In many disciplines the concept of the ego is something to be defeated. This is akin to the ego being the enemy or somehow inherently bad. However, the ego is a necessary part of our psyche. The ego has a role in keeping us safe.
To further promote the positive aspect of the ego, I’ve coined an acronym EGO. This particular acronym relates to movement. Whether conscious or not, our experience is a relationship we have with our movement. This relationship has three aspects:
Expression is the spectrum of our experience:
The spectrum of our experience relates how our limbic system is interacting with movement. This in turn directly affects our physiology and adaptation capacity.
Our emotional experiences are a spectrum from love to fear.
Our memories and coping strategies are a spectrum from safety to guarded.
Our engagement of the challenge at hand, and the skills to meet those challenges is a spectrum from flowstate to blocked.
Grace is the neutral observer:
Grace relates to how the mind is interacting with our movement. This is the non-judgmental state of awareness. It’s the accepting, the letting go of, or ceasing of judgment. This allows grace to naturally erupt, and to flow out of our experience as that is our true nature.
Organization is the assembly of the fundamental building blocks of movement:
Organization is the relationship between structure and the nervous system. Organization defines efficiency in the activity. As we progress in skills acquisition, the assembly of those fundamental building blocks become more sophisticated. Our skills acquisition follows an incremental progression so that we can access our true nature, flowstate.
Let’s consider the need to reframe the little ego into something more evolved. The acronym EGO opens the door to a more sophisticated relationship with our movement. Our personal practice is a reflection of our experience. This is an interdependent relationship. Relationships require nurturing and sometimes hard work. Our movement is no different. The development of our movement practice has many attributes. The process of claiming our true nature has a progression. The movement mentorship program is designed to empower you in your own process of experiencing that progression.
The movements you taught in the Immersion supported my healing and massively improved pain from a cervical herniated disk as well as other pain I’ve been carrying for so long. I most connected with slowing down the movements and listening to the subtle body and the emotional experience in between. I’m looking forward to diving deeper and understanding more in the Movement Mentorship Program.
— Olivia N. from a recent Yoga Immersion, discovered the potency of joint flossing in helping her experience being in the body. Olivia will be joining us in the upcoming Movement Mentorship Program.
Recently, I was reading a thread on another forum. The comments on that thread led me to believe there are several misconceptions about the SIJ. I thought it would be good to share a synopsis from the perspective of Dynamic Neuromuscular Assessment.
The SIJ is a joint that has minimal movement. Movement is not its job. The job of the SIJ is two fold. First is the SIJ transfers load between the lower extremity and the axial skeleton. The sacrum supports the axial skeleton in the pelvis. The SIJ is the interface between the pelvis and the spine.
Secondly, the SIJ is rich in mechanoreceptors that relay load to the cerebellum. Inturn, the cerebellum responds from those afferent inputs with muscular activation and deactivation. In other words, those afferent inputs have a direct effect on kinetic chain sequencing. The dynamic platform, the integration of the intrinsic, deep longitudinal, and lateral kinetic chains are interdependent with SIJ function.
The SIJ needs to have balanced integration as the structure is loaded during gait and other locomotive movement expressions. There are five muscle groups that need to be evaluated for appropriate nervous system response across their full range of motion…i.e. closed, middle, open position as well as the eccentric action from closed to open. The pelvic floor, the sacral spinalis/multifidus, glute max, piriformis and iliacus are the five muscle groups that act directly on the sacrum and affect the SIJ.
Additionally, we also must evaluate how the femur loads the acetabulum. This includes internal and external rotation of the femur, compression and distraction, lunging and squatting, and shinbox variations. These movements and movement combinations make up the vernacular for leg drive. Leg drive is the primal reflex that we need at birth as we must use leg drive to push out of our mothers uterus and through the birth canal. Infants that have a c-section birth, may be deficient in this reflexive movement. One in four people are delivered by c-section birth (reference here).
Like any presentation, we must map the nervous system response. This starts with the appropriate movement benchmarks, like how the nervous system responds to those benchmarks, and whether it is safe to interact with and provide stimulus to those benchmarks.
When we prioritize the safety of the nervous system, we can provide the appropriate stimulus to the prime driver and its main pair. This creates a huge change in the nervous system and normalizes SIJ response. This is an advanced topic in Dynamic Neuromuscular Assessment because there are several foundational concepts that must be developed so that one can safely interact with the client’s nervous system.
Are you looking for an entry point into better client assessment? Do you want to deep dive into movement and be fully in your body? Then the Movement Mentorship Program that kicks off September 2021 is for you. Learn more and register here.
