DNS for injuries, pain, pre-habilitation, and performance enhancement

Key Concepts

• DNS (Dynamic Neuromuscular Stabilization): A rehabilitation and performance enhancement approach based on developmental kinesiology and developmental milestones.
• Developmental Kinesiology: The study of how movement patterns develop from infancy through adulthood.
• Developmental Milestones: Specific stages of motor development that individuals typically progress through.
• Intra-abdominal Pressure (IAP): Pressure created within the abdominal cavity, crucial for core stability.
• Centration: Optimal joint positioning for stability and efficient movement.
• Rehabilitation: The process of restoring function after injury.
• Prehabilitation: Proactive strategies to prevent injuries and enhance performance.
• Transfer of Force/Load: The efficient transmission of forces through the body during movement.
• Quality of Movement: The efficiency, coordination, and control of movement patterns.
• Stability: The ability to control and maintain posture and joint position.

Injury Rehabilitation vs. Performance Enhancement

• The speaker works with individuals presenting with both injuries requiring rehabilitation and those seeking performance enhancement.
• Injury Rehabilitation: DNS is applied to address the breakdown in movement patterns by revisiting developmental stages. This involves relearning how to stabilize the neck, head, and generate concentric intra-abdominal pressure.
• Performance Enhancement: Athletes seek to improve specific skills, such as throwing velocity, by optimizing the coordination and transfer of force between body segments. Example: Creating a better "whip" between the hand and leg/hip in throwing.

DNS Application in Rehabilitation

• Initial Focus: Pain and injury are addressed first using manual methods within DNS.
• Integration of Exercises: Exercises based on developmental milestones are incorporated as pain decreases.
• Collaboration: Ideally, the speaker collaborates with trainers or coaches to progress athletes to strength training and sport-specific techniques.
• Emphasis on Quality: Focus shifts to the quality of stabilization, movement, and transfer of force/load once pain is managed.

Adherence to DNS Programs

• Low Adherence Rate: Only a small percentage (estimated 10-20%) of athletes who start a DNS-based rehabilitation program stick with it until they achieve significant improvement.
• Reason for Drop-off: Many individuals discontinue the program once they are out of pain, reverting to old habits. "Out of sight, out of mind."
• Transition to Prehabilitation: The goal is to transition athletes from rehabilitation to prehabilitation once pain-free.

Prehabilitation Strategies

• Developmental Kinesiology Foundation: Prehabilitation programs are based on developmental kinesiology and milestones.
• Addressing Insufficiencies: Programs target insufficiencies in coordination and stabilization identified during assessment.
• Movement Sequences and Exercises: Athletes practice specific movement sequences and exercises with awareness to improve stability strategies.
• Integration into Training: These exercises are incorporated into movement preparation routines before strength training or sport-specific practice.

Factors Influencing Program Adherence

• Program Integration: Athletes are more likely to adhere if prehabilitation exercises are integrated into their existing training programs.
• Individual Needs: Programs are tailored and adjusted based on individual progress and needs.
• Access and Availability: Access to one-on-one sessions and ongoing support can influence adherence.
• Athlete Buy-in: Some athletes readily adopt the prehabilitation approach, while others require more convincing.

Growing Acceptance of DNS

• Increased Recognition: DNS is gaining recognition and acceptance in professional sports.
• MLB Integration: Major League Baseball teams, such as the San Diego Padres, are integrating DNS principles.
• Coach Involvement: Hitting coaches from teams like the Los Angeles Dodgers are incorporating DNS concepts into their training methods.

Cultural Challenges in Sports

• Emphasis on Metrics: A strong emphasis on quantifiable metrics like personal records (PRs), lifting capacity, and strength levels can overshadow the importance of movement quality and stability.
• Need for Integration: The speaker advocates for integrating movement quality and stability with traditional strength and conditioning approaches.

Example Scenario: Lower Back Pain

• Hypothetical Group: Out of 100 athletes (e.g., gymnasts, hockey players, football players) presenting with lower back pain, only 20 are expected to adhere to a DNS program until they experience improvement.
• High Attrition Rate: 80% are likely to abandon the program before achieving significant results.

Notable Quotes

• "Out of sight, out of mind" - Describing the tendency of individuals to discontinue rehabilitation once they are out of pain.

Conclusion

The speaker highlights the effectiveness of DNS in both rehabilitation and performance enhancement, emphasizing the importance of addressing fundamental movement patterns based on developmental kinesiology. While DNS is gaining traction in professional sports, a significant challenge remains in ensuring athlete adherence to long-term programs, particularly after pain subsides. The key lies in integrating DNS principles into existing training regimens and fostering a culture that values movement quality and stability alongside traditional strength and conditioning metrics.