Lower back pain is the leading cause of activity limitation and work absence throughout much of the world, imposing a high economic burden on individuals, families, communities, industry, and governments. [1]
“Up to 70% of the people have experienced back pain sometime during their lives. Approximately 40% had an episode of back pain lasting more than a day in the last year and around 25% during the past 3 months.” [2]
DECONDITIONING SYNDROME
In most back pain cases a specific cause or diagnosis cannot be made. However, regardless of the reason of the pain, it will cause limitation with physical activity, further weakening muscles and reducing coordination of the trunk. Eventually this deconditioning will affect the integrity of the spine and 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 usually not helpful and the possibility for permanent disability increases.
MOVEMENT AS MEDICINE
Several studies have shown that movement can act as medicine for painful joints. When addressing joints like the knee, which are relatively
simple structures, movements are simple and loading is easy to apply in a controlled manner. However, the spine is a very complex structure involving vertebrae, discs, ligaments, and muscles that must function dynamically and statically to support your movement.
When pain and loss of coordination is added into the equation, it is extremely difficult to start physical exercises in a controlled manner. The David spine program involves using special equipment to isolate the targeted areas and provide total control throughout movement and loading.
With the help of the David spine program equipment spinal movements start with limited range and low loading and most importantly within pain tolerance. Long term physiological changes are slow and time is essential. Ideal treatment programs are designed over 3 months with an ongoing program afterwards as needed.
INDICATIONS & CONTRAINDICATIONS
Most back disorders can be treated successfully with the David Spine Program. These include unspecific back pain, degenerative changes, herniations, scoliosis, 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, low bone density, 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. Physical therapy evaluation assesses posture, functional deficiencies, and limitations. Device based tests include spinal strength and mobility in all movement planes.
Results are recorded in a database and an illustrative spine profile can be printed out comparing each test to normative data. Device based testing occurs at initial evaluation, midterm and at completion of program. These tests provide objective outcome reports for treating doctors and third‑party payers as well as added motivation and progress tracking 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 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. An individualized program involving the David spine program provides a safe start, which can be used in early stages of rehabilitation and the range of motion is designed to be pain free and the loading light. The progression throughout the program will be determined based off the patient’s tolerance and pain level. The program is designed to increase spinal load and repetitions in a gradual progressive manner.
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Footnotes
[1] Hoy D, March L, Brooks P et al. The Global Burden of Low Back Pain: Estimates from the Global Burden of Disease 2010 Study. Ann Rheum Dis. 2014 Jun;73(6):968-74.
[2] Deyo RA, Mirza SK, Martin BI. Back Pain Prevalence and Visit Rates: Estimates from U.S. National Surveys, 2002. Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7.