What is DNS
Stands for Dynamic Neuromuscular Stabilization. The concept of DNS is based on the scientific principles of developmental kinesiology, more specifically the neurophysiological aspects of the maturing locomotor system. It includes both knowledge and a theoretical base in assessment treatment, exercise, and functional strategies.
Who is DNS
Professor Pavel Kolar is the founder of this specific practice and strategy. Kolar is the director of rehabilitation at the Clinic 2nd Medical Faculty Charles University, located in Prague, Czech Republic. He is a physiotherapist by training who holds a doctorate in pediatrics and physiology. He is a professor of physiology along with being the head clinician for the following Czech Olympic teams: soccer, ice hockey, and tennis.
Why DNS
The DNS program helps us understand that for every movement made in the kinetic chain, energy runs through the diaphragm. For those who do not know, the kinetic chain is the interrelated groups of body segments, connecting joints, and muscles working together to perform movements and the portion of the spine to which they connect. In layman’s terms, when you move, energy transfers through the kinetic chain which always travels through the diaphragm. The foundation of DNS movement is having motor control over this muscle.
DNS in Sport
While working with athletes it has come to my understanding that the majority of them lack a proficient command of their diaphragm. One of the main reasons for their lack is not from ability, but because they have not been taught how to control that part of their body. This includes breathing properly and utilizing the whole diaphragm for air. What I have found is that putting athletes into optimal posture is step one in this entire process. Most athletes have “overactive” or “hyperactive” pectorales and neck flexors, causing their posture to almost fold forward before they make a movement. Training posture and positioning the joints in neutral position during the course of movement will help the athlete stay in healthier positions. Posture is always the backbone of movement and will allow the athlete to be precise, strong, and fast enough in their movement.
When training an athlete, understanding what the functional gap is will be everything in building a training program. The functional gap is entered when the athlete can no longer be “perfect in their movement.” The functional gap can be attacked in 3 main ways: load, speed, and endurance. When we have overreached in any of those three categories, we have reached the functional gap. It is important to spend most of the training out of the functional gap and a small percentage of time in the functional gap. It is not the end of the world when the athlete enters this stage. Training for sports, most of the time, requires athletes to push beyond their limits. Just know the athlete will report to a primitive stabilizing strategy. Ideally a solid training program will build an athlete up so that it requires high amounts of strain in the three primary areas for the functional gap to be entered.
One of the missing links when training and working with athletes is training the athlete in order to increase the body acceptance and adaptation of maximal sport loading in order to reach maximum performance. We need to train the athlete to be able to hit peak performance in the sport they play, more so than hit peak performance while training. When loading the muscles, we must understand that the movements in which we can load will have a direct effect on the athletes' on-field performance.
Understanding the Diaphragm and Abdominal Wall along with the Pelvic Floor: When it comes to core stabilization, it is best to think of it coming from the inside out. When somebody braces their core, typically they brace from the outside in. For example, when they brace for a punch to the gut, the brace comes from the outside rather than the inside. When helping individuals understand core stabilization, I first teach them to work their breath to the bottom of the diaphragm. I like telling them they have plenty of space at the bottom of this area for air. Do your best to fill the breath.
A good exercise is to have a person supine on the floor, have them place their palms on the base of their belly, and ask them to fill air into their palms. The tactile sensation will help the person feel the air fill in their “belly” while really, they are working inside out stabilization of the core by simply utilizing their breath. Karle Lewit famously said, “if breathing is not normalized no other movement pattern can be.” Most people lose much of their air since they breathe strictly from their chest. Teaching a person how to utilize their breath properly throughout their entire diaphragm may seem like a small achievement but it is a massive stride in building a foundation. A common mistake I see people make is when they teach breathing as only the belly expanding in the upward direction. The breath must be taught as a lateral expansion as well. A proper breath will enhance a person’s ability to move freely without leaking energy through the kinetic chain.
