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

Dynamic Neuromuscular Stabilization, Sport I: Review and Recap

Last month I attended the Dynamic Neuromuscular Stabilization (DNS) Sport Level I course at University of Southern California, hosted by Dr. Craig Liebenson and taught by Dr. Petra Valouchova from the Prague School of Rehabilitation.  DNS was developed by Dr. Pavel Kolar and is a treatment protocol using development kinesiology principles to restore locomotor function and stabilization. The DNS-Sport curriculum was developed for non-clinicians to apply DNS principles in a performance setting.  The main DNS educational track (A,B,C,D,) is designed for clinicians and features advanced treatment protocols.

Central tenet of DNS is that certain fundamental movement patterns are pre-programmed into a healthy baby and remain holographically stored in the central nervous system through adulthood.  With movement corrupted by daily living, the brain forgets movements that were once pristine.  DNS exercises and techniques are options to retrieve this ideal motor programming, at times working as a “recovery disk” for a mature computer (central nervous system) that has been corrupted after infancy.  Most of the context in this course was for adults, but DNS is also used to treat pediatric conditions and even learning/behavioral issues in kids.    

We’ve been fortunate to have been exposed to DNS on multiple levels, including regular access to the clinic of one of the first DNS practitioners in the United States, (who was ironically studying in Prague the week before this course).  While most of the general concepts were a review, this course was a great opportunity to step back and get the fundamentals straight from a Prauge-based source, as much of my prior learning has come on the fly.

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Some notes from the course...

*The attention to detail was profound.  Most notably, a careful audit of breathing at each developmental position, which the baby does automatically.  (“If breathing is not normalized, no other movement pattern can be.” -Pavel Kolar).  However, Petra was great about explaining each detail in context of the big picture, so it was not about nitpicking just to be picky. 

*DNS is not meant to supplant anything.  Instead, it provides a framework and exercise options to deal with motor problems we encounter in coaching (and treatment options in a clinical setting).  Use whatever manual therapies, treatments or exercises you believe will aid the process, but the ideal motor pattern is preexisting.  The healthy baby shows us what that pattern is…no one tells the baby how to get upright…it just happens!

*Remember the big picture…

  • Reboot the system…
  • Use exercises provided (or clinical techniques if a clinician)
  • Why necessary?  Because ideal movement has been distorted in some way...pain, usage patterns, disease, etc.

*Several clinicians in the course who had already been through DNS-A and DNS-B (the first two levels in the clinical track).  Nice that the group operated on a fairly high level.  Great opportunity to meet practitioners from all over the world from a variety of fields...strength and conditioning, physical therapy, chiropractic, athletic training, massage...

*USC is awesome.  These are big league facilities....

*There was a heavy dose of practical application, which is difficult to capture in words.  However, it’s worth noting we covered relatively few exercises, instead focusing on a careful audit within each exercise.  I felt my assessment skills (especially for breathing) improved dramatically during this weekend due to the attention to detail.  In addition to Drs. Valouchova and Liebenson, Dr. Michael Rintala and Dr. Yoav Nagar, two longtime DNS clinicians came to help with the practical sessions.  Their contributions were invaluable.

*The Functional Movement Screen and its corrective algorithm are rooted developmental kinesiology and the motor programming exhibited by a healthy baby.  When you go through this course it is clear why the FMS is what it is.  DNS merely exists at a more fundamental level, but the principles are the same.  The screen is a catalyst to remember optimal movement.

  • Active Straight Leg Raise > supine saggital stability, kicking
  • Shoulder Mobility > Reaching
  • Rotary stability > Ipsilateral rolling pattern
  • Trunk Stability Push up > push up, beginning to upright itself
  • Squat > Squat
  • Hurdle Step > walking
  • In line lunge > Contralateral locomotive pattern

*Pavel Kolar and Pavel Tstatsouline are saying many of the same things, particularly the emphasis on breathing and stability strategies.  ("Reverse engineering what strong people naturally do" - Pavel Tsatsouline)  Corrective drills in the RKC and coaching cues are frighteningly similar to the same strategies the baby employs to stabilize itself along different postures.   

*…such as the turkish getup….  


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*Baby’s goal is to become upright.  Central nervous system leads us to upright posture without conscious thought.  In the process, baby reaches movement milestones at are both neurologically and biomechanically advantageous. Again, these remain pre-programmed in our CNS.  Key is how do we access these patterns after years of neglect/misuse.