Joint flossing not only helps me and my clients’ healing journey, it also helps me understand the body better as a physical therapist. Our movement patterns involve joints moving in certain ways. It teaches us that each building block of a movement pattern is important for the way we move and our body to thrive. – Nick Keekstra
Recently I was asked by a colleague why Joint Flossing can be profound in helping people recover movements and for resolving pain. Here is the short answer:
Toggling between end ranges of motion stimulates the nervous system. This can restore balanced homeostasis when the source of imbalanced homeostasis is due structural correlations.
The longer answer:
As human beings we all will experience a spectrum of stress, strain and trauma. Our nervous system responds to these events. That response is a coping strategy based on the best choices with available resources.
Joints and the surrounding connective tissue structures have various densities of an array of receptors. These receptors communicate the state of our structure and movement. When stress, strain or trauma occurs, some of these receptors will become up-regulated or hypertonic as a response to the circumstances of that stress, strain or trauma.
When an individual or group of receptors become hypertonic, there is a need and resources are delegated to meet the need of the upregulated receptors. Another group of receptors will give up their resources to meet that need. This is the process of homeostasis.
Joint Flossing is stimulating the receptors in the targeted region. When we toggle between the hypertonic receptors and the receptors that are giving up their resources, also known as hypotonic response, the nervous system recognizes this relationship and can restore balanced homeostasis.
When the receptor balance is restored, the structure can restore as well. There is a bi-directional loop of the nervous system informing structure and the structure informing the nervous system. When the structure has balanced homeostasis, tissues can regenerate, and the nervous system has capacity to respond to movement. This restores the capacity to generate force production.
It becomes important to recognize that muscular capacity or force generation is a byproduct of neural drive. The nervous system controls muscular output. Additionally, muscles are at the bottom of the food chain in the hierarchy of the sensory motor system. This makes muscle response a good benchmark for assessment. However, often muscles themselves are not the reason why there would be structural imbalance.
To go higher up the hierarchy we would start with joint receptors and their influence on muscle response. This is why Joint Flossing and movement can have such a profound effect on an individual’s experience.
We need to be fluent in the vernacular of joint flossing so that we have the capacity to respond optimally to movement. This inturn translates to our ability to help our clients and patients.This is also why you need to be fluent in the vernacular of Joint Flossing.
In September 2021, I’m offering a Movement Mentorship program. We will go through the body joint by joint exploring the relationship of open chain/closed chain/open chain joint flossing. This restores the fundamental building blocks of movement. Once these fundamental building blocks are in place, then we can assemble those components into combinations of movement that require multiple joint coordinations. Everyone that has gone through the progression of joint flossing programs has had epiphanies of lost capacity of movement that they did not realize was unavailable. These are the kinesthetic blindspots that cause less than optimal movement coordinations that result in future stress,strain and trauma.
As a manual therapist, your role includes being a guide for others. You are helping clients reconcile their experience being in their body. There is a saying: we cannot lead a person on a path that we have not travelled ourselves. As a guide, you are tapping into your experience which then provides insight for helping them to navigate their experience.
When working with clients, you are helping them to create a new outcome from what they have been experiencing. They come to you because they view you as having a skill or expertise that can help them. This is why it is important for you to do both your own inner and outer work.
Inner work consists of things like:
self-examination, taking inventory of past events and associations you have to those events,
being reflective of how you respond to the joys and stresses of life,
having a mindful relationship with your sympathetic load, and using tools to down regulate to a parasympathetic state,
and continually working with the triggers that show up in your life.
Outer work includes:
how you take care of your physical body,
the nutrition you take into your body,
the nourishment you get from socialization,
and your method for exercising your body for health and vitality.
Particularly as a manual therapist, your movement practice is a critical interface between your inner and outer experience. In order to be of the greatest benefit to your clients, you must be doing your inner and outer work. This includes having a potent movement practice
The three lenses of perception, sensory, feelings and thoughts are the three categories of information that your nervous system is sorting through as you create associations that define the present moment. These three lenses are a critical component of DNA-Assessment, and here’s why. Sensation in relation to movement offers feedback that informs physical experience. When you can change the sensations in movement, you are also changing the feelings that arise from that movement. This inturn changes your thoughts and the feedback loop of perception in its entirety. We like to say in DNA, “change your movement, change your experience.”
When movement is practiced mindfully, it is one of the more tangible and objective feedback tools in your toolbox. You can sense and feel when movement is smooth, flowing, and at ease. Conversely, there is also a distinct sense and feeling when movement has elements of resistance and/or awkwardness. This is the spectrum of the movement playing field, ease to resistance. The nervous system is also following this spectrum, from normally responsive to hypertonic, or an up-regulated nervous system. (See my homeostasis blog).
