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White Paper: Functional Assessment of the Pelvic Floor

The pelvic floor is often overlooked and misunderstood during movement assessment. The pelvic floor is integral to both breath and movement. This is good news, as it allows us to use movement to assess the pelvic floor. This is important because of the sensitivity of the pelvic structure. More invasive approaches like direct palpation of the pelvic floor compromises safety of both practitioner and client. Starting with movement assessment builds safety in the nervous system. In addition, movement assessment also allows pelvic floor assessment to be accessible to practitioners where direct contact with the pelvic floor is out of their scope of practice.

There are a few principles of movement assessment to consider with pelvic floor assessment. These include functional assessment, the biomechanics involved, and how to keep the container safe. Differentiating how the nervous system is responding from structural response becomes the foundation of functional assessment. Next, we need a clear understanding of the biomechanics involved. Because the pelvic floor is fundamental to the breathing apparatus, the pelvic floor is virtually participating in every possible movement.  And perhaps most important, how we keep the container safe. The pelvic floor is a sensitive, limbically driven, aspect of our structure, and we must use caution so that we do not overstimulate the nervous system.

Download the paper in its entirety below.

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Tool-Based Versus Assessment-Based Interventions

From my perspective, there is currently a fundamental problem in the manual therapy community. Manual therapy is predominantly a tool-based intervention strategy; consisting of many variations of tools and techniques. As a result, practitioners take the particular tool they’ve been educated in and apply it to the presentation of the client.

Being a former race car mechanic, I liken this analogy: If I purchase a brand new shiny 10mm wrench, am I going to go around the car and look for fasteners it might fit? That doesn’t make a lot of sense, does it? Let’s dive a bit deeper.

We see a plethora of technique-based courses being offered in our profession. There are many reasons why we need to have an array of tools available to us. However, the tools themselves often distract us from finding the causation of each unique presentation. When we are simply applying a tool to a problem to see if the problem changes, we are guessing. This has the potential to be negligent. 

I recognize that the statement that a tool-based intervention is potentially negligent is a bold statement. Let’s build some context that supports the statement. We need to consider two specific variables in an individual’s presentation.

Adaptation

Adaptation is a learned coping strategy. Understanding why that coping strategy was implemented by your client’s nervous system is the primary consideration. That person’s experience has biopsychosocial factors that influence how their nervous system chose to cope with and adapt to the changing environment around them.

Compensation

The  combination of symptoms based on a nervous system’s chosen adaptive strategy, is not consciously chosen. It is instead a function of the survival-based nervous system. Adaptation is mostly unconsciousness behavior. However, there are exceptions when we consciously add elements to our environment for beneficial change — like changing one’s diet or engaging in a fitness plan. Maladaptive compensations are often driven by our unconscious, even if it seems like we are making conscious choices.

Here’s  a hypothetical presentation that illustrates how a tool-based intervention can be negligent. Let’s use an example of regional interdependence, where one region of the body compensates for another region of the body not participating. For example, a client comes in with sacroiliac pain. The function of pelvic sacral stability is diminished in some way. Using the model from Lovett Reactors, the therapist traces the instability to the jaw. The therapist then treats the jaw. 

There is a fundamental problem with this. While the pelvic sacral stability issue is a symptom of the jaw, more times than not, the jaw is a symptom of something else. That something else is related to an experience, which became an association that has an array of emotional responses. The symptoms we are seeing in the jaw is related to a past experience and a limbic association. Effectively, what the therapist has inadvertently done is remove the coping strategy of the limbic system. The potential for this to blow up is pretty high.

Now let’s look at a real life example. This occurred in a seminar that I attended several years ago. A combat veteran was getting a neurological treatment from a colleague to correct a movement dysfunction. Unbeknown to the therapist, that movement dysfunction was related to a combat experience. The person on the table had a full blown PTSD incident while being treated. Afterward, he became suicidal and had to be on suicide watch while his limbic system reorganized to find a new coping strategy to compartmentalize the traumatic event.. This kind of response can happen on a spectrum from mild to full blown PTSD flashback like this example.  When we are treating symptoms, we are potentially creating a vulnerability in the coping strategy of the nervous system.

