DNS (Dynamic Neuromsucular Stabilization) Q&A with The FARM Team: Week in Review 38

Summary

In this conversation, Dr. Beau and the FARM team discuss the principles of DNS (Dynamic Neuromuscular Stabilization) and its application in patient care, particularly focusing on movement, breathing mechanics, and motor control. Through various case studies, he highlights the importance of understanding fixed points in the body, the role of intra-abdominal pressure, and the significance of assessing rib cage functionality. The discussion also touches on practical applications in pediatric care and the continuous learning process involved in mastering DNS techniques.

Transcript

Dr. Beau (00:01.932)

Who knows? I can't see.

Hello in there That's what I thought at first and then like I the description

Dude, says DNS Nana. Yeah, that class looks cool, except it's just rich and Brett. Who's the third? starts with an mode. She should, but, but it's in Napa. So they're just going to drink wine. Cool. I'd like to drink one. When I saw where it was, sent to Katie into possible trip question mark. Yeah. well talking about DNS, that's going to be the

gonna say flavor of the day. I think I've been watching too much Guy Fury. I guess.

Dr. Beau (01:18.158)

All in a Copa Soba. That's not obviously all in a, that's to say that's an A and that's okay. So she'll be cool with him. Get in there. That's basically who I don't want to say. Well, whatever is basically running the rehab like Prague school at this point is just off being famous. but we are talking about DNS, any hot topics. We were just talking about how great of a

care, my kids got it, the nurse practitioner, which was leave that for behind the scenes. we had a patient that went to their primary care and had magical palpation skills. they had, they had abdominal pain and bilateral anterior hip pain and their primary care touched their like spinous process of their low back and goes, yep, you're having muscle spasms. Even though she could do like no back pain, full like toe touch extension and like

Yeah, never, I don't know, never once felt her back. But I mean, that's maybe they, where are they DO? Nah, I don't They have a piece of hair under 200 telephone book pages. The mammillary skills have gone, but. Mammalitis. Yeah, mammalitis. Any updates on any other previous patient stuff? I mean, I guess one that I haven't shared about. Scooch up a little bit there.

The one that I haven't shared about, and I actually just got off the phone with him where he, like every now and then something will come up with like with his neck and his upper back. Me and Bo both had treated him in the past. And I just looked at him last visit and I was just like, hey, I just want you to get an MRI. I'm not scared about anything. And, but just to further explain everything that's going on. And then he did. And then you could see the right neurominal frame, like narrowing.

And I was like, so this was like, when you get in a difficult jujitsu position, and you're just doing that for fun. And then you have all this stuff going on your right side. And then it's like, he's listened to Runtala, listen to like a Tia, listen to all the DNS stuff. And then it's just got me, you get to re-preach it all. Yeah, which is usually our job because we don't know anything. just, we just happened to be in Birmingham. So just, yeah. Echo chambers of other people. Any other updates? What was the last?

Dr. Beau (03:37.73)

Last one, I mean you. Scooch up on these mics, bros. I'm at the edge. You could straddle the edge. Or you could come around a little bit or you could bring this to you. Or you could just hold it like you're singing. So we had what I think for what cases we did. Last one we did was the LCL. That's right. I have not seen mine since then. mine comes in. She's running like the one month. OK.

Actually, she did. She raced a trail half marathon. She did great on, I also treat her husband and her husband did really well in the race. And he said, it's a pretty tame trail, but I rolled my ankle a couple of times. And when I did, I went, no, my wife's in trouble. I think she fell twice. But I think he's rolled his ankle like once on, yeah, for the past two years. He's been has well, and it was one of those and he goes, I just rolled it and I kept going. was fine. It wasn't like the time we saw him last year.

Hotter than hell. We're talking about the acute ankle sprain protocol thing. We just need to send more people like, hey, there's this whole video of bulletproof ankles. It's actually a way that you can probably not do that anymore. again, what do we know? That's why we're doing a podcast. We talk about what we don't know. That's actually the theme of today. So Sloan and I were talking last night. She saw two new gymnasts yesterday. So this one, again, not being my case, I'm kind of giving you the

30,000 foot view, but this gymnast had been working with a PT for the previous three months because she was having low back pain, which surprised, surprised with the gymnast. The PT referred her to Sloan. She's just like, she's not responding. She'd also taken, I don't know if she is still currently taking time off, but it had taken quite a bit of time off. Nothing was changing. So Sloan's working with her and you know, as most things usually kind of go back to like just fundamental, she's like, okay, let's, you know, end up in.

three months supine, see what she can do. She was kind of telling me she's you know, scalloped in her upper back or like super erect in her thoracic spine. And she's like, when I tried to get her to kind of depress her low back into the table, she couldn't, she literally couldn't get like T12 down to the table. And you know, then someone's like, well, I need her to get her rib cage down and she just couldn't do it. And you know, the byproduct of that is she was going into like cervical extension, which is common.

Dr. Beau (06:03.788)

when somebody's kyphos in their mid back, but then it's kind of, why are they doing that overall? And then she, so on, it's kind of going further. She's like, well, I need her to get, you know, that area of her back down. Cause that's like the fixed point. I was like, well, no, it's not. So this was like, we had a probably 30 minute conversation from that point. She goes, what do mean? That's not like the fixed point. So for those listening that aren't familiar with DNS, one of the common themes of DNS is you have a fixed point or a punctum fix them is

how as we go through movement development as a baby, you have to have something as a base of support to then move from. So if a baby is, you know, set down because a human can't do much on its own, it's set on its back, the fixed points are what? So you guys know what the actual fixed points for just, we're saying a supine, let's say six week old. So the external occipital protuberance. Should be shoulder blades. Yep.

