When was the last time you were watching a sporting event on TV and you said to yourself “This athlete just makes the sport looks so seamlessly easy”. How about when you take your child to watch someone perform live and you are sitting up close and all you can say to yourself is “Wow”.

Part of this “perfection” is, yes, genetics, this athlete was born with talent. Yet, it is also through proper training and more specifically training of the entire movement or locomotor system.

When speaking of the locomotor system we are discussing the natural movement patterns of human development constructed by the central nervous system (CNS). This central programming is developed during the first critical years of life. Do you ever wonder how babies learn how to roll, crawl, stand up or even start walking. All of this should occur automatically in the course of the CNS maturation. This is an innate process that is engrained in our brains.

1.     What is DNS

Dynamic Neuromuscular Stabilization (DNS) uses the approach in which every purposeful movement is reinforced by the coordinated activity of segmental postural stability. It is based on the scientific principles of Developmental Kinesiology (DK). The goal is to achieve optimal muscle coordination by exercising in developmental positions.  

Traditionally, when thinking about muscle strengthening in our extremities, we automatically think of what the origin and insertion of that muscle is and how can we contract that muscle. The DNS approach is much more functional. It brings the supporting joints and segments into a functionally aligned position. If one muscle is dysfunctional (weak), the entire stabilizing function is disturbed and the quality of the movement is compromised.

2.     How is our “Perfection” of Movement Lost

When you watch a healthy baby move, they move in what we called earlier “perfection” because all the joints and muscle attachments do not have compensations and are working a perfect synergy and perfect joint stabilization. The muscles and joints working in synergy help achieve the given task. As we get older, there are a few things which hinder this synergy that do not allow us to move with such “perfection”.

A.     Improper Neuromuscular Control

a.     Abnormal Postural Development

                                               i.     Developmental Delays

b.     Incorrectly Learned Activity

                                               i.     Poor Coaching

                                             ii.     Incorrect Practice

c.     CNS Adapting to a Pathological Situation

                                               i.     Casting from a Fractured Limb

B.     Muscle Insufficiency for Joint Stabilization

a.     Dyskinesia: Muscle Strengthening in Poor Alignment

                                               i.     Corrected through Exercise

C.     Ligament insufficiency and poor anatomy

a.     CAM, Pincer, Alignment of Glenoid Fossa, etc.

                                               i.     Corrected through Surgery

  

3.     How is DNS related to Exercise?

Since DNS is based on the principles of Developmental Kinesiology, we must compare the athletes stabilizing pattern to that of the stabilization pattern of what normal movement is. That basis of normal movement patterning is derived from observation of a healthy developing baby.

What is the role of primitive movement patterns in relationship to exercises we do on a daily basis? Every natural movement during the first year of life is a natural process from our central nervous system. The best examples of proper movement function to relate to our exercise choice in relationship to proper muscle and joint synergy of a developing baby. 

A healthy baby in their first year of life has proper breathing patterning, synergistic movement patterns of the trunk and the extremities and proper joint interplay during tasks. We learn from their movement patterns and break it down into components to allow for synergistic functional movements.

 

4.     Sports Example: DNS and Golf

Let’s take for example a golf swing. The ability to bring the club into the back swing not only requires strength and coordination of the shoulder muscles. It also requires a “relative stiffness or flexibility” in the abdominals and hip muscles to allow the rotation but in an eccentric manner to control that amount of rotation. According to Shirley Sahrmann (2002) compensatory relative flexibility describes the relationship of how the amount of stiffness (or tension) in one area of soft tissue results in compensatory movement at an adjoining joint that is controlled by less stiffness.

Increased stiffness of one muscle group or joint can lead to compensatory movement at an adjoining muscle group or joint that is less stiff. Relative stiffness or flexibility in a muscle affects the path of least resistance. Musculature can be likened to springs, the bigger a muscle is, the stiffer it is.

For example, if your hamstrings are over trained or shortened they may become resistant to movement, thus compensatory movement occurs at the lumbar spine. The major implication is that as the lumbar spine is now subjected to further movement, further stress forces are imposed on the joint and surrounding tissues, thus there is susceptibility for a movement dysfunction to occur.

5.     Finding the Source of Pain, Not the Location of Pain

Continuing with the example of the golf swing. You begin to develop pain in the elbow, physicians diagnose this is as “golfer’s elbow” or medial epicondylitis. Now you plan on treating this with rest, ice, strengthening of the wrist/forearm muscles and even the shoulder muscles. Taking time off from golf and allowing it to heal in your mind will solve the problem. All of which are great, but your not tracing the elbow pain back to the “WHY”. “Why did I develop this medial elbow pain?”

“Why did this pain just start now if I have been playing golf for over 5 years?”

