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.

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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.