And then, is it sacrum at that point? So I always liked the analogy. Brett Winchester said it during, think the last DNSC that I took that if, the patient was lying on a glass table and we can look underneath Adam, that's what you'd see kind of pressed in or like flush against the table. So then someone's like, well, why do we, which is, you know, these are all good questions and you know, I was an attack in her and she was asking good questions, even though, you know, we're both pretty far in our career. She's like, well, why do we want people to flatten their low back into the table? And I go,

Well, then you're asking what's the goal of the exercise that you're doing, not the position that you're in. So again, if we take a three month old baby, have they developed a lower dosis in their lumbar spine yet? Not really, right? You still have anatomical differences in the shapes of those vertebrae for the most part, but you haven't uprighted yet with gravity to kind of force you into that lower dotted curve. So when a three month old is on their back, their spine is relatively flush across the board. If we take any of us and we're at,

rest in three months supine, right? At rest, that's resting, which it should be. Your low back may be in contact, but that doesn't mean it's pressurized into that glass table, so that's flush. So would we have pressure on the top of our hand if you're picturing if somebody's laying on their back and I'm trying to slide my hand under like mid low back? Yeah, I shouldn't be able to get it under there. There shouldn't be an excessive, you know, lower doses or extension. But when we tell people to flatten their back into the table,

Dr. Beau (08:29.932)

That's not the fixed point. Sloan goes, wait a minute, T12 is not the fixed point? goes, what's your diaphragm? go, your diaphragm is the internal fixed point, but then it needs fixed points like an X, which is off of really your sacrum, right? In your scapula. And then to have movement of your head, which starts with your eyes as a, you know, six week old, which is when we first get that first optical, you know, fixation, you have to have a fixed point of that EOP to then be able to roll your head around.

Right. Which then you have another triangle from your OOP to your scapula, kind of a triangle down to your diaphragm from your scapula diaphragm to kind of the edge of your sacrum, right? Your PSIS. But that was kind of mind blowing for her. So she kept going through, she goes, well, then why do we want them to do that? go, if somebody's in start position, which for those listening, just like child's ish, a lot of the times you can use that to do what? Induce.

Flection, somebody's low back, you can use it to shut off the erectors or get them to relax. So in that position, when we say where you're supposed to flex, because again, if you laid a six week old baby or put them, know, knees under them, basically the pose that you'll use for like newborn portraits, right? Tuck their legs up under them, have them kind of laying on their own hands. That's kind of start position. That's why it's called that. They're in flexion.

So then you kind of have to start asking, what's the goal of the position? Do I want their erector to shut off? Do I want them to be able to flex their low back? Do I want their back to just be innate and I'm air quoting a neutral position? And she goes, well, I wanted her to be able to get T12 down because I knew I needed a rib cage to be able to depress. And she goes, so I just had her do a big inhale and an absolutely full exhale to get her low back flat. And I go, but in that case,

If you're not palpating the difference, which I think would be hard to do the difference between what your rib cage is doing your back. You're now watching like parasitic movement, right? Or respiratory coupling. So what that what I'm saying there is if I just say, Hey, take a big exhale. You can just be flexing your low back. So you're still running into well, I need my rib cage to move independently. Right? Of my spine. I don't want to flex my spine to use breathing. And that might be why she's in that scenario in first place. Now you're asking all these chicken or eggs.

Dr. Beau (10:50.346)

And I'm going, I'll go back to hierarchy here. But it was a very good conversation to have because she's like, well, I just feel like I don't understand DNS well enough to move out of the sagittal plane then. And I go, we don't necessarily need to. And I kind of brought up stuff that you and I have talked about, Alex. go, Sloan told me that she's like mildly kyphotic or lumbar spine, not TL junction, like lower lumbar spine, right?

And I have this kind of hypothesis that a lot of this has to do with kids being sat up too early. They don't have that lower dotted curve formed and you kind of like literally like fold in your lumbar spine and now you have to get hyperacted in your T spine. It can happen for all sorts of reasons. It's just a theory. It could be rotational sports, which this girl didn't do. So I was like, we'll just be a little more fundamental with it. Be almost like FMS or Grey Cook. So if her upper back is scalloped, you know, then we have to ask the question, well, on palpation,

Can it flex, right? If her lower lumbar spine is flex, can it extend? So the first question is what? Can it move from a just mobility standpoint? Second is, can they move it then, right? Which is a stability or motor control thing. And then it's load management beyond that. Like that's, and again, too, like, it can't be that easy. That's what you're doing all the time. And we make it complex with all this. It's three months, it's six months and, know, a fair input.

And again, you can use all that stuff to speed up any one of those processes of health and mobility or stability or whatever. And then I go, okay, so then let's, have that hierarchy. So then if we said, okay, cause she's like, well, I have a hard time. Cause I was like, if somebody couldn't get that T12 down and they have this scalloped T spine, like three months soupines probably not a good position for them. Right. Cause I would assume, and I don't know, they probably lack, you know, motor control or stability around the periscapular region.

