Running, hip mobility, and the importance of stabilization

One aspect of running gait which has been getting quite a bit of attention lately is the hips, specifically what role they play in sending a person forward.  There are many muscles in the hip, a mobile joint designed to move in the sagittal, frontal, and transverse planes.  The hip and shoulder are designed to function similarly (internally and externally rotate, flex and extend) and the anatomy of the two joints is also similar.  The hip has 6 muscles that function much like the rotator cuff.  The deep 6 muscles of the hip (piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris) are considered part of the local muscle system, which stabilizes the hip in the femoracetabular joint (Osar, 2012).  The psoas major, minor, pelvic floor, and deep fibers of the gluteus maximus also contribute to hip stabilization, although the deep 6 function primarily to maintain joint centration during rotation.  As we move superficially, the global muscle system, or the muscles that are primarily responsible for movement, can be found.  These include the superficial fibers of the gluteus maximus, gluteus medius, hamstring complex, quadriceps, TFL, adductor complex, and sartorius.  The fibers from the TFL and gluteus maximus joint together to form the IT band, which assists in abduction and internal rotation (Behnke, 2006).  While we consider the hip joint a "mobile" joint, a lot has to happen to maintain stability and throughout movement and gait mechanics.  For instance, if the gluteus medius, which functionally controls hip adduction, isn't firing properly during gait mechanics, the IT band picks up the slack.  This leads to increased knee adduction during running gait and can be a source of knee pain.  In a study performed by Wilson, Kernozek, Arndt, Reznichek, and Straker (2011), the running gait of 20 females without patellofemoral pain (PFP) was compared to the running gait of 20 females with patellofemoral pain (PFP).    EMG analysis revealed gluteus medius activation was delayed and shorter in the PFP group.  Late gluteus medius and maximus onset also correlated to increased hip adduction and internal rotation.  Runners with tight hip flexors have an extremely difficult time extending the hip with a neutral back (Dicharry, 2012).  This not only limits hip mobility, it leads to inhibition of the gluteus maximus which, as seen above can lead to knee instability.

So, what does all of this mean and what can we do about it?  Designing a focused strength and mobility program that emphasizes maintaining knee control during movement in multiple planes and hip mobility while strengthening the hip external rotators and gluteus maximus is a great place to start.  When designing a program, either for yourself or someone, it is important to look at the person's current form during movement, then choose movements to improve function where there is dysfunction, and finally, make sure the movement is executed with quality.  These three things, form, function, and quality, are the pillars of improving moving patterns and enhancing movement function.

Below is a sequence I frequently use to work hip mobility and strength.  If you try it, focus on maintaining proper knee alignment by not letting it collapse.  Also, think about maintaining a neutral spine and letting all of the movement come from the hips.  I usually do 10 per side and switch.  It's a great dynamic primer for more complex movements.

Yours in health and wellness,
Jenn

Osar, E., (2012).  Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.  On Target Publications: Santa Cruz.
Behnke, R.S., (2006).  Kinetic Anatomy, Second Edition.  Human Kinetics: Champaign.
Wilson, J.D., Kernozek, T.W., Arndt, R.L., Reznichek, D.A., Straker, S., (2011).  Gluteal muscle activation in females with and without patellofemoral pain syndrome.  Clinical Biomechanics, 26(7), pp. 735-740.
Dicharry, J., (2012).  Anatomy for Runners.  Skyhorse Publishing: New York.

Foot Function & Kinetic Transfer- a guest blog by Dr. Emily Splichal

I am excited to share that this week's post is written by educator, podiatrist, and founder of the Evidence Based Fitness Academy (EBFA) Dr. Emily Splichal.  Dr. Emily is also the creator of both the internationally recognized Barefoot Training Specialist Certification and the V-Core certification, a barefoot training workout that emphasizes functionally training the core with specific exercises.  To find out more about Dr. Emily or to check out some of her workshops, visit her website at http://evidencebasedfitnessacademy.com.  Enjoy!

Foot Function & Kinetic Transfer:

With foot fitness and barefoot training concepts at the forefront of athletic performance and fitness programming – how often do you assess your client’s feet?   