There is a solution to this problem of tool-based therapeutic intervention. The solution is an assessment-based process that determines the root cause of the individual’s presentation. That assessment process must consider each aspect of the presentation as a potential symptom. The symptom-causation relationship must be traced to the driver of those symptoms. That driver is the root causation. That assessment process must take into consideration the entirety of the biopsychosocial model. The down side of this is when the causation of the individuals presentation gets out of our scope of practice. This is when our referral network becomes very important.

As therapists, we can do better. We can advance from being the hammer and seeing every problem as a nail. Instead, we can hone our assessment strategies to derive the appropriate tool that is needed — see The Five Tenets of DNA™ to learn more. We can determine if it is safe to use that tool. We can live up to the first rule of the Hippocratic oath: Do No Harm.

Learn More About the Biopsychosocial Model

https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/biopsychosocial-model-approach.pdf

http://www.enniscentre.com/Presentations/Gatchel-Biopsychosocial%20Approach%20to%20Chronic%20Pain.pdf

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Ligaments

I was recently asked to review Robert Libbey’s new ligament referral charts. This is an important contribution to the therapeutic community. I’d like to detail a few reasons why understanding ligament function and pain referral is important in consideration for structural-based pain and maladaptive movement strategies.

Robert Libbey’s Ligament Pain Referral Pattern Posters

The area in which we sense pain is often not the source of that pain. More often than not, therapists are trying to treat the muscles around the symptom of pain. This yields inconsistent results. Muscles aren’t always the source of the pain. Muscular behavior, tonicity, and recruitment patterns are based on the response from the brain’s motor control systems.

Ligaments trump muscles in the survival-based nervous system. Ligaments act as neuromuscular switches to increase muscle tone or decrease muscle tone. This reflects the neuromuscular relationship in movement called reciprocal inhibition. Reciprocal inhibition allows for muscles to act as a team. As one muscle activates or increases its energy output, its reciprocal partners deactivate or decreases their energy output. This fundamental principle is a primary function of ligaments providing somatosensory input for the nervous system to process and respond to.

Ligaments act as a safety valve in joint response. Ligaments also inform neuromuscular sequencing. When a ligament is stressed, strained or otherwise impaired, the afferent input signals that ligament sends to the cerebellum, switches off, or inhibits the muscles that would act on that ligament. This is a protection strategy so that joint movement does not further stress the impaired ligament. The impaired ligament does not need to be injured to send signals that would result in an inhibitory response. The result however, would mimic an injury. These errant neurological input signals can be reset with appropriate manual therapy intervention.

Ligaments have two primary roles:

  1. Ligaments hold joints together in their optimal position. As joints move, muscles respond to that movement. When joints lose their optimal alignment, the muscles function that would act on those joints becomes impaired. The musculoskeletal system needs appropriately responding muscle function to control movement, to keep the structure safe.
  1. Ligaments provide somatosensory input to the brain’s motor control systems. This sensory input allows for non-thinking movement. We do not have to think about which muscles to activate when we move. The afferent information from ligaments, and other receptors, provide the field of awareness for the brain to respond. We would not be able to manage the complexity of walking and running if not for the information that the ligaments provide.

Here is an interesting fun fact about the somatosensory aspects of ligaments. There are two tracts of afferent information that goes from the peripheral to the central nervous system. The first tract, the spinothalamic tract is received in the limbic center’s thalamus. This information is processed and informs our kinesthetic awareness. This is the conscious field that is often referred to as proprioception. The second tract, the spinocerebellar tract, particularly has my interest. The majority of information that is received from the periphery directly to the cerebellum does not inform our conscious kinesthetic awareness. This is how movement occurs in the non-thinking place. The nervous system is responding to the changing environment without that person’s conscious volition .

Ligaments, both their assessment and treatment, have an essential  role in the structural therapist’s approach when working with clients. These important charts published by Robert Libbey, RMT, provide a visual reference to look deeper than the symptoms of pain. These are another set of complementary charts to add to your collection – Complementary Reference Tools.