Right? That's why they're like that. And that's why they can't get T12 down. So it's like you're like having the body when you're assessing in three months supine. All right. So if they couldn't do something in the lumbar spine, don't think it's a lumbar spine issue. Think like you don't have a fixed point above your lumbar spine to probably work from because your legs and feet aren't on the table. Cause she was trying to. Yeah. Vice versa. So now she's trying to drive her head into the table. they're either, you're like, maybe that's a problem. And then vice versa. What if Sloan

Dr. Beau (13:13.742)

took her legs, right, while we support, put T12 down, and all of a sudden you see that like her neck, like you should be working on upper quarter stuff. Which we would all be like, that's literally regional interdependence cooked into DNS right there. So then I go, okay, let's create a hierarchy where you're like, because I said in that scenario, maybe you put her in, know, start position or a modified start position to work on scapular stability or, you know, upper quarter stuff. She goes, that's where I get kind of lost. I go, okay. So Sloan was,

Not under the impression she was correct and like, I thought the diaphragm was the key. I go, is, but it has internal fixed points primarily to your rib cage and your spine. So the first thing we got to do is make sure they can breathe, which we all just work on. Like, you know, do they have a decent breathing pattern where we're getting circumferential expansion and not necessarily this apical motion? Cool. Once you've established that, then you have to very quickly do what? Determine, can your rib cage actually move? And then if it can move, can it move independent of your spine?

So that'd be the second hierarchy for me. So that's why I said, I think it's a flaw to coach somebody with huge inhale, full exhale, okay, now keep your ribs down. Cause we don't know what happened to their spine versus, you know, go from their head and literally like drive, you know, gently their rib cage down, which if you go to Prague and watch them work, that's where you're going to see is they're going to guide the rib cage down and then kind of watch what happens. Do they go into cervical extension? Do they?

you know, bring their shoulders into protraction. You know, is there a bunch of rigidity? So it's a palpation and it's a, you know, mechanical fix. And then third after that would be, well, now you can start working on, you want to flex or extend or, you know, whatever. But I think that helped her of, again, we all know that, you know, does it move? Can they move at load management? Then it's like, well, can you breathe? However we want to say that, like diaphragm, rib cage movement is a huge deal.

because of the diaphragm function and then independent movement or that uncoupling of respiratory motor uncoupling that needs to happen. And I just think that like, it took me a long time to figure that stuff out. But I think a lot of that came from me looking at breathing so much and being like, like the independent movement's a huge deal. And then also seeing how much of DNS in Prague is rib cage focused and all the Mojishua stuff and manual therapy is largely rib cage. And you guys have seen the rib cage chart.

Dr. Beau (15:40.876)

So I wanted to kind of bring that up because again, here's somebody that's taken some DNS courses, not as many as any of us honestly, using the concepts. But then in that scenario and how this all started with that gymnast was, comes in, has extension-based pain, but also now has flexion-based low back pain. My theory on that was, and I'm not knocking anybody, I bet what she was doing with the PT for the past three months, because that's when the flexion stuff started, how they were load managing a poor motor control scenario.

both parts are flex and extend. So Sloan was like, well, I put her in a Cobra and when she lifted up, was like highly lumbar erector driven, right? And she had some pain and Sloan goes, okay, let's start over. You know, got her to relax her erectors, just use her arms and go into extension. She's like, the girl said it hurt 10 times worse. She goes, so that seems really facet driven. She goes, the thing doesn't make sense is why does it hurt almost as much to flex? And I was like, that sounds like a motor control thing, right? Like you're not necessarily.

Cause she's had imaging, right? So we have all these things going, we're like, well, we've ruled out, you know, major pathology. So it's like, well, what would cause that? You can't shut off your rectors even when you are getting them to relax. Like, cause that's also a misnomer to say like, we see them on versus like, let's shut them off and go back to your extension. Well, they're, you know, probably not. Or can you palpate the multifidus? Obviously the primary care for our patient yesterday can. It's impressive. Yeah.

so again, I wanted to bring that up because we had a 30 minute conversation. think that's got value for all of us and hear people listening as well. And there's a lot of stuff that, you know, I came back from Prague and explained how one of the DNS instructors was like, I don't know how somebody, I can't remember who asked the question, but I don't know how they exactly framed it. But basically what's some of your pet peeves of DNS that you see perpetuated, you know, being taught. And it was.

agreed upon by all the instructors there from the Prague school. They're like, we don't coach IAP or intra-abdominal pressure. We want to see that occur as an ideal pattern, as a byproduct of proper position, work, reflex, whatever it is. And here was kind of a point of conjecture for a long time. What do mean? You're not going to coach it. But that scenario we just talked about is a perfect scenario. Because what would you have to work on? Breathing.

Dr. Beau (18:07.47)

But that's not necessarily being like, hey, let's create pressure. And I think there's also a difference of coaching IAP versus letting it occur and then drawing awareness to it, which is no difference than if we took somebody into a hip hinge and we didn't say, hey, we're going to look for hamstring tension. You get into a hip hinge and they're like, you say, what do you feel? And they're like, I feel hamstring tension. You're like, do you feel your low back? No. What do you usually feel? feel my low back. You just drew awareness to a difference.

