Exercise I Part 1

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com 2022
Dynamic
Neuromuscular FOUNDER OF DNS
Stabilization ®
Professor PaeDr. Pavel Kolář, Ph.D.

according to Kolář
DNS
EXERCISE COURSE I
PART I § Head of the Rehabilitation Clinic of the 2nd Medical
Faculty at the Charles University Prague
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1 2
PRAGUE SCHOOL OF REHABILITATION DYNAMIC NEURMUSCULAR

AND MANUAL MEDICINE STABILIZATION BY PROF. KOLÁŘ
3 4
WHAT IS DYNAMIC NEUROMUSCULAR

DEVELOPMENTAL KINESIOLOGY
STABILIZATION
§ The DNS concept is based on the scientific principles
of Developmental Kinesiology (DK) i.e., the § Describes in detail the
neurophysiological aspects of the maturing locomotor motor development of
system children during the first year
§ Based on research, clinical knowledge and theory of life
§ Includes assessment, treatment, exercises and § Development is driven by
functional strategies inborn automatic programs
§ The goal of the
development is to achieve
optimal posture
5 6
Dynamic Neuromuscular Stabilization 1

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SPORT SPORT PERFORMANCE

SOMATIC
FACTORS
PSYCHOLOGICAL PHYSICAL
FACTORS FACTORS
SPORT
PERFORMANCE
ØOptimal postural foundation

TECHNICAL TACTICAL
FACTORS FACTORS ØMovement quality/coordination
ØBody awareness
7 8
WHAT IS IDEAL POSTURE? IDEAL POSTURE
9 10
MATURATION OF POSTURAL
POSTURAL LOCOMOTION FUNCTION
LOCOMOTION FUNCTION
§ Universal pattern that stabilizes
any movement – controlled on a
subcortical level
§ Balanced interplay between
agonists and antagonists
muscles
§ Precedes and follows every
movement
§ Automatic function
§ Dynamic process
11 12

FUNCTION AND STRUCTURE FUNCTION AND STRUCTURE

STRUCTURAL AFFECTED
CNS MUSCLE ALTERED STRUCTURAL
MATURATION
PROGRAM FUNCTION CNS LESION MUSCLE MATURATION
OF BONES
FUNCTION OF BONES
AND JOINTS
AND JOINTS
P. Dungl, Ortopedie, 2005 www.rehabps.com A. Schejbalová, P. Chládek, Acetabuloplasty in Cerebral Palsy Patients, 2007 www.rehabps.com
13 14
POSTURAL LOCOMOTION FUNCTION FUNCTIONAL JOINT CENTRATION

§ Position of the head, § Dynamic neuromuscular strategy
chest, pelvis and § A centrated joint has the greatest interosseous
alignment of the spine are contact allowing for optimal load transfer across
determined by the early the joint and along the kinetic chain
development ØMaximum force-loading
§ Results from coordinated ØPhysiological range of motion
muscle activity ØMinimum tension in passive structures
§ This specific position of the
ØProtection of all joint structures during loading and movement
joints is called a neutral
joint position = functional
joint centration
15 16
FUNCTIONAL JOINT CENTRATION
OPTIMAL DEVELOPMENT = FUNCTIONAL JOINT

CENTRATION
17 18

19 20
FUNCTIONAL JOINT CENTRATION AND MATURATION OF POSTURAL

SPORT LOCOMOTION FUNCTION
1st Phase 0-3M
§ Sagittal stabilization = trunk stabilization
2nd Phase around 4.5M

§ Limb differentiation
§ Motion can be optimal, even if it is done with excessive 3rd Phase around 8M
load, speed or range of motion
§ Locomotion from point A to point B
www.rehabps.com M=month www.rehabps.com
21 22
TRUNK STABILIZATION TRUNK STABILIZATION
0 – 3 MONTHS
Regulation of intra-abdominal pressure (IAP) results from

proportional co-activation between diaphragm, pelvic
floor and all the muscles of the abdominal wall
23 24

