There has always been a long standing debate as to whether rest or exercise was best for lower back pain. The fact is there are instances where one may be better than the other, however as in anything there is always debate and the back pain community is always pushing for guidelines so that everything fits into a neat little box. Well with that in mind researchers were recently trying to figure out whether a subset population of lower back pain sufferers may fit into a different category. This subset includes people with what are called modic changes to their spines. Now modic changes as defined by Wikipedia is as follows…

Diagnosing modic changes

Modic changes can only be seen on a magnetic resonance imaging, an MRI. Modic changes were first described and separated into 3 different types of changes by Dr. Michael Modic in 1988.

Normal bone consists of an internal scaffolding of bone, called trabeculae. In the hollows between the trabeculae is red bone marrow, which produces blood cells.

• In Modic type 1 the trabeculae are fractured in many places, the trabeculae are shorter and broader and the “scaffolding” pattern is unstructured and uneven. The marrow is substituted by serum, the same clear liquid that is inside a blister.

• In Modic type 2 changes the trabeculae are also fractured in many places, but are shorter and broader and the “scaffolding” pattern is unstructured and uneven. With Modic type 2 changes the marrow is substituted by visceral fat, the same kind of fat we have on our hips and bellies.

• Modic Changes type 3 are rare, and it is bone scar tissue.

Researches in this most recent study wanted to determine if bed rest was more suitable for patients with lower back pain who also had modic changes in the spine as opposed to exercise.  Below is an excerpt from that study in the April 2012 issue of Clinical Advisor had this to say about this topic.

To determine which treatment strategy would work best for people with persistent LBP and Modic changes, the investigators randomized 49 such patients to a 10-week course of two hours of daily rest and the option of using a flexible lumbar belt, and 51 patients to exercise therapy once a week for 10 weeks.

No statistically significant differences were found between the two groups on any outcome measure, including pain, disability, general health, and global assessment, after 10 weeks or one year. The study authors speculated that because LBP did not improve more with rest than exercise, Modic changes themselves might not be causing pain, two hours of rest per day might not have been enough, or some types of Modic changes might respond better than others to rest.

So as you can see from this study it appears it really doesn’t matter which option you take, it seems to produce the same outcome, however long term studies have not shown either is better, you should still consult with your physician to determine whether or not one approach may be better for your particular circumstances.