DavidSpineConceptPresentation.pdf

SPINE CONCEPT

MOVEMENT AS MEDICINE

In most cases back pain is unspecific and no identifiable structural cause can be found. The correct

treatment path to these functional problems is an active noninvasive restoration on function. The David Spine Concept has been designed to meet this need.

Back pain extremely common Affecting almost everybody at some stage of one’s life.

Causes temporary or long term-term disability − Up to 78 % of the people have experienced

back pain at 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

− Up to 8% develop a chronic problem that causes permanent loss of ability to work.

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.

Specific causes for back pain Affecting almost everybody at some stage of one’s life. Although most back pain is unspecific there

are numerous conditions that can be diagnosed with traditional imaging methods and clinical expertise. It is however, often difficult to be certain of the causes of the pain which the patient is feeling: − Lumbago (Clinical diagnosis) − Disk herniation − Hypermobility − Olisthesis − Degenerative changes − Osteoporosis

Most patients in these groups benefit from active spine therapy. In the MRI-images on the right you can see a patient with a clearly visible disk herniation. After the David Spine Concept treatment it has disappeared. The structural changes shown require however, a longer period than the typical 12 week program.

Unspecific back pain Decondition syndrome leading to chronic disability In most back pain cases, it is not

possible determine a specific cause even with advanced diagnostic methods (MRI, CTI, X-ray)

However, regardless of the reason of the pain, it will cause avoidance in physical activity, further weakening the strength and coordination of the spine 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 often ineffective and the possibility for permanent disability increases significantly as time passes.

Reconditioning cycle Movement as Medicine

The aim is to brake the vicious cycle of deconditioning with active controlled movement therapy

The Spine Concept equipment allow for safe mobilization and reconditioning of the spine

By careful controlled activation it is possible reverse harmful effects of the deconditioning syndrome

The three month standard program is divided in to four distinctive phases each having a specific goal in the reconditioning process

Functional evaluation Objective measurements adding to the clinical status

Before treatment the functional status is evaluated with tests in all movement planes of the spine: − Mobility − Strength − Strength relation

The test are performed with of the EVE measurement system of the Spine Concept devices

These values are compared to a database of reference values that are dependent on the patients age, gender, weight and height

The treatment program is generated based on the measurement results

Questionnaires are used in evaluating the subjective status of the patient

Individualized treatment program Loading and movement ranges based on measurements

The goal of the treatment program is to increase the motor control, metabolism, mobility and strength of the spine, in a safe and controlled manner and eventually to restore the structural integrity of the spine − In-balanced strength of the antagonist

movements are also taken into account in the program design

The weight and range-of-motion limits are automatically calculated from the patients measurement results

The Individual treatment parameters and the patient fixation mechanisms of the devices, guarantee safe training

Treatment program Orientation Phase

The goal is to carefully start activating the spinal column possibly even without any weights if the patient is very painful. The patient gets accustomed to the training devices and methods.

It is important to start breaking the patients fear of pain avoidance behavior in normal daily activities

The device provides appropriate fixation and correct biomechanical movement patterns so that training can be done safely

The EVE Terminals on the training devices make sure that the measurement based weight and range-of-motion limits of the training program are not exceeded

Biofeedback during training

Treatment program Adaptation Phase

Nervous system begins to re-learn the normal motor control of the spinal muscles. The rotational movements are usually the most difficult ones to master.

Additional training is applied to the disproportionally weaker muscle groups to correct in-balanced strength levels

It is important to increase the metabolism and thus integrity of the target structures in preparation for the higher loading in the upcoming program

Functional tests with the device can be performed after the adaptation phase to evaluate the progression of the patient if necessary

Treatment program Exercise Phase

Increasing resistance leads to a building of the force generation ability of the spinal muscles

− Before this phase most of the increased force generating ability of the spine has been the result of improved function of the nervous system

The target is to increase the stability of the back by strengthening the supporting structures

− The ROM is not increased due to higher resistance

Careful monitoring of the patient is necessary to avoid overloading and pain

Treatment program Optimization Phase

The resistance level of the phase is only increased slightly, as the muscle strength should now be high enough to give the spine structures adequate support in normal daily tasks.

The goal of this phase is to prepare the patient for normal daily life. Patients are at this point very self sufficient in the training process, with the help of the EVE system. The system gives immediate feedback of the training metrics and quality.

Patients should learn to take the responsibility for their future health into their own hands. Training results and quality

Outcome analysis An objective view on achieved results

An objective evaluation of the achieved results is undertaken after the treatment program: − Clinical assessment − Measurements: Mobility, Strength and Strength relation − Subjective questionnaires

The outcome Spine Profile provides invaluable information in demonstrating the restored function of the patient − In most cases the outcome report and questionnaire

results are sent to the referring doctor for evaluation

Home exercise and stretching instructions are given to help prevent further problems

In most cases patients request an on-going prevention program, the design of which is based upon the outcome report − Prevention training is undertaken independently with

the physiotherapist following the progression through the EVE system

Expected results Impressive outcomes even with difficult chronic patients

1) Up to 75 per cent of the patients with chronic back pain reported a reduction of pain during the twelve-week treatment program

2) On average the strength of the back in patients with chronic lumbar pain increased by 26 to 45 per cent in different movement planes during twelve-week treatment program

3) The mobility of the back in rotation and lateral flexion of the patients with chronic back pain is generally limited. During the twelve-week treatment program, mobility in these movement planes increased by 12 to 34 per cent

1) Reduction of pain in chronic patients 2) Increase in muscular strength

3) Increase in mobility

All changes statistically significant <0.05

All changes statistically significant <0.05 except lumbar extension of men

Example results in the workplace Sick leave reduction with active prevention at Mercedes-Benz

Since August 2002 workers of Mercedes-Benz have been offered a back training program called “Kraftwerk” (power plant). It consists of device based training of the trunk muscles that can be undertaken directly at the workplace. The Institute for sports sciences of Heidelberg University was given the task to evaluate the program.

