Kolar’s Approach to Dynamic Neuromuscular Stabilization:
A Developmental Kinesiology Model
Primary Instructor: Assoc. Prof. Pavel Kolar, PaedDr, Ph.D.
Assistant Specialist, Course organizer: Alena Kobesova, M.D.
Assistants: Physiotherapists from Rehabilitation Clinic,
University Hospital Motol, Prague
Day 1:
9.00 – 10.30
Neuromotor development - basic principles
Newborn phase of development
The relationship between CNS maturation, muscle function and morphological formation of the joints and skeleton
10.30 – 11.00 Coffee break
11.00 – 12.30
Neuromotor development
Development during the first 5 months of the life; stabilization in the sagittal plane
Definition of ideal posture in the sagittal plane
Definition of ideal stereotype of breathing
Definition of the functional joint centration
12.30 – 13.30 Lunch
13.30 – 15.00
Postural development and locomotion patterns
Development from 5th – to 12th months of life
Stepping forward, grasping and supporting functions
Reciprocal movements – ipsilateral and contralateral patterns
15.00 – 15.30 Coffee break
15.30 – 17.00
Functional evaluation of the babies – demonstration
Correlation between biological and chronological age
The most important signs of abnormal early development
Day 2:
9.00 – 10.30
How to apply the principles of neuromotor development in diagnosis and treatment of the locomotor system
Integrated stabilizing system of the spine
The most important muscle synergies defining ideal postural stabilization
10.30 – 11.00 Coffee break
11.00 – 12.30
Integrated stabilizing system of the spine, dynamic neuromuscular stabilization:
Its role in diagnosis and therapy of vertebrogenic problems and radicular pain syndromes
The most important signs of abnormal spinal stabilization
Every movement depends on sagittal stabilization
Video Demonstration– typical cases presenting abnormal spinal stabilization
12.30 – 13.30 Lunch
13.30– 15.00
Integrated stabilizing system of the spine; dynamic neuromuscular stabilization:
assessment, the most important tests – demonstration
15.00 – 15.30 Coffee break
15.30 – 17.00
Integrated stabilizing system of the spine: assessment, the most important tests – demonstration and practice
Assessment of adult patients with locomotor pain syndromes – demonstration
Day 3:
9.00 – 10.30
Integrated stabilizing system of the spine, dynamic neuromuscular stabilization: assessment – practice with the physiotherapists
10.30 – 11.00 Coffee break
11.00 – 12.30 Reflex locomotion: stimulation zones, initial positions, kinesiology of movements evoked by stimulation
12.30 – 13.30 Lunch
13.30– 15.00
Reflex locomotion: demonstration
Reflex Turning phase 1
Reflex Creeping
15.00 – 15.30 Coffee break
15.30 – 17.00
Practice:
Stabilizing system of the spine –assessment
Reflex locomotion: How to evoke the pattern of ideal sagittal stabilization
Reflex Turning phase 1
Reflex Creeping
Assessment and treatment of a patient with locomotor pain syndrome – demonstration
Day 4:
9.00 – 10.30
Reflex locomotion: demonstration
Reflex Turning, phase 2, 1st position
10.30 – 11.00 Coffee break
11.00 – 12.30
Reflex locomotion workshop, practice with PTs
12.30 – 13.30 Lunch
13.30– 15.00
Cortical functions: isolated movements, body perception/ awareness, scheme of relaxation
15.00 – 15.30 Coffee break
15.30 – 17.00
Practice:
Stabilizing system of the spine –assessment
Reflex locomotion: How to evoke the pattern of ideal sagittal stabilization
Assessment of cortical function
Day 5:
9.00 – 10.30
Dynamic Neuromuscular Stabilization - self-treatment techniques – demonstration and workshop
10.30 – 11.00 Coffee break
11.00 – 12.30
Dynamic Neuromuscular Stabilization: demonstration and workshop
Assess – treat – re-assess
Self-treatment techniques
12.30 – 13.30 Lunch
13.30– 15.00
Final Technique workshop: stabilization assessment, reflex locomotion, & self-treatment,
Questions & Answers
Course Goals
Course attendees will have a clear understanding of:
The basic principles of developmental kinesiology.
Development during the first year of life: stabilization of the spine in the sagittal plane, definition of ideal stereotype of breathing and functional joint centration, development of the phasic movements coupled with trunk rotation
The relationship between development during the first year of life and pathology of the locomotor system in adulthood.
The reflex consequences following central neural programs during the first year of life.
Functional stabilization of the spine
Correction of poor stereotypical respiration
New terminology such as functional joint centration and decentration, stabilization, punctum fixum, and the integrated stabilizing system of the spine. In addition, posture will be discussed from a developmental point of view.
Key principles of reflex locomotion: Locomotor patterns, stepping forward and support function, support/stimulating zones.
Definition and importance of a cortical functions
Successful course participants will possess:
The ability to utilize the most important tests to evaluate the deep stabilizing system of the spine.
