Drupal
Athletic development specialists dedicated to the art and science of excellence in movement

Dynamic Neuromuscular Stabilization, Basic Course "A": Review and Recap

Hard to believe it has been nearly three months since we attended the Dynamic Neuromuscular Stabilization, Course A in Las Vegas, hosted by our friend and mentor Dr. Susan Wenberg.  In the previous eleven months, both Katherine and I had attended the Sport I and Sport II but were excited to add the A course to our learning experiences.  (See Notes from DNS Sport I and Notes from DNS Sport II).  Below are my notes from the weekend (taken to supplement the provided study materials). 

Overall, this was a predominantly “hands on” course with the focus upon exercise postures and an introduction to reflex locomotion.  I am very glad we attended the Sport curriculum first, as those experiences provided a richer context upon which to understand the “why” behind the reflex locomotion techniques.  However, the powerful message from the course is not adding reflex locomotion to a proverbial toolbox, but instead to achieve a better overall understanding of brain and musculoskeletal interaction.   

As with any course, the quality of attendees plays a major part in the success of any educational experience.   This course was no exception as the students included an MD, chiropractors, vision therapists, and a Feldenkrais practitioner.  Great to learn from the different perspectives each field brings to the material. 

------

Having been through the exercise component, we begin to see where complementary therapies can assist.  Some people may have difficulty getting into certain positions.  The starting position becomes the exercise.  Movement is the foundation, the manual therapies are facilitators. 

Reminded how original DNS courses had little structure…came across as “magic”…left with hundreds of slides in great detail

Reminded there is still much to learn about functional anatomy…example: rhomboids may also upright the T spine, in addition to their commonly understood role in scapular retraction

Integrative Spine Stabilizing System – mulitfidi, deep neck flexors, diaphragm, abdominal wall, pelvic floor  - Connection to subcortical function (subconscious movement).  Similarities to Cook’s “inner core”…Subcortical relies on all senses…makes the body ready for life situations. 

Sports technique is a reflection of subcortical function

All the infant has to rely upon is the subcortical…Peer into the nervous system

Deep neck flexors - --insufficient activation leads to kyphotic T spine, hypermobilie C spine…this is joint by joint, but in a different language

Similarities to Pavel Tsatsouline….breathing/stability dichotomy of the diaphragm (Breathe through the brace, but in a different language)

In addition, diaphragm controls lower sphincter of esophagus….offers insight into how function/movement and digestion can impact each other (and consider how emotion, and other factors…its all related!)

Why is anything  in DNS special?  Laying foundation for techniques taught in upper courses, so don't expect anything transformative in Basic Course-A. 

Image and video hosting by TinyPic

 

Great emphasis on importance of saggital stabilization…but this still occurs three dimensionally

Pelvic floor: ties to sphincter system/function – if diaphragm is stretched via poor stabilization, sphincter control is lost, leading to issues such as reflux

Stabilization is not just muscle strength – it is a matter of function, ability to control intraabdominal pressure subcortically (this is impacted by entire sensory panorama)

Diaphragm and pelvic floor: similar anatomy; act as partners in respiration and posture; both have sphincter function; must work together (Reflux study)

Caudal fixators of the chest: origin in lower ribcage, same as diaphragm…key stabilizers for pelvic floor….big reason why one of the fundamental DNS treatments is centering the ribcage and moving the chest caudally with manual assistance (or using the breath/exhalation to assist the descending of the ribcage and chest)

Most training focuses on concentric contraction of the core muscles….instead, train eccentric function to happen automatically (“full” look of midsection, like sails in a sailboat buffeted by the wind)

Aesthetics often lead us down dysfunctional paths in core training…

Need to “anticipate” movement to train stability (training kids: gives them experience at deducing situations…why elite athletes are not only quicker/faster, but are really just better decisionmakers)

Strive for balanced muscle tone throughout abdominal wall; not just “six pack”

Pelvic floor and diaphragm both must be trained to function eccentrically (which relies on subcortical function…which takes us back to primitive movement patterns….it all relates!)

In baby, first three months priority is to stabilize the trunk…if optimal stabilization does not occur, grasping and other functions will be affected

“Motor patterns are formed as CNS matures, enabling infant to control posture, achieve erect posture against gravity and to more purposefully by phasic muscle activity…The infant does not need to be taught when and how to lift the head, grasp, turn around, start crawling….all this should occur automatically in the course of CNS maturation!”