A well-balanced movement practice has several attributes: recovery, skills acquisition, and workload generation. Recovery of range of motion is discovering what has been lost due to inactivity or stress, trauma, and injury. Recovery consists also of restoring the fundamental building blocks that provide the nervous system with the options to solve a solution in the movement environment. When these building blocks are available, the nervous system can assemble them in the most efficient way. However, when they are not available, the nervous system must create a work around, like a coping strategy, to contend with the movement environment.
Skills acquisition is the next stage of motor learning. This is when we combine the fundamental building blocks into more sophisticated motor skills. Different activities require different skill sets. As such, the optimal method for developing those skill sets also differs. For example, a swimmer needs different skill acquisitions than a track and field athlete. What is a constant between all athletic forms is the foundational building blocks. How these building blocks are organized and sequenced defines the differences in the skill sets.
Once we have a level of mastery in place, then we can explore workload generation by taking those skill sets and further developing them by changing variables of resistance like load, speed, duration are variables one would toggle to develop workload generation.
In DNA, we use a modality called joint flossing to put these movement concepts into practice. Joint flossing is movement that toggles between available end ranges of motion under no or low load. Joint Flossing is also the entry point to recovering the fundamental building blocks of movement and it is diverse in its application. As a therapist you want to be the very best you can be for your clients. This is why you need a daily mindful movement practice that not only helps you as your own client first, but also is helpful in developing the vernacular used in your assessment process. In my course, Gait Master Class, I have clearly laid a progression of recovery of foundational building blocks, skills acquisition and workload development as it pertains to the walking gait. When you own this type of work, your capacity to help your clients will be exponential. You need movement so that you can help your clients move better and create change in their experience.
In the past I have discussed that binary Manual Muscle Testing can and will produce skewed results. The traditional binary conversion is limited to a dualistic relationship, facilitated/inhibited, strong/weak, or yes/no. The non-binary conversation includes the four possible nervous system responses to the stimulation of the MMT on structure and the nervous system. I’ve categorized those four responses as hypotonic, normal, functional dysfunctional and hypertonic. Read more about this here. There is an additional nuance that needs clarity that is generally unknown in this regard. This nuance is one of the more unique and important aspects of the Dynamic Neuromuscular Assessment™ method of working with clients.
One of the ways that people get confused in MMT is when a direct test flips to an indicator. A direct muscle test can flip to an indirect test under specific circumstances. When this occurs, it is an unknown variable that the practitioner is not aware of. This produces confusing information from the result of that direct movement evaluation.
Direct Test: This is a feedback movement evaluation where the practitioner is applying a gentle force along a specific vector to elicit a musculoskeletal response from the nervous system. The practitioner is evaluating the capacity of the NS to respond to that force and vector.
Indirect Test: This feedback movement evaluation utilizes a prequalified movement response. A qualified indicator has capacity to temporally facilitate or inhibit under specific neurological stimulation. That stimulation can be receptor based or limbic, ie… thought-based. Our thoughts and experiences can and will affect the outcome.
Now let’s clarify how the nervous system would flip a direct movement evaluation to an indicator. The nervous system is responding to stimulus. That stimulus is both conscious and non-conscious. When we are using a direct testing strategy, the nervous system can flip that direct test to an indicator in a few ways.
One way is the previous stimulation can be active in the sensory motor system. If there is a dysfunctional component within that active motor program, the NS will flip the direct test to an indicator. It is indicating that there is something wrong in the previous stimulation. This is why we must evaluate each motor component in the clear. If we don’t, we risk getting forced into the “searching for a needle in a haystack” kind of process.
Another way is either the client or the practitioner is altering the direct test by providing a secondary stimulus. For example, a client’s NS will self TL to increase their capacity to respond. In addition, the practitioner can unknowingly be adding a TL with either a secondary body contact or through limbic resonance.
As practitioners, our clarity in the objective of the assessment process affects the outcome. We can do better and we must do better. The first step to this is learning to get out of a binary conversation. A primary objective in Dynamic Neuromuscular Assessment™ is to learn how to have a conversation with the nervous system. It is through this conversation that we apply a template that vets out the skewed data points resulting from a binary conversation. After we learn the fundamental vernacular, then we can have a conversation with the structure. Vetting nervous system response in a clear and concise methodology is the beginning to have a meaningful conversation with the nervous system. This leads to deriving precisely what the NS needs to restore balanced homeostasis.
Our motor sensory apparatus requires three sets of inputs to respond to our movement environment: ocular, vestibular, and proprioceptive. These three sets determine the quality of output or motor response. This is a bottom-up approach. The bottom-up strategy relies on the inputs to derive output. The top-down approach includes motor planning.
