Dynamic Neuromuscular Stabilization: DNS

DNS

You’ve probably heard me say “mimic the healthy, mimic the strong.”  I hope this explanation of DNS helps explain what I mean by that a bit better. Dynamic Neuromuscular Stabilization (DNS) is a method of training stability and movement of the body.

DNS is revolutionizing rehabilitation, and its principles can be directly applied to any sport.  It has proven to be so affective it is now used in many pro sports teams such as the Cardinals and Arizona Diamondbacks.

Do you ever wonder how babies learn how to roll, crawl, stand up or even start walking? All of this should occur automatically in the course of the CNS (brain and nervous system)maturation. This is an innate process that is engrained in our brains and in our DNA. DNS is based on the science of Developmental Kinesiology, the study of the co-development and maturation of CNS (brain) and the musculoskeletal system.

Human babies, unlike say a cow, are born very immature, and continue with a slow maturation process with the most development in the first 18 months of life.  This is essentially brain maturation, which guides a musculature maturation, which (in conjunction with ground reactive forces) guide skeletal maturation. Take this comparison of the hip joints; when looking at newborn, normally developed adult, and abnormal development in neurological disorders such as Cerebral Palsy to see role that the brain plays in skeletal maturation. Note how the shape and orientation of the the hip joints change from baby to normal adult vs a neurologically compromised

DNS, founded and taught by Pavel Kolar PT, and the “Prague School” of Rehabilitation and Manual Medicine, owe its origins to key neurologists/physiatrists/therapist: Professors’ Vaclav VojtaKarel LewitVladimir Janda, and Frantisek Vele.  Much of their early research and treatment was based on their study of neurologic disorders, such as cerebral palsy, in children. Based upon the groundbreaking neurodevelopmental and rehabilitation principles described by these mentors, Pavel Kolar has organized the next generation of clinical protocols that are designed to restore and stabilize locomotor function.

In the DNS system we are specifically interested in respiration, core stabilization, joint centration (optimal joint positioning), quality of support (with the ground or support roll), and body awareness. This is assessed and compared to the normal developmental patterns of a healthy baby in the first 18months of life.

Intra-abdominal pressure (IAP) and respiration is the foundation of DNS training. Ideally, the diaphragm is oriented parallel to the pelvic floor (not in open scissor position) and presses downward on inhalation or simply for stabilization of the spine.  This creates pressure which is ‘received’ as an eccentric contraction of the abdominal wall and pelvic floor.  Meaning the muscles are contracting as they lengthen.  This IAP is proportionate to the task at hand. Picking up a pencil, just a little bit; kicking at 60yd field goal, a ton!  This postural/stabilizing and respiratory roll of the diaphragm and abdominal wall is part of the feed-forward mechanism that stabilizes the trunk moments before distal extremity movements.  This mechanism is consistently perturbed in chronic and acute pain cases.

Joint centration a main tenet of DNS, is defined as the ideal loading of a joint in a neutral position that enables:

  • Optimal loading
  • Ideal balance between agonistic and antagonistic muscles
  • Generation of maximum muscle power

Joint Centration is a position in which the joint surfaces are in maximum contact and the passive structures (ligaments and joint capsule) have low tension. In this position, all muscles around the joint can most effectively be activated.

When disturbed, there can be catastrophic joint injury (ie ACL tear) or more low level chronic injuries such as: forms of tendonitis, ligament strains, and spinal disc herniation’s to name a few. DNS exercises emphasize joint centration at all times regardless of the position being used to exercise.

Every purposeful movement is preceded by proximal stabilization.  For instance, ideally in raising your left arm up, the first muscle to contract should be a right oblique muscle.  This ‘feed forward’ mechanism ensure that the muscles have something good and stable to pull off of; and it seems to be disturbed in chronic pain cases.  This means that for good arm movement, there must be good scapular positioning and stabilization, good spine positioning and core stabilization, hip knee foot and so on through the kinetic chain.

It’s just the right joints, being in the right place, to do the right thing, at the right time.

The concept of DNS is based on the scientific principles of developmental kinesiology. Meaning, all positions used for exercise in DNS are the same positions every human-being will advance through in the first year of life. If the baby develops normally, and the right environment is present, the correct activation of all muscles helps to form the joint surfaces and skeleton. We frequently use positional milestones of the developing baby, often referred to as ‘X’ month position, to achieve optimal muscle coordination by exercising in these ingrained developmental positions.