DIAPHRAGM 1) RESPIRATORY FUNCTION

1) Respiration § Diaphragm moves downward during inhalation
2) Stabilization § Concentric activation of the
3) Sphincter function diaphragm
§ Central tendon lowers and
widens
§ Lower ribs widen laterally
§ IAP increases
§ Abdominal wall works in
eccentric contraction
All three functions work simultaneously and are
interdependent § Diaphragm moves upward during exhalation
kenhub.com www.rehabps.com IAP=Intraabdominal pressure; Kapandji 2008 www.rehabps.com
25 26
1) RESPIRATORY FUNCTION OPTIMAL RESPIRATORY FUNCTION

§ Upper ribs and
lower ribs –
rotation in CV
joints
INHALE EXHALE § Upper ribs –
upper chest
expansion in
ventral direction
§ Lower ribs –
lower chest
INITIAL POSITION INHALE
expansion in
lateral directions
www.rehabps.com CV=Costovertebral joints www.rehabps.com
27 28
OPTIMAL RESPIRATORY FUNCTION
“IF BREATHING IS NOT

§ Sternum NORMALIZED – NO
moves OTHER MOVEMENT
ventrally PATTERN CAN BE.”
§ Movement
occurs in SC
joints Karel Lewit
INITIAL POSITION INHALE
SC=Sternocostal joint www.rehabps.com www.rehabps.com
29 30

2) STABILIZATION = POSTURAL STABILIZATION = POSTURAL

FUNCTION FUNCTION
§ Diaphragm moves down
ØIAP increased
Thoracolumbal fascia
§ During exhalation
diaphragm reverses partially
ØIAP is regulated
according to the stability SPINE
demands Body of the
IAP
§ IAP provokes eccentric vertebrae
activation of the muscles of
the abdominal cavity
ØStretch of the
thoracolumbar fascia
IAP=Intraabdominal pressure www.rehabps.com www.rehabps.com
31 32
TRUNK STABILIZATION POSTURAL INSTABILITY

§ Intra abdominal pressure (IAP) is the main stabilizer of § Decentrated position of trunk, pelvis and peripheral
the trunk and pelvis joints
§ IAP is a prerequisite for every movement § Less mature postural pattern
IAP=Intraabdominal pressure www.rehabps.com www.rehabps.com
33 34
OPTIMAL STANDING POSTURAL

NEWBORN vs 3MONTHS OLD CHILD ALIGNMENT
§ Horizontal position - alignment above
each other:
ØFloor of mouth
ØDiaphragm
ØPelvic floor
ØFeet
35 36

ABNORMAL STANDING POSTURAL

SHAPE OF ABDOMINAL WALL
ALIGNMENT
CHEST IN CHEST OPEN

FRONT OF BEHIND SCISSORS
INITIAL POSITION
CORRECT INCORRECT PELVIS PELVIS SYNDROME
OF THE DIAPHRAGM
37 38
MOST COMMON ABNORMALITIES OPEN SCISSORS SYNDROME

§ Oblique axes of the
chest and pelvis
§ Lack of postural
activity of abdominal
wall is compensated
by the hyperactivity
of the lumbar
extensors
§ KEY BODY
SEGMENTS ARE
DECENTRATED OPEN SCISSORS SYNDROME
39 40
MOST COMMON ABNORMALITIES HOUR GLASS SYNDROME

§ Postural hyperactivity
of the m. rectus
abdominis and upper
parts of the oblique
muscles
§ Belly button is pulled
in and up
§ NOT OPTIMAL
TIMING of
diaphragm and
abdominal muscles
coactivation HOUR GLASS SYNDROME
41 42

POSTURAL SPORT PERFORMANCE AND TRUNK

STABILITY vs INSTABILITY STABILIZATION
§ Visible in both static, and dynamic situations SPORT TECHNIQUE AND PERFORMANCE MAY
VARY, BUT!!!
THE TRUNK STABILIZATION MUST BE OF THE
SAME QUALITY
“POSTURE FOLLOWS MOVEMENTl LIKE A SHADOW“

