Dynamic Neuromuscular Stabilization

About DNS

DNS is based on developmental kinesiology, which is the science of human motor development during the first year of life, from birth to walking. During that time span, the human brain and musculoskeletal system cooperate to overcome gravity and establish posture and locomotion (walking).

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Human movement involves balancing body weight over a base of support in ways that allow for optimal dynamic stability, balancing load and force distribution both within and outside of the body.

DNS Methodology

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DNS combines manually assisted exercises with reflex stimulation to address dysfunction, misalignment, loss of control and postural deviations. Based on the patient’s condition and overall movement patterns, the DNS therapist selects a position from early development where proper support though the hip, shoulders and spine can be established.

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DNS manual joint centration by the therapist reinforces ideal movement strategies preprogrammed in the brain. Joint mobilization and soft tissue manipulation are also performed with the goal of preparing the body to handle each position. Therapy progresses to higher-level positions where support and stability are more demanding.

Reflex Locomotion Therapy

Reflex locomotion is used for patients who are unable to produce certain global or local movement patterns when cued during physical therapy exercises. The therapist uses manual reflex stimulation of zones in developmental positions such as creeping or rolling over to elicit a particular movement pattern.

Reflex stimulation is also an excellent method for treating acute conditions such as:
  • Sciatica.
  • Radiculopathy and herniated discs.
  • For patients with poor body awareness who cannot properly use muscles upon the therapist’s command.
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Although DNS is an all-inclusive methodology, clinicians should be proficient in soft tissue manipulation and joint mobilization.

DNS Advantages

Ideal motion patterns
Ideal motion patterns

The superiority of DNS lies in its ability to invoke ideal or near-ideal movement patterns from the nervous system based on genetic coding. Dr. Kalika is one of the first practitioners of DNS in the United States, having received one-on-one training from Dr. Kolar himself.

Innovative treatment
Innovative treatment

At NYDNRehab, we explore every avenue of treatment to help you achieve the best quality of life. DNS therapy has proven effective for treating patients with chronic back pain and other orthopedic conditions that restrict movement and cause pain. DNS offers an innovative treatment approach when pain medications and conventional methods have failed.

Better brain and body communication
Better brain and body communication

DNS stimulates the movement control centers in the brain, helping the brain and body communicate more effectively. DNS restores proper function of the entire body, improving mobility, range of motion and stability. DNS enables your body to reestablish global movement patterns, retraining it to do what it once did naturally.

Benefits of DNS Therapy

During DNS treatment, the patient is placed in the appropriate movement position, and the therapist applies gentle pressure to reflex pressure points, stimulating innate global movement patterns.

Benefits of DNS include:
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Increased spinal stability
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Reduced muscle imbalances
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Reduced muscle pain and spasms
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Improved posture
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After multiple sessions, optimal posture and movement are once again restored.

DNS at NYDNRehab

Although DNS is now being practiced around the globe, it is still a relatively new treatment approach with limited availability. Dr. Kalika was among the first to introduce DNS to the United States, and he was the only certified practitioner in NYC at the time. Other members of our practice have since been certified, making NYDNRehab the most experienced and professional clinic for DNS treatment in New York.

Retrain your body to move the way it should with DNS at NYDNRehab, and leave pain and restricted movement behind. Our goal is to help you restore musculoskeletal health so you can enjoy the very best quality of life.

Professional associations and memberships

Dr. Kalika is currently a certified member of:

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American Institute of Ultrasound Medicine

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Active member of ISMST

International Society of Extra Corporeal Shockwave Therapy

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Active member of GCMAS

Gait and Clinical Movement Analysis Society

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Active member of NASS

North American Spine Society

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Active member of IADMS

International Association of Dance Medicine and Science

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Active member of Virtual Rehabilitation Society

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Active member of ASRA

American Society of Regional Anesthesia and Pain Medicine

Lev Kalika Clinical Director and DC, RMSK

Dr. Lev Kalika has been working to revolutionize physical medicine, rehabilitation, sports medicine and athletic performance since 1998. He went to Prague to work side-by-side with Dr. Pavel Kolar, creator of DNS (Dynamic Neuromuscular Stabilization). After studying with Kolar and certifying in DNS, Dr. Kalika was the first to introduce DNS therapy to his New York patients. Dr.Kalika’s modern approach to athletic injuries has put him on the radar of some of the world’s top distance runners, pro athletes and professional ballet dancers.

Our Specialists

HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Mariam Kodsy Physical Therapist
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In 1997 Dr. Kalika moved to Prague to work with world renowned rehabilitation specialists Dr. Vladimir Janda and Dr. Karel Lewitt. There he met physical therapist Dr. Pavel Kolar, creator of the dynamic neuromuscular stabilization method (DNS). Dr. Kalika worked one-on-one with Dr. Kolar to learn DNS, returning to New York in 2000 to introduce DNS through his clinical practice. In 2010, once a certification program was in place, Dr. Kalika became one of the first certified DNS practitioners in the United States.