I think that's maybe more appropriate or what the, know, prog instructors are saying. And again, it's nuanced. We, think feeling for IAP is way more important than creating it falsely because it's probably too much. And you know, is that going to persist? Probably not. so yeah, that was not mind blowing for me, but it was a good reminder of like, those little knowing that little thing can change everything, right? Of like, that's not our fixed point.

where is T12 or I'd say upper lumbar spine, the actual fixed point, like what positions in supine or developmental? You said the upper lumbar spine? Yeah, like L1 through L3. months? Yeah. So, and that's what I was telling Sonia ago. When the goal is to create mild flexion of lumbar spine, that's where six months, but that's a higher level position. And by that time you've also, you're probably loading up on, you know, elbows for sure, hands.

So you're having to control sagittal plane motion more off the ground. So now you have more lumbar pelvic control. When you do that, you can flex your spine. You've already started to develop a little bit of a lower dose, that's why I'm pushing into extension. But the other thing is, when you're working on that with people, a lot of times you have to assist that, right? It's a hard position to get into. you'll, I remember Dave Juring showing us like, you you're putting the tops of your feet underneath, you know, basically their butt and letting them sit in flexion and then.

playing around with breathing and pressure and can you remove a foot one at a time? But that gets back into like, I just remember learning the old SMA, like four by four matrix where it's like, can it move? Can they move it? And there was a lot of like lumbar flexion drills, because they're always working in this primary movement pattern function of like flexion or, you know, fetal position is like the first position. So you'd actually if somebody had low back this function of extension and flexion, you'd actually go after flexion first.

Dr. Beau (20:32.738)

just they were trying to create again a heuristic. So they have that little, you know, rope walk drill that we do with people sometimes reach her flexor spine up and they do cat cows and they do standing, you know, med ball stuff. But that's where Sloan kind of started with this girl. She knew she needed to flex her lumbar spine. So she gave her a med ball and had her do basically like breathing walk downs, right. And the flexion I was like, but you just want to load management. Technically you gave her load and you're working her through flexion and we don't know if she can flex your T spine.

right at all, we don't know if it moves. that's, you know, and I'm not calling my wife out here for anybody to listen like, God, they're throwing her in the bus, not there. I told someone I was going to talk about this because it's like, song couldn't answer the question goes, I can tell you for sure how well our T spine flexes. So don't go to the higher order motor control stuff. And again, you can use motor control to help mobility. I'm not saying that, but if you don't know, how do know if it changed? How do know what your actually primary like

portal of entry or your functional audit, whatever you're call it is. But we've talked about that a lot and here like just make stuff simple. And I didn't have the option to make, well, I probably made it complex in my head. I didn't have all these tools when I started. So it literally was like adjust soft tissue and bird dogs and Stu McGill's big three. So you had to really be on that because it's like, God, if I can't get somebody to move, you know, like what else am gonna do? I didn't have anything else to do with them.

And I was probably messing up DNS left and right because I was trying to do what I've been taught by Brett in clinic on the fly. but I didn't know all those nuances. So you're just putting somebody in a position and like expecting stuff to change rather than knowing the expected outcomes first. Like we were just talking about, if they can't get their, you know, TL junction down, we'll watch what's happening elsewhere. And that's kind of where you're probably working or noticing dysfunction or whatever you want to call that.

So any input or the questions on that kind of topic, specifically on like, know, fixed points, you know, that hierarchy, anything on that. Cause what I queued these guys up with before the podcast was like, Hey, we had a good conversation last night, Sloan and I, do you guys have any questions about DNS in particular that have just kind of stuck with you since you've learned it? Like you're like.

Dr. Beau (22:55.79)

It's never made sense or this has never been clear. Cause there's lots of things in DNS, the further you go through it, like you'll go to a seminar or something. You're like, God, why didn't somebody say it? that's first time. Like numerous things that I've went to and I'm like, I wish somebody would have just said that because it just was a lot easier. And some of that's language barrier when you learn from certain people. And some of it's just, there's a lot. And some of it's just, you don't, you're not smart enough when you go to take the class or you don't know enough. Yeah. guess that's more so the one. Yeah.

Well, when you're early, like I said, I got taught from an instructor working on live patients, you're like, that'd be the best. That's like learning to, if somebody was just like, hey, I'm gonna tell you if this lab values this, just tell them it's wrong, right? Hey, if this lab values this, tell them this is wrong and then tell them what to do. And you don't understand like human physiology. And you do that for a couple of years and pretty soon you're like, when this is wrong, this is what we do. You don't have an understanding, you just got.

taught like the basic rules. That's kind of what I was taught. It's like, we get in this position, you want to work on pressure, you want to work on breathing. I don't have all the know-how or the experience. So anything come to mind of other questions in other realms in DNS, and maybe we can take it outside DNS, like conceptual stuff. It's never made sense. I don't know if I'll have the answer either. Mine would be not necessarily always on just the breathing portion, but

how often would you say you try to cue someone on like the movement you're trying to get out of it instead of letting the, I guess like movement happen if that makes sense. Like you put somebody in a position and you're just like waiting to see what happens versus like, hey, I need you to do this, this and this for me while we're in this position. And you're saying with their breathing or overall? Like overall, guess, like if you're, I don't know, like a low oblique and you're really going for some tip.

And then like how often are you queuing that versus just like you just tell them, Hey, I want you to roll over that bottom hip, see what happens. Yeah. So, I was lucky enough to do a manual therapy course at Rich Olm's house last year. And so it was a smaller group, way more, you know, questions being asked. And, towards the end of the course, we all went around the room and said like, Hey, what'd you take away from it? What are you probably going to change or any big, you know, mind blowing experiences? And Rich was like, I'm going to start queuing people way more.

