Lecture 2 Diagnosed Based Treatment-Dr - Vlasta Voracek

Diagnosed Based Treatment
of Back Pain
Dr. med. univ. Vlastimil Voracek

Orthopedist
Germany - Czech Republic
Helsinki 2013
1
Samstag, 21. September 13
OTZ CPM
Orthopädisches Therapie Zentrum Centrum Pohybové Medicíny
87700 Memmingen Praha 6
Germany Czech Republic
2
Back pain Operation
?
- specific
- nonspecific
- organic
- functional
Rehabilitation
Every back pain is specific !
- organic
organic
specific + psychological
functional
- functional
3
Diagnostic
Morphology
Bones
Joints
Ligaments
Discs
Muscles
Spinal cannel
Function
Trunk and back muscles
Diaphragm
Pelvic floor
Functional integration

Morphology
5
Indications for a necessary surgery
Constant pain
Neurological indication
Narrow spinal channel
Massive spondylosis deformans
Demyalisation of nerves
Cysts
Failed conservative therapy
Caudal syndrome
Tumors
6
The preference for structural interpretation of back pain
is caused by prevailing anatomical diagnosis.
It leads to a quantification and a structuralisation of the disease pictures.
Morphologic findings
can be the pain origine!
7
Function and Morphology
8
• International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden
• Lund T, Klemetti E, Lohman M, et al. Lumbar disc changes on MRI and low back pain. A prospective
long-term study in healthy volunteers from childhood to maturity.
Teija Lund, MD, PhD, ORTON Orthopaedic Hospital, Helsinki, Finland;
A prospective long-term study that followed healthy school age

children through maturity showed 59% of them had low back pain
by the time they reached 18 to 19 years old (51 girls, 44 boys) ,
with 9% having reported experiencing low back pain at the outset
of the investigation, when they were 7 to 8 years old.
By the age of 18 and 19, 15% of young adults demonstrated black

discs and the rate of other MRI findings had increased to almost
60%, and not unexpectedly most of these changes were at the
two lowest lumbar levels
Epidemiological research has shown LBP in children and

especially adolescents is much more common than previously
thought.
Only 14% of our young adults the symptoms were severe enough to Investigators assessed sagittal T2-weighted MR images for nucleus signal
warrant medical consultation. Moreover, although the frequency of MRI intensity, disc height, protrusions, herniations, anular tears, or high intensity
zones. They graded nucleus signal intensity visually as bright, speckled (a), or
changes increased during the growth spurt. black. More severe MRI changes such as herniations (b), were rare in these
age groups.
No correlation between MRT-changes and LBP Images: Lund T
Too much emphasis should not be put on the concomitant MRI changes
9
Functional examination reveal structural deficits
standing laying flexion
10
Influence of the trunk muscles during
upper body extension on the lumbar
spine lordosis and thoracic kyphosis unphysiological posture
with wrong diaphragm function K= 55°
L= 29°
Upper body extension
K=50°
L=36°
extension with trunk

muscles activation
K=34°
L=30°
11
Weak and discoordinative muscles function leads to postural changes.
Functional adaptation and a false biomechanical load of the spinal column cause
structural decompensation
12
Function makes structure submissive
Degenerative changes are a submissive reaction of the structure
to inapropriate biomechanical load and are visible symptoms
of a poor postural function and neuromotoric coordination
Structural changes need time to occure, malfunction is visible soon.

To avoid or moderate back pain problems it is necessary to forestall structural
changes by changing function in advance.
13
Intraabdominal pressure with a functional trunk muscules centrate the joints and decrease
the biomechanical forces on the structure itself.
Thus it forms ideal morphologic formation of the joints and the spine.
.
Function of trunk muscules and diaphragm are responsible for

intraabdominal pressure and
the harmonius support and relief of the spinal column
14
If we assume that a false motoric function has a direct destructive
influence on the structure, then it is only logical that
by a functional improvement a structural relief
must be obtained.
15
DAVID SPINE CONCEPT
functional reintegration of muscles
improvement of posture
relieve of structure
16
man 65, s.p. fixateur intern
osteochondrosis L5/S1
xxxxxxxxxx

s.p. Kyphoplasty
woman 77
Osteoporosis
xxxxxxxxxx

Measuring xxxxxxxxxx
Isometric power: of the spine and trunk muscles
Mobility: of cervical - thoracic - lumbar spine
Measurements of the neck, trunk and back

muscles have proven, that there is a dependancy
between isometric power under defined
conditions, age, sex, weight and body size,
and back pain
19
man 54, icehockey, tennis
chronic back pain

xxxxxxxxxx
xxxxxxxxxx
xxxxxxxxxx

chronic pseudoradikulopathy
man 65 osteochondrosis C6/7
funct. enbloc ajustement C5-C7
xxxxxxxxxx xxxxxxxxxx
xxxxxxxxxx

woman 41, teacher
Kyphotic adjustment of
chronic head pain the upper cervical spine
cervico-brachial myalgia Disuse syndrom
cervical extension and
cerv. lat. flex. painful
xxxxxxxxxx
xxxxxxxxxx

xxxxxxxxxx
woman 19
standing > 20 min.

