Dynamic Neuromuscular Stabilization DNS-B reviewed

I had the pleasure of visiting Athlete’s Performance Institute in Phoenix, AZ and attending Dynamic Neuromuscular Stabilization recently.

I won’t even try to fully capture the full scope of DNS in this blog.  The system, developed by Dr. Pavel Kolar, is based in developmental neurology and applies the principles of turning and creeping into assessment of the core (integrated spine stabilization system) and phasic movement of the extremities.  Understanding the anticipated movements of these inborn patterns allows us to perform resisted exercise or reflex locomotion to refresh these subcortical patterns to the standard operating procedures of cortical movement.  For those versed in the traditional chiropractic model of treating the nervous system and the innate, you have not seen more evaluation and influence of the nervous system or innate abilities than you will find in DNS.  This technique may very well be the bridge from the beginnings of our understanding to some of the contemporary developments and methods.

For those who wish to know more about DNS, follow this link.

A few key points:

  • Joint centration is essential and non-negotiable.
    -positions can be modified as needed, but joint centration must remain.
    – decentration of one joint will undoubtedly lead to decentration of another joint.  (An undesirable chain reaction.)
  •  What is centration?  Centration is the position of maximal joint contact.  This allows the most even distribution of forces through the joint as well as balanced muscular coactivation around the joint. 
  • Why do we want centration? Maximal motor control and power with minimal load/stress.
  • Breathing and abdominal bracing (spine stabilization) are intimately related and are interdependent.  Both must be maintained or the integrated spine stabilization system is compromised and stability is lost.
  • Evaluate and train in multiple positions/patterns.  The ‘key link’ Janda described will be evident in multiple evaluations.  Retraining this key link will require repetition and myelinization through training in multiple positions.
  • Newborns begin with primitive, reflexive patterns.  With afferent input (stimulation) there are genetically preprogrammed movement patterns that develop at specific neurologic ages. Failure of proper neurologic development indicates a ‘central coordination disorder’ that may be indicative of CNS pathology.
  •  “Form follows function”: failure to follow typical developmental movement patterns can have morphologic consequences.  (ex. flat foot, acetabular angle, pelvic tilt, kyphosis, etc)  Louis Sullivan coined this phrase in the world of architecture, but it clearly has its place and value in human development as well.
  • Zones of support during developmental positions create areas of dense proprioception.  These areas can be used for stimulation during isometric exercise and reflex locomotion.
  • Tactile and/or verbal cuing is used when altered motor patterns are seen.  When verbal or tactile cuing is not sufficient to improve faulty patterns, then reflex stimulation may be necessary.
  • During reflex locomotion there is a vector to follow, often towards the point of support (punctum fixum) or the next joint in a phasic limb.  The vector is not a specific direction, but within a general region from the stimulation point.  The exact vector is within a ‘cone shape’ and is determined by the clinician based on anticipatory reaction generated from stimulation.

There is a broad application of the principles of DNS as they are based on universal principles of inborn, preprogrammed movement patterns.  Applications range from evaluating and treating developmentally challenged babies, to restoration of normal movement patterns in painful or restricted adults, to allowing maximal motor control and muscle activation in elite athletes.  I should also mention that maximum distribution of joint forces is also applicable to all ages and situations as it will ensure proper development and maturation, help prevent future injury and joint pathology, and prolong athletic careers. This diverse applicability makes this system a valuable tool.

For their help in learning part B of the principles of DNS, many thanks to the folks at API (Darcy Norman, particularly as he helped out the B group), Ken Crenshaw & the AZ Diamondbacks organization, the Prague School instructors and Pavel Kolar, Clare Frank who instructed the B group, and course organizer Craig Liebenson.

The question that remains for me is, where is the line between good enough and not good enough?  With DNS functional testing there is almost always something wrong with the pattern.  From little flaws in stabilizer activation to completely inadequate coordination of breathing and bracing. What do we attack and what do we leave alone?  In FMS we talk about fixing 0s and turning 1s and asymmetries into 2s and symmetrical patterns. This is easy to follow. Valdimir Janda talked about fixing the ‘key’ link, but not getting bogged down in trying to teach perfect movement.  I’ve yet to find where this line is for DNS.  The line may be clear in the case of the elite athlete, we want everything to be as perfect as possible to give them the competitive edge.  However, for the average patient or average athlete, when do we call it ‘good enough’ vs. continuing the quest for perfect patterns.  For now I’ll try to let the clinical audit process sort it out (I’m curious to hear others opinions on this question, and if I ever come up with a more concrete answer I will be sure to post it.)

For the best review of this course I know of (including this one) see Jeff Cubos’s blog.

Interviews by Phil Snell of myrehabexercise.com during the DNS course in Arizona as follows:
Dr. Alena Kobesova -DNS interview

Dr. Clare Frank – DNS instructor interview

More interview and info available on Phil Snell’s blog.

For those looking to attend DNS courses check here.
There is a Scarsdale, NY DNS-A course in August 2012.