The ability to evaluate of breathing stereotypes.
The basic techniques for reflex locomotion, including reflex creeping, reflex turning, initial positions and stimulation zones.
The most important techniques used in treatment of the deep stabilizing system of the spine utilizing the principles of reflex locomotion.
Self-treatment techniques based on developmental and reflex locomotion principles
Assessment and re-education of the cortical functions.
With the above knowledge and skills, the attendee should be able to clinically apply these principles for:
Treatment of functional pathology of the locomotor system, vertebrogenic and radicular pain syndromes where the stabilizing system of the spine plays a crucial role.
Treatment of functional pathology of the locomotor system resulting from poor early development.
Course Description
Much attention has been given in recent years to the development, maintenance and decline of the functional stability of the locomotor system. Emerging research has proven the existence of the deep, or core, stabilizing muscles and their impact in controlling safe joint motion. This is especially true for the joints of the spinal column, where biomechanical and neurophysiological demands are extremely complex . With the increased understanding of functional stability new theories have arisen regarding the etiology of functional pathology and also effective treatment methods for restoring . These techniques, however, have yielded less than satisfactory results for many frustrated clinicians. Some methods, although based on sound principles, have been criticized as impractical.
In the midst of this debate, a new method of intrinsic locomotor system stabilization has arisen attracting a great deal of attention from rehabilitation specialists. Led by the pioneering work of Pavel Kolar, PaedDr a a unique new manual approach has been developed which activates the intrinsic system and achieves exciting levels of improved function in a remarkably brief period. Based on the principles of developmental kinesiology, the neurophysiological aspects of the maturing locomotor system on which the Prague school was established, Dr, Kolar has expanded the scope of clinical options in an exciting new direction. Participants in this course will be introduced to these methods.
One of the most exciting aspects of the course is that this method describes the first new manual approach to the treatment of radicular syndromes since those of Cox and McKenzie decades ago. The success of this method has gained a great deal of interest among clinicians around the world.
The most commonly asked questions:
Five days is a long course. Is it really necessary??
The concept of Dynamic Neuromuscular Stabilization is extremely complex, encompassing principles of developmental kinesiolgy during the first year of the life, defining posture, stereotype of breathing or functional joint centration from a new paradigm. The system of spinal stabilization testing using Kolar’s original set of at least 10 tests require sufficient time for demonstration and practice for participants to recognize subtle signs of abnormal stabilization and movement stereotypes. The system of treatment is based on reflex locomotion principles, another very complex system itself, which again requires enough time for demonstration and practice. The DNS also involves the assessment/treatment of cortical functions, which is often an overlooked aspect in rehabilitation world. We strongly feel that five continuous days of training is the amount of time necessary to adequately explain the basic principles and apply the practical integration of developmental kinesiology. In other words, you need five consecutive days of instruction to be able to return to your clinic and utilize this method on a specific subset of your patients.
Course participants will also have the opportunity to observe Professor Kolar treat both infant and adult patients, . Due to the complexity of this course and necessity of individualized supervision during the practical technique hours, Professor Kolar limits the attendance for these courses.
To become a licensed DNS practitioner you may register for structured DNS programs A-D.
Who are the physiotherapists assisting during the course workshops?
For the practical part of the course, onlythe most skilled and educated physiotherapists are chosen to assist. They have all completed their Masters’ degree in physiotherapy and have studied under such renowned rehabilitation authorities as Professors Vojta, Janda, Lewit, Vele and of course, Kolar. All of them work at Rehabilitation clinic, 2nd Medical Faculty, University Hospital Motol, Prague, where Prof. Kolar is the director of the rehabilitation department. All of the PTs assisting in our courses have completed a comprehensive 8 weeks course in reflex locomotion according to Vojta, 6 weeks course in Manual methods according to Lewit and they are studying from Professor Kolar at a fascinating time, as he continues to adapt and perfect the assessment, treatment and management aspects of his method. (see Prague School P.T.s)
Who else is assisting to prof. Kolar?
Because Professor Kolar is not fully fluent in English, Dr. Kobesova will serve as his translator during the lectures. Dr. Kobesova is also the organizer of the courses. For any details regards the courses you may contact her at: alenamudr@klakson.cz
Is DNS method applicable in other diagnoses than locomotor pain syndromes?
Yes. It is very powerful technique for both neurological and pediatric disorders
Prof. Kolar’s work spawned from the work of Professor Vaclav Vojta, a pediatric neurologist who was a colleague of Karel Lewit and Vladimir Janda at Charles University in Prague. Vojta’s initial work was with children, especially those with cerebral palsy. However, Kolar’s approach expanded over time to include all ages with a variety of neurological disorders. The treatments were based on the principles of reflex locomotion, an approach designed to stimulate subcortical reflexes and facilitate neuroplasticity. Kolar, with Vojta’s support, altered the method to be utilized for acute and chronic pain syndromes, to be integrated with manual joint (mobilization/manipulation) techniques, to be utilized in either an out-patient or in-patient setting, and also to be utilized for athletic optimization. Therefore, it is a neurologically based method designed for all types of musculokeletal pain dysfunctions among both older and younger patients that are seen in the rehabilitation unit on a daily basisIn addition, the lives of patients with neurological disorders have been positively changed (due to our trial courses) from using these methods.
