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”
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 for the common cold. Up to 70 % of 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 % in the past three months.
WHO methods and data sources for global burden of disease estimates 2010-2011, WHO, Geneva November 2013.
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 affect 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 useless and the possibility for permanent disability significantly increases 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 as well as large, mostly statically functioning supporting muscles.
When pain and loss of coordination is added to the equation, it is extremely difficult to start exercise therapy in a controlled manner. Special devices are required to isolate the target area and 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 the 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.
Individualized programs require thorough understanding of the patient background, present condition and physical capacity. Standard evaluation protocol includes a validated questionnaire along with patient background, pain profiles and self assessment. Physical therapy evaluation assesses posture, functional deficiencies and limitations. Device based tests include strength and mobility in all movement planes.
Results are recorded in a database and a very illustrative spine profile can be printed out comparing test results to normative data. Evaluations done pre-, mid- and post-treatment program, provide objective outcome reports for doctors and third‑party payers as well as added motivation for the patient.
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 in line 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.
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 muscles. 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.
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. The 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
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 generates savings of 4.70 Euro.
Manuelle Medizin 2006, 44:308–312, Springer Medizin