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Dynamic Neuromuscular Stabilization approach
a developmental kinesiology approach by Kolar

Dynamic Neuromuscular Stabilization(DNS) a developmental kinesiology approach by Kolar is an innovative 21-century approach to manual medicine , which involves every component of the locomotor system (muscles, joints, discs, nerves and soft tissues) by stimulating movement control centers in the brain through activation of ideal inborn movement stereotypes.

The method helps to restore the structural and postural alignment of the body's neuro-musculo-skeletal system by invoking the Global motor pattern form the foundation of human movement and represent genetically predetermined elements of uprighting.They are activated in the specific sequence of increasing complexity during the postural development in the first months of a child's life. The Global motor pattern remain essential for control of posture and stability of the spine - the pivotal center of the entire locomotor system throughout the life of the individual.

The stimulation reactivates patient's dormant Global motor pattern and, exploiting the plasticity (malleability) of the brain, establishes new physiological connections. The spinal-joint manipulation, muscle relaxation and the soft tissue release procedures are all conducted in the primal positions of ideal movements of an infant (crawling and turning). In these positions of support the maximum spinal stability and joint centration of the entire body are achieved. This style of manipulation is unique to DNS. It is absolutely safe, non-intrusive and pleasant because the ideal laws of developmental kinesiology are observed.

The stimulation, a gentle pressure with the tridimentional vector applied with the patient situated in a primal movement position (see above), triggers global motor reaction. The latter co-activates agonist and antagonist muscle systems producing from-within centration of the entire spine-extremities complex and, therefore, spinal stability. This physiological phenomenon helps to minimize muscle imbalances and relieves painful protective muscle spasms, the result being pain relief, solid neuro-musculo-skeletal network pathway system and much improved spinal stability and postural awareness. Eventually, through repetition of the exercises, spinal stability becomes habitual and independent of the conscious.
The results achieved by DNS are superior to conventional methods used by chiropractors and physiotherapists, who tend to address the problem "locally". Due to the fact that the movements induced by DNS involve the higher centers of the Central Nervous System it prepares the body for gentle, non-forceful manipulation (adjustment) producing faster and more stable improvement of function and, therefore, long-lasting pain relief.

Basic Info
FREQUENTLY ASKED QUESTIONS

What is Dynamic Neuromuscular Stabilization Method?

Dynamic Neuromuscular Stabilization Method (DNS) is an innovative approach to manual medicine (chiropractic) and physiotherapy which involves every component of the locomotor system (muscles, joints, discs, nerves and soft tissues) by stimulating movement control centers in the brain through activation of ideal inborn movement stereotypes. The method helps to restore the structural and postural alignment of the body’s neuro-musculo-sleletal system by invoking the Global Motor Patterns.

What are the Global Motor Patterns?

Global Motor Patterns form the foundation of human movement and represent genetically predetermined elements of uprighting. They are activated during the postural development in the first months of child’s life in the specific sequence from less to more complex. The Global Motor Patterns remain essential for control of posture and stability of the spine – the pivotal center of the entire locomotor system through the life of the individual.

What is the scientific basis for the DNS therapy?

The scientific basis for the DNS is the principle of Reflex Locomotion. The concept was first formulated empirically by Prof. Vojta who used it for diagnosis and treatment of adult and pediatric neurological conditions of various degrees of severity ranging from motor delays to Cerebral palsy. His theory has since been expanded and factually substantiated by prolific physiological and neurological research. In Europe Vojta therapy has been the method of choice for the treatment of Cerebral Palsy, motor delays, strokes, multiple sclerosis and other neurological disorders and only now it is making its way to the United States.
See http://www.vojta.com/

How does the DNS utilize principles of Reflex locomotion to treat back pain?

DNS takes advantage of the plasticity (malleability) of the brain. It aims to establish new physiological connections by reactivating dormant Global Motor Patterns. With the precise positioning of the patient’s body (see below), specific proprioceptive zones are stimulated. The spinal-joint manipulation, muscle relaxation and the soft tissue release procedures are all conducted in the primal positions of ideal movements of an infant (crawling and turning). The stimulation invokes the Global Motor Patterns reflexes generating postural muscle tone which triggers global motor reaction. The latter co-activates wide range of muscle groups including deep spinal musculature, which is not under voluntary control and cannot be trained by exercises. The simultaneous contraction of agonist and antagonist muscle systems generates from within the centration of the entire spine-extremities complex resulting in spinal stability. This physiological phenomenon helps to minimize muscle imbalances and relieves painful protective muscle spasms, the result being a more stable neuro-musculo-skeletal network pathway system and much improved spinal stability and postural awareness.

How can Dynamic Neuromuscular Stabilization Method help?

The results achieved by DNS are superior to conventional methods used by chiropractors and physiotherapists due to the fact that induced movements are controlled not “locally”, but by the higher centers of the Central Nervous System producing faster and more long-lasting improvement of function and, therefore, pain relief. Like the initial stimulation, manipulation, and rehabilitation exercises are also performed in the ideal movement positions. This promotes “from-within” spinal stability, which eventually, through repetition of the exercises, becomes habitual and independent of the conscious effort.

