David Spine Concept
is a comprehensive evaluation and treatment concept for back disorders. The concept 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.
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Prevalence of back disorders
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.
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.
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.
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. Physical therapy 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.
The duration of a recommended treatment program is 12 weeks and 24 sessions. The length is essential, since prolonged back pain causes physiological changes in the tissue structure of the back, which take time to recover. The program is divided into phases with specific objectives for each phase.
The Orientation Phase (Fig. 1) aims at improving spinal movement in all movement planes, segmental coordination of the spine and improving endurance capacity of the supporting muscles. During the Adaptation Phase coordination and endurance are further improved and loading is gradually increased within pain limits. Loading is increased systematically during the Exercise Phase to increase spinal stabilization and neural muscle control.
During the Optimization Phase the aim is to optimize and harmonize coordination, mobility and endurance capacity of the lower spine and neck. Throughout the program selective relaxation and stretching are used together with equipment based exercises. These combined with ergonomic guidance are also used in home training.