One of the most important roles the human foot plays in human movement is in the transfer or unloading of kinetic energy and power!   

The secret to the unleashing of this kinetic energy and power – is supination & pronation. 

When it comes to foot function – or shall I say dysfunction – over-pronation gets the most attention.  Excess mobility or lack of foot strength can lead to excess strain on tendons and ligaments of the foot, knees and hips, leading to over-recruitment of large global muscles to stabilize.   

Let’s take a moment and look at the opposite – lack of foot mobility or over-supination.

Can this be just as harmful?  

If a foot has a limited ability to pronate (or load) how does this impact kinetic transfer and power output?

To fully understand kinetic transfer in the foot, we must also understand that the foot is greatly influenced by the hips – and therefore we cannot address foot dysfunction without integrating hip mobilization!

How is the foot influenced by the hip?

Formed by the femur proximally, the movements of the hip that impact the foot the greatest are in the transverse plane – these are internal rotation & external rotation.   

These transverse plane movements of the hip are transferred distally through the tibia which will influence the foot in the frontal plane.   Tibial movements are able to influence the foot through its direct contact with the talus.  

Talar movements are then translated plantarly to the heel bone (calcaneus) and distally to the midfoot (navicular), causing the foot to either supinate or pronate.   When assessing for integrated foot mechanics, just remember that hip internal rotation is associated with foot pronation – and hip external rotation is associated with footsupination.  

Hip mobility and foot function

If you have a client or athlete with an over-supinated or inverted foot type, you will want to assess their ability to internally rotate the hips.   Often times, I find athletes with a history of stress fractures, plantar fasciitis and tendonitis have restricted hip mobility.   

If this is the case, hip mobilization is key to achieving optimal foot function, foot mobilization and kinetic transfer with each step!   I integrate piriformis, glutes, TFL, lateral hamstrings, and adductor stretces in all planes.  

Empowered YOUth- a book review

I was contacted recently by the Youth Wellness Network to review a book written by its founder, Michael Eisen, and his father, Jeffrey Eisen.  While I feel strongly about youth wellness, it's not my normal area of expertise.  After reading about the organization and Michael, I decided it would both be fun and potentially informative (more information about the Youth Wellness Network can be found here: http://youthwellnessnetwork.ca).  I was pleasantly surprised by a book that, while written primarily for young adults and their parents, should be read by anyone wanting to make changes in their lives.

Empowered YOUth tells the story of two very different individuals.  Jeffrey was born in the 1950s and desperately sought his father's approval.  He was driven, closed off emotionally, and goal oriented.  The stress he placed on himself to succeed led to anxiety, GI issues, and pent up emotions.  As he began to achieve major successes in the business world, he focused solely on his next major accomplishment, never appreciating what he had already achieved or being present for his three children.  This lead to physical problems (he continued to suffer from both GI problems as well as Crohn's disease), and a tumultuous relationship with his youngest son, Michael.

Michael, unlike his father, was an extremely sensitive child who was rather uninterested in pleasing the adults in his life.  As a young child, he earned the reputation of being "spirited" and "challenging."  He never really fit in as an adolescent until he discovered his love of basketball could also be a way to be accepted by others.  However, rather than continuing to enjoy the sense of being in the moment basketball originally gave him, he became fixated on earning the most points each game and proving his prowess on the court.  This eventually takes away from the magic the game once held for him and results in the game becoming a goal oriented, rather than process oriented, endeavor.  One of the themes that runs throughout Michael's first 20 years of life is his need to blame others for things that happened to him, instead of focusing on how he chose to respond to difficult situations.

When Jeffrey is in his mid-fifties, he realized his business successes weren't fulfilling him.  He felt something was missing, and stumbled upon life coaching as a way to both give back and improve himself.  During this time, Michael floundered at University, attempting to figure out his path.  Through the suggestion of Allan, Michael's older brother, Michael began to be coached by his dad.  As their previously strained relationship begins to improve, both Michael and Jeffrey experience important changes in their outlooks, goals, and attitudes towards life.

