Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
The Effect of Modic Changes on Low Back Pain, Physical Activity, Muscle Endurance, and Aerobic Capacity: Cross-Sectional Research
Modic Değişikliklerin Bel Ağrısı, Fiziksel Aktivite Düzeyi, Sırt Ekstansör Kas Dayanıklılığı ve Aerobik Kapasite Üzerine Etkisi: Kesitsel Araştırma
Çetin SAYACAa,b, Büşra KIZILKANc
aDepartment of Physiotherapy and Rehabilitation, Bursa Uludağ University Faculty of Health Science, Bursa, TURKIYE
bDepartment of Physical Therapy and Rehabilitation, Üsküdar University Faculty of Health Science, İstanbul, TURKIYE
cClinic of Radiology, University of Health Sciences Sultan Abdulhamid Han Research and Training Hospital, İstanbul, TURKIYE
Turkiye Klinikleri J Health Sci. 2022;7(1):119-26
doi: healthsci.2020-75983
Article Language: EN
Full Text
ABSTRACT
 Objective: Modic changes are structural degenerative changes that occur in the vertebral bone marrow. This study aimed to investigate pain severity, back extensor muscle endurance, aerobic capacity, and physical activity levels in patients with Modic changes. Material and Methods: Sixty (39 women, 21 men) patients were included. According to the result of the lumbar spine magnetic resonance imagination, patients with or without Modic changes were divided into two groups (Modic and control). Pain severity was evaluated with the visual analogue scale. Sorensen test was used to evaluate back extensor muscle endurance, The 6 minute walk test was used to evaluate the aerobic capacity, and the Turkish version of the short form the International Physical Activity Questionnaires was used to evaluate health-related physical activity level. Results: There was a difference in the pain severity, extensor back muscles endurance, and aerobic capacity between groups (respectively; p=0.001; p=0.001; p0.05), but there was a difference in walking activity level (p=0.014). In the control group, the mean of metabolic equivalent minutes in walking activity was higher than in the Modic group. Conclusion: In patients with Modic change, pain severity was higher, and back extensor muscle endurance with aerobic capacities were lower. No difference was found between physical activity levels of the patients with Modic change except walking. In addition, while the average age of patients with Modic changes was higher, there was no difference according to the smoking rate. Studies investigating the effects of different Modic type changes on muscular strength, endurance, lumbar stabilization, aerobic capacity and physical activity level are needed.

Keywords: Spine; low back pain; physical activity
ÖZET
 Amaç: Modic değişiklikler, vertebral kemik iliğinde meydana gelen yapısal dejeneratif değişikliklerdir. Bu çalışmanın amacı, Modic değişiklikleri olan hastalarda ağrı şiddeti, sırt ekstansör kas dayanıklılığı, aerobik kapasite ve fiziksel aktivite düzeyini araştırmaktır. Gereç ve Yöntemler: Altmış (39 kadın, 21 erkek) hasta çalışmaya dâhil edildi. Lomber omurga manyetik rezonans görüntüleme sonucuna göre Modic değişikliği olan veya olmayan hastalar 2 gruba ayrıldı (Modic ve kontrol grubu). Vizüel analog skalası ile ağrı şiddeti değerlendirildi. Ekstansör kas dayanıklılığını değerlendirmek için Sorensen testi, aerobik kapasiteyi değerlendirmek için 6 dk yürüme testi ve fiziksel aktivite düzeyini değerlendirmek için Uluslararası Fiziksel Aktivite Anketlerinin kısa formunun Türkçe versiyonu kullanıldı. Bulgular: Gruplar arasında ağrı şiddeti, ekstansör sırt kas dayanıklılığı ve aerobik kapasitede fark vardı (sırasıyla; p=0,001; p=0,001; p0,05), ancak yürüme aktivite düzeyinde fark vardı (p=0,014). Kontrol grubunda yürüme