Defining DNS (Dynamic Neuromuscular Stabilization) with Alena Kobesová of the Prague School

In this episode, we break down some of the biggest misconceptions about DNS, including functional joint centration, intra-abdominal pressure, and the role of neurology in movement. The conversation explores why DNS is more than just “baby exercises,” how movement is shaped by neurophysiology, and why the best way to understand function is to look at the body as an integrated system of brain, structure, and strategy. You’ll hear practical explanations for concepts like:

- Functional joint centration

- Intra-abdominal pressure

- Reflex locomotion - The three levels of motor control

- Why movement quality matters more than position alone.

If you’ve ever wondered what DNS really is, how it differs from common rehab myths, or why it matters for athletes and patients alike, this episode is for you.

Full Transcript

Beau (01:38.7)

Any any any YouTube appropriate Pavel stories that stick in your head? Pavel stories.

I mean I can I have a couple really good ones of him doing evaluations where he like called let's start with that. Sure. Yeah, like right now. What's your Pavel story? We're going. My yeah, I know. So my I'm like the most you were actually at this. Well of course you were there because Pavel was there, right? So mine I was in St. Louis and this is the maybe the second or third time I took a DNS class. At this point, despite Brett and Robert saying no, this is good stuff.

Beau (03:38.412)

I really liked it. You did a killer job for the first one in St. Louis. But I was still pretty skeptical because you know you you take these classes and you know, the leader is always and always have magnificent stories about him. And I'm the I'm the kind of guy that's just got we were kind of like this, just sitting in the back going, bullshit, bullshit, bullshit. And he was gonna do a patient evaluation. And so we took a break. I was at the the water fountain, and you, Pavel, and Clayton Skaggs were on the other side of this little fence.

And Clayton says, Do you want to know what the case is? And Pavel said, No, no, no, no, no, no tricks. And he literally told him, Don't tell me what it was. Well, it was some famous football guy, but I don't know sports, so I don't know who the guy was. But he was he's the guy that looked like the predator that played for the Rams back in the day, running back. that guy Marshawn Lynch? No, no, no, no. But, anyways, famous dude. I'm supposed to, you know, I'm supposed to know who this person is. So he comes in.

And this first time I've ever seen someone do just an exam, and there's just no talking other than, you know, tender here, you know, push, that's all he's doing. And he does this whole exam, and I'm like, okay. I'm kind of watching him. And then he goes, Okay, stand up. And the guy so the guy stands up and he goes, It's right knee. Yes. And I was like, Okay, cool. And he goes, But it doesn't hurt when you run, it only hurts when you start to run. And I was like, that was weird. And he goes, Yeah.

And he goes, same thing with jumping. He goes, it hurts, you know, bottom of the jump here. And he goes, Yeah. And he goes, Okay, get in lunch. You know, and Pavel's very sort of like hands-on. So he's like demonstrating. He goes like Dis. And he like puts him here and goes, Come, come, come, come, stop. There. There is your pain. And the guy looked at Clayton Skaggs and goes, Who the fuck is this guy? He literally stopped him right there. And 10 minutes earlier, 20 minutes earlier, I heard Pavel say, Don't tell me what's going on. And then I watched him with no history.

Do a physical exam and tell the dude it hurts when you start to run, not when you're running. So I was impressed that he got right knee and he went all the way down to the exact position to where he actually stopped the guy in the in in the I don't if you remember that, but not exactly, but that's quite typical. Yeah. So that's just one of many just Pobble stories. I So I'll tell a story real quick. So he came into DNS golf in St. Louis in like two thousand fifteen or fourteen.

Beau (06:05.493)

This is water. It's supposed to be sleeper bits. must go off. Later. but I remember he's working up a golfer and he has him prone on the table and he he was going through the assessment, but he could people kept asking questions and he you know, he you could tell he was kinda getting frustrated. He like was trying to make a point, but he's like, You're you're not getting it. Yeah, yeah. Stop asking questions. He lifted bent both of the guys' knees and one ankle was like neutral, so there was no dorsiflexion, the other ankle was just kinda in normal dorsiflexion. He goes,

See, it's it's in his brain. And he went up like under his scapula and just like did this and both feet just went. And he just did that as a point and moved on. And everybody's like, No, no, no, no. More. What does that mean? And we're like, you know, and he's just like, No, I'm just trying to get you to realize, like, that's not there. That's you know. So that was that was my first time seeing Pavel, and that's everybody in the room's like, What is he doing? And that I think it made it worse because we're like now we're like, we don't understand anything. I'm sure this whole thing doesn't want to be Pavel stories, but the other one.

I was in Phoenix, Arizona, taking an advanced class and Petra's in the room, you know, doing it and Petra's wonderful. And so she goes, Hey, why don't we why don't we do what Pavel does? We'll just do a we'll pick someone and we'll just do the evaluations and we'll decide where it is. So we pick somebody out of the crowd. Does anyone have anything going on? You know, of course we're all physios, so of course everyone's got something going on. This guy comes up and we do all the DNS tests, we're running around and you know, for you know, thirty minutes we get to the we you it's it's right hip.

We're trying to figure it out. And it turns out it's like, yeah, the guy's yeah, I got a right hip. It's a little groint thing. We're man, we're we're pretty awesome. These like 15 advanced docs, you know, for 30 minutes. And Pavel walks in the room. They say nothing in chat. Well, they don't like, she doesn't like catch up with him. She just says, She's Do you want to evaluate the patient? And he goes, Okay. And and he's standing there and he goes, Okay, just walk two steps. He goes, see, right hip. And he like literally went straight to the hip, and I'm like, fuck.

So I I explain people when we're taking the course, you want to stay out of the gray zone. Like the the greatest thing about DNS is the worst thing about DNS, and that's that it's not black and white. So in the beginning, it's very hard for people to learn DNS because it's not like a do they turn their shoulders past ninety? Can they touch their knees? It's like, well, how did you like the quality of that? Or is that too much muscle tone or not enough? And so I tell students, just stay out of the gray zone.

