Modic changes are pathological changes in the bones of the spine, the vertebrae. These changes are situated in both the body of the vertebrae and in the end plate of the neighboring disc. Clinically, Modic Changes are often associated with constant lower back pain during the day, with peak pain occurring during the night and in the morning, coupled with back stiffness. Modic changes have been observed in approximately 6% of the general adult population regardless of ethnicity. Modic changes are rare in children and young adults. From the age of 25 to 40 years, there is a steep increase in their prevalence, which levels out about 40 years of age and is stable until 80+ years. Modic changes are estimated to affect approximately 349 million of the adult population worldwide.[July 2021 est.] Modic changes is a descriptive term used by radiologists in MRI evaluations. Conventional treatment including physiotherapy, chiropractic, acupuncture, and exercise for back pain, are ineffective in treating Modic changes. Conversely, long term antibiotic treatment has been shown to be an effective treatment if done effectively. Signs and Symptoms Several studies have shown a relationship between Modic changes in the spinal vertebrae and pain in the lower back. Long term chronic pain The last decade of studies on Modic changes have shown that Modic changes are associated with many treatment-resistant pain episodes and may result in patients entering a state of chronic low back pain. On average, individuals with Modic changes have had chronic pain for longer than individuals suffering from non-Modic changes back pain. Nightly Pain Peak pain tends to occur late at night and morning and often late-night pain often results in poor and interrupted sleep. Morning pain and stiffness Many individuals suffering from Modic changes, tend to have a high degree of morning stiffness in the back. The duration of the stiffness in the morning also tends to be longer compared to individuals with no Modic changes. Pain with lumbar hyperextension Individuals with Modic changes experience exacerbation of pain when performing a hyperextension of the back. A hyperextension of the back is the equivalent of performing an excessive backward bending of the back beyond its natural position. Causes and Prevalence Modic changes are a non-specific pathoanatomical marker observed on an MRI scan. For example, high blood pressure or high body temperature can be markers of several diseases. In 2008 the first hypothesis suggesting three possible