What are the examples of the types of cases where DNS according to Kolar has successfully been used?
Any type of pain in the locomotor system including radicular pain syndromes. DNS can be very successfully applied in cases of chronic pain where simple manual techniques failed to show any long lasting effect.
Cases requiring surgery: (severe disc prolapses, spondylolisthesis, spinal stenosis…) DNS according to Kolar proved to be effective in the prevention of further relapses of painful syndromes. In many cases after a few weeks of DNS training, the patient’s problems resolved completely and surgery was avoided finally despite severe morphological changes. Kolar’s strategy is a neurophysiological change. He attempts to reduce and optimize the disc loading and stabilize it by facilitating the “deep stabilizing system” of intrinsic musculature. In other words, this approach tries to re-establish the coordination of the intrinsic and extrinsic musculature to improve control of the motor unit and REDUCE aberrant vertebral motion and increased disc wedging. This approach was initially met with a great deal of skepticism, but the spine surgeons in Prague are now embracing his methods prior to any thoughts of disc decompression (except in cases of cauda equina), which has reduced disc surgery rates.
DNS may also prove to be effective in severe cases of chronic pain in the extremities, as is the case with epicondylitis. After improving postural stabilization, extremity movement patterns become more effective, often resulting in pain resolution. It is not rare that extremity pain disappears after stabilization training although the therapist never touches the elbow with the treatment.
Sport: through training of ideal motor stereotypes and synergies, DNS can enhance athletes’ performances as well as help prevent injuries in sports activities.
Neurological cases like multiple sclerosis: DNS approach helps to decrease spasticity, re-train physiological stereotypes, thus helping the patient to be more active and stable. It also reduces pain syndromes in neurological patients.
Pediatric rehabilitation – Utilizing DNS based on method of reflex locomotion it is possible to improve posture and movement stereotypes even in infants, till unable to cooperate fully, or later when treating children with poor posture it allows us to activate the muscles which are not fully under their voluntary control (deep intersegmental spinal muscles, some parts of diaphragm or some sections of abdominal muscles, etc…) Reflex locomotion itself is very powerful rehabilitation method in cerebral palsy cases.
Pediatric/orthopedic diagnoses – e.g. idiopathic scoliosis - via activating muscles which work against scoliotic curve it is possible to decrease progression of the scoliotic curve or sometimes even decrease (fix) the curve itself. Of course, training in neurological, pediatric or orthopedic cases must be long term and be based on parental education in methods.
Pneumology – e.g. pneumonia. Via exact positioning and stimulation of the zones it is possible to activate purposefully those muscles (skeletal but also smooth) which will help to aerate the collapsed and inflamed part of the bronchi.
Intensive care units – when the patient is not able to cooperate. Techniques based on reflex locomotion and DNS help to prevent secondary complications like pneumonia.
How may the integration of DNS according to Kolar’s impact a chiropractor’s or physiotherapist’s practice?
DNS will expand the range of patients seen to include some neurological disorders. As a rehabilitation specialist, clinicians successfully completing the course will have a new approach to complex, chronic cases. DNS will assist clinicians in re-establishing improved motor control.
Understanding developmental kinesiology, clinicians will find other concepts that are aimed to train ideal posture, respiration and intrinsic stabilization to be more logical. Finally the clinician will be able to explain and demonstrate these concepts to your patients better and they will be able to understand and visualize them. (See testimonials)
Is DNS according to Kolar new and relatively unknown method in the rehabilitation world? What is Kolar’s reputation?
His reputation continues to spread because of the strength of his method. He has gained an unbelievable amount of recognition. He traveled with the President of the Czech Republic, Vaclav Havel, whenever he traveled abroad. In fact, Pavel slept in the White house in Washington DC while President Clinton was & the current President Bush’s first term in office because he was President Havel’s doctor. Because of his reputation, the British Government flew Pavel in to treat Prince Charles for his back problem and celebrities from the US & Europe have flown to Prague to be treated by Pavel. Groups are now routinely flying in from Europe, North America & as far away as Australia or New Zealand to study with Prof. Kolar and his team. Prof. Kolar has also been very active in the world of sports. He is a former competition gymnast and has always been interested in athletics. He continues to travel with the the Czech Davis Cup team, National Ice Hockey and Soccer teams and the Czech Olympic team. He works on a regular basis with athletes such as Jaromir Jagr and Jan Zelezny. He also has treated Wimbledon champion Roger Federer.