weight bearing impossible
trunk motion painful
pain VAS 7- 10
Unstable Spondylolysis L5/S1
xxxxxxxxxx

women 40, 58 kg
Osteochondrosis
functional low back pain collapsed disc L5/S1
short movements painful multiple bone edema
xxxxxxxxxx

April 28 woman 31 akute lumbalgia with pain into left leg
no motoric but sensoric failure L5
pain 9 - 10 VAS
Lasegue 10°
standing almost impossible
Discus herniation L5/S1

Conservative Therapy
Novalgin
Diclophenac
Katadolon
acute: < 3months
Mg
Shockwave therapy
cybernetic BCR therapy
Manuel therapy
Physiotherapy
Manuel therapy
intermediate: 3-6 months cybernetic BCR therapy
David Back training
long term: > 3 months David Back training

September 10.
xxxxxxxxxx
No pain
Full mobility
load carrying limited
Sensibility restored
xxxxxxxxxx
xxxxxxxxxx

man 41, construction technician
chronic back pain since more then 1 year

March 4 pain 7-9 VAS
Lasegue positive 20°
xxxxxxxxxx Discus herniation L4/5

Disc degeneration L5/S1
Therapy: operation - herniotomy
xxxxxxxxxx

June 06, status post herniotomy 3 months
no improvement after surgery
pain 7-9 VAS
xxxxxxxxxx
positive Lasegue 20°
Failed back surgery syndrom
xxxxxxxxxx
new
Therapy:
conservative
Medication: 2 weeks
Shockwave therapy,
Cybernetic BCR
therapy,
Manuel therapy,
12 x training
therapy with
David devices

March 04, June13, August 26,
xxxxxxxxxx
xxxxxxxxxx
No pain
Full mobility
no Lasegue

Change of Structure
man, 45 years
xxxxxxxxxx
31
xxxxxxxxxx
Disc Regeneration
partly recover of the disc thickness

retracting of the disc protrusion

Change of Posture
Decrease of biomechanical load
xxxxxxxxxx xxxxxxxxxx
33
Conclusions
The background of pain in younger people is mostly a bad function,

with increasing years a progressive structural decompensation
in combination with metabolic and psychological background.
Individual approach with

Guided Diagnose Based Training
can achieve in most cases functional re-compensation,
with structural relief .

Function makes
hardware submissive ......
.......... and pain too
35

Lecture 2 Diagnosed Based Treatment-Dr - Vlasta Voracek

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Lecture 2 Diagnosed Based Treatment-Dr - Vlasta Voracek

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Diagnosed Based Treatment

Dr. med. univ. Vlastimil Voracek

Every back pain is specific !

Samstag, 21. September 13

A prospective long-term study that followed healthy school age

By the age of 18 and 19, 15% of young adults demonstrated black

Epidemiological research has shown LBP in children and

standing laying flexion

Upper body extension

extension with trunk

Structural changes need time to occure, malfunction is visible soon.

Function of trunk muscules and diaphragm are responsible for

functional reintegration of muscles

Samstag, 21. September 13

Samstag, 21. September 13

Isometric power: of the spine and trunk muscles

Mobility: of cervical - thoracic - lumbar spine

Measurements of the neck, trunk and back

chronic back pain

Samstag, 21. September 13

Samstag, 21. September 13

Samstag, 21. September 13

standing > 20 min.

Samstag, 21. September 13

Samstag, 21. September 13

Samstag, 21. September 13

long term: > 3 months David Back training

Samstag, 21. September 13

Samstag, 21. September 13

chronic back pain since more then 1 year

xxxxxxxxxx Discus herniation L4/5

Therapy: operation - herniotomy

Samstag, 21. September 13

Samstag, 21. September 13

Samstag, 21. September 13

partly recover of the disc thickness

Samstag, 21. September 13

Decrease of biomechanical load

The background of pain in younger people is mostly a bad function,

Individual approach with

Samstag, 21. September 13

.......... and pain too

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