References:

https://www.lastsite.ca

https://happybraceco.com/wp-content/uploads/2015/06/7_Solomonow_ISEK2006-JEK_Smart-bracing.pdf

http://www.blackwellpublishing.com/patestas/chapters/10.pdf

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All About Flossing

The concept of using movement to floss the connective tissue that surrounds nerves is not new.

Let’s open the lens beyond nerve flossing and look at how other aspects of our structure benefits from flossing as well.

Tissue Flossing/Pulping:

This is movement that specifically targets fascial compartments. Co-activation of functional opposites creates spirals in the fascial compartments. This effectively wrings out the tissues like wringing a wash cloth. The benefits of pulping the structure are many. Releasing residual muscle tension, squeezing and soaking the tissues in fluid exchange, restoring elasticity in the tissues, and muscular integration are important aspects of pulping.

Joint Flossing:

Joint articulation or joint mobility also has many benefits. Joint mobility is not passive. There is the co-activation present though not as intense as in pulping. The intention is to move the structure through its complete range of motion in a smooth, controlled, pain-free manner. Each joint has its unique attributes in movement. The Functional Compass™ – as outlined in Applied Anatomy for Yoga Therapeutics – provides a map for movement potential.

One distinct quality of joint flossing is working on the capacity to isolate movement to a targeted joint. This develops the individual building blocks of movement. When we have motor control of the individual building blocks of movement, these building blocks can then be assembled into larger integrated movements.

The nervous system will always look for the most efficient way to accomplish movement. The more choices that are available, translates into more options for efficiency. Also, when movement deviates in a changing environment, the nervous system can then maintain a safety valve with all the options available. The nervous system knows which movement options are available and which ones are not. The nervous system will always devise a way to work around movement options that are not available. This is a fundamental of maladaptive compensation.

Benefits of joint flossing; Joint articulations:

– renew synovial fluid in the joint capsule.

– disperse joint salts and metabolic by products.

– are a beneficial stimulation for the nervous system.

– develop the building blocks of movement.

– stimulate mechanoreceptors.

– cue the nervous system for the available building blocks of movement.

– are a form of active recovery.

– prime the nervous system for work load.

Something to consider:

In real life, there are no warm-ups. When the demands of a changing environment requires response, either the capacity to respond appropriately is available or not. Only during our training time do we have the luxury of warming-up and skill development. While it may seem pedestrian to practice joint mobility as a regular aspect of your training program, I can say as an aging athlete, it is fundamental to maintaining healthy structure and movement.

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Five Considerations for Your Assessment Strategies

By streamlining assessment via the considerations outlined in Dynamic Neuromuscular Assessment™ Seminars, you can save yourself and your client a lot of time and energy. Let’s illustrate this with several of the considerations that make DNA™ unique.

First Consideration: Keeping the container safe

DNA™ teaches us effective ways to monitor the response of our client’s nervous system in order to keep the container safe.  Our nervous system chooses adaptation strategies as a protection mechanism. These strategies have a priority. There is the primary compensation and the potential for multiple secondary compensations. These secondary compensations boost the primary compensation. If we indiscriminately remove a secondary compensation, we are inadvertently creating a void in the container of our client’s coping strategies. The nervous system then must adapt to not having that available element. What the nervous system chooses to fill that void with may potentially be more maladaptive than the original coping strategy. This can happen in all three categories of the trine in Applied Kinesiology: movement and structure, physiology and subtle body energy, and limbic associations and emotions. The danger here is that if we kick out the leg in a three-legged stool…something is going to crash. This can become a big problem if the nervous system chooses to utilize the energy system from our physiology or limbic associations to bolster dysfunctional movement.

Second Consideration: Manual Muscle Testing can and will produced skewed results

Protocols we utilize in Dynamic Neuromuscular Assessment™ allow us to recognize when the false negative and the two false positives show up in MMT. There are two causes for this. First, the practitioner may have unresolved issues in their mind/body. As practitioners, we affect the outcome. Our expectations and projections, conscious and unconscious, have an impact on the testing results. The second cause is the response we are getting from the client. There are two false positives and one false negative that are constantly showing up in our MMT. If these are not vetted, our correlation of relationship and causation will be skewed. We need a specific process, or protocol like what is shared in DNA™, to double check when the movement response gives us faulty data.

