Modic type I changes of the lumbar spine in golfers

Abstract

Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation and administered intradiscal steroid injections with a non-steroidal anti-inflammatory drug (NSAID). Treatment swiftly alleviated LBP and diminished Modic Type 1 changes on follow-up MRI 3–6 months later in all four patients. We suggest that Modic Type 1 changes play a significant role in the diagnosis and treatment of golf-related LBP.

Short tau inversion recovery MRI of Modic changes: a reliability study

“…The association between MCs and pain is inconsistent (13)(14)(15)(16), but edema type MCs might be symptomatic (17)(18)(19). Mechanical, autoimmune, and infectious explanations for MCs have been proposed (20), and various treatments have been and are being tested (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Reliable evaluation of the STIR findings is required to validate their relevance to symptoms and treatment (35)(36)(37).…”

Current golf performance literature and application to training

“…This repeated stress encountered by golfers certainly explains the changes evidenced by radiographs. 51 There is supporting statement that the articular cartilage of the spinal facet joints may become injured with 250-500 N of force during torsion stress testing. 1 Another consideration is that facet joint arthritis increases with age, and this likely limits their spinal mobility, and may increase their chances of encountering low back pain with golf.…”

“…Furthermore, there is evidence to show adaptive anatomical changes of the rightsided vertebral body and facet joints, which are evident upon radiographic examination in trained golfers. 51 There is also evidence to show that lateral bending during a lifting task produces high and potentially injurious forces to the facet joints of the spine of 350 N. 57 During the downswing through the impact, golfers who have limited ROM in hip rotations (internally and externally) tend to have reverse spine. Those golfers tend to experience this lateral bending during the impact zone in golf swing.…”

Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences

“…As stated before, there is no literature to compare our results. We only found one small case report series on four golf players, reported by Mefford et al, that mentioned only marginally the role of short tau inversion recovery (STIR) sequences for the diagnosis of Modic I changes [29].…”