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The rehab docs
The Four Pillars
Change your brain, change your body
pillar 1
Dynamic Neuromuscular Stabilization
DNS uses ideal motor patterns to exit a lack of synergy between muscle groups (phasic vs tonic. The goal of any treatment is to create a habit behind an ideal motor pattern. DNS gives the provider the ability to isolate muscle groups to build motor end units. Once enough cortical awareness of a muscle group is there (meaning the patient can actually feel the activation of the muscle), then loading the muscle through a full range of motion can be applied into functional movements. This is done to integrate ideal motor patterns into movements used on a daily basis to battle compensation. If this was not done people would go back to compensation fairly quickly. If enough motor end units are gained to a muscle group, an increase in neurologic tone of the muscle is gained. This reciprocally inhibits the antagonist and creates synergy between muscle groups.
pillar 2
Reciprocal Inhibition
The first step in any treatment plan is to neurologically shut down what is spasmed, tight, or trigger point ridden (which is the cause of most joint related issues and pain). This is done by activating the antagonist of the muscle. Using reciprocal inhibition as a pain modifier also begins the process of building motor end units to the antagonist of the chief complaint (the first step in changing a motor pattern). Using reciprocal inhibition by itself is band-aid care (only pain modification) unless integration is built into a patient's activities of daily living.
pillar 3
Phasic vs Tonic Muscles
Every muscle in the body can be categorized into phasic or tonic muscles. Look up Vladimir Janda’s research to see a full chart. Tonic muscles are the muscles that hold our bodies upright in space, hince they tend to be highly facilitated neurologically. Tonic muscles are typically highly type 1 muscle fibers because of their aerobic nature. Phasic muscles are typically the muscles that are underused. These are muscles that produce movement and do not add to posture. These muscles usually have a higher type 2 fiber content. Phasic and tonic muscles tend to be antagonist. Tonic muscles have a natural higher neurologic tone so phasic muscles are typically the first muscles isolated in a treatment process. Synergizing and integrating phasic and tonic muscles are the steps to creating an ideal motor pattern. Synergistic use around a joint gets broken down into stiffness vs torque. Stable joints typically produce more torque while mobile joints typically need more stiffness. As we enter concentric contraction, especially in a mobile joint, we need antagonistic eccentric load to create enough stiffness.
pillar 4
Integration
Integration of motor patterns in activities of daily living is missed by many practitioners. A patient typically doesn’t come in until pain is limiting them from doing something. This limitation can range from bending over to playing golf. When someone has a global motor pattern problem it shows up in the way they move. Motor patterns build upon each other into global actions such as walking. People that have chronic pain are simply using their bodies wrong over time. The motor patterns that have been built must now be perfected on a very conscious level to avoid compensation through someone's hobbies. Now that a patient is cortically aware of how to use a specific muscle through a range of motion, it is time to start transferring energy from one joint to another via kinetic chains. The basics of integration is perfecting functional movements, but integration also has to be transferred to sports. EMG studies are done to understand most single joint movements but it is very hard to get EMG studies over full body functional movements. The better we understand EMG activation of functional movements the better we can continue to integrate movement patterns, especially in sports.