Third Consideration: Global / Local / Global

Global assessment in DNA™ evaluates the ability of the nervous system to respond using feed-forward assessment. This allows the nervous system the opportunity to utilize the primary compensation. Then we can further vet the dysfunction by looking at the local components. The first global assessment gets us in the right neighborhood, the local components, or building blocks of movement, gets us to the right house. As we continue with the process we end up in the right room, in the right house in the right neighborhood. After we have vetted the primary driver, restored normal response, we can insert that back into the global movement for re-evaluation. The global local global approach is much faster at vetting the primary compensation. This is the opposite of the hit or miss strategy of relying on local assessment to resolve a presentation.

Fourth Consideration: Secondary compensation leads us astray from the primary driver

When we are evaluating movement, every dysfunction has the potential of multiple pieces. How we trace, or map, the dysfunctional components in DNA™ makes a difference in the outcome for your client. We must treat each piece as a potential symptom and completely vet the presentation before we employ a corrective strategy. This relates back to the first consideration and is a major tenet of DNA™, we do not want to remove a secondary coping strategy as that creates vulnerability. The mapping process specifically vets the dysfunctions to arrive at the primary dysfunction. Initially this may seem like the tortoise and the hare approach. The hare would be treating what they find as it presents itself. The tortoise looks at the complete presentation before using laser focused corrective strategies that have the most impact with the least amount of intervention.

Fifth Consideration: Specific Adaptation to Imposed Demand, the SAID principle is our ally in efficiency

DNA™ radically optimizes your assessment by implementing the SAID principle.  The SAID principle has two primary ways it affects the outcome of our work. The first is the preliminary steps we take during the evaluation process. Does the process complete the map of the presentation? When it does, we can then cue the nervous system to all the elements that correlate to the primary dysfunction. When we employ a corrective, then the nervous system has an understanding of how these pieces interrelate. We then get the most value from the least amount of work. The second way the SAID principle affects the outcome is related to the corrective strategy itself. If we have not cued the nervous system appropriately, then the nervous system must interpret what, how and why the pieces fit together. Often, the nervous system is unable to fill in the missing pieces. When this happens, our corrective strategy will be temporary at best. This is why clients will return with the same presentation over and over. The nervous system is not getting enough information to make a sustainable change. Instead, when the environment load increases beyond capacity, the nervous system returns to a familiar coping strategy.

Let’s look at how these five considerations weave together in an evaluation process. This is an excerpt from a recent DNA™ Module One practicum.

Intention: 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

Local Components:

Sacrospinalis / multifidus –  normally responsive

TVA –  normally responsive

Pelvic Floor –  functional dysfunctional

Vet Pelvic Floor:

Structural – L sub-occipitals TL

Vet L sub-occipitals – functional dysfunctional

Structural – R jaw TL

Vet R Jaw – functional dysfunctional

Limbic Association TL- same association as the global movement association

Double check our work:

Client TL’s the R Jaw

Retest PF and L sub-occipitals

Normal Response

Corrective:

Cue the associated movements into the nervous system (order matters)

Limbic hold on the Bennett points (a generic cranial hold while observing 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

Normal Response!

Summary:

Using Dynamic Neuromuscular Assessment™ our first consideration is the safety of our client’s nervous system.  We then add stability into the system. We did not remove coping strategies creating vulnerability. The old paradigm would indicate that we would have released sub-occipitals. If we would have tried to correct a dysfunctional component that is correlated to a limbic association, potentially the volume of that limbic input would increase. That would have essentially kicked the third leg out of the three-legged stool.

Limbic associations can have multiple layers mirroring the template of compensations with primary and secondary/s. We toned down the association. We did not necessarily remove or clear. We tone it down so that the nervous system can appropriately respond to the environment. There may be more work needed to effect sustainable change.

