Dynamic Neuromuscular Stabilization: Exercise Part I Recap

A couple months ago I had the opportunity to retake DNS Exercise I (formerly Sport I), hosted by Southern California University of Health Sciences (Katherine’s school) and organized by Dr. Michael Rintala. And it is certainly a treat when Petra is back to teach on of the DNS courses in the United States!  This course was particularly special as it was the first time Katherine and I had been in the same course since beginning our respective programs.  And it is only fitting that it occurred in a curriculum that has been so formative in our development.  

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The learning process for the developing baby mirrors the learning process for sport but on a different scale

Kinesthetic awareness was an important theme during the weekend.  It is not something we necessarily quantify, but we know that it differs in the baby compared to grown individuals, when comparing injured and uninjured, and elite athletes versus non-elite athletes.

Example of kinesethetic awareness at elite level: Jaromir Jagr could discern differences of 2mm in the blades of his skates. 

Why make the point about kinesthetic awareness?  Important to understand when taking patients/clients through exercise.  Just as kinesthetic awareness is natural part of neurodevelopmental process, it is a vital part of adult learning, both in healthy and injured populations...(How Can We Measure Body Awareness?)

Make movement look effortless.  Bring this same appreciation and demand for movement quality into clinical practice.  As Dan John reminds us, make your strength look good.     

Range of motion = most important is what is available for use in dynamic situations?  And this goes back to what the brain chooses to allow.  Baby has seemingly unlimited range of motion, but very little is actually available for upright gait and purposeful movement.  Baby lacks awareness for requisite control, just as patients with passive range of motion might not have this motion available dynamically. 

Cortical control of movement.  Repetition is required so transfer into subcortical (unconscious competence)

Learned programs = cortical; Fixed = basal ganglia, cerebellum

Anatomy is very individual…so how do we define neutral or centrated?  Maximal congruence of joint surfaces with same tension all the way around (co-contraction)

How the spine is shaped is based on how baby learns to fight against gravity.  Genetic information directs us toward bipedalism

The way we upright T spine at 3 months influences the way we use bipedal gait

Reptiles move with a lot of lateral flexion. Crawling is never the same as reptile.  Baby at 8-9 mo uses more rotation

Subcortical base for locomotion is set at 3 months

Changes to muscle tension occur before movement (Feed forward mechanism)

3month position is the “starting line.”  Lift legs off table and secure torso w/o deviation.  Starts with position at ribcage and pelvis.  If not optimal, load shifts to extremities

Control of the sagittal plane.  (Note: as I have gained experience with DNS since the first class, I have appreciated how valuable it is to spend more time in this position than any.  Avoid the temptation to move forward too quickly!)

Movements are often harder to control at slow speeds.  Can’t power through the movement (example: 2 minute Turkish getup!!)

Parallelism of diaphragm and pelvic floor occurs at 3.5months.  This allows for movement of extremities without coupled movement of the trunk

At 3.5mo, first purposeful movement is isolated head movement (in course A we get into the visual basis behind this evolution…)

Working with sport coaches…often the complaints of the sport coach regarding athlete’s technique bad habits are linked to physical limitations seen in clinic (TPI Body Swing Connection!!)

Limited T spine rotation often drives excess lateral flexion and extension. 

Poor support function of arms -->drives hunched over posture.  Support function of arms allows upper T-spine uprighting in infant

Adduction + internal rotation of arms is often subconscious way to create fake stability

Deep neck flexors require stability of abdominal wall

Case study – young patient lacking arm and hip coordination and ability for independent limb movement.  Unable to follow objects with only eyes (turned head for simple tracking).  Why important?  Must be able to see blackboard and write simultaneously in school (importance of speech and writing in school…technology eroding these basic motor coordination skills in youth?)

Joint centration – not only about biomechanics.  Important to drive afferent information to brain

Shoulder position plays role in core development in 3mo position.  Transiton from IR, ADD to ER, ABD and caudal movement patterns.  Brain sends us back to newborn posture in injury (IR + ADD)

Sometimes you get weaker in the short term using new, proper form

Knowing what NOT to do is more important than know what to do (Y is also “NOT X”)

5 mo contralateral position is the first sign of walking pattern

Movement dictates bone growth.  Hip inclination begins at 3 mo

Main time to influence joint morphology is in first year of life

First stabilizer is the diaphragm.  Applies pressure against internal organs.  Eccentric expansion

Work within certain range of diaphragm activation.  Never let it completely descend

Baby rib cage is more barrel shaped

Restriction of T spine is manifested in aberrant rib cage movement

There is an ongoing competition between postural and respiratory function in diaphragm

No matter how much you treat locally, still must address poor respiration pattern that has been ingrained via millions of reps (and going back to earlier point…be excellent at basics of 3 mo position)

Breathing is an expression of the nervous system

Respiratory function gets prioritized over stabilization function during stress

Abdominal wall contraction can prevent diaphragm from descending

Forward leaning posture = more tension in Achilles.  Diaphragm is placed in front of pelvic floor

Stress, pain, posture, digestion can all be linked.   Remember digestion works through sphincter function

Baby is driven by emotional need.  This is manifested early in ipsilateral turning

Oblique sit is entry to vertical plane

Someone can be strong when certain muscles are used as prime movers, but weak when asked to use muscles as stabilizers  

Closed kinetic chain = bringing torso over supporting area (Golf…chest moves toward the lead arm)

Diaphragm activity must be appropriate for the task…not too much or too little (SFG analogy…think of tension as a volume dial)

Poor hip movement often compensated by excess movement in T/L junction

Evaluate diaphragm function during breathing and during breath holding

Pregnant patients – work the ribcage but don’t work on intra abdominal pressure

Lowest position is not always the easiest one (important to keep in mind w/ FMS 4 x 4matrix)

How can trainers assess without license to put hands on people?  Observe compensations, teach clients to self test. 

Conclusion and General Thoughts

Is this course suitable for trainers?  That’s one of the most common questions people have with this curriculum.  My answer is a definite “It depends.”  It is potentially an excellent choice for someone with "real life" exposure to DNS and the ability to partner with a clinician.  But it is definitely a mistake to approach this course as a way to “backdoor” into the realm of pain and “post-rehabilitation.”  We’ve been fortunate to work with several DNS clinicians over the years (some of whom with roots to Prague predating the current DNS curriculum as most people know it…), so even before taking the course in 2012 we had an idea where the information would fit into what we did.   

If you want to understand movement on a certain level that you may not receive any place else, this course is unmatched.  This curriculum is skill acquisition at the most fundamental level.  My notes below don’t even do it justice.  Maybe we just appreciate this aspect more coming from our backgrounds in acrobatic sports, golf, and performing arts.   

Yet I would not approach this course with the thought of integrating a giant new toolbox of skills to bring to the gym on Monday morning.  On the training side, this course is more about adding texture than technique.  As it has been said before, even if you don’t use certain techniques directly it can help you get better at what you already do.  But it is a fair argument to suggest that on the performance side, your resources may be best directed toward getting even better at performance (bigger, faster, stronger)... 

That said, I think this course should be required before taking the clinical track (DNS-A thru D).  Drilling down the exercise and movement component adds a much richer context to what comes later in the clinical side.  Plenty of people have breezed through A,B,C,D without taking the Exercise curriculum, but I think the base for learning the clinical techniques becomes much deeper when the focus is first upon movement.

Looking forward to Course B, hopefully in the relatively near future…