St Andrew’s War Memorial Hospital has welcomed brain and spinal neurosurgeon Dr David Johnson and his successful Functional Movement Training Centre, into a dedicated space on level four, as part of his City To Coast Neurosurgery practice.
Dr Johnson describes his approach to medicine and hhealthcareas “foundational”. He sees his role as neurosurgeon and doctor, to guide and educate patients to optimise four primary foundational elements of health that we are all in control of – sound nutrition, proficient movement, effective stress management and quality sleep.
Embracing this philosophy, he has created his one-stop multidisciplinary facility at St Andrew’s where all of these health imperatives are defined for patients, prioritised and addressed by a team of nutritionists, physiotherapists, registered nurse, research assistant, exercise scientist and movement therapist’s.
As the surgeon in the team, Dr Johnson maintains the important clinical aspects of treatment. He sets the optimal road map to follow in sometimes very challenging patients, often biased toward failure due to their prior history of having exhausted all commonly available spine pain treatment methodologies.
“With few exceptions, surgery on the spine is only indicated, if it will enhance the patient’s capacity to improve their ‘Movement’ foundational pillar,” Dr Johnson said.
“In patients with spine pain, there is almost always the presence of movement dysfunction.”
“The vast majority of patients with back pain do not require surgery, but nearly all of them require correction of motor patterns manifesting as movement dysfunction.”
Dr Johnson utilises the Functional Movement Training Centre’s NeuroHAB program for this common problem. NeuroHAB has a distinctive and unique focus on central nervous system (CNS) motor patterns. When you conceptualise that back pain symptoms are in fact a CNS movement disorder, this approach makes total sense, he said.
“I developed this approach after appreciating that global peer reviewed literature is increasingly acknowledging the failings of existing treatment to manage the growing economic and clinical burden of back pain symptoms.”
His team have adopted the “Movement” approach with all his patients since inception of Functional Movement Therapy and NeuroHAB in 2011. “Our research and outcomes are extremely satisfying and drive us to reach more patients with spine pain symptoms.”
Dr Johnson says, the earlier we correct movement dysfunction the quicker we can eliminate relapsing, remitting or chronic symptoms and prevent non-surgical symptomatic degeneration transforming into surgical problems.
“This is the natural history if patients are on the roundabout of futile therapy for too long, or “Failed Rehab Syndrome” – a term I coined that is real but rarely acknowledged, in contrast to the commonly used term “Failed Back Surgery Syndrome” which approaches a rate of 50 per cent.”
“I think this very high failure rate is actually a reflection of failed rehabilitation rather than failed surgery and we are conducting further research to clarify this theory”.
One of the most satisfying parts of Dr Johnson’s job is seeing patients transform over the period of the NeuroHAB program, from someone with extremely poor movement proficiency, pain and functional capacity into someone moving virtuously with significant reduction in pain and re-acquisition of amazing functional capacity. He describes Functional Capacity as the ultimate metric of health.
The Functional Movement Training Centre has a philosophy to re-establish and practice proficient skills of movement in all activities of daily living.
The service is located at St Andrew’s War Memorial Hospital (Brisbane) with other satellite centres located in Maroochydore, Caloundra, Toowoomba and Mackay.
The NeuroHAB program runs for 6-8 weeks, after an initial clinical spinal assessment by Dr Johnson. It then comprises two, one-hour sessions each week. Once patients have completed the NeuroHAB program they can progress to the NeuroFIT program to further increase functional capacity.
Multidisciplinary group consultations are conducted monthly with Dr Johnson, NeuroHAB Movement Physiotherapist’s and Musculoskeletal Physician, Dr Mark Craig for education and assessment of suitability for entry into the NeuroHAB program.
He also conducts surgery at St Andrew’s, with his expertise covering a wide range of brain and spinal neurosurgery, including complex spine surgery, keyhole sacro-iliac stabilisation and minimally invasive approaches, neuro-oncology, acute cerebrovascular surgery, brain and spine trauma, trigeminal neuralgia, CSF diversion surgery and pain neuro-stimulation surgery of the spinal cord and peripheral nerves.