Using only one corrective – in the DNA™paradigm – 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 in our assessment and correction.

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Adaptation and Keeping The Container Safe

As therapists, our clients come to see us to help them with issues they are experiencing. They often have a clear idea of what they believe is going on. However, we know that the symptoms they are experiencing are often not the root of the issue. Our client’s symptoms do, however, provide us with the necessary clues to arrive at the source of their experience. As therapists, we know maladaptive compensation has a primary causation with secondary supporting players. Often, the symptoms of the secondary compensations lead us astray from addressing the primary causation.

We are familiar with the peeling of the onion analogy. When we are “peeling away the layers” what we are doing is removing secondary compensation from the nervous system’s coping strategy. We are creating a void in the container that could then be filled by unknown element. For example, it is becoming more acknowledged that athletes will perform poorly if their event is after a deep tissue style massage. The reason for this is the global secondary compensations have been removed and as a safety valve, the nervous system puts the brakes on. And if that athlete pushes through that safety valve, strain or injury is the result. Many of us have experienced our clients getting worse after a treatment. The reason why is we removed a secondary compensation without addressing the primary. This left a void in the container and the nervous system filled that void with something, an unknown element.

Let’s unpack this further.

One of our greatest survival attributes is adaptation. Adaptation allows our species to learn from and cope with a changing environment. Without this capacity, human beings would not survive.

There is a universal truth that defines adaptation:

The organism will adapt to its environment regardless of the outcome.

This has far reaching implications on how we adapt to our environment. When we consider short term verses long term adaptation strategy, short-term adaptation may be beneficial. However, as a long-term strategy, the short-term adaptation may not be sustainable and will eventually lead to reduction of optimal function.

The spectrum of adaptation can be further reduced with a second universal truth:

Specific Adaptation to Imposed Demand.

The SAID Principle governs how specifically we adapt to a changing environment. As a survival strategy, it is how we learn to reproduce results with greater efficiency.

When we combine these two universal truths, we can see how our environment, both external and internal, both conscious and unconscious, is influencing our response. We are in a continual process of utilizing coping strategies to respond to our environment. Our coping strategies are learned through the process of adaptation. How we learn from our environment is directly correlated to how we cope with that environment.

When we employ a particular coping strategy, we are reinforcing that strategy. Each time we then use that particular strategy it becomes easier to reproduce. The effect of employing that strategy has three potential outcome categories.

Beneficial:

When an adaptation strategy is beneficial the organism thrives.

Neutral:

When an adaptation strategy is neutral there is no change in the organism.

Maladaptive:

When an adaptation strategy is maladaptive the changes in the organism are unsustainable.

Because these qualities of adaptation are universal, they can be applied to the whole spectrum of our human experience. This includes the triad of Applied Kinesiology; psychology, physiology, and structure.

There is one more universal truth that we need to unpack: keeping the container safe.

The container refers to the collective adaptations and coping strategies that we have utilized in the past. Each one has its own unique signature. Some may be conscious, while others are unconscious.

Keeping the container safe:

Displacing an element with a beneficial strategy keeps the container safe

 In the therapeutic process this is of the utmost importance. As a therapist, we cannot simply remove an element from the container, as this leaves a void in the container. That void is then going to be filled with an unknown element. When we are working with a maladaptive strategy, and we remove that maladaptive strategy, what is going to replace that strategy is also going to be maladaptive. To keep the container safe, one must displace a maladaptive strategy with a beneficial strategy. Or at the very least, a strategy that is more beneficial than the maladaptive.  This can be applied to our whole spectrum of human experience.

Let’s look at how this would apply to manual therapy. We have heard the analogy of peeling the onion of compensation. This peeling of the onion analogy illustrates that in the adaptation process, there is a root causation with multiple layers on top of or covering up the root causation. Let’s explore this through the lens of adaptation.