aktivitesinin metabolik eş değer dakika ortalaması Modic grubundan daha yüksekti. Sonuç: Modic değişiklikleri olan hastalarda ağrı şiddeti daha yüksek iken, aerobik kapasitesi ile sırt ekstansör kas dayanıklılığı daha düşüktü. Modic değişikliği olan hastaların, yürüme dışında fiziksel aktivite düzeyleri arasında fark bulunmadı. Buna ek olarak, Modic değişiklikleri olan hastaların yaş ortalaması daha yüksek iken, sigara içme oranı açısından fark yoktu. Farklı Modic tip değişikliklerin kassal kuvvet, dayanıklılık, lumbal stabilizasyon, aerobik kapasite ve fiziksel aktivite düzeyi üzerine etkilerinin incelendiği çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Omurga; bel ağrısı; fiziksel aktivite
REFERENCES:
  1. Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001;13(2):128-34. [Crossref]  [PubMed] 
  2. Kuisma M, Karppinen J, Niinimäki J, Ojala R, Haapea M, Heliövaara M, et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976). 2007;32(10):1116-22. [Crossref]  [PubMed] 
  3. Rahme R, Moussa R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29(5):838-42. [Crossref]  [PubMed] 
  4. Alpaycı M, Balbaloglu Ö, Kandemir A. Brucella serology in patients with low back pain with modic type 2 lesion. Nobel Med. 2014;10(2):55-8. [Link] 
  5. Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C. Modic changes and their associations with clinical findings. Eur Spine J. 2006;15(9):1312-9. [Crossref]  [PubMed]  [PMC] 
  6. Herlin C, Kjaer P, Espeland A, Skouen JS, Leboeuf-Yde C, Karppinen J, et al. Modic changes-their associations with low back pain and activity limitation: a systematic literature review and meta-analysis. PLoS One. 2018;13(8):e0200677. [Crossref]  [PubMed]  [PMC] 
  7. O'Sullivan PB, Mitchell T, Bulich P, Waller R, Holte J. The relationship beween posture and back muscle endurance in industrial workers with flexion-related low back pain. Man Ther. 2006;11(4):264-71. [Crossref]  [PubMed] 
  8. Lunde LK, Koch M, Hanvold TN, Wærsted M, Veiersted KB. Low back pain and physical activity- a 6.5 year follow-up among young adults in their transition from school to working life. BMC Public Health. 2015;15(1):1115. [Crossref]  [PubMed]  [PMC] 
  9. Sahin G, Toraman NF, Muratlı S. [Evaluation of VO2 max and anthropometric properties of elder people aged 50-65 years]. Turkish Journal of Geriatrics. 2002;5(2):54-8. [Link] 
  10. Özmen T, Gündüz R, Doğan H, Zoroğlu T, Acar D. [Relationship between kinesiophobia and quality of life in patients with chronic low back pain]. F.Ü. Sağ Bil Tıp Derg. 2016;30(1):1-4. [Link] 
  11. Zhang YH, Zhao CQ, Jiang LS, Chen XD, Dai LY. Modic changes: a systematic review of the literature. Eur Spine J. 2008;17(10):1289-99. [Crossref]  [PubMed]  [PMC] 
  12. Shimoji K, Aida S. Pain measurements. In: Shimoji K, Nader A, Hamann W, eds. Chronic Pain Management in General and Hospital Practice. 1st ed. Singapore: Springer; 2020. p.173-200. [Crossref] 
  13. Alaranta H, Luoto S, Heliövaara M, Hurri H. Static back endurance and the risk of low-back pain. Clin Biomech (Bristol, Avon). 1995;10(6):323-4. [Crossref]  [PubMed] 
  14. Jenkins S, Cecins N, Camarri B, Williams C, Thompson P, Eastwood P, et al. Regression equations to predict 6-minute walk distance in middle-aged and elderly adults. Physiother Theory Pract. 2009;25(7):516-22. [Crossref]  [PubMed] 
  15. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95. [Crossref]  [PubMed] 
  16. Temiztürk F, Temiztürk S, Özkan Y, Özgüzel H. [Investigation of the relationship between clinical examination and magnetic resonance ımaging findings in patients with low back pain]. Kocatepe Medical Journal. 2015;16(2):110-5. [Crossref] 
