nd exercises that do not require clinicians assistance and can be performed in the privacy of the patients home. This proactive approach ensures patients dynamic involvement in the healing process and minimizes doctor-patient dependency.
The advantages of DNS over the conventional physical therapies show that patients with neuro-muscular disorders have a superior alternative to the commercially established methods of treatment.
DNS was invented by Pavel Kolar, a pediatric physiotherapist. The basis of DNS is the mechanism of natural maturation of the human infant. The infant learns in a progressive, natural way how to control posture and move in a purposeful way. All infants exhibit the same progression of postures during development.
Underneath the “core” muscles lies “the deep core.” The deep core consists of a balanced use of the deep cervical flexors, the spinal extensors, the diaphram, pelvic floor, and abdominal muscles to regulate intra-abdominal pressure and spinal stiffness. This process provides dynamic stability of the spine. The deep core operates under automatic and subconscious control. Adjustment of the deep core to properly prepare the spine precedes any purposeful movement. Injuries and developmental disorders that interfere with this process cause impairments in anticipatory postural control. Training programs intended to restore or improve the precise muscular coordination and timing of the deep core can improve the efficiency of movement.
Kolar talks about the concept of “joint centration” which refers to a joint that is dynamically stabilized throughout its range of motion to allow the joint and muscles to operate at their optimum. A centrated joint experiences minimal stress. An example of lack of centration is work by Kolar suggesting that abnormal postural activation of the diaphragm can contribute to chronic lower back pain. Individuals who don’t use the diaphragm effectively in postural control have increased compressive forces on the spine, thus incorrect use of the diaphragm prevents the spine from achieving centration.
If one link in a motion pattern is weak or not being used effectively other muscles may be used to create an inefficient motion pattern. These patterns are stored in the central nervous system as habits. Habitual use of inefficient motion patterns can cause chronic pain, injuries, and poor performance.
When trying to rehabilitate an injured person, working only with the obviously affected joint or limb (the one that is injured) is often ineffective because it is not the root cause of the problem, it is just a symptom. Focusing on the core stability first and the injured or weak limb second may seem counter-intuitive but it works very well. Examining the entire motion chain to identify the “weak link” in the motion chain and then working to correct that error is much more effective than focusing on the most obviously affected limb or joint. For example, an athlete suffering from chronic shoulder pain will not be helped by physical therapy directed at the shoulder if the actual problem is a weakness in core stability that is causing the athlete to use the shoulder incorrectly. Correcting the core stability weakness will not be effective either unless the habitual motor patterns can be re-written incorporating the correct motion patterns.
The DNS approach to rehabilitation (or injury prevention) is to compare the athlete’s stabilization pattern to the pattern of a developing infant with the intent of correcting the athlete’s pattern. The initial DNS evaluation consists of a series of functional tests to try to identify “weak links” in the core stabilization.
Once a “weak link” has been identified, a series of active exercises are prescribed. These exercises are intended to activate and restore the optimal patterns of stabilization and movement. Each exercise involves restoring the optimal respiratory pattern and intra-abdominal pressure by re-training the use of the diaphragm, restoring stability of the spine to support dynamic limb motions, and restore joint centration. These exe