Two treatment approaches to persistent lower back pain (LBP) —”rest and reduced load” and “exercise and staying active” appeared to be equally effective in patients with Modic changes.

Exercise therapy is the recommended treatment for chronic LBP (BMC Med. 2012;10:22). But for the subpopulation of LBP sufferers who also have Modic changes in the spine, in which the bone marrow is infiltrated by serum, fatty deposits, or sclerosis, the underlying pathology of these changes may make rest a better option.

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.

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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. 

Another project focusing on musculoskeletal pain indicated that cold-water baths reduced the muscle soreness that commonly results after sports and exercise activity. However, the optimum method of cold-water immersion and the safety of this form of cryotherapy are not clear, wrote Chris Bleakley and colleagues in an online report for The Cochrane Library.