How is Dynamic Neuromuscular Stabilization Method different from most of chiropractic and physical therapy methods?

The DNS brings faster and more stable results due to its direct access to automatic motor “programs” in the brain which promote proper movement through utilization of global motor reactions. The activation of these global patterns release muscular spasm and allows gentler, non-forceful manipulation. Such manipulation (adjustment) is only possible when the body is placed in specific infantile positions of support and the joints become centrated. These support positions emulate body positions of the infant in which maximum spinal stability is achieved as the basis for the forward movement (crawling), turning or creeping. This style of manipulation is unique to Kolar technique. It is absolutely safe, non-intrusive and pleasant because the ideal laws of developmental kinesiology are observed.

Does that mean that anytime you put the patient in these ideal movement positions the joint manipulation is easy and non forceful?

No, DNS does not use any forceful thrust. The manipulation is very gentle slow, but yet produces the same release as chiropractic thrust. It achieves that due to manipulation being performed only after stimulation which co-activates agonist and antagonist around the spinal joints as well as deep spinal muscle .All this together creates centration of the joints. Also the manipulation is conducted in primal position of crawling and turning of infants. This type of manipulation is the safest because there is no shearing or rotational forces. The forces applied are slow, gentle and distractional.

Is it possible to further disrupt already bulged or herniated disc with an adjustment(joint manipulation)?

It is extremely rare and only occurs in the hands of health professionals who are not adequately trained to manipulate. It is impossible with KTM method of manipulation due to described above principles and technique.

Is DNS (refl locom ) method mainly used for neurological disorders and rehabilitation of pediatric neurodevelopmental disorders?

The answer is yes and no. Prof' Kolar work has spawned from the work of renouned Professor Vaclav Vojta, whose method has been a method of choice for treatment of Cerebral Palsy and other neurodevelopmental disorders in Europe and is considered the most effective method to affect neuroplasticity of immature nerous system . However, his method expanded with time to include all ages with a variety of neurological disorders The treatments were based on the principles of reflex locomotion , an approach designed to stimulate primitive subcortical reflexes and facilitate neuroplasticity. The Vojta treatments typically required multiple therapists and multiple sessions per day in an in-patient hospital setting. Kolar, with Vojta's support, altered the method to be performed by a single clinician, to be utilized for acute and chronic pain syndromes, to be integrated with manual joint (mobilization/manipulation) techniques, to be utilized in either an out-patient or in-patient setting, and also to be utilized for athletic optimization, injury prevention. The combination of this treatment with external decompression is extremely effective for intervertebral disc disease( ddd, bulges, herniation and etc.

Are there any exercises involved in this method and how do they differ from classical physiotherapy muscle strengthening exercises?

In most of the physiotherapy and chiropractic schools of rehabilitation, as well as in personal training, muscles are trained in isolation. Strengthening weakened muscles in isolation from the unified locomotor system however does not guarantee that established power will automatically transform into adequate performance. Moreover, trained movements that are not integrated into a global locomotor system cannot become involuntary and therefore would be of little help to the patient. For example, we usually do not consciously manage how we walk, stand or seat. These and other habitual movements are controlled by the independent movement patterns "programs" embedded in the Central Nervous System. The DNS treats locomotor dysfunction by integrating the corrected movement into the frame of these programs. This way the movement becomes automatic and patient is able to use it without thinking.

Most of the DNS exercises are conducted in the classic creeping, crawling or rolling positions. They are applicable for patients with variety of acute and chronic conditions as well as for athletes who are trying to improve their performance and also prevent or rehabilitate injuries.

These exercises could include the use of gymnic balls, therabends and other related equipment. The exercises are not only used to improve the stability of the spine, muscle coordination, balance and strength. They are also designed to increase the body's awareness (see sensory integration). Linking motor learning with global reflex motor pattern and the interactions of sensory input leads to the most efficacious interventions in spinal care.

Glossary

Locomotor system is a term originally used by European neurologists in the field of movement disorders. In Norht America a term Musculoskeletal system is more frequently used by physicians and general public. Locomotor system is a system of the human organism which creates, ensures and controls movement and stability of the human body .It controls gate (locomotion), posture, dynamic stability and purposeful movement. It is controlled by the intricate interplay of different structures in the human brain. It creates movement by sending neural signals through the spinal cord and peripheral nerves to the muscles which move the bones of the spine and extremities against the gravity in space. This system is in direct relationship with internal organs of the organism by maintaining their integrity, providing support and participating in function of respiration, mastication, speech, swallowing, and excretion of urine and stool as well as facilitating the movement of blood and other fluids throughout the body. It doesn’t only influence other organs within the human body, but it is influenced by alteration of function or pathology of other organs in the human body. The maintenance of health of this system is paramount for ones well being and longevity.

The major elements of the locomotor system are: central and peripheral nervous system, muscles, bones, joints, ligaments, fascias and skin.

Structural pathology of the locomotor system - irreversible damage to the elements of locomotor system which doesn’t always results in pain, but could be a sign of aging. Ex., joint and bone arthritic changes, disc bulging and herniation, ligamentous and muscular trauma resulting in permanent damage, paralysis and etc…These changes must be visible and objectified by radiographic means.

