The following post is a commentary on an outstanding summary paper from the Prague School by Dr Kobesova and Professor Kolar for the Journal of Bodywork and Movement Therapy. The full paper can be found here. Please look through the paper for the excellent photographs that help contextualise the principles being explored.
The italics below are direct quotes from the paper. The writing that follows arises from my experiential investigation with the principles of the teaching. Their wording is very precise and succinct as is their teaching. I appreciate this very much as it leaves no room for ambiguity. Ambiguity is the enemy of clarity, and clarity emerges when understanding is true in experience.
My contribution as a commentator on the DNS approach, encompasses time as;
- Being influenced by the principles and teaching of Professor Janda
- Strength and Conditioning Coach of elite athletes for 20 years
- Program Design Author and Manager of a Team of Coaches for Integral Movement Education
- Bodyworker with 18 years experience,
- Movement Coach using DNS as the basis of the intervention over the last 10 years.
I spent 8 years with Bluearth Foundation researching and experimenting in the design of an Empirical Movement Pedagogy that would serve as a Integral Framework for Movement Education. We took the best of Movement Education from Sports Performance, Yoga, Developmental Movement, BMC, and Parkour, and experimented professionally in our shared time together, while also educating children and their teachers in schools. Bluearth continues to invest in a team of Coaches who deliver this Approach to Teaching Professionals.
My current work consists of time with athletes from AFL, Swimming, Tennis and Recreational Athletes. I also work with people from 40-70 years of age who are after sound advice and experiential guidance on how to be active with ageing. There are a growing number of cases who are wishing to avoid surgical intervention.
I teach 4 different types of classes each week, and I enjoy each one for different reasons as they coalesce to inform each other. I consult to Hawthorn FC, Melbourne VicCentre, and enjoy an excellent relationship with the Team at Evolutionary Medicine Clinic; Paleo Osteo in Bendigo.
New perspectives are arising all the time as break-throughs in cross-over techniques, movement sequencing and new exercises emerge and are trialled.
DNS represents our True Core Stability because it is Intrinsic to Full Function, and it is based on the developmental unfolding that occurs as our brain and CNS mature.
What needs to be realised, if you like me, want to continue to move ideally through a life-span, is that the exercises arising from DNS need to be practiced consistently as part of an ideal understanding that fits your life situation.
Now, lets look at the Facts of Development Kinesiology, with some of my First-Person observations as a contrast.
Primitive reflexes organized on spinal and brain stem levels do not “disappear” after the neonatal stage. These motor patterns are simply inhibited by higher levels of control as the CNS matures. They become integrated within more complex patterns controlled at the subcortical and cortical levels. Under pathological conditions, such as brain injury or stroke, the primitive reflexes or its components become disinhibited and reappear.
When we consider the brain from the perspective of its vertical functioning capability we can appreciate the evolutionary hierarchy from spinal cord to brain stem to mid brain and limbic system, to neocortex. This unfolding, which has led to our Upright Stability is a miracle of the causes and conditions of Evolution. Our Upright bi-pedalism, with its Stabilising Function, along with our gait mechanism in its gliding ‘out of phase’ rotation expression, is the peak of this evolutionary trajectory.
Anatomic maturation continues after birth and, besides other factors (i.e. genetic, hormonal, metabolic, and immunological), it depends on the CNS control of muscle function. Muscles pulling on the epiphyseal plates greatly influence structural formation. Therefore, it is critical that the muscles acting on the epiphyseal plates function in balance. Correct CNS control ensures proportional activation between the adductors and abductors, external and internal rotators, flexors and extensors and allows for an ideal skeletal formation.
When we understand that the pull of muscles are influencing the shape of our bones and this pull is part of a global strategy that I term our ‘stabilising strategy’ it means we can pay attention to postures and exercises that will establish us in ‘functional ideal’ as our automatic strategy.
This strategy is our default gravity perception and shows that posture is a living response to gravitational vertical. Once we understand that our ‘Deep System’ is an informational system that informs posture/stability for moving, we can locate attention to our deep system to optimise movement efficiency.
If you have bow legs, a flat back, tight hamstrings, an increase in your lumbar curve, an increase in your thoracic curve, forward head posture, flat feet etc. All these are insufficiencies in Deep System Stability and are implicated as a part of a non-preferred strategy. The living problem is that these non-preferred strategies have become your ‘new normal.’ The opportunity with the DNS approach is to start again using ‘functional ideal’ as the basis for moving well.