Our somatic experience is based on perception. How we perceive and respond to the world around us is directly affected by the three lenses of perception: sensory, limbic, and thought. There is seemingly a lot going on with the input and response relationship of our motor sensory apparatus. We can dissect these inputs and outputs into these three general categories. Those three categories can then be expanded into subsets. The sensory set is based on how our structure is relaying somatic inputs from our five primary senses: smell, taste, touch, hearing, and vision. There are non-primary senses as well. Proprioception is considered one of them. Proprioception is the set of inputs that allows us to close our eyes and touch our nose. There is an inner map of where our body is in space and the relationship to movement. Without proprioception, we would not be able to develop fine motor skills.
Proprioception relies on the other two motor sensory apparatus inputs to respond appropriately. Impede any of these inputs, and the output will be impeded as well. The three inputs of sensory apparatus and the three of lenses of perception are intrinsically interdependent. Understanding this helps us become better therapists as we fundamentally cannot separate or compartmentalize any of these attributes when working with people.
When we watch a really talented athlete perform their craft, it is hard to discern the amount of training that went into their development. For instance, when we watch a gymnast on any one of their four apparatuses, the physicality of their performance elicits strong feelings. The effort feels like ease, time seems to slow down for them as they can compact more movement into smaller increments of time. Their movement flows in spirals and the human potential brings a sense of awe to the observer. This is a product of both talent and conditioning.
The five elements I outline in The Five Principles of Optimal Movement white paper below are a recipe for performance. The ingredients for that recipe are as varied as the spectrum of sports and activities that we all love to participate in, but are rooted in these five elements that exist in order to optimize our movement.
In February I had the honor of sharing my craft with a great group of practitioners. We had an international crowd. Physical Therapists, Chiropractors, movement therapists, and massage therapists all came together to learn how to appropriately assess and interact with the breathing apparatus.
Our host John Goldthorp works with accomplished athletes at Fix Your Run in Philadelphia. I met John 7 years ago at an Anatomy in Motion seminar in NYC. John and I have stayed in touch over the years, and when the opportunity to share Dynamic Neuromuscular Assessment, I was happy to come out and share my craft.
John and I share many of the same philosophies of movement and training. One aspect of this is how we interact with our clients to co-create an experience.
Here’s what John has to say about his experience:
“Recently, I had the pleasure of taking Joseph Schwartz’s excellent Dynamic Neuromuscular Assessment™ Module 1 seminar. To say there were a few a-ha moments would be a massive understatement; they kept coming, seemingly a few every hour. While that may sound overwhelming, the way the course was structured allowed for plenty of hands on time to synthesize the new information.
I personally experienced the power of this work during the course, having observed my body measurably change in the roughly 5 weeks since I attended, and would love to share with you my experience.
Two years ago, I experienced a ruptured appendix which required an extensive surgery and recovery period. This was certainly a major trauma to my body, but I have been able to recover and get back to – and even exceed – previous levels of performance thanks to the help of many of my movement assessment colleagues.
However, despite making quite a bit of progress in the first year post-surgery, I seemed to have plateaued in terms of my diastasis recti even though I’d been diligent with breathing and strength work.
As Joseph was teaching, I naturally began to wonder, “Is there a prime driver in my situation? Is there a reason my diastasis, although improved, was resistant to further improvement?”
DNA™ teaches you how to have a conversation with the nervous system so that you can determine the prime driver of a compensation.
Perhaps the biggest takeaway of DNA™ is that in order to assess accurately, one must “keep the container safe.” In other words, as my colleague Shannon Connolly so brilliantly stated, “you have to treat the central nervous system with respect. We have to remember that we all have developed coping strategies in order to protect ourselves. Just forcing a modality like a soft tissue release or specific movement/pattern onto someone just because it is “tight” or “feels good” when their nervous system is not prepared for it or cannot cope with that strategy can actually make things worse or keep driving the coping mechanism.”
A ruptured appendix – was it just a structural trauma? Of course not.
DNA™ enlightens us to become aware that a prime driver of movement compensation can be structural, physiological, or emotional in nature and each will affect the other.
During the course, I was chosen to be a breathing assessment demo for the class. Despite having a wealth of knowledge about breathing – and doing my best to breathe properly – I ‘failed’ a majority of functional manual muscle tests involving the breathing apparatus. Now, this wasn’t a huge surprise as I did still have a noticeable diastasis recti, but I couldn’t wait to find out WHY. What was my prime driver, the parking brake holding me back from making more progress?
During the assessment many tests improved when I touched (therapy localized) the scar, however, not all of them.
