I was greeted with a pleasant soothing atmosphere during my visit to the Zonnestraal estate. I end up in a wooded area of the town Hilversum in the heart of the Netherlands. Here I spoke with Rogier Bokelman physiotherapist and co-owner of OREC.  Zonnestraal was opened in 1928 as a labour and aftercare colony for diamond workers suffering from TBC. It is situated in a varied landscape of forest and heather on the transition from sand to peat.

Outside in the garden of the estate, I ask Rogier about their impressive accommodation. Rogier: ”Since last month, we moved the training room to the 1st floor of the complex. The floor is completely surrounded by glass so there is a lot of light entering the training area. We have chosen this facility because it fits the OREC philosophy in that we can combine indoor and outdoor rehabilitation and inspire patients by the fantastic nature around us. This fall we have installed all 17 DAVID medical devices.”

Exercise Therapy to treat lower back pain

The OREC success formula is a multi-disciplinary approach. Co-owner Roger describe it best: ”The OREC method is based on the bio-psycho-social model. At our center doctors, physiotherapists, occupational therapists, and dieticians work together under one roof. Depending on the diagnosis, we call in the various disciplines”.

Low back pain is a common diagnosis for those that come to the OREC medical center. “The OREC approach for low back pain treatment assumes that intermuscular adipose tissue occurs in the lower back”. This evidence-based approach is supported by various scientific studies based on patient and control groups.

In case of prolonged back pain, there is increasing evidence that certain muscles around the spine in the body are weakening (also called fatty tissue). Even when training, these muscles remain weak and only the surrounding muscles become stronger. So it is important to activate the weakened muscle tissues. “With the DAVID devices, we have a method to deal with this weakening. The isolated movement activates the right muscle groups that need to be made stronger”.

“The simulation of these muscle groups ensure that you (re)activate the muscle control from the cortex inside the brain.”

“By training in isolation, intramuscularly and at a high intensity you prevent, according to the researchers, the use of muscle groups that want to compensate for the movement. Especially in chronic patients, you see that movement strategies have been developed to mainly avoid the flexion movement of the lower back. The stimulation of these muscle groups ensures that you (re)activate the muscle control from the cortex inside the brain.”

OREC shares its treatment plan for people with lower back pain. The treatment template is standardized but through the EVE software it can be personalized to each individual. This includes settings such as weight load and range of motion.

The treatment plan for lower back pain:

• Total treatment duration is 12 weeks with an additional 8 weeks.
• Lower back program starts at 30% and is accelerated towards 75% of the person’s maximum strength in the last 8 weeks.
• Range of motion gradually increases over time

The treatment plan is different in chronic pain complaints, depending on the load capacity and the presence of central sensitization. The program’s intensity is much lower and starts from 25% to 45% (of maximum strength), and follows a step-based training program.

OREC is conducting further research into the effects of this approach in collaboration with the University of Amsterdam.

The DAVID Shoulder Solution is a valuable addition for OREC

Despite the short time that the DAVID Shoulder Solution has been installed at OREC, there are already several successful cases. The big advantage of the shoulder devices, says Rogier, is the intensity with which it can be trained.

“It is important that the muscles around the shoulder joint and rotator cuff are trained with the right intensity and range of motion. The DAVID shoulder devices allow the intensity to be evenly distributed over the full range of motion, which benefits the safety and quality of exercise and ultimately the treatment outcome.”

The DAVID Shoulder Solution benefits the safety and quality of exercise and ultimately the treatment outcome.

The EVE system is an important focus area for the patient to perform the exercise correctly, the pain is distracted and the correct load is applied.

The business model is a combination of reimbursement by health insurers and memberships.

Rogier explains OREC’s interesting business model. ”Most people have a referral with which they get their physiotherapeutic care reimbursed by health insurers. As OREC, we find it important to fully devote these consultations to the patient but do not find it necessary to stand next to the patient at all times in the training room. Patients receive (manual) therapeutic care and have a membership to train on the DAVID devices.”

“We notice that patients, despite a clear explanation, find it difficult to maintain the correct movement technique. The David instructors make sure that patients get tips to ensure that exercises are performed correctly. EVE monitors the exercises as a virtual assistant so that the right range of motion and intensity is selected.”

In the future,  technological innovations such as DAVID will play a dominant role. At OREC we are clearly prepared for the future of physical therapy!

What does the future of physical therapy look like? Rogier: ”I believe in a holistic approach to treat patients. The various disciplines are slowly combining into an integrated approach to treat complaints. Here, technological innovations such as DAVID will play a dominant role. At OREC we are clearly prepared for the future of physical therapy!”