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

1) Up to 75 per cent of the patients with chronic back pain

All changes statistically significant <0.05
reported a reduction of pain during the twelve-week
treatment program 3) Increase in mobility
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

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
Development in muscle strength over Changes in functional back capacity at
summer 2005. About 1000 patients fulfilled time in Newton metres: beginning (T0), T0, T1, T2 measured by the FFBH
the evaluation criteria, the mean age was 38 16 session (T1), 32 session (T2). (Hannover back capacity score). In the
figure 100 means 100% back capacity.
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
Absence-from-work days per 100 insurance years
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 Treatment cost and related costs by specific categories during the four
save 4,7 € 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

F150 Lumbar / Thoracic

Lateral Flexion
F140 Cervical Extension /
Lateral Flexion
F130 Lumbar / Thoracic Flexion

F120 Lumbar / Thoracic Rotation

F110 Lumbar / Thoracic Extension

 All devices measurement functionality for range-of-motion, force and endurance

 Medical-CE approved
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 Measurement functionality:

Guidance and biofeedback:

 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
Results and program overview:
 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
EVE Web Access
A powerful tool for the treatment professional
Quality control and center activity report:

 The EVE Professional main

program is accessed with a regular
web browser
Program analysis and Spine Profile:
 Location independent multi-
location functionality possible
 Multi-language support
 Patient information and training
program creation
 Automatic quality control
 Measurement analysis and
powerful reporting tools
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 Collaboration with Universities

 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
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.