  17. Järvinen J, Karppinen J, Niinimäki J, Haapea M, Grönblad M, Luoma K, et al. Association between changes in lumbar Modic changes and low back symptoms over a two-year period. BMC Musculoskelet Disord. 2015;16:98. [Crossref]  [PubMed]  [PMC] 
  18. Marcinik EJ, Potts J, Schlabach G, Will S, Dawson P, Hurley BF, et al. Effects of strength training on lactate threshold and endurance performance. Med Sci Sports Exerc. 1991;23(6):739-43. [Crossref]  [PubMed] 
  19. Visser M, Deeg DJ, Lips P, Harris TB, Bouter LM. Skeletal muscle mass and muscle strength in relation to lower-extremity performance in older men and women. J Am Geriatr Soc. 2000;48(4):381-6. [Crossref]  [PubMed] 
  20. Larivière C, Bilodeau M, Forget R, Vadeboncoeur R, Mecheri H. Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976). 2010;35(22):E1178-86. [Crossref]  [PubMed] 
  21. Suh JH, Kim H, Jung Gp, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: a randomized controlled trial. Medicine (Baltimore). 2019;98(26):e16173. d [Crossref]  [PubMed]  [PMC] 
  22. Weiss EP, Spina RJ, Holloszy JO, Ehsani AA. Gender differences in the decline in aerobic capacity and its physiological determinants during the later decades of life. J Appl Physiol (1985). 2006;101(3):938-44. [Crossref]  [PubMed] 
  23. Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005;5(1):24-35. [Crossref]  [PubMed] 
  24. Wang Y, Videman T, Battié MC. Modic changes: prevalence, distribution patterns, and association with age in white men. Spine J. 2012;12(5):411-6. [Crossref]  [PubMed]  [PMC] 
  25. Hautier C, Bonnefoy M. [Training for older adults]. Ann Readapt Med Phys. 2007;50(6):475-9, 469-74. [Crossref]  [PubMed] 
  26. Leboeuf-Yde C, Kyvik KO. At what age does low back pain become a common problem? A study of 29,424 individuals aged 12-41 years. Spine (Phila Pa 1976). 1998;23(2):228-34. [Crossref]  [PubMed] 
  27. Wang Y, Videman T, Battié MC. Modic changes: prevalence, distribution patterns, and association with age in white men. Spine J. 2012;12(5):411-6. [Crossref]  [PubMed]  [PMC] 
  28. Karchevsky M, Schweitzer ME, Carrino JA, Zoga A, Montgomery D, Parker L, et al. Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol. 2005;34(3):125-9. [Crossref]  [PubMed] 
  29. Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, Manniche C, et al. Predictors of new vertebral endplate signal (Modic) changes in the general population. Eur Spine J. 2010;19(1):129-35. [Crossref]  [PubMed]  [PMC] 
  30. Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T, et al. Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg Am. 1983;65(2):213-8. [Crossref]  [PubMed] 
  31. Han C, Kuang MJ, Ma JX, Ma XL. Prevalence of Modic changes in the lumbar vertebrae and their associations with workload, smoking and weight in northern China. Sci Rep. 2017;7:46341. [Crossref]  [PubMed]  [PMC] 
  32. Hanımoğlu H, Çevik S, Yılmaz H, Kaplan A, Çalış F, Katar S, et al. Effects of Modic type 1 changes in the vertebrae on low back pain. World Neurosurg. 2019;121:e426-e32. [Crossref]  [PubMed] 
  33. Udby pM, Bendix T, Ohrt-Nissen S, Lassen MR, Sørensen JS, Brorson S, et al. Modic changes are not associated with long-term pain and disability: a cohort study with 13-year follow-up. Spine (Phila Pa 1976). 2019;44(17):1186-92. [Crossref]  [PubMed] 
  34. Grobler LJ, Robertson PA, Novotny JE, Pope MH. Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine (Phila Pa 1976). 1993;18(1):80-91. [Crossref]  [PubMed] 
  35. Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC. Pathobiology of Modic changes. Eur Spine J. 2016;25(11):3723-34. [Crossref]  [PubMed]  [PMC] 

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