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11.12.13

DNS Functional tools

Kolars Approach to Dynamic


Neuromuscular Stabilization in sport
and fitness
DNS Exercise course PART III/1
Rehabilitation Clinic
University Hospital Motol
Charles University
Prague, Czech Republic

Athletic performance
! Throwing, kicking,
lifting, running,
jumping!.
! Involves part of the
global patterns
! Picture of perfect
body segments
aligment
Functional joint
centration

Functional joint centration


= Neutral joint position
! Able to generate maximal muscle
power
! Improve sport performance
! Equal loading of the joints - decreases
load on ligaments and tendons, prevent
cartilage overuse and degeneration
! May prevent repetitive strain injury

Dynamic Neuromuscular Stabilization

! Posture assesment comparison with


ideal developmental posture
! Movement analysis in context with ideal
developmental pattern
! Corrective training of the stabilizing and
dynamic function of the muscles in the
kinematic chain

Development of
Functional Joint
Centration
Position of joints is
controlled by coordinated
co-contraction of
antagonists. Also linked
up with muscles providing
joint stabilization.
Well balanced activity of
antagonists ensures wellcentrated joints and this
depends only on a
normally developed CNS.

Physiological development
4,5 months: sagittal stabilization of
spine, chest and pelvis completed
Physiological
CNS maturation
!Ideal stabilization
!Ideal
biomechanical
condition
!Functional joint
centration

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11.12.13

Postural Tasks
Loading, Exercise, Weightlifting..

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Viscera are pressurized by diaphragm,


pelvic floor and abdominal wall
Intra-abdominal pressure increases
Posture = Initial position (axis)
diaphragm and pelvic floor Essential
Quality of stabilization pattern

Global motor
patterns

m. transversus abdominis
!!! YES !!!
!!! NO !!!

Ipsilateral
p.

Throwing, kicking, lifting,


running, jumping!.
Involves always part of those
global patterns

Sagittal stabilization

Kontalateral p.

2nd phase of development un subcortical


level: Between 5-12 months:
Stepping forward and supporting function of
the extremities

Ipsilateral pattern

Contralateral pattern

Dynamic Neuromuscular Stabilization

Ipsilateral pattern

Contralateral pattern

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11.12.13

Ipsilateral patterns in Motor


development
! Rolling from supine to prone
! Oblique sit

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Ipsilateral patterns

Throwing
Ground Strokes
Golf swing
Kicking

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Cocking ! acceleration

Acceleration muscle activity

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Dynamic Neuromuscular Stabilization

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11.12.13

Support function upper extremity


! Facial side support function
! Scapula is centrated around
head of the humerus via distal
muscle pull (long head of biceps,
triceps, external rot.) and
adheres toward the thorax via
serratus ant and oblique muscle
chains
! ADD of the scapula has distal
pull and upright T spine allow
segmental rotation via mm
multifidis, rotatores
! Proper stabilization function and
centrated segmental aligment
allow greatest muscullar
efficiency on the fasical side

! Medial edge of the


scapulae should be
parallel with spine
! Angles adhering
towards rib cage
! Mid trapesius and
rhomboidei uprighting
T spine
! Via serratus anterior
connected with
abdominal wall
oblique muscle chains

Support function - lower extremity

Supporting leg
Tibialis ant. and triceps keep the ankle in 90- fix point
Hamstrings and rectus abd. - dorsal tilt of pelvis

! Weight bearing on the left


foot
! Knee extension via vasti and
gastrocnemii
! ADD rotates pelvis around
the hip
! Rectus femoris and
hamstrings in cocontraction
control ventrodorsal stability
of the pelvis
! External rot. via excentric
contraction controls
lateral stability in hip
!
distal muscle pull

External rotatores rotate the pelvis around the hip


Add- antigravity function

Stepping forward
Stepping forward

weightbearing

Contralateral patterns in development


!
!
!
!

Stabilization of the
shoulder blade

Crawling
Tripod
Standing up
Walking

5th MONTHS

WB on medial elbow, < 90 shld flexion


! WB on pubic symphysis and L-S area
- time where the pelvis reaches neutral
position and there is a coordination
between pelvic floor and diaphragm
muscles to produce the intra-abdominal
pressure for stability

Dynamic Neuromuscular Stabilization

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Contralateral pattern

11.12.13

Trunk stabilization via oblique


muscle chains

Stepping forward

Contralateral pattern in sport

! Running
! Skating
! Skiing
! Jumping from one leg long jump, high jump
! Cycling

Global motor patterns


! Critical for physiological development of our
structure
! Dynamic neuromuscular strategy that leads to
optimal joint position that allows for the most
effective mechanical advantage during full range
of movement
! Allows for maximal muscle pull and protection of
passive structures
! Well balanced activity of antagonists ensures
well-centrated joints and this depends only on a
normally developed CNS

Dynamic Neuromuscular Stabilization

Athletic Performance
Automatic utilization of all the principles described
!Automatic integration of postural locomotion function with
afferent information
!Oro-facial muscles also fulfill stabilization function
!Integration of eyesight eyes are leading, move (proceed) in
the direction of stepping forward = throwing hand
!Reciprocal position/movement of the extremities.

Muscle function????
Excentric contraction
Distal muscle pull
Stabilization function

Concentric contraction
Proximal muscle pull
Steping forward

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How to asses the quality of the


postural function

Janda: Minimum muscle activity is necessary for


primary stance: Evaluate muscle tone distribution

! Visual assesment of the posture


muscle tone distribution
! DNS tests postural function of
diaphragm and core
! Movement analysis compare with
quality of global pattern (ipsilateral,
contralateral..)
! Quality of cortical function ability of
relaxation and making isolated movements

Clinical Postural Impairments


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DNS principles for athletic


population and training!

Dynamic Neuromuscular Stabilization

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