Statistics On Lower Back Pain

Dynamic neuromuscular stability is sometimes referred to as “core stability.” Core stability is not just a function of adequate muscular strength in the abdominal and spinal muscles; rather, it is a function of the precise coordination of these various muscles. Dynamic neuromuscular stabilization training (DNS) can be used to rehabilitate the injured and can be used to optimize the movement of the athlete to prevent injury. It can also be used to improve sports performance by optimizing the efficiency of motion.

When compared to conventional physical therapies the advantages of the DNS become apparent. DNS uses neuro-plasticity of the Central Nervous System producing rapid and long lasting improvements in pain relief and the function. Conventional physical therapy methods, on the other hand, take a longer time to produce any effect and those tend to wear off soon after the therapy stops.

The DNS method is the only therapy that focuses on improving spinal stability and motor control acting directly on the Central Nervous System. The training is conducted in the most natural (ideal) body positions. These are the positions that infants assume when straggling against the gravity to stand up and walk. When trained in this way, the pathologically disrupted neural pathways of the central movement control are re-established and stabilizing mechanisms become automatic providing basis for healthy and efficient movement.

In contrast, conventional Physical therapy works by strengthening weakened muscles in isolation from the rest of the locomotor system. The effect of such therapy is strictly localized and does not guarantee that established muscle power will automatically transform into adequate overall performance. Moreover, trained movements are not integrated into the global locomotor patterns and cannot become involuntary and therefore would be of little help to the patient.

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Unlike the conventional physiotherapy, DNS does not rely on the passive care. Instead DNS teaches patients self correction, prevention techniques and exercises that do not require clinicians assistance and can be performed in the privacy of the patients home. This proactive approach ensures patients dynamic involvement in the healing process and minimizes doctor-patient dependency.

The advantages of DNS over the conventional physical therapies show that patients with neuro-muscular disorders have a superior alternative to the commercially established methods of treatment.

DNS was invented by Pavel Kolar, a pediatric physiotherapist. The basis of DNS is the mechanism of natural maturation of the human infant. The infant learns in a progressive, natural way how to control posture and move in a purposeful way. All infants exhibit the same progression of postures during development.

Underneath the “core” muscles lies “the deep core.” The deep core consists of a balanced use of the deep cervical flexors, the spinal extensors, the diaphram, pelvic floor, and abdominal muscles to regulate intra-abdominal pressure and spinal stiffness. This process provides dynamic stability of the spine. The deep core operates under automatic and subconscious control. Adjustment of the deep core to properly prepare the spine 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 talks about the concept of “joint centration” which refers to a joint that is dynamically stabilized throughout its range of motion to allow the joint and muscles to operate at their optimum. A centrated joint experiences minimal stress. An example of lack of centration is work by Kolar suggesting that abnormal postural activation of the diaphragm can contribute to chronic lower back pain. Individuals who don’t use the diaphragm effectively in postural control have increased compressive forces on the spine, thus incorrect use of the diaphragm prevents the spine from achieving centration.

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

When trying to rehabilitate an injured person, working only with the obviously affected joint or limb (the one that is injured) is often ineffective because it is not the root cause of the problem, it is just a symptom. Focusing on the core stability first and the injured or weak limb second may seem counter-intuitive but it works very well. Examining the entire motion chain to identify the “weak link” in the motion chain and then working to correct that error is much more effective than focusing on the most obviously 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 the actual problem is a weakness in core stability that is causing the athlete to use the shoulder incorrectly. Correcting the core stability weakness will not be effective either unless the habitual motor patterns can be re-written incorporating the correct motion patterns.

The DNS approach to rehabilitation (or injury prevention) is to compare the athlete’s stabilization pattern to the pattern of a developing infant with the intent of correcting the athlete’s pattern. The initial DNS evaluation consists of a series of functional tests to try to identify “weak links” in the core stabilization.

Once a “weak link” has been identified, a series of active exercises are prescribed. These exercises are intended to activate and restore the optimal patterns of stabilization and movement. Each exercise involves restoring the optimal respiratory pattern and intra-abdominal pressure by re-training the use of the diaphragm, restoring stability of the spine to support dynamic limb motions, and restore joint centration. These exercises were developed, by studying the patterns of movement used by infants just learning how to use their bodies. Through repetition of these exercises the old motion patterns held in the central nervous system are replaced by new ones and these new efficient patterns of movement become automatic.

The choice of infant movement patterns is based on the idea that the human brain is designed to learn movement patterns in a specific way, namely the way infants do. Therefore re-exposing the brain to its natural way of learning movement patterns is easy and effective. Some refer to it as “returning to basics” or “re-booting” the brain’s motion pattern processor.

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

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)
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)

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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