One of the themes that ran continuously throughout the book as a way to become empowered was the concept of mindfulness.  Mindfulness, as defined by www.psychologytoday.com, is "a state of active, open attention on the present.  When you're mindful, you observe your thoughts and feelings from a distance, without judging them good or bad."  This is an extremely valuable tool and one which can be difficult as a young person to grasp.  When I was an adolescent, one of the adults in my life (I can't remember which one) gave me the copy of a speech entitled "Attitude."  I read it often and while I couldn't always fully grasp the meaning behind the author's words, the last line impacted me greatly.  It stated, "I am convinced that life is 10% what happens to me and 90% how I react to it.  And so it is with you...we are in charge of our attitudes," (Charles Swindoll).  Though I didn't realize it at the time, this tool of simply recognizing my reactions helped me deal in a much more positive way with difficult issues in my life.  Being a teenager is a very self absorbed time, where everything that happens is viewed from the eyes of "how does this impact me."  That tends to be the place we react from, which leads to much more emotional responses as a young person than is necessary.  Those who learn to internalize their responses often end up sick, as represented by Jeffrey in the book.  Being in the moment and understanding the control we have over how we respond enables us to both deal with the difficult situation at hand and not over react.  One of the things that helps tremendously with this is exercise.  Sports is such a wonderful outlet for emotion and allows us to be calmer in the moment.  Dr. John Ratey's book "Spark" does an excellent job explaining the psychological benefits of exercise, particularly on mood.  One point he makes which is also made by the Eisens, is that exercise should be mindful.  We need to be present while we exercise, aware of what we are doing, focused on how we are feeling in that instant, rather than putting on headphones, watching TV, and going through the motions.  Viewing exercise as a skill is helpful with this, and finding a type of exercise that one actually enjoys is also helpful, rather than perceiving it as a chore, a drudgery that must be done because it is "good for me."  Yoga, martial arts, learning a sport, powerlifting, running, a well designed complex functional training program, all of these are movement skills that can and should be performed with a level of mindfulness and attention that have benefits reaching far beyond just the physical.

I would highly recommend Empowered Youth not just to adolescents and young adults, but to their parents, teachers, and people who want a better understanding of how their actions impact themselves and others.  Empowered Youth can be purchased at Amazon (follow link here).

Yours in health and wellness,
Jenn

Bridging, hamstring dominance, and how to find your glutes

Bridging is one of those movements that shows up in multiple systems, with multiple variations, for differing reasons.  There is the post rehabilitation bridge, designed specifically to work hip extension, the yoga bridge, which emphasizes opening up the front of the body, and the Pilates bridge, which focuses on vertebral segmentation.  There is the Cook hip lift, the handstand to bridge in yoga, and the interesting CST bridge involving arm reaches and rotation, which I have only been exposed to once and in no way have mastered.  All of these movements share the basic premise of hip extension and, when done incorrectly, can lead to either compression of the lumbar vertebrae or hamstring cramping/discomfort due to moving from the wrong place.  Today, I am focusing on the latter, although I would argue that learning how to activate the gluteal musculature not only takes pressure off the hamstrings, but also allows the lumbar region to stay stable during hip extension.

The two main muscles involved in hip extension are the gluteus maximus (GM) and the hamstrings muscle group, specifically the long head of the biceps femoris (BF) and the semimembranosis (SM) (Ono, Higashihara, and Fukubayashi, 2011).  In an ideal world, the gluteus maximus would be the prime mover, or main muscle used, and the BF and SM would be synergists, or muscles that help the gluteus maximus do its job.  Unfortunately, what happens often in a culture where we spend a lot of time sitting and is these muscles become, in the words of the wise Sarah Young, "lazy."  As a result, the BF and the SM pick up the slack, and take over as the prime mover.  Why is this bad?  Unlike the gluteus maximus, the BF and the SM aren't designed to generate large amounts of force.  In a case study of a 42 year old triathlete complaining of hamstring cramping, EMG analysis showed excessive hamstring activation during hip extension and GM weakness (Wagner, Behnia, Ancheta, Shen, Farrokhi, and Powers, 2010).  A hip strengthening program focusing on GM activation got rid of the cramping and increased GM strength.  I would argue that an even greater issue with the hamstrings becoming the prime mover is an increased risk of hamstring avulsion.  If the BF and SM are responsible for generating force repeatedly throughout the day, during standing up from a chair, running, and walking up stairs, eventually the wear and tear on the muscle will take its toll.  Research needs to be done in this area to support this hypothesis, but I know I can think of three people off the top of my head who have either strained their hamstrings or experienced a rupture.