When the neonatal developmental period is completed (the first 28 days after birth), the postural-locomotor function related to maturation of the subcortical CNS (second) level of motor control begins. Prior to movement of an extremity, the head or the neck, the core needs to brace within the gravitational field (Hodges, 2004). To stabilize the neck and the upper thoracic spine, balanced synergy between the neck flexors and spinal extensors is required (Kapandji, 1992). A feed-forward activation of both the neck flexors and extensors is a necessary mechanism for stability of limb movements as well as for the visual and vestibular systems; therefore ensuring stabilization and protection of the cervical spine (Falla et al., 2004).
To stabilize the lower thoracic and lumbar spine, a complex synergy between the diaphragm, pelvic floor, abdominal wall and spinal extensors is essential. Harmonious concentric activity of the diaphragm and the pelvic floor is followed by eccentric activity of all sections of the abdominal wall. This muscle synergy increases intra-abdominal pressure, thereby stabilizing the low back from the front. Under ideal conditions, this activity is in balance with the spinal extensors.
This stabilizing muscle synergy develops during the first 4.5 months of life. After the neonatal period, the infant begins to lift their legs in supine and lift their head when prone. For postural activity to occur, balance among all the stabilizers is necessary and depends on optimal utilization of the supporting segments. A 3-month old infant can lift their legs and weightbear on the upper sections of the gluteal muscles while maintaining an upright spine (Adde et al., 2007; Vojta, 2008). The chest and pelvis are in a neutral position, the axis of the chest and pelvis are in a parallel alignment, thus allowing for a balanced postural function.
Since the upper thoracic segments functionally belong to the cervical spine, as the infant lifts their head, the movement is initiated in T3/4/5 segments at the origin of the neck extensors: semispinalis cervicis and capitis, splenius cervicis and capitis. The extensors work in balance with the deep neck flexors (Kapandji, 1992). It is important for the activity of all the stabilizers to be proportional. If one link (a muscle or just a certain section of a muscle) is weak, it must be counterbalanced by another muscle, leading to an imbalance in the global stabilization chain. Unless restored early by therapy, it may remain for the rest of life and become a primary etiological factor in the development of chronic pain in the locomotor system.
The above paragraphs are a succint summary of the most important aspects of stability for the low back and head, neck, shoulders. Implicit in this description is the understanding of how thoracic mobility occurs and is maintained.
It is interesting to observe elite athletes from Rugby Union, League and AFL who have marked TL Junction in-sufficiency. What this means from a developmental kinesiology perspective is that the most basic of all stabilising functions is insufficient. Stabilisation of TL junction begins to occur at 6 weeks when the diaphragm begins its stabilising function, this is mature by 4.5 months.
The insufficiency exists because of the confusion around what constitutes core stability. Experience and previous dysfunction in my stabilising strategy informs me that we should follow the programs that are encoded in the CNS as a result of maturation in the first 4 years of life.
Interesting that the trouble starts when we go to school and start to sit for half the day, and begin to learn specialised activities! This has its place in our culture, but it is the arrogance of ‘conceptual based thinking’ that under-appreciates what evolution and developmental forces have provided as our birth-right.
Emotional motivation is also an important component in postural development. The infant starts to lift their head and legs to adjust the entire posture to be able to look around, later to grasp and, eventually, to start moving. Proper interaction with the environment influences the infant’s complex behavioral repertoire.
After basic stabilization of the core in the sagittal plane is completed, the locomotor function of extremities occurs (Hermsen-van Wanrooy, 2006; Vojta and Schweizer, 2009). At 4.5 months, the infant starts to reach across the midline when supine. Motivation, once again, triggers trunk rotation at the age of 5 months when the infant can turn to a sidelying position and complete rolling from supine to prone at 6 months of age.
The ipsilateral pattern of extremity locomotor function develops from the supine position. The ipsilateral extremities serve as support. These are activated in a closed kinetic chain, the direction of muscle pull is distal and the proximal segments (e.g. the acetabulum at the hip and/or the glenoid cavity at the shoulder) move against the fixed head of the femur and the humerus. Reciprocal, or the stepping forward and grasping/ reaching function, occurs in the opposite (top) extremities. They are activated in an open kinetic chain, where the direction of muscle pull is proximal, the distal part of the segment moves against the fixed proximal part, i.e. the humeral and femoral head move against a fixed glenoid cavity or the acetabulum, respectively.
In the prone position, the contralateral pattern of locomotor function develops. If the left arm serves as a support, the infant simultaneously weightbears on the right knee, with the right arm reaching and the left leg stepping forward. The kinetic chain principles are the same as described for the ipsilateral pattern. Stepping forward and supporting functions are reciprocal; they are the same movements, only in opposite directions.