Assessment showed the prime driver in my case was a limbic association with the ruptured appendix experience. In fact, it was determined that it was the fear experienced after I learned I would need surgery which was the underlying limbic association. Think your breathing might change in response to fear? You’d better believe it. I was ‘stuck’ there, breathing inefficiently, ever since.
We cleared that association using a tool called ‘self rescue’ (just like releasing tight muscles, there are many tools useful for limbic associations) and retested. ALL breathing apparatus tests were now functional. I took my first truly functional breath in two years.
I’m excited and pleased to report it has been roughly 5 weeks since the course and I’ve seen the size of the diastasis recti decrease noticeably for the first time in about a year!“ — John Goldthorp
Thank you John for sharing your experience! I’d like to take a moment and share how The FiveTenets of DNA™ are so potent in providing the nervous system with the optimal environment for beneficial learning.
The Five Tenets of Dynamic Neuromuscular Assessment™
Keeping the container safe is perhaps the most important aspect of the practitioner-client interaction. How we stimulate and tone down the nervous system of our client has a profound effect on the outcome of our interaction.
We utilize the premise that the nervous system learns coping strategies as a means for safety and survival. Those coping strategies have a purpose. How we determine if it is safe to displace a coping strategy with a more beneficial or optimal option is an important aspect of our interaction with the nervous system.
Technique-based therapeutic interventions do not consider whether it is safe to remove a coping strategy. Instead, the application of technique-based interventions is based on whether symptoms change or not. Without considering why the nervous system has utilized a set of coping strategies, can produce undesirable effects by trying to change them. For example, when our client’s return over and over with the same symptoms, or their symptoms worsen, this illustrates that the coping strategy has not been appropriately addressed.
There is an alternative to a technique-based intervention. This requires a specific process to identify the Prime Driver of the coping strategy so that the driver can be appropriately addressed.
~ Manual muscle testing can and will produce skewed results
This is the elephant in the room. Traditional manual muscle testing has some inherent problems. I’ve identified two false negatives and two false positives within the binary context of MMT.
However, there’s no need to throw the baby out with the bathwater. Instead we can employ a specific process to have non-binary conversations with the nervous system. This starts with autonomic nervous system response. We know that the receptor’s response changes when the parasympathetic up-regulates to the sympathetic nervous system. This becomes the first step in creating a tangible benchmark in movement assessment.
The ANS response is an indirect movement assessment. This is then combined with a direct movement assessment. These two aspects of the assessment process sophisticates the faulty binary approach to a more accurate non-binary conversation with the nervous system.
~ Global / Local / Global
Global movement engages feed-forward motor planning. This gives the nervous system the opportunity to utilize its preferred coping strategy. Once that coping strategy is stimulated by movement, we can dissect the individual building blocks of that movement. This allows us to go deeper and more effectively in the assessment process.
~ Secondary Compensation distracts us from the Prime Driver
Secondary compensation is the low hanging fruit we see in our clients symptoms. Our primary coping strategies require resources. The symptoms clients are experiencing have a correlation to giving up the resources needed by the prime driver. If we remove the option for those resources, we are creating a safety issue for the nervous system. This is counter to keeping the container safe.
~ Specific Adaptation to Imposed Demand, the SAID principle is our ally in efficiency
The SAID principle affects the outcome of corrective strategies. How the nervous system is cued with the symptom causation relationships, builds the internal kinesthetic picture of the nervous system’s coping strategies. When the dots aren’t connected for the nervous system, it may or may not be to make the connection between correlations and symptoms.
This is why the mapping process I teach in DNA™ is essential to honor these five tenets. In DNA™ Mapping, we derive the common denominator, the prime driver. We then evaluate the prime driver. We then can simply do one intervention that resets the whole paradigm of prime driver, main pair, and secondary compensations. In John’s experience, the combination of the limbic association and the structural adaptation from surgery had to be appropriately interacted with so that the nervous system had the opportunity to reset all the players in respiration. When the nervous system can respond appropriately, the structure can follow. The result is his diastasis recti can now mend more fully.
For every symptom you’re seeing come into your office, there is something driving that symptom. It may or may not be obvious. These symptoms are a coping strategy that the nervous system perceives as necessary for safety. In addition, coping strategies require resources to sustain. An often overlooked and underappreciated element of assessment is asking yourself two questions: 1) Where do those resources come from? 2) Are those resources in sustainable supply?
By the end of this article, you’ll have a fresh lens that frames adaptation and coping strategies. This reference will help you better evaluate, assess and treat your clients so that their nervous system has the optimal opportunity to make lasting change.
Let’s look at the universal principle of homeostasis to further gain understanding how the nervous system is allocating and engaging resources.