Beau (08:30.571)

And if you're not sure, move on to the next test until it becomes a black or white issue, a yes or no. And the better you get at this, the smaller your gray zone is. So Pavel has no gray zone probably. He just looks at something and it's just like yes or no, dysfunctional, not dysfunctional. Well, let's save your Pavel story for later. So on that bit. She's like, no. We'll give her time to think. We'll get a real good one. if we're talking about the gray zone, so we the first day of D, there were a couple questions about joint centration of like, well.

You know, can we be centrated here? Is a runner in this position centrated? And you kinda always just said, What's dynamic? Dynamic neural school strategy. Yeah, if you had somebody that's never taken I mean, these are people that are in a D course becoming practitioners. If somebody's never taken a course or one or two, what's the best explanation that just kind of gives them, you know, an idea that it's not a position by itself to kind of you know explain this? And then that dives us into some of the other concepts we're gonna explore.

Maximum interosseous contact, great balance of muscles, it just adequate activity of all muscles around the joint. There is no hyperactivity and there is no hypoactivity because you have concentric contraction, eccentric contraction, and they need to work in a concert. And whenever you stop the motion, whenever you stop the movement, you should see good muscle balance. So I think

Because we don't consider functional joint centration as orthopedists do. They see centration, laxation, sublaxation. So it's an imaging study, how they diagnose it. For us, it's functional, it's really about function. And I think though you take a slow motion, for example, video, and whenever you stop the video, you see good muscle coordination, or you can palpate appropriate muscle coordination. So I think.

We see functional joint centration through muscle function. Okay. Because I again I think a a misconception, at least with students in particular, is that it's just a position. It's just nope, it's gotta be in this position. Any end range position, any mid position, any phase of the motion. You can still have functional joint centration. Yes. And when you stop it, you see good muscle balance. Do you

Beau (10:48.683)

So let's kinda we'll hop around here a little bit. So back to some of those Pavo stories of being able to see somebody walk two, you know, steps. I I'm sure he's skilled just innately, right? Has some skills that maybe I'll never have just of how his eyes work, approprioception. What what led to the ability to look at joint centration like that for somebody like him? Was it looking at how babies moved? Was it looking at just thousands of cases of injuries? Everything. Top athletes.

Because he he keeps telling us if you want to see optimal pattern, joint centration, stabilization, muscle coordination, watch healthy babies, how they move, because they are not spoiled yet. No one told them yet that you need to h do hollowing to look slimmer and nicer. Yeah. So normally developing babies and infants, top athletes, because usually if you want to make it to top level.

You really must have a perfect coordination. And especially those top athletes who have a long career, who can like you know check hockey play Jagger, he still played in his fifties in Florida on a top level. And so they also do not suffer repetitive strain injuries or even acute injuries because muscle coordination protects them. So usually top level athletes.

And then also reflex stimulation or reflex locomotion, we we call it. If you stimulate properly, you evoke a reflex muscle coordination, which also demonstrates optimal joint centration, optimal stabilization, optimal respiratory pattern. So these are the three options. And since Pavel has been working with many, many athletes, all variety of sports, he has seen thousands and thousands of.

patients and he also works with a pediatric PTs and of course he sees lots of children both healthy and unhealthy. So this is a great experience. And also of course he has a great palpation but he relies more on inspection, I believe. Like Carl Levit he mostly relied on his hands. He had really big hands and the palpation was

Beau (13:11.942)

his most important type of assessment for Powell it's both, but I think that r really observation is more important for him. Which is that part's really interesting, at least in the United States, because we want to talk about international differences, we get kind of beat up that we can't look at somebody's movement and determine quality or function because they're like, that you can't that doesn't have any data behind it, right? Statistics, but like, I just think that's silly. So when we talk about gray zones, when we're talking about

You know, the principles, because you mentioned reflex locomotion, reflex stimulation. What are the underpinnings of DNS that lead to things like, you know, the ideas of intrabdominal pressure and functional joint centration? Like what's the a student just asked me the other day, like, what's it mean when they're talking about this neurophysiological framework? So how do we explain that again to somebody that you know doesn't know DNS at all? You're like, well, what are we actually doing with DNS besides just looking at, you know, how joints and muscles function? Every movement is neurophysiological.

That's the problem with some rehabilitation books. You can learn everything about muscles, everything about joints and soft tissues, but nothing about brain. Without brain, there would be no motion, and obviously spinal level of integration as well. And without afferent stimulus, there is no movement. First, I need to perceive my body. I have to have a good sense of position, motion, and visual ability and balance. So

I have to perceive my environment and my body, and only then I can perform purposeful movement. So obviously, neurophysiological it means that I constantly integrate afferent information: vision, vestibular, hearing, tactile perception, proprioception, and I constantly react to the environment. So I control the muscles.

To have the most economical and purposeful motion in the environment. And obviously, this is fully dependent on all structures of CNS. So movement is a neurophysiological principle. Without neurology, without brain, without spinal cord, peripheral nerves, you can't move. Tell me or tell the guest what you were telling me last night. I mean, you're a trained neurologist that you said.

Beau (15:34.189)

You didn't really learn neurology or feel like you didn't learn neurology until you actually started working with Pavel and kind of kind of like, like that's what it means. Because after I finished my medical school, I went to neurology. So I worked at a neurology ward as a regular doctor resident. And of course I learned all these assessment procedures. So I learned what is Babinski and Orosolimo.

And how to assess tendon reflexes and spasticity. I see brisk reflexes and peripheral paresis, I see little muscle tone, and I I see decreased tendon reflexes. And I I I learned all these assessment tricks, but I didn't really understand what it means. Like what is actually Babinski? And I went to senior neurologists, I say, okay, Babinsky, spasticity, but

Why? What does it mean? Why does the big toe does per you know when I stimulate the foot? Why do I see extension? Why is that? Why why exactly this? Why not I don't know, flexion? Yeah. And they were like, it's a sign of spasticity. I say, okay, but why? Got it. Yeah, what's the principle behind it? And no one really gave me a clear explanation, but only then when I learned from Pavel about primitive reflexes.

All of a sudden I realize that Babinski is actually a trace of primitive reflex. Because when we watch, for example, cross-extension reflex in a newborn until six weeks of age, we see that actually this extension of the big toe is a part of this primitive reflex. Also, when a child is small and starts to perform new stereotypes.