Dr. Beau (25:21.41)

He goes, was under this, because there used to be this guise of DNS of like no talk, reflex, stem, it's all manual, like reactions are gonna happen, which is true. But then, mean, we're there with Martina and then Robert Arden was there and then like just queuing all over the place. So my thing is, your queues, no different, well it is, it's motor learning. So how you're queuing is a big deal, right?

drive your knee into the table is not nearly important as a cue to me of, can you get your hip to work? Watch what happens. Do they try to drive their foot into the table? Do they drive their knee into the table? Or do they turn more? So it's no different than what we just said with Sloan. If Sloan's like handy, they're T12 down and then you're watching what happens. So then you gotta ask, okay, what's the goal of the position? Well, then if I cue something around that, so let's say Seth said low bleak. Let's say it's five months shoulder roll.

sort of they're on their side, their arms kind of out in front of them like a, know, pitcher stretch almost position. And we would know, okay, what's the goal of that position? A little eccentric load, you know, on the posterior capsule, you know, creating a synergistic kind of action around the shoulder, hopefully offloading the neck. The neck doesn't get too involved. So we could, you know, that's where I give the cue all the time. I'm not telling them, hey, I want you to do this. I'll just smash them to the table. I'm like, hey, can you lift me up?

Because the first thing we want is that lateral expansion, right? We don't want them to just like drive their arm into the table. And then you watch what happened. They turn their neck on. Okay, well, that's now I might have to cue like, what's the cue? Shut this off. Like I'm fine with that. If they can't do that, then you got, you know, props, which again, if you're motor learning, what's low level stuff, it's device feedback. So if I give them something to like rest their head on, that's not near as important as like, can I get a good pattern while they're, you know, doing it on their own or offloaded?

So think that's a big deal is like, don't go hard after what you just need to happen. Like I know I can get if I just drive your knee through the table or hey, resist me. You can do the resist me stuff because that's kind of the manual input. But maybe the better thing there is if it's resistance first is don't tell them to resist you. Right? Like a lot of DNS is like, think if they're in three months supine, you're not like pushing on their ribs and telling them like, hey, let your ribs go down yours.

Dr. Beau (27:46.872)

See what happens if you push on somebody's hip and let's say they give you no resistance or you can't move it, you're also palpating like tone and stuff like that. So you could kind of push them for a second and then if they push back to feel like keep going or like there's a lots of ways but remember I put out that Instagram posts that walk through the phases of motor learning. That's what DNS is and a lot of it we try not to give verbal stuff but like Rich said like why not like best in world are doing it more than he was.

Right, which he, this was a manual therapy course too. It's not like an exercise course. So that's where he was really blown away. goes, man, like we're doing rib cage work and stuff and you know, lot of cues with that. So yeah, it's a quite a bit, but don't go hard and heavy after I need this to happen. So I just go after this. And then also never have the expected, you're going to feel this. So I think we're all doing that well. And here if you do something like, Hey, what do you feel? Rather than like, Hey, do you feel your hip?

Like it's a bad, that's leading the witness. Like don't do that. Cause it got a lot of people. How many times have you done like a sideline, like hip roll, you know, movement and somebody has pain, right? And then the pain's not where their issue was or cramps in the top leg calf. you're like, yeah, or whatever it is. you know, what do feel? I'm feeling, yeah. Cramp them up her back and you're working on their hip that could tell you something. Maybe that means nothing. I don't know. You gotta, you know, that's information you gotta deal with at that point. Yeah.

That was a very important, I forget when we talked about that, several meetings, staff meetings ago of asking them, what do you feel here versus, you should feel your hip in this. And I still do that occasionally, unfortunately, but for the most part, I'm trying to think, all right, how, what do you feel here and let them tell me, and then decide if that's important to change or have different. thing to reconcile is.

So the question out there is, what if they feel the wrong thing? That ain't up to you. So how do you determine right from wrong or good from bad with a rep? Does it have the desired outcome? So let's say, I don't know, like a single leg deadlift. Let's just say that. So what would we expect somebody to feel in a single leg deadlift? Lower than the posture hip. Yeah, like hamstring. Yeah, that's what we'd expect. We wouldn't want them to feel probably pain in their low back.

Dr. Beau (30:08.954)

Yeah, that. So what if somebody's like, feel my right cue well, and they're on their left leg. Looks perfect, you know, all that. Maybe, you know, that's where it gets a little more nuanced because that's, know, Greg Rose is really good at this of everybody's got different input. Some people have different kinesthetic awareness, but also like, why is that thing hard for him while you're working on in first place?

you know, it might not be because they need to feel their hamstring. It might be, hey, what if they lack central stability and they're a single like deadlift, now they do feel their opposite side like flank. That might be a good thing, you know, especially if it's loaded. See, that's a hard reconciled thing and that's not a rule that's just, you know, per case, per scenario, per exercise type thing. But again- I can't put one in mind of like, she wasn't good at like, she has like some hamstring issues that she's dealt with like in the past. Like at least one of my patients said that she had like a-

hamstring tear at one point. So then we started working on like some coronal plank because she has like terrible balance. So I had to do suitcase carries. Well, before thanks, this was like right before Thanksgiving came back and she was like, I was almost down for the count during like all of Thanksgiving because I was so sore around like my obliques and on like my right QL that like I almost couldn't like touch it. And this is a lady who runs like, you five miles, like three or four times a week. How much weight were you using? I think I used 20 pounds. Yeah.