The universe is made up of atoms. Atoms can have many configurations and combine in multiple ways. The periodic table of elements gives us insight into the many ways atoms are expressed. The construct of the atom is the building block of matter. Atoms have a balanced charge of positively charged neutrons and negatively charged electrons — homeostasis! The balance of these charged particles are the blueprint for how atoms assemble into larger structures. Atoms have the same number of protons as electrons. When an atom is missing an electron, it is called a free radical. “The unpaired electron makes them unstable and highly reactive. In a process called oxidation, free radicals steal electrons from other molecules.”
Our neurology follows a similar pattern of homeostasis. When one of our systems has a need, that need requires resources. The nervous system acquires these resources from an available donor – it is a reciprocal partnership.
Our neurology is affecting our breath, movement, and structure. These are the more tangible elements of the interdependent body systems. Reciprocal partnership — homeostasis — is affecting each and everyone of these systems as well. Let’s first look at how this is reflected in the musculoskeletal system, and then we can open up the lens.
One commonly known example of reciprocal partnership is the reciprocal inhibition. Reciprocal inhibition is a function of how muscles behave in the musculoskeletal system. Reciprocal inhibition can be defined as when muscle response increases, the functional opposite muscle response will decrease. For example, when we do a bicep curl, our tricep must relax so that the bicep is not competing with the tricep when moving the weight.
If we didn’t have this fundamental principle in movement, the muscular system would be constantly competing for energy.
This same principle applies to the parasympathetic and sympathetic nervous system. When the sympathetic nervous system becomes stimulated, or up-regulated, the counterpart, the parasympathetic down-regulates. Homeostasis happens in every system of the human organism.
Let’s apply this template to a therapeutic setting using events, adaptation, and prime drivers.
An event is an experience someone has involving multiple elements including perception, sensory, feelings, and thoughts. Each of these lenses contribute to how an event is then interpreted and registered by the person’s nervous system.
An event and adaptation are intrinsically linked. Adaptation is a learning process of the nervous system to cope with and respond to the changing environment. Adaptation has three characteristics: beneficial, neutral, and maladaptive. The adaptation that occurs during an event is perceived by our nervous system as necessary, as its job is to keep us safe.
The prime driver is the first element the nervous system utilizes during an event. The prime driver requires resources to function. As the prime driver’s needs increase, the resources of its reciprocal partner are decreasing. The reciprocal partner is giving up its resources in order to boost the resources available to the prime driver. This is mirrored by the example of reciprocal inhibition.
The prime driver is in a reciprocal partnership with another element. This element is giving up its resources to boost the prime driver. We will call this second element the prime driver’s main pair. Now, what do you suppose happens when the prime driver’s main pair no longer has sufficient resources to maintain the relationship? The prime driver looks for another element that can give up its resources. We will call this a secondary. There is the potential that there are many secondaries that are supporting the prime driver. As the needs of the environment increase, the needs of the primary driver to maintain sufficient response increases as well. Environmental load, and the coping strategies to meet that load, are affecting how our nervous system is responding.
Nervous System Response
Under a low load context, our nervous system should have capacity to remain normally responsive. As our environmental load increases, we should have capacity to appropriately respond to those needs when required. Sometimes this includes the need to up-regulate. Then as the stimulus of the environment ceases to require that up-regulated response, the resources requirement then down-regulates or returns to a normal response. When it does not, this is referred to as a hypertonic response. A hypertonic response is a coping strategy.
Muscle response gives us a tangible benchmark for how our nervous system is responding to a changing environment. This can be qualified by the conversation received by the afferent signals from peripheral receptors. Our receptor response changes when the nervous system upregulates from the parasympathetic to the arming of the sympathetic nervous system. The muscle response graph gives us insight how the nervous system is responding to environmental load. This is a key element in the assessment process. Rather than treating a symptom or toning down the symptom, in order to really help our clients, we must identify the specific stress that is creating inappropriate movement response and specifically what the nervous system needs to restore parasympathetic homeostasis.
The limbic system is the primary information gathering and response center in the brain. It receives a portion of neurological inputs from our environment that are the perceived experiences that are then processed and collated. This is so we can respond to these inputs in real time. The limbic system is commonly known as the emotional center, in addition to the function of memory, autonomic regulation, and motor control. Associations and the correlating emotions to those associations have an effect on both autonomic regulation and motor control.
The Limbic Associative Feedback Loop (LAFL) demonstrates how coping strategies work.
We live in a changing environment and our somatic sensory pathways are constantly monitoring and taking in information. Each instance potentially becomes an event.
Events are registered through somatic sensory pathways. This information is both conscious felt sense and our unconscious unfelt sense.
When we receive new somatic sensory information, the limbic center looks for something similar that it can attach to the new information — past events inform the present moment.