Like for example, nine months, ten months old starts to sit up, and it's imbalanced, it's kind of a challenging situation for him. In this challenging situation, all of a sudden you can see extension of the big toe. It's all of a sudden the trace of a primitive reflex becomes positive. But in a healthy child, it's only a sign of immaturity. And later, as we grow up, these primitive reflexes are gone.

Beau (17:56.475)

And we don't see it on a normal adult person. And then brain injury, stroke, tumor, a lesion occurs. All of a sudden, the higher levels of CNS are dysfunctional and the lower levels kick in. All of a sudden, I can see again parts, traces of these primitive reflexes. So lots of neurological assessment I started to understand only.

After learning from Pavel about ontogenesis and the three levels of motor control, only then it started to make sense to me. And going back to the stories actually with Pavel, and it's actually close to this topic of neurophysiological assessment and neurophysiology behind DNS. I don't know, five years ago, maybe, he asked me about one colleague we know.

colleague for a long time and he comes to me and says, I think he starts Parkinson's disease. And I was like, hmm, why do you think? I don't, I don't really see anything. And he was, this person is like a little bit artistic talented and he has a very good sense of humor. So sometimes you make a joke, everyone laughs and he is like stone faced and you know that it's it's a like social

social behaviour or interaction like he doesn't laugh but he actually laughs or he tells you something very very funny but he doesn't laugh so just you know it's this attitude he has always been that way and so I didn't really see anything and later four years later he realized he has Parkinson disease and we could see it and it was actually the hypomimic face

But he always have been a little bit hypomimic as his person as a part of his personality. So it didn't catch my attention because, okay, that that's him, that's him. But Pavel could recognize this difference and he really diagnosed him four years before the person started to realize that he has a movement problem and he started to develop tremor and hypokinesis. So he could see it really much earlier than us.

Beau (20:21.066)

And much earlier than the person himself. But I think a big takeaway for me, like not early when I was taking DNS course because I didn't understand this when I was really into it, was understanding things like that and realizing, well, that's showing it may not be, you know, a brain lesion or Parkinson's, but it's showing up in how people move. That's kind of de like you're seeing this all the time. Somebody doing a squat and that you their toes are extending and you're like, that's just a center-mass thing. Like maybe or a little bit, but it's kind of making you

aware of the things you can't cortically control. And then that's the things we're trying to change in all of our patients in rehab. But again, I I tried every once in while play the game. If I didn't know anything about DNS, like what would I be doing treatment wise? Because I would just be looking at how muscles pull on are muscles tight and do joints move? And again, yeah, but then why is that muscle tight? Why does that joint move? So I just think it's really interesting. Again, we go through at least our schooling,

You know, we don't get taught. We get taught neurology, we get taught neuroanatomy, but you never, like you said, I mean you're a neurologist, we just get a neurology class. Yeah. And then we're we we're supposed to go out and basically be treating the neurologic manifestations of everything, but nobody tells us that. Well, but I mean I mean several years ago Pavel did a talk. It was us talking to a dozen, but he basically was saying that like you can look at it from the view of Mackenzie, you can look at it from the view of Stecko.

And he's like, but really they're all just attacking the problem that is, you know, the brain. So for me, DNS isn't really like the baby exercises, it's a it's a comprehensive explanation of movement and function that looks at that through the lens of neurology. So it appreciates the impact that neurology has on all those processes. So for me it's it's great because you can use DNS as a therapy, you can use it as an assessment, but it's most powerful for me understanding the complete picture of why is that happening.

Why is that muscle tight? Why is that shoulder doing that? And if you know the why, then you can more effectively apply the appropriate tools, whether it's dry needling or joint mobilization or a DNS exercise. And that's kind of like where I think people miss the the full power of DNS by just thinking, I can put in a three month position and do that. No, no, no, no, no. That's one of the things that we use to treat it, but the understanding movement like Alana was talking about.

Beau (22:45.452)

you know, as an expression of neurology at all three levels is I think the most important thing to get out of DNS personally. Well, and another concept again that I think if we had to, you know, cause some DNS concepts are taught in like clubs and schools and American things of like, hey, what are we doing? But one of the things that I don't think is understood well, but is probably talked about the most is like interabdominal pressure and central stability. So you know

it was my first time in an instructor's meeting and that was still being talked about of like well, what exactly is going on? So if we just had to say, okay, when we are talking about this intra abdominal pressure phenomenon or whatever, what's the way that you just easily explain, like, hey, this is what's going on or this is what we think is happening with that? And Rich is covering his mouth because he doesn't I want your perspective on the performance. No, no, sure. I can talk about from the rehab side, but this is the this was the topic.

That made me buy in on DNS because this I wanted to know how you're supposed to stabilize for lifting. Right after she taught it to me, I was like, that's how you're supposed to do it. But anyways, go ahead. What was your answer? It's like functional joint centration. It's dynamic neuromuscular strategy. It's a complex interplay among all the muscles of the abdominal wall, but also trunk muscles and also diaphragm and pelvic floor, of course. And you know, to generate

Just sufficient pressure to stabilize and to be able to modify it depending on the actual demands. And so it goes talking about misconception also that lots of people still think that DNS is a deep stabilizing system of the spine. But actually, in for example, intraabdominal pressure.

It's not controlled by deep muscle. Actually, how is deep muscle defined? What is it? Also, multifittus or which other muscle is deep and which muscle is not deep? And intraabdominal pressure is controlled by all sections of the abdominal wall, plus diaphragm, plus pelvic floor muscles. But then you also have a great influence of, for example, trunk muscles. If you have too much activity of upper chest fixators, your diaphragm will reach a different position, very often oblique position.

Beau (25:05.324)

Then you cannot pressurize your intraabdominal cavity sufficiently, and you will not be able to generate optimal intraabdominal pressure. So, for me, when I explain in classes, of course, I use the typical DNS diagrams and pictures where we show how abdominal wall must work in concert with perspinal muscles, and how important is alignment between the chest and between the pelvis.