What does this have to do with bridging?  It is important when learning how to bridge and teaching bridging to make sure the hip extension is initiated with the gluteus maximus.  For the sake of this blog, I am going to focus on a post-rehabilitation bridge with the ultimate goal being something like the Cook hip lift or some other version of the single leg bridge, although both yoga and Pilates have their own tricks for ensuring proper activation patterns.  I find having the person perform the exercise barefoot helps with GM activation.  There has been surprisingly little (or no) research done on the effects of barefoot training versus shod training on GM activation, so this is purely anecdotal.  The feedback from the floor and the focus on big toe activation seems to help the person find the right area.  Another part of neuromuscular retraining which I find useful is visualization.  Livesay and Samaras (1998) reported a significant increase in forearm EMG activity in subjects who were asked to visualize squeezing a ball with their dominant forearm.  I have individuals focus on planting the foot firmly and evenly into the ground, using the big toe, pinkie toe, and heel to evenly distribute the weight.  Then, I have the person imagine the GM, or butt, is doing the work to lift the hips on the ground.  I have the person think about this while taking 3-5 deep, diaphragmatic breaths, maintaining that sense of grounding with the feet.  After breathing and visualizing, I ask the person to lift up, extending (not squeezing) at the hips.  I am looking for a straight line between the knees, hips, and shoulders.  I make sure there is no compression at the cervical spine and that the lumbar spine stays in a neutral position, not arching.  The person holds for a count of 5 and lowers down, repeating 10-15 times.  Once the person has mastered this, it is time to progress to alternating bridges, which involves moving the feet all of the way together, placing the hands on the hip bones to make sure they stay even, and picking up one foot, and then the other.  There should be no hip rotation and, if the foot and GM are integrated properly, there should be no cramping in the hamstring.  The final progression is the single leg bridge, which can be done by starting in the same position and lifting the right leg off of the ground, the Michael Boyle version, which involves putting a tennis ball between in the hip flexor crevice of the right hip flexor and holding it there, or the Gray Cook way, which involves placing the hands around the shin of the right leg while lifting up.  Everything else remains the same, and it is extremely important to maintain good contact with the ground with the left foot, focusing on extension of the left hip.

And, for the final question, why do we work on bridging?  Hypothetically, if we can master hip extension in a supine position, it should make it easier to transfer the concept of hip extension while standing during movements such as squatting, walking, running, and stepping.  These movements should be initiated with the GM and assisted by the BF and the SM, not the other way around.  Remember: maintaining proper movement patterns allows you to move better and hopefully move more.

Yours in health and wellness,
Jenn


Ono, T., Higashihara, A., & Fukubayashi, T., (2011).  Hamstring functions during hip-extension exercise assessed with electromyography and magnetic resonance imaging.  Research in Sports Medicine, 19(1), pp. 42-52.
Wagner, T., Behnia, N., Ancheta, W.K., Shen, R., Farrokhi, S., & Powers, C.M., (2010).  Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings.  Journal of Orthopedic and Sports Physical Therapy, 40(2), pp. 112-119.
Livesay, J.R., & Samaras, M.R., (1998).  Covert neuromuscular activity of the dominant forearm during visualization of a motor task.  Perceptual Motor Skills, 86(2), pp. 371-374.