Participants were evaluated at the beginning of the program and after 16-32 training sessions between January 2003 and summer 2005. About 1000 patients fulfilled the evaluation criteria, the mean age was 38 years and the percentage of women 11 %. About ¾ of the participants were suffering from back pain.

The program showed significant improvement of physical performance and participants reached reference strength levels only after 16 session

The cases of absence from work could be reduced 48 % in the participating group

Development in muscle strength over time in Newton metres: beginning (T0),

16 session (T1), 32 session (T2).

Absence-from-work days per 100 insurance years

Changes in functional back capacity at T0, T1, T2 measured by the FFBH

(Hannover back capacity score). In the figure 100 means 100% back capacity.

Cost-Benefit analysis Significant return on investment for insurers

Insurance company Gothaer Krankenversicherun AG (Germany) selected 400 of its customers with chronic low back pain to participate in a cost-benefit study between 2000-2003.

The customers were divided in to two groups:

− Control Group: Traditional treatment methods

− Active group: Active Spine Care

All treatment cost and related costs were calculated during the 4 year period. Average savings in the active rehabilitation group compared to the control group was 1390 € / year. The cost were on average 5842,44 € higher in the control group. The cost of active intervention was calculated at 1247,55 €

The ROI was 4,7. This means that every 1 € invested in active spine care group was able to save 4,7 €

Treatment cost and related costs by specific categories during the four year study period per patient in the control and active groups

Technology Precisely targeted training effect The challenge is to isolate hip

extensor and flexor activity and focus the training effect on the m. erector spinae, small, dynamic intervetebralis muscles and rotatores muscles

The Hip-Fix mechanism locks the hip and the correct muscle groups are activated − EMG study shows that the erector

spinae muscle group is mostly activated

The curved back support guides the extension / flexion movements and activates the muscles of the whole spinal column sequentially. This physiological phenomena is usually lost when back pain becomes prolonged.

Adequate fixation is needed so that patients feel safe and secure. This allows training without pain and fear of it.

EMG activation measurement in a lumbar extension movement

Loading principles The effects of ''Stretch Shortening Cycle and muscle fatigue

The effect of ''Stretch Shortening Cycle" on muscle strength: Muscles act differently when comparing “concentric only” movement and “eccentric – concentric cycle”. Inertia plays a big part in this phenomena

Muscle fatigue during a set of repetitions: Muscle fatigue is disproportionate during a set of repetitions. Fatigue phenomena is more predominant at the shortened position.

Unique CAM design Compensated David Resistance Curve The natural loading principles of

the David cam incorporates the strength-length, stretch-shortening-cycle and fatigue phenomena in a unique way

The natural loading allows safe training of difficult chronic patients without harmfully straining the joints

With the David cam it is possible to do a full range-of-motion movements even with fatigued muscles

The inertial effect of natural weights is essential for the reconditioning of the nervous system and for improving fine motor control

Spine Concept devices Activating the whole spinal column in all movement planes

All devices measurement functionality for range-of-motion, force and endurance Medical-CE approved

F120 Lumbar / Thoracic Rotation

F110 Lumbar / Thoracic Extension

F130 Lumbar / Thoracic Flexion

F140 Cervical Extension / Lateral Flexion

F150 Lumbar / Thoracic Lateral Flexion

EVE Professional A complete measurement and monitoring system

Complete evaluation, monitoring and motivation tool to increase quality of training and client loyalty

All devices networked and communicate in real-time with each other

EVE Terminal Biofeedback and motivation

Guides patients through exercises with biofeedback

Visual feedback on actual movements improve motor control and motivate patients in improving their results

Gives immediate feedback after training on quantity and quality quality

Measurement and program editing functions

User friendly touch screen graphical user interface with RFID login

Wireless transmitting of all training and measurement data to the main program

Measurement functionality:

Guidance and biofeedback:

Results and program overview:

EVE Web Access A powerful tool for the treatment professional

The EVE Professional main program is accessed with a regular web browser

Location independent multi-location functionality possible

Multi-language support Patient information and training

program creation Automatic quality control Measurement analysis and

powerful reporting tools

Quality control and center activity report:

Program analysis and Spine Profile:

History of David Innovation through scientific research

Established in 1981 in Finland Collaboration with numerous Universities New knowledge was developed about the

biomechanics of sports people as well as injured people − Issues like stretch shortening cycle and disproportionate

fatigue were understood in context of exercise

In the 90’s focus shifter towards medical rehabilitation − Hundreds of published studies in internationally acclaimed

journals

The David Spine Concept method is the golden standard for LBP treatment in many countries

Hundreds of installations globally: Germany, Austria Finland, Russia, USA, Belgium, Netherlands, Spain, Egypt, China, Korea

The “original” Spine Rehabilitation Concept in Europe

Collaboration with Universities

Since the beginning of 80’s David has been the leader and innovator in resistance training and rehabilitation and one of the most imitated companies in its field. Many features that are self evident in modern devices have been

initiated in David’s research programs.

Today, David is showing the way again in applying the latest IT – technology to turn world class rehabilitation and prevention technology into effective concepts. For individual users the exceptionally easy-to-use touch screen

panels offer motivation, guidance and automatic quality control. With the new technologies training becomes more controlled and more productive than ever before. With “future proof” technology and on-line software solutions,

concepts are rapidly developing according client needs all over the world.