To allow diaphragm and pelvic floor working in concert, in harmony. And so I use these pictures to explain, but basically it's again dynamic neuromuscular strategy which is under neurophysiological control. Now I have a couple questions on this one. I don't know the true history of that. Who again, maybe they they obviously didn't come up with it by themselves, but who was the main culprit?

For that being at the center of DNS. Was that Pavel? Or who? Okay. Yeah. And who did he draw from for that concept? Was that just something he brought to the table or is it like, hey, somebody was kind of working on this and then he really finished it? The interabdominal pressure you mean? I believe he did his PhD study on a diaphragm activity and involvement without stabilization. Was that the the the spirometry?

They lift the legs. also, yes, yes. And what made him think primarily about diaphragm, frankly, I'm not quite sure. I think that there was an older doctor, rehabilitation doctor, I believe, who taught lots of breathing exercises with rehabilitation. And I think through listening to him, Pavel started to realize how important is breathing with

Rehabilitation, stabilization, and that probably triggered his interest in diaphragm as a chief respiratory muscle. So his first research was on diaphragmatic activity, independent of stabilization, in combination with stabilization, and then he started, you know, more detailed research, and then we brought Peter Bittnar, who is involved in visceral manipulation or rehabilitation of viscera.

Beau (27:26.97)

And we started to pay attention to sphincter function of the diaphragm, and so now we have more research, more details. But as far as I know, it was Pavel who brought diaphragm into the center of attention and then the DNS developed around that concept. Yeah. And of course, a big influence on Pavel always had Professor Boita. Right. I do think that

The IAP that is a is a misconception about DNS. So we talk about it a lot. We talk about the diaphragm, you know, being like creating the pressure in the belly. You know, mechanically, it creates an outward pushing force that is then resisted by the abdominal wall, the pelvic floor, all the other trunk muscles. And that resistance is what results in the pressure, right? But you want to think of it, I think people think that IAP implies like a maximum brace.

IAP should be present in all motions at varying levels depending on what you need. And when you go to a DNS class, or if someone sees something online, they see, like, I'm I'm I'm making pressure. It's like, yeah, you are, but you're making way more pressure than you need. So you want to think of intra-abdominal pressure as one force amongst hundreds of muscular contractile forces that result in the dynamic control of posture and movement. It's not

The main one. So, you know, the di outward pushing force will synchronize the trunk muscles together. It of course directly stabilizes the spine for the front, which we can't do. It creates a fulcrum for healthy flexion. But people overemphasize IAP in everyday movement because when they learn how to create it, they're creating way too much. And even in the strength training courses, we teach if you're bracing, which is a conscious stabilizing effort, you're automatically over bracing.

I don't think that the cortex can properly activate the stabilizing strategy to the to the perfect adequate level. I think that can only be done on a subcortical level where it's using all the afferent information. And so if you're stabilizing well and just normal movement, you shouldn't feel an outward pushing force in your belly. That's what the Robert says, his quote. Brace as much as necessary but as little as possible. That definitely that's one of the things that we see these student clubs. I mean, they again they

Beau (29:50.915)

you know, maybe you've taken an A or an exercise one and then they go back and it's like you said it's yeah, that the goal is the maximum intra abdominal pressure. That's and I think that's not right at all. Actually you would it would result in abdominal compartment syndrome. Yeah. If you would have a too much intra abdominal pressure, that's life threatening condition. That's definitely not the goal of DNS. I'm adding that to the strength training courses for sure.

I think what isn't explained to them is that this is my take. We know that setting up that ideal kind of scenario for the dynamic stabilization centrally allows things in the extremities in the periphery to, you know, express themselves a little more as they should. I think they think that if you get this, all this stuff just naturally gets better. It's like, well, that's not it's to the task or the postural position or to the demand. And if you go above that, it actually

goes against everything. The other thing that people mistake is so IAP is good, but IAP and mobility are inversely related. The more pressure you have, the stiffer the trunk is. And if you want to have fluid, effortless motion, you can't have a maximum brace because it literally you you make the torso mechanically rigid and it can't actually move. So if everything to me in DNS goes back to functional centration, what are the three aspects of functional centration?

Balanced coactivation resulting in maximum congruency of the joint, irrespective of whatever position they're in, and minimal effort necessary for the task. So the minimal effort necessary for the task is a theme that should be in every DNS position anytime that you're rehabbing someone. The goal is maximum efficiency, and efficiency is the ratio between input and output, effort and output. And a lot of people they try to get, you know, I'm centrated.

It's like, no, no, no, no, no, no. If you're centrated, it looks effortless. And IAP is the same way. We owe we, not meaning us, but people in the in the early in their journey, for me it was like a decade I did that. You over brace for everything. But the the maximum you know pressure is only necessary if you're picking up a you know a 500-pound barbell off the ground or a ballistic event where you're you know you're trying to generate maximum force.

Beau (32:15.916)

And it's usually a very temporary period where you have maximal stiffness in every other thing, especially if you're rehabbing a normal patient, not in a scenario where maximum stiffness is necessary. I think a lot of times the misconception is that we want maximum pressure. It's like no no no no. We want minimal effort necessary for the task. Well, I think something also, and I'd like to hear your point on this, Alana, because Yana, when she was going through a workshop this weekend, kind of just

pose the question, she goes, What could we do right now? She had somebody in just three months supine to improve, you know, what is going on, you know, through the canister. And never kinda sat there, she goes, just make sure that the base of support is like being picked up. I think that's what's missed with a lot of these students is they the position is kind of just like, it's okay. Right. And they don't and if your base of support is not pretty good, I'm not gonna maybe perfect isn't a great ex explanation, but that's what I want you to Better is better.

Better is better and then they go for this like artificial, you know, stabilizing strategy. And I really loved Janna saying, like, make sure the base support is adequate or really good, and then everything should get better for that. It's a really important point. And also bigger intra abdominal pressure does not equal better muscle coordination. You can increase intra abdominal pressure, but with bad coordination, and actually it may make you worse or weaker.

Well, no, I inability to turn off your low back. Well, but an another and I don't know if this is with DNS in general, but you know, in the strength training courses we talk a ton about IAP, obviously. I think people think that you can if you have IAP, you're stabilizing correctly, and that's not true. Right. No. IAP is one of several stabilizing forces. The major ones are gonna be the erectors, the abdominal wall, and IAP. It's actually every muscle in the torso, but to keep it simple.

