Dynamic Neuromuscular Stabilization (DNS) Frequently Asked Questions

What is Dynamic Neuromuscular Stabilization Method?

Dynamic Neuromuscular Stabilization Method (DNS) by dr Kolar is an innovative approach to manual medicine (chiropractic) and physiotherapy which involves every component of the locomotor system (muscles, joints, discs, nerves and soft tissues) by stimulating movement control centers in the brain through activation of ideal inborn movement stereotypes. The method helps to restore the structural and postural alignment of the bodys neuro-musculo-sleletal system by invoking the Global Motor Patterns.

What Are the DNS Global Motor Patterns?

Global Motor Patterns form the foundation of human movement and represent genetically predetermined elements of uprighting. They are activated during the postural development in the first months of childs life in the specific sequence from less to more complex. The Global Motor Patterns remain essential for control of posture and stability of the spine the pivotal center of the entire locomotor system through the life of the individual.

What Is the Scientific Basis for DNS Therapy?

The scientific basis for the DNS is the principle of Reflex Locomotion. The concept was first formulated empirically by Prof. Vojta who used it for diagnosis and treatment of adult and pediatric neurological conditions of various degrees of severity ranging from motor delays to Cerebral palsy.

His theory has since been expanded and factually substantiated by prolific physiological and neurological research. In Europe Vojta therapy has been the method of choice for the treatment of Cerebral Palsy, motor delays, strokes, multiple sclerosis and other neurological disorders and only now it is making its way to the United States.

How Does Dynamic Neuromuscular Stabilization Utilize Principles of Reflex locomotion to Treat Back Pain?

Dynamic neuromuscular stabilization takes advantage of the plasticity (malleability) of the brain. It aims to establish new physiological connections by reactivating dormant Global Motor Patterns. With the precise positioning of the patients body (see below), specific proprioceptive zones are stimulated. The spinal-joint manipulation, muscle relaxation and the soft tissue release procedures are all conducted in the primal positions of ideal movements of an infant (crawling and turning).

The stimulation invokes the Global Motor Patterns reflexes generating postural muscle tone which triggers global motor reaction. The latter co-activates wide range of muscle groups including deep spinal musculature, which is not under voluntary control and cannot be trained by exercises. The simultaneous contraction of agonist and antagonist muscle systems generates from within the centration of the entire spine-extremities complex resulting in spinal stability. This physiological phenomenon helps to minimize muscle imbalances and relieves painful protective muscle spasms, the result being a more stable neuro-musculo-skeletal network pathway system and much improved spinal stability and postural awareness.

How Can Dynamic Neuromuscular Stabilization Method Help?

The results achieved by DNS are superior to conventional methods used by chiropractors and physiotherapists due to the fact that induced movements are controlled not locally, but by the higher centers of the Central Nervous System producing faster and more long-lasting improvement of function and, therefore, pain relief.

Like the initial stimulation, manipulation, and rehabilitation exercises are also performed in the ideal movement positions. This promotes from-within spinal stability, which eventually, through repetition of the exercises, becomes habitual and independent of the conscious effort.

How Is Dynamic Neuromuscular Stabilization Method Different from Most of Chiropractic and Physical Therapy Methods?

The DNS brings faster and more stable results due to its direct access to automatic motor programs in the brain which promote proper movement through utilization of global motor reactions. The activation of these global patterns release muscular spasm and allows gentler, non-forceful manipulation. Such manipulation (adjustment) is only possible when the body is placed in specific infantile positions of support and the joints become centrated.

These support positions emulate body positions of the infant in which maximum spinal stability is achieved as the basis for the forward movement (crawling), turning or creeping. This style of manipulation is unique to Kolar technique. It is absolutely safe, non-intrusive and pleasant because the ideal laws of developmental kinesiology are observed.

Does that Mean that Anytime You Put the Patient in These Ideal Movement Positions the Joint Manipulation Is Easy and Non-forceful?

No, DNS does not use any forceful thrust. The manipulation is very gentle slow, but yet produces the same release as chiropractic thrust. It achieves that due to manipulation being performed only after stimulation which co-activates agonist and antagonist around the spinal joints as well as deep spinal muscle .All this together creates centration of the joints. Also the manipulation is conducted in primal position of crawling and turning of infants. This type of manipulation is the safest because there is no shearing or rotational forces. The forces applied are slow, gentle and decompressing.

Is DNS Method Mainly Used for Neurological Disorders and Rehabilitation of Pediatric Neurodevelopmental Disorders?

The answer is no. Prof. Kolar work has spawned from the work of renouned Professor Vaclav Vojta, whose method has been a method of choice for treatment of Cerebral Palsy and other neurodevelopmental disorders in Europe and is considered the most effective method to affect neuroplasticity of immature nerous system . Since then this method expanded with to include all ages with a variety of orthopedic,back pain and sports medicine disorders. The treatment is based on the principles of reflex locomotion , an approach designed to stimulate primitive subcortical reflexes and facilitate neuroplasticity. The Vojta treatments typically required multiple therapists and multiple sessions per day in an in-patient hospital setting. Kolar, with Vojta’s support, altered the method to be performed by a single clinician, to be utilized for acute and chronic pain syndromes, to be integrated with manual joint (mobilization/manipulation) techniques, to be utilized in either an out-patient or in-patient setting, and also to be utilized for athletic optimization, injury prevention. The combination of this treatment with external decompression is extremely effective for intervertebral disc disease( ddd, bulges, herniation and etc.)