So it shouldn't have been super heavy. And yeah, she was like on my right side, which is where she has all our hamstring issues on, was just like destroyed. But there you go. that's, know, is that a good thing or a bad thing? And I only had her go down our hallway twice. Yeah. She did it on both sides. She did it on both sides. And her right one is the one that like got smoked. Yeah. So again, that scenario, like I kind of like that stuff because again, soreness now gives you more feedback. You're more aware of that area. I mean, there's a

all sorts of stuff you can play around with that. But yeah, think the more, again, if you layer understanding, know, great grows would be like, if you understand motor learning and you can do whatever you want, because that's like, you understand the concepts of all rehab more or less. That's what we're doing. Then you have to kind of understand physiology to understand like tissue demands and you understand aerobic capacity. So if you want to be in the rehab realm, you understand those like big pieces. I think you do pretty good. Obviously you got to play a little bit of intrinsic motivation stuff.

Dr. Beau (32:34.04)

Cool. You got the rehab part down. on table, maybe it's a little bit different, right? There's more palpation nuance there. Maybe, maybe less. don't know. any other questions like that within DNS realm or yeah, what do, what do we think is happening when let's say you're looking at somebody in three months supine and, there's an asymmetrical expansion of interdominal pressure from side to side.

and you're able to cue them up to create it uniformly across one. Why, why do we, what's the mechanism behind why that's only showing up on one side and how are they then able to change it? we contracting half of the diaphragm? Like what's, what's creating the inability to eccentric those muscles in the abdomen on that side. And then how did they actually change it? Yeah. And I don't, anybody listening, I'm not an instructor.

I'm only able to think like I'm the all-knowing DNS whatever, but in this office, I kind of have to, because I'm the senior kind of clinician. like these are the questions we're addressing. We're addressing all the time. No, great question because that's part of the assessment, right? Like it's, you know, you're looking at somebody in three months supine from the head. If you're in DNS, what B, you're kind of like, there's, you know, big valleys there.

or a valley you're saying on one side. go back to what we said with what would you see on the glass table looking underneath? So you basically see EOP a triangle down to the shoulder blades. And then if you cross triangles over to the sides of the sacrum and then the diaphragms in the middle was six different attachments, roughly different anatomical attachments for everybody in the middle of your abdomen. So also realize that it's not a contraction game so much in terms of like PRI where you're having a harder time doing in my opinion.

functioning of the diaphragm differently. You said a very good thing of like, why aren't they able to, let's say somebody had a right-sided inability to create IAP or they have kind of an indentation around their hip flexor, just more tone. Well, they don't have a great oblique sling stabilization strategy going across there. So that's why they can't let it eccentric load because they're in a concentric load to create some semblance of stability. You're saying you would expect to see some change in the opposite scapula.

Dr. Beau (34:55.682)

Point of support. can't write rules, right? So we have what? Ipsilateral and contralateral patterns. So if I'm, we're using a three month supine position. So that is a what position? Ipsilateral, or sorry, that's bilateral. Well, it's yeah, ipsilateral homologous, right? So it's basically flipped over, you're on hands and feet. When you're there, do you need a lot of oblique control? No, right? Cause you should have everything kind of paired up. But if you have dominance on one side, right? You've had an injury, you shut down function.

It's just kind of how you play. So you can't say, they have right-sided, it's going to be left-sided shoulder blade stuff, right? Not necessarily, right? Because it can be still ipsilateral, be rib cage expansion on the right, right? They don't have enough pliability. So there's a lot of options, but you're just taking that piece of information and saying, exactly, well, why wouldn't they have it? Well, if I go feel their abdomen, it's soft, that's not a heavy concentric load thing. So that's different than somebody that's like brazed up and no IP.

Here's two wildly different things. So now I can do what I can change the position and see if the inter abdominal pressure changes, which what they're saying in Prague of like look for it rather than coach it. Let's say you see it change in a right sideline position. But that side down. Yeah. I mean, you can make that a contralateral ipsilateral position, depending on how you, you know, move the top, know, extremities.

Well, you can play around with that a little bit and you're like, man, it's better regardless when they're on their side. Well, that seems more like a right-sided like issues. And I'm looking at like maybe rib cage piability again, like can they expand in the lateral, you know, compartment, maybe even their hip, how that plays into it. But that's, and again, you don't have to use all that stuff, but I'm just saying if there's a single sided things, what I usually guess there's like a blank sling stuff. Yeah. But it could just be a rib cage movement. That's, know, you know, lateral scoliosis, like changing.

Yeah, and train things like that. I think it's also good to note the difference between high threshold pattern and low threshold, like they have nothing going on at all, right? Or like, they're just not able to create pressure because they're so like cranked on. Those are two wildly different things. And then we get into all the stuff that they'll teach you in DNS, which is just likelihoods. So do you remember what you're taught in DNS when somebody has like, let's say an inadequacy and intra abdominal pressure on one side?

Dr. Beau (37:16.558)

Like more often than not, that's the side that you're gonna have injury or pathology in lumbar spine. And that's not really research driven that I am familiar with. That's just more anecdotal in the terms of like when you're looking at, you know, assessment from a DNS standpoint.

