The Monday Memo
August 13, 2018 PITT DPT STUDENTS
Dynamic Neuromuscular Stabilization: A Brief Overview
What is DNS?
Dynamic Neuromuscular Stabilization (DNS) is an approach to facilitating appropriate core coordination that enables our patients to appropriately activate their core for optimal function. DNS is based upon principles of early childhood development that follow pre-determined, predictable patterns. These CNS movement patterns progress naturally as an infant learns to control its posture against gravity, roll, creep, and eventually stand and walk. The concept of an efficient kinetic chain – requiring adequate trunk coordination – is imperative for sport-specific tasks as well as activities of daily living. The DNS approach seeks to address inefficient motor synergies and re-train the CNS to promote optimal function. Per Panjabi’s model of spinal stability, there is an interaction between neural, active, and passive elements to promote spinal stability and allow for optimal function. Treating core strength or passive elements alone is not enough to address these stability deficits. The DNS approach can be useful in addressing the neural element for patients suffering from chronic, recurrent low-back pain (LBP), those we often think of as a “stability” patient.
How can we Apply DNS?
There are several positions in which we can encourage stability. It is important to account for weight-bearing and non-weight-bearing positions. There are a few principles to keep in mind when guiding patient treatment:
- Restore respiratory pattern and abdominal stiffness (See Brooks Kenderine’s article on abdominal stiffness vs. hollowing)
- Establish quality support to allow movement of the extremities
- Ensure joint centration throughout the movement
Our interventions should be scaled with these in mind, and the patient’s ability to perform well in low-level developmental positions will indicate the addition of external resistance or advancement to the next position. Let’s look at some simple progressions:
Supine Dead Bug:
- Unilateral or Bilateral 90/90 Isometric Hold
- Cue patient to activate core to resist increased anterior pelvic tilt/lumbar lordosis as they bring one or both legs to 90/90 position of hip and knee flexion.
- This is a great way to get the patient comfortable with diaphragmatic breathing and maintaining abdominal stiffness.
- Unilateral UE/LE March with Straight Leg Raise
- The patient will maintain 90/90 position with one leg, while alternating UE/LE extension and flexion.
- Regression: Keep the leg in hook-lying position and perform UE/LE taps with SLR.
- Alternating UE/LE March:
- Emphasize slow and controlled tempo, and maintaining good diaphragmatic breathing.
- Isometric Physioball Hold
- The patient will squeeze physio ball between opposite UE/LE and hold, then switch.
- Isometric Hold
- Ensure patient maintains chin retraction, good scapular positioning, and neutral spine.
- Alternating LE Raise and Hold
- The patient will raise and hold one foot, while maintaining chin retraction and neutral spine.
- Alternating Bear Steps
- The patient will step forward with opposite UE/LE, and then backward, alternating side to side.
-Joe Dietrich, SPT, ATC
Disclaimer: These are merely some of the movements described within the DNS system. The principles of appropriate spinal alignment and breathing techniques should be utilized across the board when prescribing therapeutic exercises to our patients.
Frank, C., Kobesova, A., & Kolar, P. (2013). DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy, 8(1), 62–73.