The 2030 report and why exercise professionals have to work together

There were several topics I considered writing about in this month's blog (pain and how it impacts movement, gluteal versus hamstring dominance and how it affects bridging), but after reading "F as in Fat," a report released by Trust for America's Health, I decided those other posts could wait.  "F as in Fat" paints a rather dark picture of the potential state of America's obesity problem (to read the full report, click here: http://healthyamericans.org/assets/files/TFAH2012FasInFat18.pdf).  The good news is that some progress is being made.  In Mississippi, for instance, the rate of overweight and obesity in public school elementary students dropped from 43% in 2005 to 37.3% in 2011.  That is a substantial difference, and one that should be applauded.  However, over 35% of adults are considered obese (BMI of 30 or greater) and 19.6% of children between the ages 6-11 were considered obese in 2008.  This is tragic, not only from a healthcare cost aspect, but because of the negative impact obesity has on wellbeing.  Obesity has many causes and can be looked at from many different angles, but from a fitness professional's standpoint, increasing physical activity is paramount, both in our children and in our adults.  In California, one of the fitter states with 23.8% of the adult population obese, 19.1% of adults reported they participated in no physical activity in the last 30 days.  And in Colorado (the fittest state, at 20.7% obese), only 29.2% of high school students were physically active for 60 minutes, 7 days a week.

In all fairness, as an exercise professional and one who reads the trending news bits in popular media, it is easy to see how daunting exercise can be.  "How much?"  "What type?"  "Is one better than the other?"  "This fitness professional is showing me the best movement to tone my behind, but I tried to bend like she did and strained my back.  What should I do now?"  "And how come some people say high intensity is the only way to go?"  This, coupled with some of the bootcamp style exercise programs popularized by shows like "The Biggest Loser," is enough to make a person's head spin.  Top that off with the fact that industry experts can't even agree (Running is bad!  Crossfit is bad!  Yoga will hurt you!  You should be doing short burst for 4 minutes a day!  Personal training is a waste of money!  People should be self motivated!) and it's overwhelming, to say the least.  When people come to me and ask me what type of exercise program they should embark on, my first question is always, "well, what do you like?"  Dr. Stuart Brown points out in his book "Play" that often we can reflect on what type of play we enjoyed in our childhood and turn that into a hobby as an adult.  I personally think that the words "exercise" and "workout" conjure up images of drudgery.  As Dr. Brown states in regards to running, "Sometimes running is play, and sometimes it is not.  What is the difference between the two?...Play is a state of mind, rather than an activity," (2009).  As exercise professionals, this should really be the first thing we embrace when encouraging physical activity.  As a result, we should stop focusing on the fact that one type of movement/activity/exercise is better than another and embrace a person's individual motivation for increasing movement.  If someone derives motivation and a sense of play from participating in a Crossfit class, despite the fact it is not my personal movement of choice, I am not going to talk him out of it (although I am going to strongly encourage finding an experienced and educated coach).  And every time I see negative comments by fellow professionals crop up about running or yoga (two of my favorite movement choices), I remind myself that no one but me has to approve of my exercise selection.  But I am an educated, knowledgeable professional in the area.  Think of how this must appear to someone who decides he wants to begin integrating exercise into his life and, when reading multiple blogs on the internet, he learns that fitness professionals have an extremely difficult time agreeing what the "right" type of movement is.  People should be encouraged to try a variety of things until they find something that they enjoy, that makes them lose themselves in the moment the way play does.  Instead of arguing over whose method is right, let's work together.  It never bothers me when I realize I can't provide the type of training or the type of movement a person needs.  I simply point the person in the direction of a professional specializing in that type of movement that I trust and holds a similar philosophy of quality over quantity.  If we want to change the course of America's plunge into a nation of osteoarthritis, diabetes type II, coronary heart disease, we have to start working together and embracing all types of movement as valid and good.  Our country deserves it.

Yours in health and wellness,
Jenn

Brown, S.B., (2009).  Play, Penguin Group: New York.