Kind of makes sense. Your dysfunction, maybe shut down. It's like an ankle sprain. You shut down your, I don't know, right? Mechanisms, you can make anything plausible. You could also say, well, it's going to be opposite side, right? But that's what you're kind of, or least I was taught, is like when you see single sided dysfunction, that's usually the side. But those are the games like, you know, Pablo's playing, he's like, you have lumbar sprain. Like he's just looking at the presentation and kind of making the best guess. Yeah. Anything else on that in particular?

trying to make up anything else or any more input on that. How often are you assessing the rib cage in different positions besides just three months? are you using that as like your main assessment and then going from there? Main assessment, honestly, I do it seated. I mean, with almost everybody I'm having to go hands on head and I'm just kind of giving them like, I don't even know what those, there's compression tests. You're checking for rib fractures. Yeah, rib fractures. Like I'll do that right away.

on a lot of people, then yeah, three months and then on their sides, but on their sides is where I start usually working on it, from manual therapy, but it's intercostal, it's just rib cage pliability. Yeah, three months supine because again, you can do it prone, I guess it doesn't really matter. It's just literally, I think rib cage pliability is one of the easiest things to feel. Then you got to determine, well, what are you actually going to do? You're to use breathing and your manual therapy, just exercise to get that to move better. it?

we've talked a lot about in here of is that rib cage stiff because they lack stability on the opposite side. So that's again, that like posturing around it, like good luck manual therapy and that into a more mobile rib cage on that side. But going back into the asymmetrical finding stuff, mean, that intra abdominal pressure is no different than if we had somebody in a four point rocker test. So hands and knees rock and then you see one shoulder blades like massively flared or winged or something. The other side's normal. You can't

Dr. Beau (39:27.342)

draw the immediate assumption that like, they have an abdominal like oblique sling or oblique sling issue because you're still right in a homologous position. Yeah. So it again gets back into assessment, taking parts away, change positions, you know, stuff like that. Any other questions in DNS realm? Daniel. mean, I feel like my biggest thing is, you know, my own kids. It's like,

You know, have my one and three could be poster kids for DNS. My middle one where it's the one and like every guy wants their son to be a stud athlete. And he just so happens to be the one who was born with like a little bit larger diastasis who kind of started to drag his leg, but is also the one who if I'm throwing a ball with my boys, like one of them is going to catch it with his body.

And the two year old is going to like reach up and catch it with his hands. And I'm like, of course you are. And then it's like the whole rib cage like playability, like we're talking about, like I brought up to you where, you know, I could see him dragging his leg and like my weakest point is for sure. Knowing when and making sure I'm doing a stem the right way. And his crawl ended up took longer than I wanted it to. Cause you know, you want to feel like, you know, DNS. So you want it to start, like you want to do it and you'd be like, boom, change in a week. I'm amazing.

And then it really took at least a month where you start seeing it normal and then I'll be and it's kind of like some of the things that were said just about patients general I just feel like you see the position you want to say why mm-hmm and then so like with him like I'm in the we're in the den like two nights ago and He brings up because I put the DNS kids poster up and he was just like I want to do the bear and I was like perfect and then so like we're doing it and then like I'm trying to treat it like a game like we're playing and then

he'll be in a position for like a second and a half. And I'm like, nobody, let's keep on doing this. And then he wants to do a different one. So I'm like, okay, cause I want to treat it as fun, play, cause then he's going to want to keep doing it. And so that's like the biggest one that I'm working on now with him is just rib cage pliability. And then just like making sure you like compensation patterns because, you know, I don't know, you know, you hear anything from like three to five.

Dr. Beau (41:50.446)

And who knows if it's even older, but it's like, I'm in my mind, I'm like, okay, those are like my age limits where like, want him to be resolved to this before we get to that point. Cause then it's just all fun from there. But then just always making it fun for kids because I mean, if you've ever worked with a baby or a kid, they don't love it. And then you're trying to make them do what they don't want to do. so, yeah. Yeah. You know that, you know, I've talked a lot about Maddox our oldest was

in the birth canal like head cock back into extension and oblique. And then, I mean, not right away. But when she started like trying to lift her head up and stuff, like she literally couldn't like she goes into like extension and like had to roll to the side. And I was like, man, now you were at the course with Brett. And when we had Maddox in there, and she was nine months old, he goes, you got a perfectly healthy six month old baby. Yeah, nine months old. got a variance in there.

But that for a long time, was like, God, so, you know, I was working with her. wasn't changing. You know, looking at other stuff and she gets collarbone fracture that adds a little more peace into it. But while I was talking to someone last night, the kids were in the living room and I go, well, look at Maddox. Like, you know, she had this deep neck flexor kind of, you know, whatever you say, weakness and stability. We've worked on it, but then look at her rib cage from A to P is like shrunk down or pretty compressed. You look, she's like,

upright like this. So she could turn into that person that's got like a scallop T spine because why when she goes to get up off the ground, like she probably has to extend heavily from here and like push her head into the ground. Right. So she doesn't have this like clean, like, I have a fixed point. Where's the fixed points for you to get up off the ground, shoulder blade, and then you can lift your head up and then you could do a crunch. So again, we each remember we do the kind of Lindell lift test. so she couldn't do it. I her head just, wow.

So that's like a sit up and then little by little she would go into gymnastics and they do sit ups and they're coaching her. So now I'm like, did she just learn how to compensate well enough that a sit up looks 95 % better and it's terrible or is it better? that's, you know, I feel like I don't know everything by, feel like I know a lot and I'm like, I still don't know with her. is it perfect? And then there's no perfect, right? That's the thing. It's not, is it better? Yeah.