Horses can stand up after one hour, but humans require approximately one year…bones are not ossified and joints not properly formed

Movement patterns and postures are essential for joints to centrate properly during development, otherwise skeleton will not form properly.  Joints can only develop if muscles co contract properly

Joints are passive structures but depend on muscles to work properly…but muscles are controlled by the brain

Proper formation of skeleton both relies on sensory perception and can affect sensory perception

Shoulder blades and pelvis connecting with torso allows for purposeful movement (and lack of connection is common movement flaw)

Movement inhibits primitive reflexes; reflexes may persist longer if movement does not occur (highlights importance of grasping, sipping cup, playing with toys)

Diaphragm only has breathing function in baby….learns stabilization as it progresses through developmental sequence (importance of actually going through developmental sequence)

Lesions of the CNS…Janda noted similar patterns in CNS patients and orthopedic patients

Understanding manual therapy approaches: joints may be tight, muscles out of position not because of mechanics alone, but because brain has either consciously or subconsciously chosen to adopt pattern or posture.  DNS fits into comprehensive approach to have the most appropriate conversation with the nervous system to achieve normalization of movement

What does the hand say? 

  • Baby in uterus vs post birth
  • Uterus = purposeful movement, grasping ---safe, low light, plenty of support

Birth = lack purposeful movement, less safe because added demands of stability.  No stability = most movement responses are reflexes

Based on the above, understand how the environment interacts with movement and behavior

Newborn  = like fish out of water, each change in posture creates de-centration.  Global movement patterns only, no specific movement.  Very short optic contact (quick looks only).  Again, reflection of nervous system

Grasping reflex is different than purposeful grasp.  The latter depends on stability.

Sense of self – seeing hand during grasp and crawl helps baby recognize its own body

Primitive reflexes open the gate to higher level brain function, but must not persist too long.  For example, grasping reflex precludes the development of purposeful grasp

Open scissor posture – often tied to reflux in both babies and adults.  Once posture resolved, food stays down better due to more appropriate sphincter function.  But still look beyond mechanics of posture and understand why brain has chosen its postural habits

Forearm support is critical for development of turning

Stability is critical for volitional grasping (great emphasis on stability often colored by work with children….is it mobility before stability?)

Serratus anterior – critical as fixed point (clear why it should not be trained as a prime mover).  Helps stabilize rib cage.  Reflective of diaphragmatic function (high chest = no fixed point, poor breathing, no anchor for rib cage)

Learning to load elbow is key for turning

Challenge of teaching parents to allow development to happen along time course…not rush for bragging rights!

Diaphragmatic dysfunction – reflection of all senses!

Poor sensory integration also linked to behavior issues

Eyes and body stabilization tied closely together (becomes readily apparent in blind people).  Baby instability is result of undeveloped vision

Review of joint centration (see, Hannon, Relaxation Training, Centration, and Skeletal Opposition)

KEY: Baby shows emotional need for grasping before it is able to grasp!

Saggital stabilization with joint centration occurs before ipsilateral and contralateral turning

Turning is driven by optical fixation and emotional need

Optical fixation drives loading of one side, which unloads opposite side

Pull of serratus anterior adds stability to T/L junction in addition to intra abdominal pressure

Hand placement milestones in 90-90 posture (groin, knees, feet, foot to mouth)

Abdominal wall differentiates throughout movement – change function with each pattern – change vectors of muscle pull, yet joint centration maintained throughout

Reciprocal movement of hands and feet during ipsilateral turn

Cross support pattern during five month prone posture reflects maturation to grasp object while in prone (again, goes back to emotional needs and sensory perception driving movement development)

Faulty scapula position is indication that rib cage is not working

Pain causes reversion developmentally

Ventral muscles are latest to turn on

Sucked in gut look – often paired with headaches and tight traps

If baby lacks saggital stabilization on back it won’t be able to load elbow to turn

Everything you look for in reflex locomotion is what you see in normally developing baby

Reflex locomotion – drive the system with what’s intact; feeling of comfort in movement that patient is not yet able to access alone

Motor pathology is blockage of motor development

Relieve spasticity – then allows cortical function to occur; Reflex locomotion bridges the subcortical and the cortical

Patient is less exhausted – use the subcortical to access the pattern

Lateral walk is often ignored as a gait stage

Gnostic function – learning what muscles to turn “off” (Example of failure = using whole body to move computer mouse).  Tension and relaxation.  “Do X and also means Don’t Do Y”.  Learning to disassociate eyes and body.

Comments

Post new comment

The content of this field is kept private and will not be shown publicly.
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.