And so you can crank your back on and produce a massive amount of pressure. Have abdominal compartment syndrome. Yeah, get it. You can die from abdominal compartment syndrome. But so you have, you know, an extension compression stabilizing strategy with a ton of pressure. Right. Right. So we call that a hybrid one strategy. You're still compressing the spine, you're still maximally loading the facets, you're still creating a bending force through the neural arch, but you have pressure there to make the spine even stiffer.

Beau (34:39.852)

And so people think, if you have IEP, you're stabilizing correctly. It's like, no, stabilizing correctly is balance coactivation. Now I would go a little bit deeper in the rabbit hole and say that balance coactivation is built upon the outward pushing force created by the diaphragm. That doesn't mean a lot of it's a strong force, but the diaphragm, why respiration is so important, when the diaphragm contracts, it pushes the abdominal contents out against the abdominal wall, down against the pelvic floor.

And that creates this eccentric activation. But then it's dynamic too. So when you're moving around, then the abdominal wall is but basically think of it as the abdominal contents or a conduit transferring the force between all of the structures of the torso to create that muscle balance. And so yes, IAP should be present, but it really shouldn't be percep perceivable in most. Yeah, it's adequate. Adequate. Well.

Better really listening right now, it's like Jesus, they really like to talk about this stuff. So any other any other kind of misconceptions or like maybe even like kind of pet peeves, you're like, I see this kind of talked about and that's not quite right. Is there anything that stands out or are those? Also, maybe misconception is that DNS equals exercise in supine three months position and breathing into abdominal wall. Yeah, that's it. That's it. Yeah. But it's

about the whole variability of all the movements, DNS, it's that's why Pavel says it's not a method, it's philosophy, it's a ways of thinking. And from this perspective, everything is DNS. Yeah. Because you will find all concepts, they only have a different standpoint, different explanation. Still all rehabilitation training concepts worked with the same anatomy, same neurology, same principles.

So it's just the explanation, but basically, you know, it's all the same. It's about body, brain, muscle. I mean, for for me, the central concept of DNS is functional centration. And you know, if you're we're we're basically in DNS, we're trying to improve the the the patient's capability of moving well. So that's mobilizations, that's you know, some soft tissue work, that's the DNS exercises, but the ultimate goal.

Beau (37:00.822)

Is that they're able to maintain centration in their movements subcortically. They don't have to think about it, they just naturally happens. And so you can express DNS in a ballistic snatch in the weight room by having coactivation the whole time, even though it's maximum force, you know, and it and they have to work super, super hard if you have the balance coactivation and minimal effort necessary for the task, even though that

Minimal effort there is almost maximal for that athlete. That's still DNS. On the other side, and people don't think about this, merely doing three months or using a developmental position, but in a decentrated position, that's not DNS. It looks like DNS, but that's not DNS. So they have them in a three-month position and the ribs are up and they're overpressurizing. It looks like DNS riding by on a fast horse to use a Brett Winchesterism, but it's not DNS. So to me, DNS is about.

Getting the patients able to express and maintain that functional centration in all of their movements. What has anything changed majorly from the inception? I mean, I know it was a thing kind of before it was named DNS, but like since kind of the inception of that as a the framework, right? The concept, has anything major changed? Not really. And I think it's actually good. What that what Pavel keeps telling us that.

He has never totally changed his standpoint or his philosophy. Sometimes you have clinicians and they do one thing, and ten years later, I did that, but that wasn't really good. Now I do this. And then two years later, that was nonsense. I'm doing something else. I changed my mind and I changed my skill. But DNS keeps developing, but we never say what we taught ten years ago that was wrong.

Because we base everything on a neurology and there is no voodoo, no artificial explanation. And that's what I like, what Pavel always tells me when you are at a conference and people ask questions. Never ever use argument Pavel Collar set. This is no argument. You have to argue with neuro physiology, anatomy, you know.

Beau (39:26.618)

Medical explanations. If you don't know, say I don't know, but never use me as an argument, okay? I don't have a patent for knowledge. And so because you always based what he has been teaching on a neurology and anatomy and on a real medicine, even now, twenty years later, you would never say, Well, what I was saying fifteen years back, that was wrong.

So we are going into more details, we get maybe more research, we now have more pictures and photos and diagrams, and we have videos to demonstrate. So maybe we have more details also about proprioception and how afferent information can trigger neuromuscular strategy, et cetera. But the philosophy has never changed. And I think that's that's the reason why I believe.

The DNS will be everlasting. Maybe I don't know, three generation. Yes. Five generations later, maybe someone will say we don't like the term DNS. Now we call it differently. But yes, the the concept states it's everlasting as neurology is everlasting. Yeah, like the femur is still a long bone. Yeah, it's gonna be a long bone. Like the rectus femuris is gonna create inflection forever. And this tendon reflex will always be L two, L four reflex.

Like one multi neuron reflex. That's not gonna change. I love that 'cause when I'm teaching students, I always tell them your job as a a clinician is not to have people tell you what to do and that this is right or wrong. It's to kinda be a scientist because you get taught science and to be does that follow physiology, anatomy, neuroanatomy, or you're like, Hey that somebody is selling a method and it's like that doesn't make any sense and like you said, if that's what it's based on, it's just gonna stick because it's just a very

principally based concept. So out of that, when what are some of the things that do get questioned in DNS? Well there there there are to step in to answer your first question, there are two misconceptions that I think that that Collage has clarified that might be looked at as the people think, no, they weren't teaching that before. Well she just clarified the difference. One is you know we used to emphasize the importance of the diaphragm and the pelvic floor being parallel.

Beau (41:53.239)

Which is true. In normal posture, you should see this. You don't want to see them stuck in, you know, that open scissor posture where the diaphragm and pelvic floor are oblique in the sagittal plane. But now the the clarification is, well, if you're going through movement, of course there are times when the diaphragm has to, you know, break that parallel relationship. And so you can still have, you know, centrated movement, good movement in positions where you don't have that relationship, right? That was one.