Are There Any Exercises Involved in This Method and How Do They Differ from Classical Physiotherapy Muscle Strengthening Exercises?

In most of the physiotherapy and chiropractic schools of rehabilitation, as well as in personal training, muscles are trained in isolation. Strengthening weakened muscles in isolation from the unified locomotor system however does not guarantee that established power will automatically transform into adequate performance. Moreover, trained movements that are not integrated into a global locomotor system cannot become involuntary and therefore would be of little help to the patient. For example, we usually do not consciously manage how we walk, stand or seat. These and other habitual movements are controlled by the independent movement patterns “programs” embedded in the Central Nervous System. The DNS treats locomotor dysfunction by integrating the corrected movement into the frame of these programs. This way the movement becomes automatic and patient is able to use it without thinking.

Most of the DNS exercises in acute stage are conducted in the classic creeping, crawling or rolling positions. In the more advances stages of rehabilitation higher positions such as oblique sit, tripod, kneeling or standing positions are used. These exercises are applicable for patients with variety of acute and chronic conditions as well as for athletes who are trying to improve their performance and also prevent or rehabilitate injuries. The DNS exercises are conducted in a special way.These exercises are called actively supported exercises because clinician insures that the patient maintains proper support and executes ideal motion according to the laws of ontogenesis ( human development).

These exercises could include the use of gymnic balls, therabends and other related equipment. The exercises are not only used to improve the stability of the spine, muscle coordination, balance and strength. They are also designed to increase the body’s awareness (see sensory integration). Linking motor learning with global reflex motor pattern and the interactions of sensory input leads to the most efficacious interventions in spinal care.

Is DNS an Alternative Medicine?

No. DNS is a scientific method created by prof.Kolar in Motol Hospital, Prague, Czech Republic. It is based on years of research in the fields of manual medicine, adult and pediatric neurology and sports medicine. In Europe it is practiced by Medical doctors, Physiotherapists and Chiropractors. There has been a number of well conducted studies in Prague as well as in US proving DNS efficiency.

Why Is Dynamic Neuromuscular Stabilization a Holistic approach?

DNS is wholistic approach because it treats the origin of pain in the musculoskeletal system by adressing all of its dysfunctional components together by activating global motor stereotypes.This type of stimulation achieves regulation of many different centers in the brain affecting : motor , sensory, autonomic components of the nervous system as well as joints, muscles and soft tissues in the periphery. This type of activation helps to regulate all these functions together with breathing. Synchronizing automatic breathing with movement brings most effective results in spinal care because it achieves ultimate stability of the spine and most economic use of muscles ,thus preventing repetetive strain, overuse and destruction to the disc material.

Is Dynamic Neuromuscular Stabilization Method ( DNS) the Only Approach You Use to Treat in Your Practice?

No. Not at all. The key to our success is our expertise and understanding of functional pathology of the neuromusculoskeletal conditions, which allows diagnosing functional disturbances and selecting a procedure most suitable for a patient. Being trained in variety of most advanced functional clinical diagnostic methods Dr.Kalika carefully chooses which method or combination of methods fit particular patient. In our experience, however we see faster and more sound results with DNS and ISM ( Integrative System Model approach).We also use variety of classic physical therapy and chiropractic methods which survived the test of time.

Being educated personally from grands of famous Prague Rehabilitation School as well as prof.Kolar Dr.Kalika also use number of unique Manual Medicine approaches derived from Europe. Dr.Kalika has studied with professor Kolar from the very beginning of this methods creation. Dr.Kalika is also one of the first few DNS practitioners in US. We also treat conditions which usually respond poorly to Physical Therapy or Chiropractic.

Because of the breakthrough scientific basis of DNS we often succeed where everything else fails. We believe that DNS is truly a 21st Century approach in conservative care. Here is a list of therapeutic interventions we use in our practice: DNS , ISM, Classic Manual Therapy according to Lewit and Janda (Czech school of Manual Medicine), Shirley Saharmann’s approach, thoracic ring approach, Feldenkrais, Vojta Therapy, Brugge approach, Klapp crawling, Active release technique, Kinesiotaping, Myofascial release and Trigger point therapy.We also utilize variety of cutting edge rehabilitation technologies such as C.A.R.E.N ( computer assisted rehabilitation technology) and ESWT ( extracorporeal shockwave therapy).

Our Awards

Research at NYDNRehab

Whole-Body Neuromuscular Ultrasound for Evaluating Posture and Targeted Management of Muscle Spasticity and Pain Meeting: 2019 International Congress R. Bubnov, L. Kalika (Kyiv, Ukraine) https://www.researchgate.net/publication/336134647_Whole-Body_Neuromuscular_Ultrasound_for_Evaluating_Posture_and_Targeted_Management_of_Muscle_Spasticity_and_Pain
Whole-Body Neuromuscular Ultrasound for Evaluating Posture and Targeted Management of Muscle Spasticity and Pain Meeting: 2019 International Congress R. Bubnov, L. Kalika (Kyiv, Ukraine) (part2) https://www.researchgate.net/publication/336134647_Whole-Body_Neuromuscular_Ultrasound_for_Evaluating_Posture_and_Targeted_Management_of_Muscle_Spasticity_and_Pain

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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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