Functional pathology of the locomotor system- reversible changes of the locomotor system, which always occur throughout the whole body and are in direct connection with each other throughout the body by motor control the central nervous system. Changes in the function cannot be objectified by radiographic means, however are constant and proven by clinical examination.

Motor control- is the way in which the Central Nervous System controls motor performance.

Motor learning- is an ability of the human nervous system to learn and modify motor programs.

Uprighting-is an ability of the child to move up against the gravity.

Verticalization- is gradual transformation of an infant from completely horizontal positions to standing and walking. These positions include: head lift, elbow support, palm support, oblique sitting, sitting, crawling, standing, sided walking, and finally walking.

Manual medicine-is relatively new medical science of treatment of pain which mainly originates in within the spine and other parts of the locomotor system. This pain is considered to be of a reflex and/or mechanical origin. The methods of dealing with this pain are: soft tissue, muscle and vertebral manipulation, remedial exercise and rehabilitative exercise. Manual medicine is most helpful for treatment of functional disorders, although most of the structural pathologies initially originate from neglected dysfunction. Its use is unfortunately limited to private practices, although in many European countries it is already a part of conventional medical education and is provided in major Hospital settings. The popularity and success of manual medicine has moved it into a special, although sometimes conflicting place within the medical disciplines. In some countries (Switzerland, France and Sweden) manual medicine specialist are considered among the elite where in others they are still fighting for the recognition within the conventional medical world. Manual medicine has different flavors in different countries. In Czech Republic it is a domain of neurologists. In Denmark it is a domain of rheumatologists. In Belgium and Netherlands it is done by highly specialized physiotherapists and in USA chiropractors and the osteopaths are in the foreground .In Russia it is a separate and distinct medical specialty. In other countries it is either done by orthopedist or physical medicine and rehabilitation specialist.

Deconditioning-diminished ability or perceived ability to perform tasks involved in person’s usual activities of daily living.

Developmental kinesiology – a science of studying functional maturation of muscles during postural ontogenesis.

Motor pattern - reaction of the motor system to afferent stimulation. The nervous system produces motor functions that appear in the same way from one generation to the next. These genetically determined factors of motor behavior are called motor patterns.

Postural ontogenesis – A science of studying maturation of motor component of central nervous system...It is a science of development of postural system during first year of child’s life.

Deep muscles- are muscles which are not under voluntary control. These muscles are mostly activated in orchestrated fashion together with other muscles which act in the stabilization process of the spine. These muscles are called intersegmental because they connect adjacent vertebras. They are: multifidus, intraspinalis, intratransversrii and transversospinales .They also function as dynamic ligaments of the spine.

The principle of joint centration- the position in which there is the most favorable distribution of pressure on the joint facets during every phase of motion, resulting maximum stability and load capacity. This depends exclusively on the normal development of the central nervous system.

Neutral position of spinal joints- relates to the shape of spinal curvatures where neither lordotic nor kyphotic curves are exaggerated. This ensures that all spinal joins have maximal joint surface contact throughout any movement or static position. See joint centration above.

Reflex locomotion- motor reaction occurring in well defined and coordinated manner throughout entire skeletal musculature as well as eye movements, swallowing process, bladder and bowel function and breathing.

The genetically predetermined authentic motor reaction is provoked by graded pressure applied on certain body parts which are called “stimulation zones”, with the patient placed in these specific positions and reproduced at any time.

Zones of support- are areas of the body which help the child to move up against gravity. They serve as support ensuring erect posture during ontogenesis. They are areas with a great number of attachment points of tendons and ligaments; hence they produce a strong proprioceptive input.

These are medial epicondyle at the elbows, the linea nuchae, the spina iliaca anterior superior and etc.

Co-activation- synchronous activation of agonist and antagonist (cocontraction) in order to centrate and stabilize the joint. This type of contraction is used when movement is slow and performed in order to hold a position or resist against some external force .Unlike reciprocal activation which is a primitive reflex activity on the spinal cord level, co-activation is more complex activity realized above the brain stem.

Neuroplasticity – is the brain’s ability to recognize itself by forming new connections. This interaction between the tissues, neurons, and chemicals of the brain is what molds the structure and function of the nervous system.

Agonist antagonist coactivation- is simultaneous activation of two opposing muscles around the joint. This results in increased stability of the joint.

Trigger points- foci of hyperirritability in the muscle which produce a characteristic pattern of referral unique to that muscle.

Functional muscle chains- are muscles which contract in predetermined sequences according to genetically imbedded motor programs

Functional muscle synergies- are activation of muscles in appropriate sequence, timing, direction and force. These variables are organized as a ratio. They are flexible and soft wired, therefore could be influenced (reprogrammed) by the therapy.

Joint restriction (subluxation) - is decreased or aberrant movement of the joint which changes mechanical regime of functioning of this joint, reflex changes in the nervous system and ultimately results in pain somewhere in the locomotor system.

For more information, visit www.rehabps.com or www.vojta.com