Another one is functional centration. So a lot of times with functional centration, and this actually ties into the first question of the day, or you know, about misconception about DNS. we're t we typically start in a mid range position when we're talking about centration. Well, then the the the misconception is like, DNS is only training in a mid range position, like a three month position, or only this is is centration. No, this can be centrated.

This can be centrated because it's the balance correct. Any movement. As long as you're within an active range of motion, you can coactivate. If you can coactivate, you can centrate. But we start there for a reason, and that is because in the middle range of the position, that is the greatest opportunity, the easiest position in which to achieve functional centration. So we start there, and then as you go through all the developmental exercises.

Then you're bringing them out of that position into more end range positions. And then you're adding speed, load, and duration to really challenge that nervous system to make sure that it's resilient and is able to express those proper centrated movements in whatever environment their sport demands. That's that's the full continuum of DNS, but everybody looks at it from the side and they see one course and they're like, they only train in a neutral position. It's like, that is not true. We start there.

So that they can learn it in that position and then we challenge it with range of motion, movement complexity, respiratory demand, flow, speed, and duration. That's how you s you strengthen functional centration neurologically in the brain, basically. Well something I I kinda like being a little bit of a contrarian, so I really love this when Pavel the first day of D said

Beau (44:10.85)

You know, basically was saying DNS isn't a method, but he goes, people still think like trigger point, treat the trigger point. And then he he was kind of alluding to like you need to question why it's there in the first place, what's causing it. But I like that because again, another thing that I see in student bases or new DNS docs is, we're that we're using DNS to get rid of trigger points. We're using DNS to get rid of joint restriction, and you're still missing the whole concept that why was it there in the first place instead of saying, hey, this position, this strategy can change it.

Like he even said in his slide, should you even change it? That might be a you know, a positive compensatory mechanism. But again, that goes back to and again, I'm trying to, you know, push DNS here little bit. There's no other conceptual framework, like you said, that explains human movement from development, you know, even through life, right? Of how we may degrade away from the the original model. But I just wish as people got into this, they didn't take it for, I'm supposed to be able to get into this position.

Because that's how we developed. It's like, yeah, that's part of what's being said. But like the whole thing is like, why are all these things happening? From an injury to a compensation to why a muscle's tight to why I have pain sometimes. And that's I really appreciated him bringing up all the things are saying the same thing, right? Or looking at this organism. You can use all of the things with DNS. I think it amplifies everything because it explains why you you know, the dry needle might work here and sometimes why I could do something else.

But when we get into, okay, we're gonna take DNS and then we're gonna try to say, you know, like Pavel said, look at the top level athletes. They're gonna give you a really good model to look at. One of the things that gets beat up quite a bit is, well, we have to be able to train, you know, positions that aren't on this chart, right? We do go in range, but you're like, that's where I feel like the most pushback occurs. Well, we're never gonna be able to keep somebody in this position, which you just said, but it's still, they'll still throw back.

But you want me to go do baby exercises for my rehab, but the person has to go throw a baseball 130 miles an hour. So how do we get them to realize? To clarify that a little bit, there's a a movement, pun intended, I guess, or pun unintended, in rehab and strength training where if you're gonna get into this bad position, like a really bad valgus position, we should train in that position to increase tissue resiliency so that you can handle it.

Beau (46:35.608)

So I've got a I've got a longer answer to that. Yeah, this is yeah. Whereas we start in the middle, they're saying you need to go there. And if you're never exposing the body to that, then that's that's in an inferior system because you're never putting them in that position. I'll step away now. But well, I know that there is this philosophy kind of that you will you will train in decentrated position to train resilience and the soft tissues will adjust to it in a certain way, maybe yes, but

When you combine biomechanics with neurophysiology, you know, there will always be overloading over certain tissues. And long-lasting a repetitive overloading will finally result in some kind of a problem. And this is what Stu McGill said: that repetition doesn't make perfect, it makes permanent. And we don't want to have permanently poor pattern.

I understand, and Pavel also he emphasized even in the D course now or instructors course that to change the strategy, it's a matter of several months. And of course, the the top athlete doesn't come to see you and to hear that, okay, now you have to stop your career for half a year and we will be doing exercises in developmental positions. Yeah. So you will probably never see this athlete again. So but on the other hand, Pavel says.

If you cannot perform a simple movement under no pressure, no weights, you know, slowly, and you can't do it correctly. How can you do it correctly when you compete, when you need maximum strength, maximum speed, when you need to be extremely skillful? So he says, Of course, I cannot tell the athlete now you stop your your routine and you will only do DNS. No.

He only tries to show him what to train slowly with a full attention to really on a not subconscious level but fully conscious level to really because this is very important to differentiate from appropriate movement and poor movement. And very often that gets beat up in America because people will say, Well, who determined proper movement? And

Beau (49:01.676)

We're back at the conceptual framework of neurologic, biomechanic revolutions. Well, but like I can kind of answer we we we tackle this head on in the strength training classes because there's there's basically, you know, two assumptions that we have in DNS that are difficult to research and difficult to prove. One is that we have some sort of inborn motor programs. Okay. The other one, you know, is that this is gonna be an expression of good movement. So when you think about like you ask somebody like, well,

What is good movement? What is optimal movement? We've got three major ways we figure that. One is just normative data. Okay, we look at 10,000 people and we look at their scapular humoral rhythm and you just say, okay, right in the middle, it's it's two to great, cool. That's that's what it is. You can also look at elite athletes, you can look at orthopedic safety, but all of those have pros and cons, right? So you wouldn't look at an elite athlete and say, okay, everyone has to do that because their bodies are just

freakishly talented in some way. You also like BMI. I've been, I think it's severely obese my whole life in the BMI chart. Yeah, I'm sorry, I'm still working with it. So, but the the same problem with normative data happens with shoulder movement, it happens with rotation. How should you stabilize? So when you think about this, it actually has a very strong case for it. And I think where people think, that's a dumb idea, is they're just looking at just the babies.

You have to realize that underneath the skin, their their graphesthesia is changing, their awareness, their visual perception is changing, their vestibular chest. And we can see this in all of the testing that we do in early development from the postural reflexes and the primitive reactions. Said that backwards, but those go away in the same order from any human anywhere on the planet. So it's not just, okay.

