Dynamic Neuromuscular Stabilization - My personal take on DNS
Dynamic Neuromuscular Stabilization, or DNS as it is commonly referred to, is a manual rehabilitative approach designed to optimize the control and efficiency of the movement system. DNS principles are aimed at stimulating the inherent movement control system in the brain in order to activate the body’s stabilization system. Based on the Developmental Kinesiology principles of motor control and ontogenesis, DNS has been developed by Professor Pavel Kolar in Prague, Czech Republic, and has been rapidly gaining attention and acceptance worldwide as an effective functional rehabilitation approach.
Let us stop there for a moment. The description listed above is usually how the DNS concept is presented and explained and I do sincerely believe that unless you are a practitioner it does not make any sense at all. I would even dare to guess that most practitioners would also find it hard to comprehend unless they have already been exposed to the DNS approach. I am therefore going to make an attempt to explain DNS in terms that everybody will be able to understand.
To better understand how DNS works let us start by looking at the “DNS is based on the Developmental Kinesiology principles of motor control and ontogenesis” statement. What this means is that DNS is based upon the fact that unlike many other mammal species, when humans are born they are more or less useless and unable to even carry out small purposeful movements. As the brain and the rest of the Central Nervous System (CNS) mature, the baby develops accordingly and starts to adopt new postures and movement patterns dependent upon the stage of development needs of feeding, looking and listening for parents, curiosity and wanting to play. The first 4.5 months are basically spent developing good sagittal stabilization (core stabilization) and only after that has been achieved can babies assume positions where they can reach across the midline, start the turning process, and for example take one arm out of its support function to reach for a toy or other interesting objects. The most fascinating phenomenon in baby development is that all the correct movement patterns are already programmed in the baby’s brain. Most babies don’t have to be taught how and when to turn, sit, crawl and walk and yet they all do it the same way, roughly at the same age, and with perfect stabilization patterns. As the CNS matures the baby keeps changing. As the bones of an infant are relatively soft, the postural positions along with the effects of gravity and the muscles actively pulling on the bones are important in developing good shapes of bones, joints, and muscle alignment. The term “Joint centration” refers to the ideal alignment of a joint where there is maximal contact between the bones in conjunction with a symmetrical activity between stabilizing-muscles. Most babies perform all their movements in good joint centration.
The DNS approach initially offers an opportunity to assess the babies during the maturation process to determine if they are developing ideally. The baby’s posture, quality of the movements, ability to achieve proper stabilization and what age it is when reaching the expected milestones are evaluated.
Therefore dysfunctional patterns may have occurred during infancy by the baby not going through the entire development process properly, but they can also have been established in adult life where many factors like injuries, stress, postural habits can corrupt the ability to move correctly.
In the adult population we also evaluate the ability to maintain correct postures and perform movements with ideal stabilization. To maximize the input from the genetically “pre-wired” movement programs DNS utilizes many of the baby positions when evaluating and later activating the ideal patterns in the adults.
In adults, the first indication of dysfunctional movement patterns is often a feeling of discomfort or pain. When dysfunctional stabilization patterns have been identified the first step is to see whether the individual can correct the pattern themselves with just instructions. If that is the case the individual is taught to feel the difference between the ideal and dysfunctional pattern and so should be able to correct the pattern over time by regularly performing the specific corrective exercises.
When the individuals cannot correct the dysfunctional pattern by themselves DNS offers a variety of options:
First there is the use of “Reflex Locomotion” which is system derived from Vojta therapy where the individual is placed in specific positions with the practitioner applying a gentle pressure at the “Reflex Zones” to facilitate automatic stabilization and movement responses in the patient. The location of the zones and direction of the pressure are very specific. Once the ideal pattern has been facilitated in the CNS a number of times it is often possible for the patient to reproduce the pattern by themselves, which again allows for home exercises. When performing reflex locomotion the individual will activate muscles in a specific fashion so as to perform an “anticipated movement”, and the effect of reflex locomotion can be further enhanced by the practitioner resisting the anticipated movement in a correct manner.
Another method to facilitate ideal stabilization patterns is the use of "DNS specific therapeutic exercises", where the individual is placed in different positions depending upon which muscle is affected and where in the movement the dysfunction is present. The practitioner applies resistance in a specific way when the individual is moving, to activate the ideal stabilization patterns. Both the direction of the resistance as well as the level of resistance are important, and are determined by the individual’s ability to stabilize. Once the correct patterns have been facilitated the individual can perform the exercises at home.
The basic principles of DNS can be summarized like this:
It all starts with Sagittal stabilization (core), which is completely dependent upon the diaphragm’s ability to create sufficient Intra-Abdominal Pressure (IAP), while still performing its breathing function. Most other core stabilization theories are based on tightening of the abdominal wall, while the DNS approach to core stabilization is working from the inside out. Since the ability to create sufficient IAP depends upon the diaphragm function, the DNS approach begins with an evaluation and correction of the breathing pattern.
Once core stabilization has been achieved the individual is able to exercise, and the exercises should only be performed with ideal stabilization of the core and extremity joints. There is strong clinical evidence that back pain is more prevalent in those individuals with reduced ability to activate the diaphragm’s dual functions of postural stability and breathing. Core stabilization should be integrated in all activities we perform as research shows core stabilization is automatic with the diaphragm, pelvic floor and the abdominal wall being activated before any other movement occurs.
The support function of muscles around a joint are most often what have become dysfunctional, and to restore the normal pattern we have to perform exercises which challenge that specific support. It is important to realize that it usually is not the lack of muscle strength but the inability to activate the muscle properly that is the problem.
Joint centration is where the joint is maintained in an ideal position throughout the entire movement. This process is crucial, and sometimes the practitioner has to manually place the individual’s joints in centration to facilitate proper stabilization.
The stabilizing function can be further facilitated by the clinician approximating the joints (gently pushing the joint surfaces together) to maximize the effect of joint centration.
Neurology plays a very important role in the DNS concept, with activation (facilitation) of the ideal movement programs stored in the brain as the main goal. In DNS a great emphasis is also placed on improving the ability to feel joint positions (proprioception) and to increase the control and awareness of movements.
DNS and sports
DNS is not only a magnificent approach for preventing and rehabilitating pain syndromes in the movement system it is also becoming extremely popular in sports performance circles. The same ideal patterns that keep an individual out of pain also maximize the efficiency of the movements, which not only reduces risk of injury but improves performance.