even with the same type of modic, people have also seen that people respond differently when comparing treatment outcomes in between relatively equal patients.

Diet and Modic Changes

Several studies have indicated that, among other things in Type 1 Modic, some inflammation (natural, mild inflammatory reaction, for example, injury) is involved. Therefore, with proven Modic changes, they should be careful about what they eat, and most preferably focus on anti-inflammatory foods (fruits, vegetables, olive oil and unrefined products to name a few) and avoid pro-inflammatory foods (sugars, buns / sweet pastries and processed ready meals).

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Also read: - THIS You Should Know About Arthritis!

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Sources: Han et al, 2017 - Prevalence of Modic changes in the lumbar vertebrae and their associations with workload, smoking and weight in northern China. Nature. Scientific Reports volume7, Article number: 46341 (2017)

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