How is the core stabilized?

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Belinda Smith
5 years ago
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What is Dynamic Neuromuscular Stabilization (DNS)? Dynamic Neuromuscular Stabilization (DNS) is a new rehabilitative approach to improving and maximizing performance of human movement.

This is a predictable pattern of motor development that is thought to be ingrained since birth. DNS utilizes this principle to improve core stability, muscle recruitment and breathing efficiency.

1 What is Dynamic Neuromuscular Stabilization (DNS)? Dynamic Neuromuscular Stabilization (DNS) is a new rehabilitative approach to improving and maximizing performance of human movement. It focuses on the principles of developmental kinesiology, otherwise known as the pattern in which an infant learns to go from rolling to crawling to walking. This is a predictable pattern of motor development that is thought to be ingrained since birth. DNS utilizes this principle to improve core stability, muscle recruitment and breathing efficiency. What is Developmental Kinesiology? At approximately 28 days old, infants begin to learn postural and movement control. Prior to moving an extremity, they must have a stable core, which is achieved through a simultaneous contraction of the diaphragm, pelvic floor and abdominal muscles. This contraction increases intra-abdominal pressure and helps to stabilize the spine from the inside out. 1 Why is this important? The erector spinae muscles. This is a muscle group that lines your spine and is often a culprit of muscle spasms when overused. One of the many reasons that this can occur is because the erector spinae attempt to stabilize the spine when there is weakness in other areas including the core. Past thoughts on core stability have focused on crunches and other forms of exercise that tone the anterior stomach. musculature. What s wrong with this? What s wrong with this? It neglects the nature of the abdominal cavity and the force of the erector spinae. If you only train, the anterior stomach musculature you end up having no counterforce to the spinal musculature and true core stability is not achieved. 1 How is the core stabilized? Figure 1. Top left describes the view of the abdomen. Top right shows where the core muscles are located. Bottom left shows how core stabilization is not truly achieved without intra-abdominal pressure and how a collapsing in of the core and spine occurs. Bottom right shows how intra-abdominal pressure creates equal pressure and true stabilization of the core and spine. 2,3 However, if you train the diaphragm, in addition to the traditional musculature, you can use intra-abdominal pressure to aid in the stability of the spine and core (Figure 1).

Once a stable core is achieved, the infant begins to move their extremities, typically at around 4.5 months old. 1 At this point, using the core as a form of postural stabilization is automatic.

Under such control, joints are aligned in a position that is of maximal advantage to the infant to enable them to move and recruit as much strength from their muscles as possible.

It is not a static position but a way in which the joints of the body align perfectly during both static and dynamic movement to enable optimal congruency within the joint. Why is this important?

2 Once a stable core is achieved, the infant begins to move their extremities, typically at around 4.5 months old. 1 At this point, using the core as a form of postural stabilization is automatic. The coordination of core stabilization and movement is the result of brain and spinal cord control. Under such control, joints are aligned in a position that is of maximal advantage to the infant to enable them to move and recruit as much strength from their muscles as possible. This balanced alignment of the joints is referred to as a centrated position. It is not a static position but a way in which the joints of the body align perfectly during both static and dynamic movement to enable optimal congruency within the joint. Why is this important? Let s consider the length tension relationship of a muscle. In order to do this, think of a muscle as a spring. If compressed too little, the pull on the spring will not be as strong and it will not move the load far. If the spring is stretched too far, it loses some of its contractile force and it will not be able to return to it s shortened position. An overstretched spring will not be able to compress to its original length so a smaller contraction will take place and the force that it can push is decreased (Figure 2). What is a lever arm? Muscle or Spring? 4,5 Figure 2. On the left is a depiction of two springs, one that can achieve full compression, Spring 1, and one that cannot, Spring 2. Note the difference in distance that the 2lb weight can travel. On the right, is the biceps as a visual reminder of how a muscle looks and how it can be compared to a spring. Figure 3. Note the shoulder is the point of movement, the lever arm is the length of the arm and the load is at the hand. The longer the lever arm, the more difficult it is to lift the object. 6 In addition to compression length, a spring that is too long ends up having difficulty accepting a load due to the lever arm. The lever arm is the distance from the load to the point of movement (Figure 3). The greater the distance, the harder it is to lift. To understand this, try holding a small weight in your hand (~1lb). Keep your arm straight and in front of you and then try to bring your arm overhead. Note how much effort is required and how heavy the weight feels (Figure 4). Figure 4. Note how a straight arm creates a long lever arm.

Figure 5. Note how with a bent arm, the lever arm is shorter, thus it is easier to lift the weight. Now, bend your elbow so that it is at a 90 degree angle in front of you.