Professor Kolar is the only Educator that I have heard, who educates about the differentiated role of the limbs. It is fascinating that as our Ipsilateral Stabilising function develops that the Brain/CNS see support from the extremity back to the spine, and see stepping from the spine to the extremity. Imagine the length and space that this creates in the living body!
When you consider that up to 95% of the exercises that people are performing in the gym setting are sagitally based, with no differentiated function, it is no wonder that we are declining and de-evolving functionally with ageing.
The opportunity that presents for people reading this post, is that time moving and exercising in nature, utilising different surfaces and settings equals optimal sophistication for your functional capabilities and living health.
- Free photons from sun on your skin.
- Free electrons from the earth if you are moving barefoot, or in leather shoes.
- Walking, Running and moving in different ways all challenge our contralateral stabilising function, so this represents you exercising your highest functional capability.
What you need to add, to what we might call, conventional modes of exercise, are the DNS postures to keep your body/brain established in functional ideal.
Both supporting and stepping forward extremity functions fully depend on trunk stabilization (Hodges, 2004). Therefore, during development, stabilization must initially occur in the spine, chest and pelvis and only then it is followed by a phasic extremity function. The same is true for a spontaneous motor behavior for the rest of life.
Prior to any movement, the core needs to brace (Hodges, 2004; McGill et al., 2009; Borghuis et al., 2008). Naturally, conscious focus is on the phasic part of any movement, while the stabilizing function is subconscious and automatic. Therefore, stability is often compromised and not easily retrained. It is suggested that corrective stabilization training should be a primary step in any rehabilitation program (Akuthota et al., 2008; Kobesova et al., 2012; Frank et al., 2013). Balance or strengthening exercises prescribed to a patient with poor stabilization will have limited effect or they may even promote pathological patterns of movement and exacerbate the patient’s pain (Akuthota et al., 2008; Kol ́ar and Kobesova ́, 2010; Kolar et al., 2011).
Assuming that core stability and basic extremity locomotor function are mainly under the subcortical CNS control, if CNS control is adequate, and muscles are activated in balance, then each posture and each spontaneous movement automatically bring all the joints into a functionally centrated position. The functionally centrated (neutral or functionally optimal) joint is not a static position but a dynamic neuromuscular strategy that leads to the most optimal joint position which then facilitates the most effective mechanical advantage throughout the entire range of motion. The joint contact area between the joint head and the cavity is affected by ligament strain (Novotny et al., 2000), and it is assumed that the centrated joint has the greatest interosseous contact, which allows for optimal load transfer across the joint and throughout the kinetic chain. This implies maximum loading, minimum tension in the joint capsule and the ligaments, and the protection of all joint structures during loading.
From a training and PT perspective, it is rare to see skilful guidance in loading and challenging the client at the level they present. This is due to a large range of factors;
- Movement Intelligence is poorly understood and appreciated by our culture outside elite sport as entertainment value.
- Core stability is poorly understood and represents the main confusion and point of departure between disciplines and professionals.
- The majority of Trainers need much more on-going training and guidance beyond basic concepts and practices, that are largely metabolically based.
- Very few Trainers or Coaches have therapeutic or manual medicine training, therefore it is difficult to appreciate the importance of rehabilitation principles underpinning all advanced training.
- Good observation of posture and movement is rare. This is probably the first skill that should be developed, and people should use their own first-person experimentation to build their understanding.
The treatment is based on developmental positions. The goal is to achieve optimal muscle coordination by placing the patient into various developmental positions while bringing the supporting joints and segments into a functionally centrated position. At first, the patient is manually and verbally guided to recognize the difference between the poor and the optimal stabilizing stereotype. Then, the patient is instructed to maintain the optimal pattern in different positions and later also during a movement. Since the stereotype of stabilization is closely related to a respiratory pattern (Kolar et al., 2009, 2010, 2011), the DNS assessment always includes the evaluation of a breathing pattern. The training also addresses simultaneous stabilizing and respiratory functions. The ultimate goal of DNS is to teach the patient the integration of an optimal pattern of breathing and stabilization within the activities of daily living and sport performance.
The cortical level of motor integration presents the highest level of CNS control. It incorporates gnostic function, such as multisensory integration, allowing for body image, self- location and first-person perspective (Ionta et al., 2011) The better the body perception, the better the quality of phasic movement, the better the ability to perform isolated movement in only one segment and the better the ability to relax.
Body perception, primarily proprioception, alows differentiation of an object’s weight, position and motion. We can “read” a joint position (Mon-Williams et al., 1999) and repeatedly perform the same movement. These principles are critical in both sport performance and rehabilitation. The better the body image the more precise and efficient the movement is. Clumsiness and poor coordination may be related to abnormal proprioceptive control.