CS Sherrington, Brain, 1915
43 44
HUMAN MOTOR CONTROL MOTOR LEARNING

§ Motor learning is a
CNS complex process
CORTICAL LEVEL occurring in the
brain in response to
SUBCORTICAL LEVEL
practice or
(6W+)
experience of a
SPINAL AND BRAIN STEAM
LEVEL
certain skill, resulting
(0-6W) in changes in the
central nervous
system
CNS=central nervous system, W=week www.rehabps.com www.rehabps.com
45 46
MOTOR LEARNING IN SPORT MOTOR LEARNING IN SPORT
§ Allows for the development Three phases by

of new motor skills Abernethy in Čoh, 2004:
§ Often involves improving
1)Verbal cognitive
the smoothness and Ø 15-30 hours of training
accuracy of movements, 2)Associative
which is necessary for Ø 3-5 month of training
developing controlled 3)Autonomous
movement and calibrating Ø Takes years, never
simple movements completely finished
47 48

DNS INTEGRATION INTO TRAINING FUNCTIONAL THRESHOLD

1) COMPENSATORY EXERCISES
§ Overloading prevention § Training for
§ Injury prevention sports involves
2) REPROGRAMMING OF MOVEMENT PATTERNS pushing oneself,
sometimes
MOTOR CONTROL
REPROGRAMMING
beyond limit
CORTICAL
MOVEMENT
§ Ideal locomotor
CORRECTION strategies have
SUBCORTICAL their thresholds
MOVEMENT
AUTOMATISM
49 50
Strain (load, speed, endurance)
ABSOLUTE FATIGUE
FUNCTIONAL THRESHOLD
§ Whenever the FUNCTIONAL
threshold is GAP
exceeded the FUNCTIONAL CAPACITY
athlete will resort to
a more primitive
stabilizing strategy
= newborn posture
§ Threshold is
affected by loading,
speed and duration
of activity
51 52
OPTIMAL SPORT TECHNIQUE

OPTIMAL SPORT TECHNIQUE
=
OPTIMAL SPORT PERFORMANCE
Olympic games
1988, 1992,1996, 2000
Championships
ME (1987, 1993, 1995, 1999, 2001)
MS ( 1994, 2006)
World record – still valid
98.48m (1996)
84 throws over 90m – 52 of them by
BEFORE THRESHOLD TRAINING AFTER THRESHOLD TRAINING Železný
www.rehabps.com cs.wikipedia.org/duklasport.cz www.rehabps.com
53 54

EXTREMITIES DIFFERENTIATION GLOBAL MOTOR PATTERNS

Around 4.5 months 1) UNDIFFERENTIATED MOTOR PATTERN
§ Both of the upper and lower limbs serve the same
§ Support function function
§ Phasic function/stepping forward
2) DIFFERENTIATED MOTOR PATTERN
§ Ipsilateral pattern – Extremities on the same side will
serve as support function whereas the opposite will be
active in stepping forward function
§ Contralateral pattern – Extremities on the opposite
side will serve as support and stepping forward
function
55 56
UNDIFFERENTIATED PATTERNS DIFFERENTIATED PATTERNS

§ Limbs are providing the same type of function § Limbs are differentiated into support or stepping
§ Usually this is a prerequisite for achieving forward function:
differentiated position § Support
§ Phasic (reaching)
57 58
OPEN KINEMATIC CHAIN OPEN KINEMATIC CHAIN

HIP FLEXION
§ Proximal muscular origin is § Stepping

stabilized (punctum fixum = PF) forward
§ Distal muscular attachment is function of
moving (punctum mobile = PM) extremities
towards punctum fixum § Head of the
proximal muscle pull femur is
moving in the
socket
59 60

CLOSED KINEMATIC CHAIN CLOSED KINEMATIC CHAIN

§ Distal muscular § Support function of the TRUNK
extremities FLEXION
attachment is
stabilized § Socket is moving over
(punctum fixum) the head of the femur
§ Proximal muscular
origin of the joint is
moving (punctum
mobile) against
punctum fixum
distal muscle pull
61 62
IPSILATERAL PATTERN IPSILATERAL PATTERN

