IT is widely accepted that chronic diseases are associated with behavioral, social –economic and genetic factors that are not within the control of today’s medical delivery system.

Back pain, muscle aches, spine distress, shoulder tensions and joint stiffness or immobility are all common syndromes associated with Musculoskeletal Disorders. Common as it may be, such soreness ranges from acute to chronic, affecting our daily activities, work performance, emotion and state of mind; compromising our abilities; and at worst, obliterating our self-confidence. Recent studies show that four out of five people suffer from back or neck pain at some point during their lives; Out of every hundred people, seven will experience pain in the shoulder region.

In acute back, neck and shoulder pain it is important to address the cause and ameliorate the distress of musculoskeletal pain by appropriate medication. The length of the pain episode may be reduce and the risk of chronicity reduced if the patient stays active, keeps spirits high and avoids fixing thoughts on pain.

Staying active to the extent possible is important in all musculoskeletal conditions.

For instance, in acute low back pain it has been show that "it is reasonable to advise people with acute low back pain and sciatica to stay active." This recommendation is based on a systematic review of randomized clinical trials in which advice to stay active was compared with advice to rest in bed. The recommendation is based on the potentially harmful effects of bed rest. (Hilde et al.2001.)

The DBC method is based on the principle of functional restoration, and cognitive behavioral approach . Treatment based on the functional restoration principle combine the benefits of exercise therapies and the cognitive behavioral approach. That is why functional restoration treatments produce good results for instance in reducing work absenteeism, as was noted in a recent Cochrane review.

"Physical conditioning programs that include a cognitive behavioral approach plus intensive physical training ( specific to the job or not) that includes aerobic capacity, muscle strength and endurance, and coordination, are in some way work related; and are given and supervised by a physiotherapist or a multidisciplinary team, seem to be effective in reducing the number o sick days for some workers with chronic back pain, when compared to usual care". (Source:Schonstein et a. 2002)

Treatment Process

In DBC functional restoration programmes, exercises are directed at specific deficits of the ailing musculoskeletal system. Reductions in pain and disability are achieved as improvements are gained in function, control and cognitive behavioural dimension.

After a doctor’s examination has ruled out severe specific conditions, each patient is assessed according to a DBC protocol specifically developed for the purpose.

Treatment programme start with a careful, multidimensional initial assessment of each patient.

Each patient gets a verbal and a written report on the results of the assessment.

1. Baseline assessment
   Which consist of clinical & functional evaluation and bio-psychosocial profile for the patients.
   The resulting profile is used to design of an individual treatment plan.
   This is one to one session for 60 -90 minutes.
   
2. Individualized Programmes
   • Duration of Treatment
     • Duration : 60 minutes
     • Frequency : 2 sessions are run per week
   • Length of Treatment Programs
     it depends on the severity of the individual condition
     • For Chronic Neck, Lower Back and Shoulder problem ~~12 – 48 sessions of exercise programs.
     • For Acute Neck, Lower Back ,Shoulder and Knee problem, and less than 6 weeks pain ~~ 6 or 9 sessions of exercise programs
     • For Recurrent Lower Back Pain more than 6 weeks to 12 weeks ~~12 – 24 sessions of exercise programs
     • For Knee Rehabilitation ~~ 12 – 48 sessions of exercise program
   
   1st ,2nd and 12th session : one to one assessment session between 60 to 90 minutes.
   
   1st or 2nd session : Baseline evaluation including questionnaire, clinical examination, objective testing of mobility and EMG test (for back assessment only)
   
   3rd to 11th session : small group training to best suit the profile of the patient for the most successful rehabilitation. Treatment/functional exercises with DBC specific training devices
3. Progress Check Evaluation – after the 6th sessions
   This is to enable adjustment of the treatment plan when is necessary.
4. Out come Evaluation – after the 12th session
   The Outcome evaluation provide information on the progress and treatment outcomes as opposed to the initial measured parameters of the baseline assessment.
5. Continuously Active
6. After the 1st Package (12 sessions) of DBC functional rehabilitation, based on the level of improvement and with the physiotherapist recommendation, the patient can decide to continue on a second DBC package, Start a maintenance programme and follow with a home exercise programe in order to maintain the results and keep active.
7. Dressing
   Patient’s are required to wear proper attire for their exercise treatment programme.
   Advisable outfits are : Confortable T-Shirt and Short or long pants.

Treatment Devices

“Tools for Safe and Effective Exercise”

The DBC devices guide patients movements through planned, targeted , controlled and physiologically correct patterns.

The movement patterns have been designed on the basis of thorough biomechanical research with the aim of restoring the natural arcs of movements in the Lumbar, Cervical and Shoulder regions.

The reconstruction of physiological movements takes place on the basis of repeated, isolated exercises with variable resistance level using three-dimensional arcs of movement as required.

Assessment Tools

EMG - Used to measure “muscle fatigue” during exercise with the DBC Lumbar Extension Device.