Visual perception is also essential for purposeful movement (Mon-Williams et al., 1999). It allows for estimation of distance and speed as well as facilitation of an adequate and coordinated motor response within our surroundings. For example, the earlier a tennis player sees an approaching ball, the quicker the estimate of the angle, direction, and speed of the ball. Continuing the tennis example, an individual’s quality of visual perception would be a key aspect to success (Moreno et al., 2005; Ghasemi et al., 2011). Visual perception and integration at a cortical level enables us to mimic body positions, movements, or gestures of another personda critical aspect in sport and rehabilitation.
Vestibular perception is important not only for postural balance (Angelaki and Cullen, 2008), but also for vertical line perception.
Research shows that insufficient uni- or multi-sensory integration at the cortical level may lead to painful syndromes within the locomotor system (Flor et al., 1997; Imamura et al., 2009). Injuries, degenerative joint disorders, enthesopathies, orthopedic problems resulting from chronic overload and repetitive stress injuries are typical consequences. These disorders are usually considered to be primary diagnoses rather than a consequence of an altered sensorimotor integration and CNS control which is more likely to be the real etiology. The therapy then only targets “the diagnosis” rather than the primary etiology. Consequently, the chosen therapy usually ends up being unsuccessful in the long run.
The cerebellum is involved in all three levels of integration and matures simultaneously with other parts of the brain. This plays an important role in muscle tone regulation, postural and balance maintenance. It helps to regulate the movement’s accuracy, including very precise movements, such as playing musical instruments.
The cerebellum coordinates movements in time and space and plays an important role in cognition (Beaton and Marie ̈n, 2010) and speech (De Smet et al., 2007). It develops during ontogenesis. At 3 months of age, the functional activity in the cerebellum increases substantially (Chugani, 1998; Hadders-Algra, 2005) and its maturation continues along with the rest of the brain until adulthood. According to Hadders-Algra, the nervous system obtains its adult configuration at approximately 30 years of age. Based on the available research (Grossberg and Paine, 2000; Katanoda et al., 2001), we assume that it is especially the maturation of the cerebellar cortex and frontal and parietal cortices that allows for hand motor dexterity that is sufficient for writing at the age of 6, the age that, in most countries, correlates with the beginning of school education which is the age at which hand movement accuracy allows for writing. Also, at that age, language and cognitive functions are sufficiently developed. All three aspects play a critical role in school education as well as in rehabilitation.
Inputs to Stability: Body, Balance, Vision
1.Visual System: the establishment of “visual horizontal” gets primary input from vestibular system and processes incoming visual data relative to horizontal visual cues.
2.Vestibular System: via sensory input provided by the semi-circular canals of the vestibular apparatus, provides information about the three dimensional orientation of the head in space within gravity while the otoliths register linear momentum.
3.Proprioceptive System: provides rapid, detailed information about the relative position of one body part to another. Responds to changes in length and the rate of change in length occuring in muscle spindles. In the neck postural muscles are richly endowed with proprioceptors – 200-300 spindle cells/100grams as compared to 20-30 spindle cells/100grams in a power muscle such as the biceps.
The cerebellum size and sophistication is due to our need to constantly assess our relationship between body position and gravity. The major sensory tracts which branch into the cerebellum include those from the eyes, ears, touch receptors, vestibular system, proprioceptors, and golgi tendon organs. In addition to these sensory tracts, several major motor pathways feed into and exit the cerebellum,. These links include the reticular formation, the basal ganglia, the subthalamus, the thalamus, and the motor cortex.
The cerebellum monitors and modifies signals which begin and end somewhere else. The cerebellum is the great integrator of vast amounts of information, but it is never the source of that information. It takes up one tenth of the brain by volume, but contains over half of all its neurons. Its electrical activity is 10 times as fast and one tenth the amplitude of the cerebrum, which is why it took so long for its activity to be detected by neurologists.
The cerebellum continuously monitors body position relative to gravity as reported by the vestibular system and compares this to your actual location as reported by proprioceptors. The vestibular nuclei are modulated by the cerebellum and also activate the reticular activating system which is critical to our attentional system.
Colleagues that I regularly consult with and train with such as Cameron McMullan, Dr Josh Lamaro, Dr Aaron Anderson, Rick Ravensdale and Pete Rutty all believe that we are on the brink of an Integral Paradigm in Treatment and Training where the variables discussed here will increasingly come to life. We are all committed to this happening. The final quote from Kobesova and Kolar capture this possibility succinctly!
Postural exercises based on ideal ontogenetic patterns may be used to achieve optimal postural function and phasic movements. It is suggested that these methods should not be conceived as comprising a treatment technique, but rather an educational approach based on neurophysiology of individuals.