I’ve been reading through the forum on low back/disc/herniations and have gleaned a lot of useful info. I haven’t seen much about Modic changes so am hoping some experts can weigh in.

I’m F, 40, former D1 runner. Also swam competitively years ago. Now just run and dabble in sprint tris occasionally.
My low back blew up a year and a half ago during an incredibly traumatic time in which I lost both parents. One day I could hardly walk or get out of bed without excruciating low back pain. No acute injury and no imaging or diagnosis at the time (I’m in Europe with socialized medecine). Gradually, most of the pain went away with running but still had achiness lifting my toddler and cleaning.

Three months ago the same pain returned and I got an MRI (image attached):
Normal position. No lysis, nor listhesis. At level L5-S1disc dehydration, central anulus tear and protrusion, without radicular compression.
Here also an intraspongous herniation with Modic 1 changes. No canal stenosis.
Sacroiliac otherwise no abnormalities demonstrated.

I have constant stiffness achiness and sometimes sharp pain across my low back, but mostly on the right side around the iliac crest and SI joint. I tried lots of core work (McGill, McKenzie press ups) and saw a few fysios who thought it was an SI problem. Did several prolotherapy sessions. Everything seemed to just make things tighter and more inflamed and stiff. I’m can’t run at all and elliptical and swimming aggravate it too. I can barely do daily household tasks most days. I walk a ton and that usually is ok. Pain is always with movement and not with sitting or lying down. In the morning I feel better. No radiating pain or nerve involvement.

After a lot of medical runaround I found a holistic private spine/pain clinic. Have been examined by a neurologist and MDT fysio. They think MRI is not terrible and that there is no hernia. Maybe a minor bulge. They are focusing on the tear and Modic inflammation as possible source of pain. They’ve done research on Modic and have a stepped protocol involving epidural, NSAID’s, possibly antibiotics. I’m scheduled for an epidural next week and will also get evaluated by an MSK doctor who works with elite athletes. Right now I’m in too much pain to do fysio other than very light Pilates work.

Being physically incapacitated on top of the emotional turmoil of the past year has been devastating. Many people have suggested that the pain is at least partly related to trauma/stress. I’m in so much pain and it seems to go up and down fairly randomly. I’m at my wits end and am hoping I might gain more insight by posting my story and imaging. Many thanks in advance.