At this juncture, the limbic center processes both the somatic sensory information and the association. That information is then directed to different parts of the brain depending on where that information falls in the spectrum of “need to respond” in a survival based hierarchy.
A person’s response to an event is based on multiple factors. Their ability to appropriately respond to the stimulus of an event is based on conditioning and the relationship to adaptation. Additionally, depending on the perceived survival need, the spectrum of the response will come from the amygdala, prefrontal cortex, cerebellum, or brain stem. This output becomes the next potential event. Receiving information from our environment and responding to that information becomes a perpetual loop.
What LAFL Looks Like:
A person experiences an event by receiving neurological inputs into the limbic system. There is now a need to respond. The limbic system begins looking for similar neurological inputs to this event and how it has previously responded to those inputs. That coping strategy has a prime driver. In order to create homeostasis, there will be a main reciprocal partner as well as the potential for multiple secondaries. As the need for the prime driver increases, multiple secondaries can create a multi-symptom presentation.
What if the event is a novel experience? In the future, that novel experience will become a new association along with new coping strategies utilized to respond to a similar set of circumstances.
The nervous system has a full palette of options it can utilize as a prime driver at the time of the event. It can be structural, physiological, or limbic . Likewise, the nervous system can choose a main pair and subsequent secondaries from the same palette. This pallet is generalized in the Triad of Health chart.
Good Intentions – Wrong Approach
One of the common problems to recognize in the assessment and treatment of the musculoskeletal and its corresponding motor control systems is that therapists are frequently treating the symptoms. This is problematic because often those symptoms are being recruited by the nervous system for a reason. Without adequately vetting why those symptoms are present, we can inadvertently remove a necessary coping strategy. This can create vulnerability in our client’s nervous system. When we apply the universal principle of reciprocal partnership, we can be more efficient therapists. Instead of treating the low hanging fruit of the symptom, we can follow the symptom-causation relationship to derive the prime driver. When we appropriately address the prime driver, not only do we accomplish more in helping our client’s presentation, we are also honoring the primary coping strategy of their nervous system, keeping the container safe.
Let’s take a look at some examples of how the nervous system may choose to support a reciprocal relationship. As manual therapists we may be familiar with how joints and ligaments affect muscle response. Ligaments will act as neuromuscular switches for the muscles that would act on that ligament. When joint position is compromised by load, speed or vector, the ligaments role is to protect that joint. When a ligament becomes strained, it sends input signals to the cerebellum to inhibit the muscles that would act upon that joint/ligament. This is a non felt sense protection mechanism. The strained ligament will look for a reciprocal partnership to sustain this protective adaptation strategy.
An example can be applied to the knee. If during movement, the ACL gets stressed and the stress load is sufficient enough that the receptors are unable to return to a normal resting response, the movement that caused the knee to deviate into a position that stressed the ACL would be the event. The response to this event is the up-regulated receptor response to the cerebellum. The cerebellum then instructs the assisted muscle to inhibit as a protective strategy. Next, the nervous system looks for a reciprocal pair for the main driver, the strained ACL. Often in structure, the nervous system picks functional opposites. For example, the oblique popliteal ligament has an opposite function in the rotary capacity of the knee.
The low hanging fruit are the muscles that are inhibited. But there is a big problem if we then strengthen those muscles, as the action on the knee is going to increase the already hypertonic response of the ACL. This is treating the symptom! Instead, we need to derive the prime driver and cue that driver to its main pair. When the nervous system receives that information, the cerebellar response is normalized and the associated muscles return to normally responsive.
Prime drivers that are of the emotional association nature will often pair with an organ. The resources needed by the emotion is given up by the organ. A few classic examples are anger/liver and worry/stomach. The rub is if we remove the secondary compensations without addressing the prime driver, we are potentially weakening the ability of the prime driver to maintain its resource needs.
When we remove a coping strategy of the limbic system, the nervous system goes on alert with a sympathetic response. Further, depending on the spectrum of the association, mild to severe, this can be destabilizing and highly counter productive. In the severe spectrum, this can cause a PTSD episode. This is why we must evaluate the source and causation of the imbalance we are seeking to treat, before treating symptoms in the musculoskeletal system. This is how we move into being a master in our craft regardless of the corrective tools we deploy.
Let’s look at a Dynamic Neuromuscular Assessment™ Module One case study to further illustrate the concept of the prime driver.