As a baby develops, they must use their body as efficiently as possible which means proper joint centration, intra-abdominal pressure, and global stabilization.  There are three main phases for development this stabilization function that are:

  1. 0 – 4.5 months (Sagittal stabilization)
  2. From 4.5 months (Extremity function, reaching and rolling)
  3. From 8 months (Development of locomotion)

For example, at 5 months of development we begin to see rolling patterns. This is a complex strategy that involves many muscles. Correct diaphragm position and intra-abdominal pressure is a prerequisite for activation of key scapular and hip stabilizers. Using closed chain exercises (shoulder, elbow or hand support) is useful for establishing the correct stabilization. This allows the muscles to be pulled from the opposite direction. Because the distal segments are now fixed (elbow/shoulder and hip/knee) all the muscles reverse their direction of pull. Traditional rehabilitation neglects this function.

What goes wrong in our posture?

When you observe the movements of a healthy baby, they move in what we call “perfection” because all the joints and muscle attachments do not have compensations and are working a perfect synergy and perfect joint stabilization. The muscles and joints working in synergy help achieve the given task.

Since DNS is based on the principles of Developmental Kinesiology, we compare the athlete or patients stabilizing pattern to that ideal patterning derived from observation of a healthy developing baby.

As we get older, there are a few things which hinder this synergy that do not allow us to move with such “perfection”.  These can be:

  1. Abnormal Postural Development
    1. Developmental Delays
    2. Unhealthy toys such as walkers
    3. Being placed seated to frequently to early
    4. “The W Sit” position
    5. Lack of “tummy time”
  2. Incorrectly Learned Activity
    1. Poor Coaching
    2. Incorrect Practice
    3. Play positions as they get older of poor posture (screen time)
  3. CNS Adapting to a Pathological Situation
    1. Casting from a Fractured Limb
    2. Other Traumas

What is the role of these developmental movement patterns in relationship to what we do on a daily basis? These patterns formed in the first year are used in daily and sport activities such as walking, running, standing, throwing, turning, squatting, lunging and so on.  These adult movements begin and baby milestones. Every natural movement during the first year of life is a natural process from our central nervous system.

How is DNS Related to the Throwing Motion?

This could be any rotational sport, kicking, punching, tennis, golfing ect, but lets look at the throwing movement. They are all what we’d call an “ipsilateral pattern.” This means that the pelvis and chest are moving in the same direction.  When this left-handed pitcher throws a baseball, for example, the left upper and lower extremities are considered the stepping forward limbs. Conversely, the pitchers right upper and lower extremities are considered the stabilizing limb.

As you can see, the pitchers left arm is moving, as well as the left leg. The right leg is stabilizing into the ground and his right arm is in stabilizing roll, even though its not technically ‘fixed’ to the ground.  His support leg is literally pulling his pelvis towards home plate. This helps to create force production. As the left arm continues through the throwing motion, the right arm maintains stability against gravity to allow the left arm to follow through. The shoulder muscles here are again literally pulling the body cylinder towards home plate, allowing us to throw precisely with very high speeds

The support and stepping forward extremities always perform in equal but opposite movement of the joints. As the stabilizing extremity moves into internal rotation, adduction and extension then always does the stepping forward extremity moves opposite; into external rotation, abduction and flexion.

The approach to rehabbing and recovering from injury needs to be assessed as a whole person and movement pattern, not by isolating single muscle groups. It is key to strengthen weak muscles in primitive patterns since these body weight positions are engrained in our brains. Breathing and core stabilization is imperative in the overall strengthening of our extremities.

Conversely, take this contralateral pattern of sprinting.  The left arm and right leg are forwards, about to transition into support roll as the opposite side steps forwards.  Both extremities pined to a stable body cylinder.  The sprinter is an excellent example of this body stiffness with extremity fluid motion, but it is also seen in our most common means of locomotion, walking.  Walking assessments and gait analysis provide us with valuable information that help guide future treatments.

It would be fairly logical to say that contralateral pattern begins with crawling, which is a contralateral pattern that we train in rehab, but contralateral patterns actually start sooner than crawling, which is a relatively advanced motion. This position seen below, which I refer to a a 4.5 month position is the first viewing and training position for contralateral support.  Where the opposite knee and elbow are weight baring fixed segments.

The stabilization required for contralateral support begins to show typically around 4.5 months, and is the basis of bipedal locomotion.  You have to LEARN to crawl, before you learn to walk!

Thanks for reading, if you think that DNS based rehab can help you, you have come to the right place.  You can see more DNS rehab in action on our youtube channel:

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