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Dynamic Neuromuscular Stabilization - a course participant's view

By Roger Kingston

Course Report:

An Introduction to Dynamic Neuromuscular Stabilization (DNS) by Professor Pavel Kolar at the European School of Osteopathy (ESO)

The ESO hosted Professor Pavel Kolar and Dr Alena Kobesova, of the Prague School of Manual Medicine in the Czech Republic, and this being the first time that their concepts of Dynamic Neuromuscular Stabilization has been presented in the UK. We were not disappointed!

The basic concepts behind DNS are that at birth the human CNS and anatomy are immature. Anatomical / biomechanical development is determined by genetically predetermined “programs” in the CNS and physical development is proportional to the maturation of CNS, i.e, at what age sagittal stabilization / core control occurs, turning / rolling, crawling, sitting and verticalisation occur. These “programs” are subconscious and are always running in background.

Assessing a child by observing its patterns posture, movement, quality of movement, we can determine its “developmental age”, not chronological age, if there is a difference the child requires treating. Further neurological assessment of primitive reflexes and physiological reflexes gives an indication of severity.

Similarly in adults when normal patterns of function are disrupted by injury, poor training including poor habitual posture, then the central “programs” can be corrupted and breakdown in biomechanical function occurs. In particular sagittal stabilization or core control (the level of a 4.5 month old physiological baby) is imperative for all normal function.

Professor Kolar, or Pavel, started with a translator but soon took over with very good English. They rapidly covered the neuro-biomechanical development of a baby and examined several babies with a demonstration of how they treat the problems they discovered. Plagiocephaly, torticolis, squints and a neurologically dysfunctional hand being some of the presentations.

We were shown how to assess an adult for stabilization dysfunction and again a variety of “hard to fix” patients care of the ESO clinic were assessed. Parvel literally within minutes had them assessed and treated with recommendations for care and further rehabilitation. Gasps were heard and mutterings of “black magic” were heard. We were then given a chance to practice what we had learnt.

For the rest of the day Kolar & Kobesova went round the group assessing individuals and explaining how they would treat them. Parvel was on fire and his passion and expertise was clear for all to see. The DNS approach is applicable to all forms of CNS and Muculoskeletal dysfunction with specialized application in the sub specialities.

Steve Bettles, the ESO post grad coordinator was besieged at the end of the day not being asked but being emphatically told by delegates that they wanted the full DNS educational program run at the ESO.

I have been using this approach for over a year now and the results can be spectacular in children and teenagers. What it does though is give me a way of treating the “hard to fix” or chronic / recurrent problems that present on a daily basis to us.

The ESO will be hosting phase 1 & 2 later this year and early booking is highly recommended as this course will be full.

Roger Kingston

I must admit that much of this went straight over my head and I had to do some research to discover what you were talking about.

One aspect that disturbs me is the idea that a baby that is developing at a non median level would be deemed as being in need of treatment. Is the claim being made that all infant development should follow the median line? I don't think any of my children developed their physical capacities in the same order or on the same time scales.

It rather sounds as though I and my wife should have been concerned about this even though all my living children have excellent musculature and corporal development.

Hello,

The non median line is open to interpretation, but a child who isn't rolling over by a year would concern us or a child who isn't walking by 2 years old would be a huge concern.

The average / median is a guideline and here we are saying this is what a child should be able to do, if not then what stage are they at which distinguishes their biological age from their physiological age.

It is particularly useful if you have worries that the child may have had neurological damage at birth. 2- 3 months of delay in a case that has no sinister history isn't a major issue but we would like to keep an eye on it.

Everyday in clinic I see adults in pain who have impaired spinal stabilisation below the level of a 5 month old baby. But they walk and function everyday fairly well but are in pain because mechanically they have poor development.

I would hope that in the same way a good dentist watches how a child's teeth and bite develop that now we have the knowledge parents would like to ensure their child developed a fully functioning spine. Especially when you look at how epidemic spinal pain is!

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