Case Study: Assessment of the Breathing Apparatus
Global Skill: QiGong Posture
Visual: appears that the diaphragms move out of alignment creating a lack of integrity in the core cylinder
MMT: Functional Dysfunctional Response: Correlation to Limbic Association
Limbic Association TL- same association as the global movement association
Double Check Work:
Client TL’s the R Jaw
Retest PF and L sub-occipitals
Cue the associated movements into the nervous system (order matters)
Limbic hold on the Bennett points (cranial hold, observe the breath)
Retest: (in the same order)
PF normal response
Sub-occipitals normal response
Jaw normal response
Re-insert local components back into the Global Movement
As body helpers, our first consideration is client’s safety — what I like to call keeping the container safe. We did this by adding stability into the system. We did not remove coping strategies which would result in creating vulnerability to the system. The old MMT paradigm would indicate that we should have released the sub-occipitals. If we would have tried to correct a dysfunctional component correlated to a limbic association, potentially the response of that limbic association would have increased. That would have resulted in harming the client!
Limbic associations can have multiple layers mirroring the template of compensations with primary and secondary/s, so we had to tone down the association so that the nervous system could appropriately respond to the environment. There may be more work needed to effect sustainable change over time. However, with one corrective, we restored movement function to all the local components and the initial global assessment. That could not have happened if we did not utilize the SAID principle, specific adaptation to imposed demand, in our assessment and correction strategy.
If you’re not fully vetting your client’s presentation, you may be taking them down a path you don’t need to travel. Mapping is an essential tool in your toolbox to avoid wasting valuable resources and time for both you and your client.
Often times, practitioners are treating their clients before they know the root source of their client’s presentation. Not only is this a waste of time for both the client and the practitioner, it may also mean they end up treating the symptoms of secondary compensation. This can be a perceived threat to the nervous system and lead to further layers of compensatory adaptation down the road.
When I started implementing mapping into my own assessment, here’s what happened.
In the past I would evaluate movement response and look toward what was needed to restore that response. This was a method of looking for the low hanging fruit with the hope that it would make a tangible difference. The process was hit or miss at best. As I became a more adept practitioner, I wanted to understand why I had the misses. I started taking more time in the assessment process. I also started to look for the common denominator that was correlating to the inappropriate movement response in my clients. Then I would assess that correlation. It took longer to assess, but that investment in time was more than made up for in the optimization of the corrective strategies that were utilized. Instead of multiple correctives to the nervous system, I was only using one or two laser focused interventions. I found people were getting faster results with minimal stimulus to the nervous system, because it was the right stimulus.
When you implement an assessment process that honors the nervous system’s need for safety, you will begin to see an optimization in your assessment — a leveling up so to speak. This starts with building safety into the nervous system by not removing coping strategies that have been put in place for a reason.
In order to do so effectively, we need to understand why the nervous system has organized the coping strategy that is being presented. I call this mapping. In mapping, particularly through the lense of Dynamic Neuromuscular Assessment™, we are evaluating the symptom-causation relationship. When evaluating the symptom-causation relationship, we have to keep in mind that the causation of one set of symptoms may be a symptom of another causation.
Let’s use a recent pelvic floor client assessment to illustrate the symptom-causation relationship. After doing a thorough movement assessment process, I found the movement functions that did not respond appropriately correlated to a ligament in the coccyx. I then evaluated the ligament in the coccyx. This assessment correlated to a limbic association.
If I would have spent valuable time working directly with the ligament, it could have been problematic for a number of reasons. One problem could have been that the limbic association would have trumped any structural change that might have happened temporarily. Another problem, and more potentially detrimental, is a safety issue for the coping strategy that the nervous system put in place to support the limbic association. When we remove that coping strategy as an option for the nervous system, that potentially can create instability in the limbic center’s ability to cope with the association. This can derail a person’s capacity to appropriately respond to their environment.
In this example, the limbic association required support from the structure. That support is a resource. If we remove that resource, the nervous system will come up with a strategy to replace that resource. The best case scenario is that the nervous system recruits a similar or familiar coping strategy. The worst case scenario is that things could take a turn for the worse with the nervous system replacing that resource with a less desirable coping strategy than its original choice. This could be a structural, physiological or even a limbic maladaptive strategy.
If you’ve ever had clients that either did not respond to treatment or had their symptoms return, this is the reason why: The root source of their presentation was not addressed appropriately, so when day to day activities loaded their nervous system, their symptoms got worse and/or were compounded by a new coping strategy. This is when utilizing mapping in our assessment is critical to derive appropriate intervention with the nervous system of our clients.
Would you like to learn how to optimize your assessment and utilize the process of Mapping to help your clients in a profound and efficient way? Dynamic Neuromuscular Assessment™ is a method by which to have a conversation with the nervous system through movement. Our next DNA™ Seminar is February 22-23rd in Philadelphia. Hosted by John Goldthorp of Fix Your Run.