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David Spine Solution

 

David Spine Solution is a comprehensive evaluation and treatment concept for back disorders. The solution uses carefully targeted movement and controlled loading to reverse the deconditioning syndrome related to back pain.

Individualized programs are planned based on a questionnaire, physical evaluations and tests. Specially designed devices provide a safe and effective way of improving mobility, strength and spinal coordination.

“Back pain is among the most common disorders in western societies”

Disorder prevalence

Back pain is among the most common disorders in western societies causing more financial losses to companies and insurance systems than any other single disorder except common cold. Up to 70 % of the people have experienced back pain sometime during their lives; around 40 % had an episode lasting more than a day in the last 12 months and around 25 % during the past three months

WHO methods and data sources for global burden of disease estimates 2010-2011, WHO, Geneva November 2013.

Deconditioning syndrome

In most back pain cases, a specific diagnosis, such as disc hernia, is not possible to obtain. However, regardless of the reason of the pain, it will cause avoidance in physical activity, further weakening the strength and coordination of the back and eventually affecting the integrity of the tissue structure.

This can produce a vicious cycle resulting in more pain and loss of function and if prolonged, also psychological effects. When the problem has reached this level, traditional methods of treatment are helpless and the possibility for permanent disability increases significantly as time passes.

Movement as medicine

Several studies have shown that movement can act as medicine for painful joints. With joints like the knee, which are relatively simple structures, movements are simple and loading is easy to apply in a controlled manner.

The spine, however, is a very complex structure involving vertebrae, discs, ligaments, dynamically functioning rotator and intervertebrae muscles and large, mostly statically functioning supporting muscles.

When pain and loss of coordination is added into the equation, it is extremely difficult to start physical exercises in a controlled manner. Special devices are required to isolate the target area provide total control in the movement and loading.

 

 

All movements should start with limited range and low loading, within the pain tolerance. Time is essential since physiological changes are slow. Ideal treatment should run for three months with an ongoing program afterwards.

Several studies have shown that movement can act as medicine for painful joints.

Indications and contraindications

Most back disorders can be treated successfully with the David Spine Concept. These include unspecific back pain, degenerative changes, herniations and post operative situations. Participation requires exclusion by a specialist of any contraindications and consent by treating surgeon within four months of the surgery. Contraindications include tumors, acute inflammations, and recent fractures. Successful treatment requires patient consent and motivation to participate.

Evaluations

Individualized programs require thorough understanding of the patient background, present condition and physical capacity. A standard evaluation protocol includes a validated questionnaire including patient background, pain profiles and self assessment. Physicaltherapy evaluation assesses posture, functional deficiencies and limitations. Device based tests include strength and mobility in all movement plains.

Results are recorded in a database and a very illustrative spine profile can be printed out comparing each tests to normative data. Evaluations done pre, mid and post, provide objective outcome reports for treating doctors and third‑party payers as well as added motivation for the patient.

Treatment program

The overall goal of a successful treatment is that the experienced pain decreases and the quality of life increases. In order to achieve this goal the active therapy must be progressive and inline with the individual’s ability to adapt the changes.

The treatment is always based on individual assessment. The progression of the program follows the patient’s subjective evaluation of the experienced resistance and the pain indicators. A default program for the Spine concept provides a safe start, which can be used in early stages of rehabilitation. At the beginning, the range of motion is designed to be small and the loading light.

Space efficient solution

The treatment room can be as small as 25 m2.

Scientific evidence

Validation

EMG validation studies were done in collaboration with the university of Cologne, Germany to find out if David’s isolation principle really fatigued the target muscles and blocked the strong surrounding muscles2. These studies demonstrated in a beautiful way that not only were the strong hip extensors blocked but in fact inhibited creating high level of activation in the spinal target muscles.

The Spinal Muscular Profile, Achim Denner, Springer 1992

Medical

There is a set of three published outcome reports by FPZ, a chain of over 200 licensed back centers in Germany. These publications are looking at various outcome measures, like pain intensity, pain frequency, sick leave days, visits to doctors, etc. The N’s in these data sets are very large, ranging from 4.559 to 37.943 subjects. Results are excellent. For example, 41% of the patients were pain free after the program and of the rest 88% had significant pain reduction.

E.g. Integrierte Versorgung Rückenschmerz, Wissenschaftliche documentation 2006 – 2008, Dr. Frank Schifferdecker-Hoch, FPZ

Economic

Gothaer insurance discovered that by investing in back treatment, the insurance company was saved almost 5 times more in medical and sick leave costs.

The return of investment for the back concept is 4.7:1, meaning that every Euro invested in the back concept services leads to savings of 4.70 Euro

Manuelle Medizin 2006, 44:308–312, Springer Medizin

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