Training the foot (and what happens when you do trigger point work daily)

At the beginning of August, I went to Arizona to attend lectures and meet some of my classmates I have been virtually conversing with for the last two years.  One of the women I met, Emily, is a podiatrist who believes in treating the foot like any other body part and strengthening it to withstand everyday use.  Her website is here: http://evidencebasedfitnessacademy.com/index.html.  I am hoping to attend one of her workshops when she comes back out west, but I started to think about this concept of training the feet and how ignored this body part often is.  Charlie Weingroff refers to the "short foot" in his DVD "Training=Rehab" and Dr. Evan Osar discusses forming a tripod by engaging the big toe, pinkie toe, and heel while standing in his book "Corrective Exercise Solutions to Common Hip and Shoulder Dysfunctions."  When we think of the foot, we often think of the plantar fascia, a sheath of fascia that wraps underneath the foot and attaches near the proximal metatarsalphalanges (Bhenke, 2006).  Beneath the plantar fascia are four layers of muscles that control the motion of the foot when static and during locomotion.  When these deep intrinsic muscles are not as strong as they should be, the plantar fascia becomes the primary mechanism for preventing foot collapse; while the posterior tibialis functions primarily to prevent foot collapse and prevent excessive tension on the plantar fascia, other muscles, such as the flexor digitorum longus, flexor hallucis longus, peroneus longus, Achilles tendon, gluteus medius, gluteus minimis, and TFL all work together to control foot motion and shock absorption (Bolgla & Malone, 2004).  Clearly, as with training any other body part, it is important to focus on strengthening the entire kinetic chain during dynamic motion to gain muscular synchronicity and efficiency.  The short foot is an easy way to begin to bring awareness to the deep stabilizers of the feet.  Two small studies, one performed by Jung, Kim, Koh, Kwon, Cynn, and Lee (2011) and the other performed by Lynn, Padilla, and Tsang (2012) suggest performing short foot exercises were more effective than toe curl exercises at improving height of the medial longitudinal arch (MLA) and decreasing center of pressure.  This makes sense; rarely in regular life do we curl our toes.  However, if we can teach our MLA to not collapse during everyday movement, especially if we are on our feet often (runners, factory workers, hairstylists), we should hypothetically be able to reduce the tension on our plantar fascia.  I find Dr. Osar's cueing useful when teaching a short foot.  I have also seen practitioners physically lift the medial arch and cue the person to feel the activation of the foot muscles with the arch lifted.  (As a side note, I find people prone to supination have a different problem with being able to engage their big toes during movement.  The muscles of the feet lack the flexibility needed to perform pronation, which is a natural movement that occurs during locomotion).  Another important aspect of the foot is maintaining toe mobility so the toes can perform properly during toe-off.  This is particularly important during running gait, when the intrinsic muscles of the foot contract to stabilize the transverse tarsal joint, absorb ground reaction forces and propel the body forward (Dhugan and Bhat, 2005).  If these muscles are not working properly, one risks placing more stress on the surrounding ligaments and joints.  Gaining a sense of awareness of how your foot feels while in contact with the ground and beginning to train some of these deeper, stability muscles can lead to a better sense of alignment all the way up the kinetic chain.

While I was chatting with Emily about her philosophy and experience with feet, she mentioned she recommends everyone stand with a golf ball under each foot at the end of the day.  "Stand on it, don't roll," was her advise.  Trigger points, or areas which are sore when pressure is applied, can occur where ever there is fascia.  The feet, which are used all day, are susceptible to trigger points in the plantar fascia and in some of the deeper layers.  Me, being the slightly compulsive person that I am, decided to stand on a little tennis ball I have that is about the size of a golf ball both in the morning and in the evening (if once is good, twice must be better, right?).  When I started, it was difficult to apply much pressure at all.  I start with the ball right in front of my heel and every 30 seconds, move it forward just a little bit.  After 3 weeks of diligent use, the trigger points in my feet have lessened significantly.  I will save the science behind soft tissue work for a different day, but if you have trigger points anywhere, know that the pain will greatly be reduced if you perform self soft tissue work regularly.  This reduces overactivity in the muscles with trigger points and allows other muscles to begin working.  Even better, see a talented massage therapist at least twice a month and perform soft tissue work on yourself daily.  Your body will thank you.