*....Or more more positively, how can we align existing quality movement to make it better...

*Sometimes it is easiest to understand the importance of DNS when things go wrong …flexion, internal rotation, loss of rotation...healthy baby naturally learns extension and external rotation.   Access the pre-downloaded material to restore what needs to be restored. 

*So how do we change posture when it is automatic?  Certain “doors” allow for entry…breathing, posture, joint centration within pre-programmed movement patterns.  DNS helps identify where the doors are.  Clinical courses offer ways to “crack the code” with more advanced techniques, such as reflex locomotion. 

*Knowing where the doors are = Simply lead people to the doors and guide them through.  Some people need more guidance than others.  But overall, less need for verbalizing and cumbersome interventions in coaching and treatment.  The exercises and postures are there....Let people rediscover what they already know!  

*Core preactivation.  Example: baby stabilizes before picking up ball.  This is established during early motor development.  Many adult dysfunctions are caused not by weakness but instead by core not activating in timely fashion (or staying activated too much = too much tension).  Goes back to the importance of the breathing audit within each pattern. 

*Each joint has neutral position in each phase of movement.  If joint is out of neutral position, it results in compensatory movement and the central nervous system gets chipped away ----> autonomic nervous system stress)

*Centration of joint allows muscles to work equally around the joint (Jandacoactivation of agonists and antagonists)

*Peripheral joint centration allows rest of body to work properly.  Foot and hand are very important….think baby crawling.  Great deal of attention paid to hand position on the floor (hand position reflection of reaching patterns and stability....same with foot relating to kicking patterns and lower extremity stability)

*Each de-centration has consequences.  This is clear on a global level; one obvious example is foot prontation in the squat.  However, minor decentration in baby can be imperceptible and serious for development, although adults can compensate through this (but ultimately become injured).   

*Neutral joints established at 3-4 months.  Before this the baby lies asymmetrically because joints are not centrated.  (Foundation for movement variability concepts...Movement initially disorganized, but becomes more organized with development.  Each subsequent stage of mastery allows for greater movement variability). 

*Chest and pelvis are anchored first in the baby via co-contraction of trunk muscles.  These are the first cues for restoring optimal function in adults.  

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*After anchoring….hip flexion (90-90) then arm flexion –> ribs and pelvis parallel (adults lose this = scissor posture)

*Next = head lift at 3 months in prone (most people lift head with c spine, not enough with t spine...early signs of the Joint-by-Joint approach...).  Training prone t-spine extension was one of the most difficult exercises to do correctly.

*Any trauma takes us backward developmentally toward undeveloped newborn (shoulder internal rotation, elevation…).  

*Brain changes patterns to protect against pain
1)      Injury/motor disorder – treat injury and train patterns after injury
2)      Prevent injury – ideal joint centration
3)      Train patterns according to developmental kinesiology

*Use whatever exercises, therapies, equipment you want…but developmental kinesiology provides the ground rules everyone plays by and the way to access pre-downloaded programming to get us out of trouble and make dynamic performers even more dynamic

*When muscles have clear information they can pull economically

*Ideal muscle patterns form the anatomy.  (example…hip angle changes dramatically during early development…if muscle positioning does not allow femoral head to be centrated into pelvis, the baby will develop with serious problems…same concept with adults even though skeleton is less malleable)

*And where does muscle positioning come from?  Central nervous system programming.  

*Alteration to central nervous system program -> out of position muscle → structural change → lost function → threat to brain --->pain?

*Respiration is response to 1st contraction of the diaphragm

*Diaphragm stabilization follows the child in any movement.  That’s why we audit in each position.

*Ideal breathing mechanics for baby = RKC "breathing behind the shield"

*Cool video – organs moving during each breath…move MORE during breath holding

*Ipsilateral and contralateral patterns – same patterns baby utilizes to achieve uprightness are same patterns used in athletic movements kind of like a game of where’s waldo…the patterns are there, just know how to look for them...only difference is baby uses floor for support

Summary

It’s been a great year for continuing education and DNS-Sport just made it even better.  This course was a much needed primer on the fundamentals I had learned over the years, but previously did not grasp with sufficient depth.  I can’t emphasize enough the level of detail covered in the initial postures. 

Looking forward to Sport Level II in January and eventually the clinical courses when I begin PT school next year!

Related: DNS Rehabilitation, Prague School Introductory Video

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