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. 2013 Feb;8(1):62-73.

Dynamic neuromuscular stabilization & sports rehabilitation

Clare Frank  1 , Alena Kobesova, Pavel Kolar
Affiliations

Dynamic neuromuscular stabilization & sports rehabilitation

Clare Frank et al. Int J Sports Phys Ther. 2013 Feb.

Abstract

Dynamic neuromuscular (core) stability is necessary for optimal athletic performance and is not achieved purely by adequate strength of abdominals, spinal extensors, gluteals or any other musculature; rather, core stabilization is accomplished through precise coordination of these muscles and intra-abdominal pressure regulation by the central nervous system. Understanding developmental kinesiology provides a framework to appreciate the regional interdependence and the inter-linking of the skeleton, joints, musculature during movement and the importance of training both the dynamic and stabilizing function of muscles in the kinetic chain. The Dynamic Neuromuscular Stabilization (DNS) approach provides functional tools to assess and activate the intrinsic spinal stabilizers in order to optimize the movement system for both pre-habilitation and rehabilitation of athletic injuries and performance.

Level of evidence: 5.

Keywords: Core stabilization; developmental kinesiology; dynamic neuromuscular stabilization; integrated spinal stabilizing system.

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Figures

Figure 1.
Figure 1.
IAP Regulation by diaphragm, pelvic floor and transversus abdominis.
Figure 2.
Figure 2.
Impaired ISSS resulting in anterior shear stresses on lumbar segments.
Figure 3.
Figure 3.
Seated diaphragm test. Clinician palpates for adequate lateral excursion of rib cage and lateral abdominal activation; and excessive superior excursion of rib cage and overactivity of paraspinals.
Figure 4.
Figure 4.
(A) Establishment of ideal ISSS and IAP regulation in a 4½ month old baby. (B) Training of ISSS & IAP regulation with hips and knees in 90° flexion. Rolling from side to side can be incorporated with or without the ball to facilitate oblique muscle chain activation, while maintaining proper form. (C) Maintaining good respiration and IAP regulation with increased load
Figure 5.
Figure 5.
(A) Rolling pattern of a 5-6 month old baby. (B) Exercise with elastic band corresponding to rolling pattern of a 5-6 month old baby.
Figure 6.
Figure 6.
(A) Oblique sit position corresponding to 7½ months of age. (B) Rotator cuff strengthening of right shoulder while training the stabilizing function of the left shoulder in a modified oblique sit/side plank position, while maintaining good IAP regulation.
Figure 7.
Figure 7.
(A) Oblique sit position transitioning towards a quadruped position. (B) Training an athlete in an oblique sit position focusing on stabilizing function of right shoulder and dynamic function of the top reaching arm. (C) Training an athlete transitioning from oblique sit position to a quadruped position. Emphasis is on stabilizing function of the right shoulder where the glenoid fossa is rotating over a fixed/stable humerus and dynamic function of the left reaching arm where the humerus is rotating over a fixed/stable glenoid fossa.
Figure 8.
Figure 8.
(A) Sitting posture of a 8-9 month old baby with well balanced ISSS and IAP regulation. (B) Training proper respiration and IAP regulation in seated position with tactile feedback. (C) Utilizing proper respiration and IAP regulation when exercising with load in the gym.
Figure 9.
Figure 9.
(A) Bear position corresponding to 14 months of age. (B) Training of an athlete in a bear position from 4 to 3 points of support when he lifts his left foot off the ground. This exercise can be progressed to 2 point support where contralateral extremities lift off the ground to crawl forward.
Figure 10.
Figure 10.
(A) Deep Squat position corresponding to 16 months of age. (B) Training for good squat pattern to avoid “quad dominant” pattern where the knees move anterior of the feet. (C) Squat & reach with Thera-Band resistance. Focus is on good IAP regulation and ideal coordination of ISSS.
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