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David Spine Solution

The 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 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% of people had an episode of more than a day in the past three months.

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

Deconditioning syndrome

In some cases regarding back pain, a specific diagnosis cannot be obtained. Regardless of the reason for the pain, most people will avoid physical activity, which further weakens the strength and coordination of the back and will eventually affect the tissue structure.

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

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 intervertebral muscles, as well as large, mostly statically functioning supporting muscles.

When pain and loss of coordination are 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, low loading, and 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

With the David Spine Concept, most back disorders can be treated successfully. These include nonspecific 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 consent and motivation from the patient.

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Individualized programs require a thorough understanding of the patient background, present condition, and physical capacity. Standard evaluation protocol includes a validated questionnaire along with the 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.

The results are recorded in a database, and an illustrative spine profile can be printed out comparing test results to normative data. Evaluations are done pre-, mid-, and post-treatment program, and provide objective outcome reports for doctors and third‑party payers and give added motivation to the patient.

Treatment program

The overall goal of a successful treatment program is that pain decreases and quality of life increases. To achieve this goal, the active therapy must be progressive and in line with the individual’s ability to adapt to 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 that can be used in early stages of rehabilitation. In 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


EMG validation studies were done in collaboration with the University of Cologne, Germany, to find out if David’s isolation principle really engaged the target muscles and blocked the strong surrounding muscles. The results showed that not only were the strong hip extensors blocked, but in fact inhibited, creating a high level of activation in the spinal target muscles.


A set of three published outcome reports by FPZ, a chain of over 200 licensed back centers in Germany, looked at various outcome measures, including pain intensity, pain frequency, sick leave days, visits to doctors, etc. The N’s (sample size) in these data sets were very large, ranging from 4.559 to 37.943 subjects. The reports showed excellent results. 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 saved almost five 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

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