Yours in health and wellness,
Jenn
www.bewellpt.com



Osar, E., (2012).  Corrective Exercise Solutiojns to Common Hip and Shoulder Dysfunction.  On Target Publications: Santa Cruz.
Bhenke, R.S., (2006).  Kinetic Anatomy: The Essentials of Human Anatomy, Second Edition, Human Kinetics.
Bolgla, L.A., & Malone, T.R., (2004).  Fasciitis and the windlass mechanism: a biomechanical link to clinical practice.  Journal of Athletic Training, 39(1), pp. 77-82.
Jung, D.Y., Kim, M.H., Koh, E.K., Kwon, O.Y., Cynn, H.S., & Lee, W.H., (2011).  A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch during toe curl and short foot exercise.  Physical Therapy of Sport, 12(1), pp. 30-35.
Lynn, S.K., Padilla, R.A., & Tsang, K.K.W., (2012).  Differences in static and dynamic balance task performance following four weeks of intrinsic foot muscle training: the short foot vs. the the towel curl exercise.  Journal of Sport Rehabilitation, [Epub ahead of print].
Dhugan, S.A., & Bhat, K.P., (2005).  Biomechanics and analysis of running gait.  Physical Medicine and Rehab Clinics of North America, 16, pp. 603-621.

Dynamic Neuromuscular Stabilization- A workshop review

It's all about the breath.  That is the basis of dynamic neuromuscular stabilization, or DNS, a movement philosophy based on Pavel Kolar's work as a physiotherapist with a PhD in pediatrics (more info on Dr. Kolar can be found here: http://www.rehabps.com/REHABILITATION/Kolar.html).  DNS focuses on reestablishing proper breathing patterns using the entire diaphragm to create intra-abdominal pressure (IAP).  Once IAP is established and joint centration has occurred, movement can take place (joint centration refers to the proper position of the bone in the socket).  Movement patterns that are grooved use a developmental kinesiology approach, i.e. legs in the air, diaphragmatic breath, a caudal rib positioning, similar to a 3 month old baby, with the arms and legs then moving in various patterns while maintaining IAP.  This is far harder than it sounds and was a bit eye opening for those who consider ourselves strong (and there were a few of us in there).  Our instructor, a physiotherapist from Prague named Zusana, was fantastic- patient, with an obvious mastery in the information she was conveying.  The class consisted of people from all over the US (Baton Rouge was the furthest anyone had travelled) and diverse backgrounds.  Some of the people in attendance were a Pilates instructor, ATC from a physical therapy clinic, Stanford athletics ATC, Feldenkrais practitioner, ortho bionomy practitioner, Football strength and conditioning coach, and massage therapist.  I felt the content had wide reaching application and I appreciated Zusana's approach to the material.  When someone asked her "how" to sequence an exercise program, her response was, "there is no cookbook approach.  You all do what you do.  The goal is to incorporate some of the principles into your approaches."  She wasn't trying to change how any of us do things; rather, the goal was to simply get us to think about things a little bit differently and give us more tools so we could do our jobs a little more effectively.

I was familiar with the principles of DNS, thanks to listening to webinars with Charlie Weingroff and reading/watching presentations by Dr. Evan Osar, both of whom have a more integrated approach than many strength and conditioning coaches.  One of the hardest things for me within the personal training field is there are so many different ways of doing things and no "expert" has resonated with me enough for me to want to "study" with him.  This is different than yoga, for instance.  There are many different types of yoga.  Once you find a style that speaks to you, you can take workshops or classes with senior teachers.  I have learned a ton of both practical and conceptual aspects of Ashtanga by attending workshops with a number of senior teachers and it has always made me a bit sad there is nothing like this in the personal training world.  The DNS approach feels like what has been missing, at least for me.  It is a fundamental concept I can thread through my sessions that makes sense.  I will take Sports Course part II in November if Zusana comes back to SF (there were rumors she will come up to the bay area after teaching in Phoenix), and from there, I might consider moving into the Basic Courses.  While I am unable to do soft tissue work, the better understanding I have of how the body works, the better trainer I will be.  I feel like many trainers get stuck.  They learn how to move, figure out what works for them, and never really expand past that to learn more techniques and apply new principles.  This doesn't always address some of the more basic stability problems and often allows individuals to continue adopting efficient compensation patterns.  I strive to help people move better and move more, and I think DNS might help me do that.

Yours in health and wellness,
Jenn
www.bewelllpt.com