Dynamic Neuromuscular Stabilization

Dynamic neuromuscular stability is sometimes referred to as “core stability.” Core stability is not just a function of strong abdominal and spinal muscles; it depends on the precise coordination of those muscles. Dynamic neuromuscular stabilization training (DNS) can be used to rehabilitate athletic injuries and to optimize the athlete’s movement to prevent injury. It can also be used to improve sports performance by optimizing the efficiency of motion.

When compared to conventional physical therapy, DNS offers many advantages. DNS uses the neuron-plasticity of the Central Nervous System to produce rapid and long lasting pain relief and functional improvement. Conventional physical therapy methods take a longer time to produce any effect, and the benefits tend to wear off soon after the therapy stops.

DNS is the only therapeutic method to focus on improving spinal stability and motor control by acting directly in concert with the Central Nervous System. The training is conducted in the most natural (ideal) body positions. They are the positions that infants assume when learning to overcome gravity, to eventually stand and walk. When trained in this way, pathologically disrupted neural pathways of central motor control are re-established, and stabilizing mechanisms become automatic, providing a basis for healthy and efficient movement.

Conventional Physical therapy works by strengthening weakened muscles in isolation from the rest of the locomotor system. The effect is strictly localized and does not guarantee that increased strength will translate into improved overall performance. Isolated movements are not integrated into global locomotor patterns, so they cannot become involuntary and are of little help to the patient.

Follow thIs link for more information about physical therapy in NYC.

Unlike conventional physical therapy, DNS does not rely on passive care. Instead, DNS teaches patients self correction, prevention techniques and exercises that do not require a clinicians assistance and can be performed in the patients home. This proactive approach ensures that patients become actively involved in the healing process and minimizes doctor-patient dependency.

The advantages of DNS over conventional physical therapy give patients with neuromuscular disorders a superior alternative to commercially established methods of treatment.

DNS was invented by Pavel Kolar, a pediatric physiotherapist. DNS is based on the natural development of the human infant. The infant learns in a progressive and natural way to control posture and move with purpose. All infants exhibit the same progression of postures during the first year of development.

Beneath the “core” muscles lies “the deep core.” The deep core relies on the balanced use of the deep cervical flexors, the spinal extensors, the diaphragm, the pelvic floor, and the abdominal muscles to regulate intra-abdominal pressure and spinal tension, to provide dynamic stability of the spine. The deep core operates under automatic and subconscious control.

Recruitment of the deep core to properly prepare the spine for movement precedes any purposeful movement. Injuries and developmental disorders that interfere with this process cause impairments in anticipatory postural control. Training programs intended to restore or improve the precise muscular coordination and timing of the deep core can improve the efficiency of movement.

Kolar introduced the concept of “joint centration” to describe a joint that is dynamically stabilized throughout its full range of motion, allowing the joint and muscles to optimally function. A centrated joint experiences minimal stress. An example of lack of centration is work by Kolar that suggests that abnormal activation of the diaphragm can contribute to chronic lower back pain. Individuals who don’t use the diaphragm effectively for postural control experience increased compressive forces on the spine, preventing the spine from achieving centration.

If one link in a motor pattern is weak or is not used effectively, other muscles may be recruited to compensate, creating an inefficient motor pattern. These patterns are stored in the central nervous system as habits. Habitual use of inefficient motor patterns can cause chronic pain, injuries, and reduced performance.

When trying to rehabilitate an injured patient, working with only the injured limb is often ineffective because it is not the root cause of the problem, it is just a symptom. Focusing on core stability first before addressing the injured or weak limb may seem counter-intuitive, but it works very well.

Examining the entire motor chain to identify its “weak link” and then working to correct it is much more effective than only focusing on the affected limb or joint. For example, an athlete suffering from chronic shoulder pain will not be helped by physical therapy directed at the shoulder if a weakness in core stability is causing the athlete to use the shoulder incorrectly. Correcting deficiencies in core stability will not be effective either unless habitual motor patterns can be re-wired by retraining the brain.

The DNS approach to rehabilitation and injury prevention compares the athlete’s stabilization patterns to the patterns of a developing infant for the purpose of correcting the athlete’s movement. The initial DNS evaluation consists of a series of functional tests to identify weak links in core stabilization.

Once a weak link has been identified, a series of active exercises are prescribed to activate and restore optimal patterns of stabilization and movement. Each exercise is aimed at restoring optimal respiratory patterns and intra-abdominal pressure by re-training the use of the diaphragm, restoring stability of the spine to support dynamic limb movement, and restoring joint centration.

These exercises were developed by studying the motor patterns of infants as they learn to use their bodies. Through repetition of these exercises, old motion patterns governed by the central nervous system are replaced by new ones, and the new efficient motor patterns become automatic.

The use of infant movement patterns is based on the idea that the human brain is designed to learn movement patterns in a specific sequence, the way infants do. Re-exposing the brain to its natural way of learning movement patterns is an easy and effective way to restore optimal movement. You can think of it as “returning to basics” or “re-booting” the brain’s motion pattern processor.

Once the correct motion patterns have been re-trained in the brain, they are used effortlessly in daily life and in sports Using the correct movement patterns stops chronic damage from occurring and allows chronic injuries to heal. It can also prevent injuries from occurring in the first place, and it may improve sports performance.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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