Relationship between Lumbar Spinal Movement and the Location of Type 1 Modic Changes in Elite Athletes

Type 1 Modic change (MC1) is strongly associated with chronic low back pain, but it is unclear whether its anatomical distribution reflects sport-specific spinal loading in elite athletes.

We retrospectively reviewed elite athletes with chronic low back pain and magnetic resonance imaging (MRI)-confirmed MC1 who had a history of low back pain for >3 months and concordant pain relief after fluoroscopy-guided discography or selective disc block at the MC1 level. Athletes aged >60 years and those with a history of lumbar surgery, scoliosis >10°, or sagittal translation >4 mm were excluded. Three blinded reviewers classified the dominant spinal movement of each athlete during competition (flexion, extension, right/left lateral bending, or axial loading). The distribution pattern of MC1 (anterior, posterior, right, left, or entire) was determined on short-tau inversion recovery MRI scans. Correspondence was assessed only when all reviewers agreed on the dominant movement.

Eighteen athletes (19 levels) with a mean age of 34.5 years were included. MC1 (63%) was most frequently observed at L5-S1. MC1 was localized anteriorly in 42%, to the right in 26%, to the left in 16%, and involved the entire endplate in 16%. There were no posterior-only lesions. Rater consensus on the dominant movement was obtained for 10 athletes (involved in seven sports). Nine of these 10 athletes (90%) showed correspondence between the dominant movement and the distribution of MC1, including flexion with anterior MC1 and right lateral bending with right-sided MC1.

Sports with a single dominant repetitive spinal movement often showed a match between that movement and the location of MC1. This finding supports a focal, load-related mechanism linking sport-specific spinal loading with MC1 in elite athletes with chronic low back pain.