§ Extremities on the same
side have the same
function, i.e. support or
stepping forward
§ Axes of the shoulders
and pelvis moves in the
same direction
§ Chest and pelvis
remains mostly parallel
§ Related to the turning
process
63 64
CONTRALATERAL PATTERN CONTRALATERAL PATTERN
§ Extremities of the
opposite side has the
same function ,i.e.
support or stepping
forward
§ Axes of the shoulder and
pelvis moves in opposite
direction
§ Related to movements
forward, locomotion
cs.wikipedia.org www.rehabps.com www.rehabps.com
65 66

RECIPROCAL PRINCIPLE
STEPPING FORWARD
FUNCTION
§ Right kicking leg moves
ASSESSMENTS AND
in open kinematic chain
§ PF is on pelvis
CORRECTIVE EXERCISE
(proximally) BY DNS
SUPPORT FUNCTION
§ Left standing leg moves
in closed kinematic chain PRINCIPLES
§ PF is on the femur
(distally) BASIC RULES
PF=punctum fixum www.rehabps.com www.rehabps.com
67 68
DNS ASSESSMENT DNS ASSESSMENT

Comparison between the quality of sagittal
stabilization in various developmental patterns and
sport performance
!
69 70
DNS ASSESSMENT DNS ASSESSMENT: WHAT TO OBSERVE

1) Do the joints and segments maintain a neutral 1) Cylindrical shape – the quality of trunk
position when loaded and sustain it during full ROM? stabilization
2) Which muscles are activated too much and which are 2) Breathing pattern
insufficient?
3) Joint alignment (chest, pelvis, spine, support
POSTURAL joints)
INSTABILITY 4) Stabilization during movement
Ø A segment or joint that
looses neutral position
during postural loading
or movement
71 72

DNS ASSESSMENT DNS ASSESSMENT

§ Diaphragm test in sitting
§ Evaluate trunk stabilization in different positions, during
§ 3M model supine loading, and during sport
§ Arm elevation test § Evaluate and analyze sport technique and movement
§ 3M model prone § Joint centration and torso/pelvis axes during the
§ On all fours movement
§ Bear § Choose 2-3 DNS tests – identify insufficient or
§ Squat incorrect motor patterns
§ In the testing position chosen, you can start corrective
exercises
73 74
EVALUATION OF SPORT EVALUATION OF SPORT

PERFORMANCE PERFORMANCE
§ Videotape athlete during sport activity/movement § Notice any lack of coordination, jerky movement,
§ Pay attention to joint centration and movement coupled movement
pattern’s characteristics (IPSI/CONTRA)
www.rehabps.com en.wikipedia.org www.rehabps.com
75 76
DNS CORRECTIVE EXERCISES EXERCISE

§ Every developmental CATEGORIZATION
position can be used as an DNS APPLICATION
exercise
§ We can exercise in a static A) SKILL ACQUISITION of
position or in a dynamic optimal stabilization
sequence B) SKILL APPLICATION of
stabilization during basic
movement patterns such as
squat, leg press, throwing etc.
C) SKILL STRENGTHENING of
stabilization during load
77 78

1) SKILL ACQUISITION 2) SKILL APPLICATION

§ Exercise with the goal of teaching optimal stabilization § Exercises where an athlete is taught to apply the DNS
patterns the majority of DNS EXERCISES movement strategy to a particular movement
OTHER EXERCISES/SYSTEMS
79 80
3) SKILL STRENGHTENING DNS PRINCIPLES IN SPORT

§ Athlete is working to raise their threshold for DNS § Keep working on the following steps:
patterns
1) Sagittal stabilization with optimal breathing
pattern
2) Centration of segments ( focusing on support
points)
3) Differentiation of muscle function within global
motor patterns
Ø Stepping forward or supporting function
Ø IPSILATERAL and CONTRALATERAL patterns
81 82
DNS CORRECTIVE EXERCISES DNS PRINCIPLES IN ATHLETES

§ 3M model supine § Respect ideal posture as defined by developmental
§ Arm elevation kinesiology
§ 3M-6M model prone § Train variability – adaptation to sport loading
§ On all fours § Cortical function training – improve sensory integration
§ Bear
§ Squat
83 84

DNS ONLINE VIDEO LIBRARY DNS ONLINE VIDEO LIBRARY

§ DNS animations
§ DNS Self treatment booklet
§ DNS posters
§ Exercises in developmental positions

§ DNS group training
§ DNS Sport
§ Czech Get Up
§ DNS specific aplication
https://www.rehabps.com/video-on-line.html www.rehabps.com www.rehabps.com
85 86
DNS APLICATION TO SPORT

ONLINE DNS VIDEO LIBRARY
https://www.rehabps.com/video-on-line.html
87 88

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www.rehabps.