Dr. Beau (44:10.072)

Can she get a public ground doing a setup? Yeah. Does she choose to still? No. So I just watched her the other night cause she's doing like four rolls or somersaults all the time now and stuff. And like, if she goes on her back, well, she'll just roll to the side. And it's like, I don't know. Cause that's a preference thing. You look at our youngest, who's not even two, she just literally gets a ball ground like a ninja. That's different. Yeah. So then again, a lot of people listening, like, why don't you work with them more?

It's not easy, right? That's not a cop out. And we still do work with her. I worked with her two weeks ago. We were down in our garage working on it. And at the same time, I don't want to be like overbearing with it where they think they have an issue. And yeah, so we just try to make it fun. We look at it. And then if it got, anything got severe enough or she started to complain of pain or something like that, it's like, yeah, we're going to go after it. So it sounds like a wait till they're in discomfort, but like nobody is developed.

perfectly. And maybe there's some, I don't know. Maybe you'd be like, isn't that what the best athletes in world? No. Good kinesthetic where you're second, right? You've got some stuff different, but kinesthetic awareness and athletic ability, whatever you want to call that, which we were just talking about that course, which they're going to talk probably a lot about that. at that, what was it? The neurologic approach to athletic development.

That's probably what they're gonna be talking about is like, well, can we help it? Yeah, are some people inborn with it? Can you improve those? You know sensory motor processes for sure and that's what we're working on with DNS Not just the mechanics and calming down, know trigger points knee-centric stuff Yeah, you're aware of it for sure Any other question? Sorry, nevermind. Yeah. Yeah. It looks like it. It looks like it you tell me that is not like Nana Of course it is. Nana, California?

No, DNS. at the top. It DNS Nana. yeah. I was wondering what you were saying. was like... Because the P is like... Yeah, okay. Well, Rich will love that you called out his design skills. please come at me. He'll himself to sleep tonight. That's okay. We all need to do that every once in a while. Any other big conceptual questions outside of DNS? Where you're like, doesn't make sense. And if you're listening, if you have any of those, like, you know, share it.

Dr. Beau (46:32.75)

And a comment or something when we share this the Instagram or Facebook Or you know, whatever write me a letter send out on a carrier pigeon or something Anything else? I just think every DNS course you go to you just like what's the why try to understand why you're doing it like I remember when I first got with Bo Like I did exactly what you're not supposed to do like I jumped around a different DNS course is not necessarily in order and then some of the basics once they clicked and I mean like

you know, being a Rambo every day, like it clicks pretty quickly. But it's like, understand the why then I think you're looking at different cues. mean, now I think every seminar I go to, my notebook is just filled up with like cues and old wording. we're talking about DNS goes for everything. Yeah, right. Like diving into Z health stuff, soft tissue. Like I was telling these guys that I think they need to go take an ART class because helps massively with palpation skills you have.

Not that you have to be able to legit soft tissue thing to fall back on. Sometimes when you're like, you see this calm down, it's not. And let's say you're not gonna dry needle. It's a kid and they're terrified of a needle and know, stecho, you need a bunch of different tools, but also you're expanding your knowledge. then if you're like, dude, I take the ART stuff, it just doesn't make sense that like, creating a slight pressure, moving the muscle is gonna calm down or trigger point. I'm with you. That doesn't make any sense to me. But if I'm talking about,

increased tone in the muscle and a nerve that's running through them, the nerves irritated, makes perfect sense to me, right? Especially if I had a trigger point, calm down the trigger point, now I wanna move stuff through there. Maybe that's not a time for neurotraining. Like you have all these reasons, but then all the concepts need to be questioned when stuff persists, which I've had a bunch of where you're like, that just doesn't make sense. Like maybe they're not right as an option, right? Or maybe you just aren't far enough down the road to have it make sense, but that's what's gonna make you better is to constantly like,

ask those questions and get around the right people. And I'm trying to think what I asked. We were watching Pablo work somebody up in the auditorium in Prague and Robert Lardon was standing in front of me. I asked him, why is Pablo doing that? And he's like, I don't know. And this is somebody who I've put on basically the same level. He literally was like, I don't know. So that's at same time, like not everybody has all the answers all the time anyways, if you think they're best in the world.

Dr. Beau (48:56.366)

All right. Speaking of DNS, DNS April 4th through the 6th in Nashville, Tennessee, we actually still have an extended Black Friday sale, I think going until Audra wants to shut it off this weekend because she's mean. It's going to run longer than that. We'll see. So Black Friday, 20 % off with Brett Winchester, DNS in, I keep wanting to say Vegas, but Nashville, Nash Vegas.

A lot of fun stuff going on there. And then we talked about the course, is July 25th, 26th. They didn't tell me to talk about it. It just looks like cool course with Rich, Brett and Alana. That'll be a cool one. yeah, anything else? Merry Christmas. Yeah. I guess this will be the last one for Christmas, won't it? Yeah, for sure. So we'll see. We'll be the last one for this year. No, you have one right after. right. For Christmas.

I will be gone. So Merry Christmas everybody. It's on Kwanzaa. Can't miss that. And the first day of Hanukkah. So yeah, I'll have some different costumes waiting. All right. So Merry Christmas and see you this year.