Functional restoration helps overcome pain and DBC treatment programmes are based on this principle. Reviews of medical studies have shown that this is the most effective approach in reducing pain and sick days among patients with chronic back pain.
FUNCTIONAL RESTORATION AND COGNITIVE BEHAVIOURAL FACTORS TO TREAT CHRONIC NECK, BACK AND SHOULDER PAIN
Evidence on the benefits of functional restoration in the treatment of chronic neck pain is convincing. The first results obtained at DBC clinics confirm the promise of the approach in the treatment of chronic shoulder pain too. What makes the functional restoration approach special is that it includes not only physical training but also addresses cognitive behavioural factors. After years of suffering from intense pain, every patient needs convincing information about the underlying safety and benefits of planned exercises. The functional restoration approach induces physiological changes and facilitates learning by doing.
The DBC method enhances the benefits of this approach. Exercises used in the DBC programmes have been carefully designed so that their impacts are focussed on the most important areas of the musculoskeletal system. The exercises are individually tailored for each patient for maximum safety, benefit and comfort.
The DBC method relies on the skills of doctors and physiotherapists, who have received special training so that they know exactly what is the target and function of each exercise. DBC devices are designed so that the correct patterns of movement come naturally to each patient.
PROLONGED BED REST IS BAD FOR CHRONIC MUSCULOSKELETAL CONDITIONS AND PAIN
Inactivity hampers recovery from chronic musculoskeletal pain. Physical exercises are an integral part of the functional restoration approach. It is important for patients having chronic musculoskeletal pain to understand the harmful effects of prolonged bed rest. It has been proven that prolonged bed rest is not only a bad option in the treatment of chronic back pain but that it also aggravates other medical conditions.
Complete bed rest is ``a highly unphysiologic and definitely hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible.`` That was the conclusion of an article published in 1944 in the Journal of the American Medical Association. Nevertheless, only a decade ago, prolonged bed rest was in many countries the treatment method of choice for lower back pain. Similarly, various forms of rest or support were often recommended for recurrent pain in the neck or shoulder. Since then there has been a complete change in the way of thinking, and medical researchers associated with DBC International and DBC clinics have contributed to this change.
Now it is widely recognized that rest and traditional physical therapies in which patients receive treatments passively are not very effective in chronic musculoskeletal conditions. Physical inactivity has several harmful effects:
- Muscles, ligaments and bones weaken
- The spine stiffens and loses control and coordination
- Overall physical fitness deteriorates
- Patients become prone to depression and sensitive to pain
- Resumption of normal activities and daily routines becomes more and more difficult as time passes
The current consensus is that inactivity is the wrong response to acute and chronic back pain, chronic neck pain and chronic shoulder pain. In acute pain, it is advisable for patients to continue daily activities as much as possible. In chronic pain, physical exercises can bring about some relief gradually, and the best results are obtained when carefully designed functional restoration approaches are followed.
Research is an integral part of the ongoing development of the DBC system. Results of DBC research collaboration have been published in medical journals such as Spine, Archives of Physical Medicine and Rehabilitation, and Journal of Spinal Disorders and Pathophysiology. The practical implications of research are taken into account in the development of DBC protocols and devices. Data on thousands of patients treated in DBC clinics are an important source of information. While medical information on individual patients is strictly confidential, information obtained from patient assessment yields important aggregate data on the efficacy of treatments given in DBC clinics.
Acute pain is a warning signal of tissue damage. In chronic pain, discomfort continues even though the original tissue damage has been healed, and there is no clearly identifiable physical cause for pain. Instead, tissues and the central nervous system may have become overly sensitive so that ordinary stimuli are interpreted as pain by the central nervous system. Often back pain that has lasted for less than 6 weeks is classified as acute; subacute or prolonged when its duration has been between 6 and 9 weeks; and chronic if it has lasted more than 12 weeks.
RANDOMISED CONTROLLED TRIAL, COCHRANE LIBRARY AND REVIEWS TO ASSESS THERAPY FOR MUSCULOSKELETAL PAIN
Musculoskeletal pain is pain associated with muscles or joints. Evidence based medicine is healthcare applying therapies based on the best available information and scientific evidence on the effectiveness of each individual intervention. In medical research, the Cochrane Library has been designed to provide such information on a systematic basis and is therefore widely referred to in our research. The criteria for assessing therapies:
- Efficacy: does it work as expected in randomised clinical trials (RCTs)?
- Safety: does it have adverse effects?
- Effectiveness: does it work in normal clinical environment?
- Cost-effectiveness: is it an efficient use of resources?
Randomised controlled trial (RCT) is an experiment in which investigators allocate eligible people randomly into intervention groups that receive or do not receive treatments that are being tested. The results are assessed by comparing outcomes in the treatment and control groups.
A systematic review of RCTs is a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant RCTs, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies. Example: Cochrane Reviews.