When I work with athletes, I like to always teach simple tactics and to do them extremely well. For instance, the idea of posture is a key fundamental in movement for any person, especially those performing athletic movements. Now posture does not just mean standing up straight with your shoulders back. Posture, in my eyes, is thought about as the joints in the body that maintain a neutral position when they are loaded during a full range of motion. Our body tends to shift or overload certain sides of the body. Typically, what I see is athletes tend to load their dominant side. When an athlete performs a squat, they can maintain even hips as they work through their exercise, but once they enter the functional gap and as the weight increases, they start to slide to their dominant side. Now most high-level coaches or athletes will obviously notice the shift but how they “fix” that shift may be inconsistent. This goes back to doing simple better and working up from the foundation. Most people need to continue to get better at breathing in to out, truly learning how to create intra-abdominal pressure. The breath is the most fundamental movement the human body experiences, and we rarely work on it.
How this is functional for athletes. How do I fill the gap for athletes?
I fill the gap for athletes because of my understanding of the fundamentals of movement. I aim to clean up movement patterns in the gym and on the field. Having a deep understanding of elite performance on the field and what it requires not only physically, but also mentally, and emotionally gives me the advantage of taking work in the weight room and being able to translate it to sport. For example, when I work with rotational athletes and inquire as to what their training program consists of, the majority of if not all the strength work is done on only two planes of motion. Thus, being the sagittal and frontal plane. This is not a bad thing; athletes need to be trained in these planes of motion for multiple reasons which I will not dive into in this article. Although, one of the problems is that they perform on the transverse plane in their sport. It is important to teach an athlete to be able to translate the work they are doing in the sagittal and frontal planes, and to teach them to use it on the transverse plane as well. This concept might be new to some or obvious to others and you may be asking yourself, what kind of exercises would you do this? While I love certain movements or exercises to help athletes transfer their strength into the transverse plane, it is important to remember this concept: follow principles over tools. What I mean by that is exercises or movements can be as diverse as the coach or athlete wants them to be, but at the end of the day, it is not about how many “sexy” exercises you learn, it is about the number of principles you follow.
Case Study One
Now my principles do not stop with rotational athletes, which leads me to my case study number one. I worked with an athlete by the name of Joe Noteboom, an offensive lineman for the Los Angeles Rams. Joe was a traditional trap dominant athlete who was lacking extension in his reach. It was not his fault he was trained earlier in his career to tense his traps before every movement he made in the gym. The reason I say trained to have tense traps is because he was never coached away from that movement, meaning that as a coach, if you do not coach your athlete away from a negative movement, you are then indirectly training him or her to move that way. In opposite fashion, every single movement Joe made with me during the offseason he had to follow these steps: fill the diaphragm, soften the traps, pack the lats. I had helped Joe gain two more inches on his reach while strengthening his stability in his shoulders in the extended position. While it may seem like a small achievement, his 2 inches of reach might be able to save Matthew Stafford from being sacked and more importantly to me, create longevity in Joe's career.
Case Study Two
Lori Smith is my second example of learning that the inside out breath can create strength long ways away from the diaphragm. Unlike Joe, Lori does not play offensive line for the Rams, but she has struggled with staying pain free from exercise for a long time now. Lori has had quite a list of injuries which include a fractured femur, two torn ACL’s, ankle surgery, knee replacement, and nerve damage to her neck. When I first met Lori, she did not tell me about her laundry list of injuries. Although, when I asked her to do a reverse lunge during her assessment that day, she said that she would not be able to complete that movement. I asked her why then she proceeded to go down the list. I had asked her what the protocols had been for her, in her training and physical therapy. What I learned was that it seemed to me that her trainers and PTs had been trying to just put Band-Aids on her problems rather than working with her foundation. So once again, we trained our breath, learned how to breathe properly, and strengthened her core from the inside out. We perfected our breath and created newfound strength in the abdomen wall. After we built up what I would consider the base of movement, we then moved to the legs. We worked quad strengthening, specifically her vastus medialis and lateralis along the rectus femoris. With exercises such as backwards walking up hill, goblet squatting (with slant board), and anterior tibialis strengthening. We evolved into assisted single limb movements and a month later, Lori was easily moving into reverse lunges without a problem. She had been trying to do a movement like that for 9 years. Doctors told her to just not do that, PT recommended staying out of that position, and trainers didn’t want her to hurt herself by doing an exercise like that. For Lori, I was able to fill the gap by building a foundation from the inside out which gave her the confidence to then make a movement she had been hesitant to complete for a long time.
References
- Frank, Clare et al. “Dynamic neuromuscular stabilization & sports rehabilitation.” International journal of sports physical therapy vol. 8,1 (2013): 62-73.