You should notice that it is much easier to reach overhead when the elbow is bent because the weight is closer to the point of rotation, your shoulder.

3 Figure 5. Note how with a bent arm, the lever arm is shorter, thus it is easier to lift the weight. Now, bend your elbow so that it is at a 90 degree angle in front of you. Keep the same weight in your hand and again try to reach overhead with the weight, this time keeping the elbow bent (Figure 5). You should notice that it is much easier to reach overhead when the elbow is bent because the weight is closer to the point of rotation, your shoulder. If the weight is too far away, the muscle has to generate even more force to move. A centrated joints aligns the bones and the muscles to allow for a good length-tension relationship, which, in turn enables better muscle recruitment. How does DNS utilize Developmental Kinesiology? DNS begins by training patients how to properly use their diaphragm to breath as well as to achieve intra-abdominal pressure for core stabilization. Unfortunately, as humans grow they tend to breathe through their chest instead of their belly causing dysfunctional diaphragm activation and it perpetuates muscle imbalances. Each position that is used in DNS mimics a stage of infant development in order to retrain the brain and muscles to fire properly (Figure 6). As core stabilization improves, patients are progressed to the next stage of development. Why is the diaphragm important? Initially, the diaphragm s function is respiration but then it adapts during development and also serves as a postural stabilizer at around 6 months old. 1 Figure 6. This depicts three steps in an infant s development along with the corresponding exercise that mimics that stage of development. 7 As we age, we often don t use the diaphragm correctly and to it s fullest potential which can lead to injury provoking compensations. If recruited properly, the diaphragm aides in the production of intra-abdominal pressure, which is necessary for core stabilization. It can also help to increase the amount of air that you breathe in by up to 30%. 2

4 How does the diaphragm help us to breathe? 8 As you can see, if the diaphragm is able to contract down fully, it allows for more space near your lungs, which allows for more air to fill your lungs (Figure 7). The goal of DNS is to improve your breathing pattern, improve core stabilization through intra-abdominal pressure and to provide a stable base with centrated joints during static and dynamic movement. 3 Figure 7. This is a diagram of how the diaphragm moves during respiration. Where did DNS come from? DNS was developed by Professor Pavel Kolar, PT, PhD, a Czech physiotherapist and current Director of Rehabilitation at the The University Hospital Motol, School of Medicine, at Charles University in Prague, Czech Republic. Kolar is also the medical specialist for the Czech Olympic Team, Davis Cup Tennis Team, National Ice Hockey Team and many more. Kolar s development of DNS was heavily influenced by his well respected mentors and instructors at The Prague School of Rehabilitation including Professor Karel Lewit, late Professors Vaclav Vojita and Vladimir Janda and many others. 2 Who can be helped? DNS is most well known for its use in the sports population for injury recovery and prevention. However, its methods can also be utilized by the general population in recovery from acute and chronic injuries. 3 Conditions that have been successfully treated through DNS include but are not limited to the following: Low Back Pain 3 Upper and Lower Extremity Injuries 3 Chronic Migraines 4

5 REFERENCES: 1) Kobesova A, Kolar P. Developmental kinesiology: three levels of motor control in the assessment and treatment of the motor system. J Bodyw Mov Ther Jan;18(1): )DNS website. 3) Frank C, Kobesova A, Kolar P. Dynamic Neuromuscular Stabilization & Sports Rehabilitation. International Journal of Sports Physical Therapy. 2013;8(1): ) Juehring DD, Barber MR. A case study utilizing Vojta/Dynamic Neuromuscular Stabilization therapy to control symptoms of a chronic migraine sufferer. J Bodyw Mov Ther. 2011;15(4): ) Oppelt M, Juehring D, Sorgenfrey G, Harvey PJ, Larkin-Thier SM. A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient. J Bodyw Mov Ther Jan;18(1): Image References: 1) 2) 0f4ae43e9fad0~mv2_d_1600_1321_s_2.jpg 3) 4) 8eab33525d08d6e5fb8d27136e95/2/_/2.5_id_chrome_plated_cs_s eries_1.png 5) 6) muscles/shoulder%20muscle%201.png 7) 8)

Dave Juehring DC, DACRB Director Rehabilitation and Sport Injury Department and Rehabilitation Residency Palmer Chiropractic Clinics Davenport IA

Dave Juehring DC, DACRB Director Rehabilitation and Sport Injury Department and Rehabilitation Residency Palmer Chiropractic Clinics Davenport IA Dynamic Neuromuscular Stability the Czech Approach to Stability