So, the pain subsides and you go back to golfing and 2-3 months later your elbow pain returns! The CAUSE of the pain is NOT in your elbow. The pain site (elbow) is only the source and the cause of the pain needs to be investigated. The goal is to explore, analyze and eliminate the true cause of the elbow pain. If this scenario sounds like you, then take a step back and look at the bigger picture of how you can control your body in a dynamic movement such as golf rather than the where the pain is directed.

“He who treats the site of pain is often lost”, quote from Karel Lewit, MD

The cause of the pain is most likely related to the movement of your golf swing and narrowing down where the faulty pattern is occurring is critical.  It is not always the best situation to change your golf swing, but having the proper muscle synergy and activation is key. Problems in your lower extremity can lead to compensations in your upper extremity and vice versa. Without having stable intra-abdominal pressure across the trunk, the ability to move your extremities in correct anatomical alignment, more specifically the joints related to the movement, is physiologically difficult to control. Without a stable foundation the rest will collapse.

 

6.     How is DNS Related to the Throwing Motion?

Now, moving in conjunction with the golf swing, we begin to look at the throwing rotational movement. This movement is what is called an “ipsilateral pattern”. When discussing an ipsilateral pattern or the same side pattern, we look further into what is happening on the same side of the upper and lower extremities. When a left-handed pitcher throws a baseball, for example, the left upper extremity and the left lower extremity is considered the stepping forward limbs. Conversely, the pitchers right upper extremity and right lower extremity is considered the stabilizing limb (see image).

As you can see in the diagram below, when the pitcher is at the release point, his left arm is moving in space as well as the his left leg. The right leg is stabilizing into the ground and his right arm is stabilizing in space to create force production through our oblique chains of movement. As the left arm continues through the throwing motion, the right arm maintains stability against gravity to allow the left arm to follow through. 

Without this stabilization of the stabilizing arm (right arm) the speed and velocity of the throw will be greatly altered. It is a combination of open kinetic chain (left extremities) and closed kinetic chain movement patterns (right extremities) that allow us to throw with great power.

 The support and stepping forward extremities always perform in equal but opposite movement of the joints. As the stabilizing extremity moves into internal rotation, adduction and extension then always does the stepping forward extremity moves into external rotation, abduction and flexion.

 

7.     How can this be Related to My Pain

The approach to strengthening and recovering from injury needs to be assessed as a whole movement pattern, not by isolating single muscle groups. Exercises to regain functional strength needs to be related to what is happening mechanically to allow them for the best possible recovery and to reduce the “WHY” factor. It is key to strengthen weak muscles in primitive patterns since these body weight positions are engrained in our brains. This way the entire oblique chains through the trunk are constantly firing to elicit maximal strength. Breathing and core stabilization is imperative in the overall strengthening of our extremities.

 

References

Kobesova, A. Kolar, P. Developmental Kinesiology: Three levels of motor control in the assessement and treatment of the motor system. Journal of Bodywork and Movement Therapies. 2013

Kolar, P., et al. Clinical Rehabilitation. 1st Edition. Rehabilitation Prague School. 2013

Sahrmann S.  Diagnosis and Treatment of Movement Impairment Syndromes. 1st Edition. Mosby, Inc. 2002.

 


BIO

Andrew Morcos, PT, DPT, OCS, SCS, ATC, CSCS, FAAOMPT is the founder of MOTUS, a functional movement approach to clinical rehabilitation for amateur and professional athletes. Prior to opening his own clinic he was the Director of Rehabilitation at the University of Southern California-Athletic Medicine Department. He continues to serve as an Adjunct Instructor of Clinical Physical Therapy for the Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry at USC. He earned a B.S. in Kinesiology with an emphasis in Athletic Training from the University of Nevada, Las Vegas. He received his Doctor of Physical Therapy degree from USC followed by completion of a residency in Orthopaedics and a fellowship in Sports Physical Therapy through Kaiser Permanente, Los Angeles. He has experience as an athletic trainer and physical therapist in Division 1 Athletics, NFL, NBA, USA Indoor Volleyball, USA/AVP Beach Volleyball and the World’s Strongest Man Competition. He is on the board of context experts to design item questions for the Sports Clinical Specialist exam. He served as the Rehabilitation Coordinator for USC Athletics and a clinical instructor and mentor for the USC Division 1 Sports Residency program. He is also a clinical instructor for the Kaiser Permanente Sports Fellowship program and Azusa Pacific University Physical Therapy Department. 


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Tim DiFrancesco, PT, DPT, ATC, CSCS is the Head Strength & Conditioning Coach of the Los Angeles Lakers and founder of TD Athletes Edge.  He is nationally renowned for his evidence-based and scientific approach to fitness, training, nutrition, and recovery for athletes and fitness enthusiasts.

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