Professor PaeDr. Pavel Kolář, Ph.D.

PRAGUE SCHOOL OF REHABILITATION DYNAMIC NEURMUSCULAR

WHAT IS DYNAMIC NEUROMUSCULAR

Dynamic Neuromuscular Stabilization 1

SPORT SPORT PERFORMANCE

ØOptimal postural foundation

WHAT IS IDEAL POSTURE? IDEAL POSTURE

Dynamic Neuromuscular Stabilization 2

FUNCTION AND STRUCTURE FUNCTION AND STRUCTURE

POSTURAL LOCOMOTION FUNCTION FUNCTIONAL JOINT CENTRATION

FUNCTIONAL JOINT CENTRATION

OPTIMAL DEVELOPMENT = FUNCTIONAL JOINT

Dynamic Neuromuscular Stabilization 3

FUNCTIONAL JOINT CENTRATION AND MATURATION OF POSTURAL

2nd Phase around 4.5M

TRUNK STABILIZATION TRUNK STABILIZATION

Regulation of intra-abdominal pressure (IAP) results from

Dynamic Neuromuscular Stabilization 4

DIAPHRAGM 1) RESPIRATORY FUNCTION

1) RESPIRATORY FUNCTION OPTIMAL RESPIRATORY FUNCTION

OPTIMAL RESPIRATORY FUNCTION

“IF BREATHING IS NOT

INITIAL POSITION INHALE

SC=Sternocostal joint www.rehabps.com www.rehabps.com

Dynamic Neuromuscular Stabilization 5

2) STABILIZATION = POSTURAL STABILIZATION = POSTURAL

TRUNK STABILIZATION POSTURAL INSTABILITY

IAP=Intraabdominal pressure www.rehabps.com www.rehabps.com

OPTIMAL STANDING POSTURAL

Dynamic Neuromuscular Stabilization 6

ABNORMAL STANDING POSTURAL

CHEST IN CHEST OPEN

MOST COMMON ABNORMALITIES OPEN SCISSORS SYNDROME

MOST COMMON ABNORMALITIES HOUR GLASS SYNDROME

Dynamic Neuromuscular Stabilization 7

POSTURAL SPORT PERFORMANCE AND TRUNK

“POSTURE FOLLOWS MOVEMENTl LIKE A SHADOW“

HUMAN MOTOR CONTROL MOTOR LEARNING

CNS=central nervous system, W=week www.rehabps.com www.rehabps.com

MOTOR LEARNING IN SPORT MOTOR LEARNING IN SPORT

§ Allows for the development Three phases by

Dynamic Neuromuscular Stabilization 8

DNS INTEGRATION INTO TRAINING FUNCTIONAL THRESHOLD

Strain (load, speed, endurance)

OPTIMAL SPORT TECHNIQUE

Dynamic Neuromuscular Stabilization 9

EXTREMITIES DIFFERENTIATION GLOBAL MOTOR PATTERNS

UNDIFFERENTIATED PATTERNS DIFFERENTIATED PATTERNS

OPEN KINEMATIC CHAIN OPEN KINEMATIC CHAIN

§ Proximal muscular origin is § Stepping

Dynamic Neuromuscular Stabilization 10

CLOSED KINEMATIC CHAIN CLOSED KINEMATIC CHAIN

IPSILATERAL PATTERN IPSILATERAL PATTERN

CONTRALATERAL PATTERN CONTRALATERAL PATTERN

Dynamic Neuromuscular Stabilization 11

DNS ASSESSMENT DNS ASSESSMENT

DNS ASSESSMENT DNS ASSESSMENT: WHAT TO OBSERVE