At six months, you should be able to roll from supine to prone. You know, it's your gallant reflex is gonna go away at a specific time. And when your graphesthesia presents, well, then that's when your your grasping actually sort of changes. And everyone does this. So to me, now you're looking at like there's so many consistently correlated processes that happen with every child, black, white, you know, man, woman, doesn't matter.

Beau (51:24.322)

They're all going through this in roughly the same order. To me, we you don't we may not have, you know, 27 double blinded crossover studies that prove that, but it's hard to argue against that. Well, then explain to me why that's happening. Cause most people say, like, there's no such thing as a motor program, and they're all just figuring it out. Really, they're all figuring it out and they all learn to do it at the same process in the same order, like really everybody. Millions of people are doing this. I just don't buy that. So I don't, for me.

I don't need a double-binded crossover study to say, yep, there it is. In this gyree right here, we found the inborn motor programs. There's just too much anecdotal evidence pointing at the same thing. So to me, it's a strong case for this is actually a pretty good way to to identify not identify to to classify optimal movement. The last one is that this is an expression of how we have evolved to move over millennia.

So if your scapula moves a specific way after millions of years of of adaptation and evolution, and now that's what we're doing, that is a very, very, very strong argument for that is the correct way to do it. Because it's been millennia that we've been doing this, and those are also observable and measurable and and traceable. So I Okay, now you have a definition of optimal movement, but then your client must

Recognize the difference, must feel the difference. How often it happens, you give them some self-treatment, then the patient comes back, says, I do the self-treatment, and I'm inverse. Yeah. Because they don't promote appropriate pattern, they promote actually pathology with their exercise. Sometimes they need a medule manual guidance first. So when Pavel Pavel just was teaching a 40 minute lecture at a golf course with Brett Winchester.

And he explained his experience with Nelly Corda, top yeah, yeah, really top athlete. And she also had some issues, I don't know if it was low back pain or whatever it was. And of course, because she's a professional athlete, top level athletes, her stereotypes are very fixed, are kind of permanent. And when Pavel started again looking on a key link, what's the why? Why does she have a pain?

Beau (53:46.252)

What's the problem? So he started to work with her to change her stereotype of rotation because rotation in transverse plane is a typical movement pattern in playing golf. And slowly he guided her through the motion and by palpation and also I don't know, taking pictures and video and explaining what must be changed. So he guided her through this process of training.

But at the same time, of course, she did her routines and she competed, but she slowly started to understand what must be changed and she started to implement it into her routines. And although maybe at start her performance wasn't that good, finally she was not only pain free, but even her sport performance improved. So he said it took several months.

But finally she was quite thanksful that she could change. She could do a little changes in her rotation because it made a really good or it was a good result for her, you know, to get rid of the pain, but also for her performance. Well then something to reiterate as the you know, Brett asked the question in instructor meeting of like, what's the expected timeline to make these changes? I think that's a common thing.

is a misconception. Four months, five months, six months. And then I like the follow another question that Pavel answered kind of it was almost funny to me and I don't think it will sound as funny as somebody asks in D course, well, when do we start this with an athlete? And he goes, ideal world you start as a kid. And then and then he goes, Well then it you know, everybody else it's as soon as possible, but then it's how much do we expect them to change while they're still doing their activity. It takes months because it's always kind of a two steps forward, one step back game.

Pavel's advantage is that usually when athletes come to see him, they come with a personal trainer with a couch. So Pavel teaches the personal trainer or you know, members of their team how to work with them, how to guide them. And these people are very well trained in motion, in sports, in strategies. So they pick up very quickly from Pavel what should be changed and how to evoke a better strategy, better pattern.

Beau (56:01.24)

So I think this is obviously convenience when you are kind of great clinician, everyone knows you and everyone will follow your instruction and you work with highly motivated people who understand motion. Well, the you have a great quote from your three levels of motor control that I put on all my courses, and it's perception is a prerequisite for control. Yes. And I think that people they skip over that. So they're doing DNS.

And they've got the person or the patient in a pretty good position, but they're not asking, can you feel this? You know, can you do this? And there's a lot of afferent stimulation that you can do to increase their awareness of the area. And then once they're aware, now they'll know, this is good, this is not good, or when my pec turns on, that's the wrong, and this is what I need to do to get into a better position. And then they have to go home and just sort of repetitively, you know, put that through it. I tell I tell people that you

You learn new new movements through repetition and respiration. So as you're like incorporating the breathing into it and then repeatedly doing that, that's how you gain the motor control. But if they can't perceive what's good or bad, then they're just gonna do the movements and it they might come back and say, my shoulder hurts worse. Okay, well. Going back to the team approach or kind of the team approach to Paula, right? Getting to work with the coaches, and I think that's really important to highlight because that highlights the

The different tracks within DNS. Yeah, you have a clinical track, you have an exercise track. Yeah, a lot of clinicians take exercise. But I know like Brett's office, our office, we have a gym right next door where you know our coach is versed in that and the same principles. Maybe you wouldn't you wouldn't go into our gym and think, they're this they're doing DNS, but they are, right? Because the principles are underlying that, hey, we don't let people, you know, this is where we plug the strength training course, I think. Is that is that the doing That's what I'm saying.

