Dynamic Neuromuscular Stabilization - C

With an all-star cast of faculty, organizers and participants, it wouldn't be difficult to say that the DNS program held at Athletes Performance - Arizona may be one of the best opportunities for the professional development of rehabilitation-based clinicians in North America.

Along with the medical staff members of several major league baseball teams, prominent and budding physical therapists and chiropractors, I was fortunate to attend the "C" course, where our knowledge of the system was tested, advanced and enhanced throughout this 4-day learning weekend. Because the "A" and "B" courses in this program form its foundation, this "C" course not only packages all the DNS principles together seamlessly, but also takes its principles to specific conditions whereby troubleshooting becomes much, much easier. Now because I am a big fan of learning principles over specific tools and methods, the following information will be based on some of the key points that resonated best with me. My apologies for those that are new to the DNS system and may not be familiar with some of the concepts below. Should this be the case, please check out my review of the "A" course here prior to moving forward.

• One of the key tenets stressed in this course was the thorough understanding of the anticipated movements. Knowing what should "come next" and what you should expect, essentially will help guide and gauge whether you are right or wrong in your approach and treatment.
• When encountering troublesome hip problems, it may be wise to check the muscle activity and pressurization ability low down in the abdomen (near the groin) to assess for compensation. The body may be robbing Peter to pay Paul. Most, if not always, the goal should be balanced intraabdominal pressure throughout the entire cavity.
• Unilateral hip flexion is dependent on Thoracolumbar junction stability and contralateral hip stability, among other regions.This is based on the concept of the punctum fixum.
• Quite often, dysfunctions in neck stability/motor control stem from lower down the body. Just like the glenohumeral joint needs a stable scapulothoracic girdle, so too does the cervical spine. The "cannon from a canoe" concept applies here as well. Again, the importance of IAP cannot be stressed enough here.
• In chronic posterior chain dysfunction patients such as achilles tendinopathies, plantar sided foot pain, etc, again it would be more than wise to assess intraabdominal pressure. Trust me.
• Too much concentric activity of the abdominals, pectorals, trapezius, etc may negatively affect the diaphragm's ability to induce pressurization. The diaphragm and pelvic floor largely play a concentric role. All other muscles (i.e. above), are more important eccentrically.
• This is a no brainer, but a muscle's ability to relax is very important.
• Gluteal filling (volume expansion) is important for lumbosacral and sacroiliac stabilization.
• Very often a lack of coordination of muscle activity is more important that a lack of strength. Proportion of muscle forces is important.
• Hips often do not need surgery, they need to improve their movement patterns.
• For stabilization, it is likely more important to simply hold the position (i.e. isometric holds) than dynamic repetitions.
• We can learn a lot from sumo wrestlers. They are very strong but rarely bench. They simply do thousands of centrated movements in a slow and controlled manner. Therefore, when working with young athletes, training a high number of centrated movement patterns is likely more important than loading.
• It is always important to assess whether the problem is a contralateral pattern dysfunction or that of an ipsilateral pattern.
• In high tone/stress individuals, it may be wise to first start with mobilization and/or release. In persons possessing a parasympathetic state, load them up with stabilization.
• You can use which ever exercise progression you want, just respect the principles of a) centration and b) support and stepping functions.
• "Train the same pattern, only in different positions"
• The body's ability to relax is related to body awareness. A lack of body awareness can be called "Body Blindness" - the inability to know the body, especially with the eyes closed.
• Low back (i.e. discogenic) patients with good quality of stereognosis (body awareness) will have a better likelihood of surgical success. Those who lack stereognosis would be wise to improve body awareness prior to surgical referral.
• The principles of stereognotic training (which is based on Feldenkrais and Ayres) is slow, precise, repeated and simple movement with high central nervous system control. To me, it is the "recognise" of movement based rehabilitation. The objective is to learn to differentiate movement, controlled relaxation of the body with movement, and progression to higher level positions. Essentially, this may be an excellent intervention for motor morons.
• The goal of DNS rehabilitation is not only to improve the integrated spinal stabilizing system, but also to restore stereognosis. Therefore, Tai Chi may be an excellent method of physical activity for patients of all ages. As a side note, I'm really looking forward to Tai Cheng.
• DNS is not about the baby, it's about optimal movement.