It's gonna take time. So if you're not gonna get somebody to come to your office for five months twice a week, which none of us are, unless I don't maybe you are, you're gonna have to have people to work with you. And that, you know, highlights there's all of these different aspects from pediatrics to exercise to strength training to specialty courses. And that's from my understanding, to take a neurologic concept that explains human movement, you're gonna have to basically like cover a lot of ground and

Beau (58:19.085)

Terms of coursework, right? To say, well, how does it get applied specifically? Yeah. The whole team must be on the same page. Otherwise. Otherwise, if you teach them something, but they coach us something different, maybe even contradictory, then you know effortless. Then it's Backwards. Yeah, no backwards. I mean, a huge misconception people have about that process is they think that it's like a s it's a it's a stair-step process. You have to finish one to go to the next one. And it's really an intertwined process. So

The reason it's valuable to have a coach there is because the athlete's gonna push it and and do something that sort of breaks that pattern, and then they're going to practice the pattern again, and then they'll be doing some what I call skill application work to get better at expressing that pattern in their sport. And that just keeps winding round and round and round for months until they can do it, you know, on a T-Box in a major, and they can still swing and express the pattern that Pavel showed them six months earlier. But

What we're not saying is that okay, we're gonna stay here, we're gonna do baby exercises working on this rotation with no load or minimal load until it's perfect, and then we're gonna go and try to do it here, and that's gonna take you five months. It's like no no no. There's a rehab part of it, like a in a the beginning where you have to like learn what's good and what's not, and then it's this constantly integrating it all the way up the chain. Yeah. I think

The concept or the idea I'd like to leave off with here is cause we talked about the team approach, but it's then who all from which is kind of eye opening to me is like who all is involved with like the DNS concept from where it's taught, right? To who is, you know, taking this education. So I mean, in you know, that room there's you know, with just the D course, massage therapists, chiropractors, PTs, coaches, DOs, MDs, naturopath, like.

across the birth, but in Czech Republic from my understanding. Like it's just part of the curriculum because it is such a strong conceptual framework. Is that here just at Motel or is that no no and for physio we don't have chiropractors, we don't have osteopaths, we only have physicians and PTs physiotherapists so for physiotherapy school I believe that at every physiotherapy school

Beau (01:00:38.645)

It's a part of a pre-gradual curriculum. And at our medical faculty, we also teach basics students of medicine. So they obviously they don't learn exactly all the tricks, but they have basic knowledge. So Pavel Collage at our faculty, we have bachelor's degree, master's degree for physiotherapy. We have medical students, and Pavel teaches all of them, and of course, all of us, the whole team.

And then we have a PhD program, so we do research. And so here we have I think quite a good influence on pre-gradual education. Which I just when I f learned that, I was like, man, how much easier would our job be in the States if like everybody kinda understood, maybe not to the degree that you know the physio that's working with them. Yeah. That's what's frustrating about it, is it's not this magic trick. He's just basically it also gets confusing because we'll talk about

you know, neurology or functional neurology. Well that term's already been taken. Right. You're just describing how neurology influences movement and posture and function. That's all you're doing. And so that's a different kind of it. And then I you and I talked about this years ago, but then you could have a pathological pattern which is different than structural pathology in the nervous system. So when we say, that's a pathological strategy, we're not saying that like you have

You know, an upper motor neuron lesion. No, no, no. There's just something in there, so it's pathological. It's a software program. Yes, but then hardware. I know, but then you're having to like differentiate between those two things. Because it's that's pathological neurology. It's like, yeah, we don't mean it like cerebral palsy. We mean it like, well, there's like you said, like a software problem. So we just have to sort of change the program a little bit. And so I think that it's it's sort of sad there needs to be like a new word for just

that description of neurophysiology. Like that plays into the muscoskeletal system. So you think, okay, just because you have a pathologic pattern doesn't mean you have a brain lesion. You can have pain with no structural damage. Everybody would agree with that, especially in the pain science world now. Yet if we have to go back to the explanation of it, they'll end up back in the neurology realm. Then you have to explain it back out. So again, it runs in a circle of best explanation in in my terms of how we develop movement throughout our lifetime and then you know the whole framework of neurology.

Beau (01:03:02.7)

This is just coming back around to where we started, which is DNS basically is just an explanation of movement and function. So it like for me, I'm a McKenzie certified doc and I, you know, I do a lot of soft tissue work, but like where I do McKenzie, why I think McKenzie works, why I think mobilizations work, why I think trigger point is there versus not there, all of that is just explained by DNS. So that's

That's the most important thing for with DNS. Not the baby exercises. It's having a framework. And now the way that she's been talking about is kind of like eye opening for me. It's like, yeah, we're not talking about anything other than this is just how we've evolved to move. This is just the neurology of movement. So call it whatever you want, but like that's just how we're you don't need to call it DNS. You just read general neurology, I think, and put it together with anatomy book and musculoskeletal literature, and you will understand.

You don't have to call it DNS. But you've tried to package it in classes and seminars that people can't understand so they can't apply it. That's the tough thing is if you had to do that on your own, everybody I mean, that's why we have all these methods. Everybody's doing the same thing and trying to deliver it in. Yeah. am I interfacing with the soft tissue? I'm interfacing with the joint. You're always interfacing with the nervous system. And that's what I think you guys have done the best of creating this education system that allows people to interface with the This is one toolbox. This is one tool which explains.

Why and how to use the other tools in the books. Well, but he when Pavel said it's a philosophy, not a method, I actually disagree with that. It's a philosophy and a method. The philosophy is just like we're just describing movement. The method is and you can use baby positions to assess movement, you can use them to restore optimal movement. But it's also like you could do DNS and never use a developmental position. Right. Yes.

Yes. You're just okay. I'm A position is developmental position, right? Our genes gave us the shape of our structures and they determine the range of motion. And the muscles are the the architecture and the muscles are penate to cover from A to Z, from one end range to another end range. Whenever you stop the motion, it's developmental position. We had to develop the position to be able to use the position.

Beau (01:05:24.03)

handstand videos that were being shown of yeah, but you still have Think about it is like structure sets the boundary for function. Yes. And within that boundary, DNS is training them to be able to maintain balance coactivation in all positions through all movements with all types of resistance and stresses on the nervous system, speed, load, duration, movement complexity, range of motion, and respiratory demand. Those are the major ways you can stress the system.

And if you train them or or or rehab them right, they're able to do that in whatever environment their support demands. Well and the underpinning there though is your neurology determines your structure too. So like that's again, you're you're back in that circular fashion. Yeah, neurology is responsible for function. Function forms the structure, dysfunction deforms the structure, and structure serves the function. Boom. Easy. Good finish all in a well done. Yeah.

Thank you so much for doing this, Alana. Really appreciate it, thank you to you too. Thank you very much. And now you cut me out of this. Yeah, we'll clap her right here, right, yeah, yeah, yeah. And keep his monologue. Yeah, yeah. And that's it. Yeah.