When we have learned a maladaptive compensation, the nervous system has a need to make that compensation easier to reproduce. As the needs of the environment increase through frequency, intensity, and/or duration, that learned coping strategy will be challenged. When the nervous system perceives that the present strategy is insufficient to respond to the environment, the nervous system will look for a supporting compensation for the original perceived need. If the environment demands a continual response, another supporting compensation will be added to the equation. As the layers increase, the nervous system does not discern between the need to respond and whether that response is sustainable. This comes back to the first universal truth of adaptation: the organism will adapt to its environment regardless of the outcome.

Said another way, we designate the response to the original causation as the primary compensation. All the other subsequent compensations are secondary. These secondary compensations are put in place by the nervous system to support the primary. As environmental demands increase, so does the need for secondary compensation.

The unknown element that the nervous system chooses to replace a secondary compensation brings up the next concern. The nervous system has a whole palette of systems it can tap into and utilize to support or boost a primary compensation. Compensation is not simply limited to musculoskeletal elements. Compensation occurs in any system within the triad of the emotional, physiological and structural.

When we remove secondary compensation without addressing the primary, we are doing our clients a disservice, as we are not keeping the container safe.

There is a solution for maintaining a safe container. In Dynamic Neuromuscular Assessment™ we share a specific protocol called Mapping. The mapping process identifies and correlates the involved players – primary and secondary – in a compensation.

Only when the global picture of our client’s presentation is understood, can the primary causation be addressed. Don’t simply treat the symptoms, investigate deeper to discern the primary causation.

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Optimize Your Assessment

Optimizing Your Assessment 

Q: What Will I Learn at a Dynamic Neuromuscular Assessment™ Seminar?

A: You will learn to optimize your assessment skills in order to amplify the results you achieve with your clients.

The assessment skills I learned in DNA have proven invaluable with clients, especially athletes. I now have the ability to go beyond muscle testing and assess their feed-forward movement patterns. Learning how to uncover and treat breathing problems and hypertonic muscles has been a game-changer. Clients are getting faster, more lasting results because we’re finally uncovering the heart of their issue, which often means addressing ligament and joint issues.

~ Beth T., Breakaway Bodyworks, LMT

In DNA™ Module One we start with the Intrinsic Kinetic Chain. Breath, breathing, and the players of respiration sets the groundwork to explore the DNA™ template of assessment.

When you complete the Module One seminar, you will have a greater understanding of integrating the following skills and neurological principles.

How to:

  • Qualify an indicator
  • Identify the 4 modes of indicator response
  • Identify the players of respiration in the exhalation and inhalation phases of breath
  • Assess the subsystem function of the breathing apparatus
  • Sequence a long series kinetic chain
  • Eccentrically evaluate the pelvic and thoracic diaphragms
  • Map the players of respiration in the breathing apparatus
  • Use multiple therapy localization strategies that allows you to double check your work
  • Establish and maintain a safe container for your clients

Integration

Optimizing your assessment via DNA™ uses the integration of two ingredients: Physiology & Philosophy.

Physiology is made up of the neurological principles of structure, movement and motor control. This hardware/software relationship defines the framework in which we can interact with and have a meaningful conversation with the nervous system to create beneficial change.

Philosophy is the road map we use to approach the building blocks of movement integration and how those components assemble into the global picture. The manner in which we have a conversation with the nervous system through kinesiology and how we establish a container of safety effects the outcome of therapeutic intervention. DNA™ provides the template for this conversation so that you are able to maximize the results you’re getting with your clients in achieving their goals.

DNA™Module One introduces The 5 Essential Skills that will be integrated into your movement evaluations.

The Five Essential Skills:

Essential Skill #1 – Hybrid Movement Assessment:

Direct and indicator assessment techniques.

Essential Skill #2 – Functional-Dysfunctional Movement:

Uncovering hidden compensation patterns.

Essential Skill #3 – Completing the Feed-back Loop:

Using feed-forward and feed-back strategies to complete the proprioceptive feedback loop.

Essential Skill #4 – The Functional Compass:

Movement assessment through the lens of multi-planer potential.

Essential Skill #5 – Eccentric Movement Assessment:

Challenges movement over a range rather than a snapshot.

Having a solid foundation in Module One will allow you to progress to more advanced movement assessment strategies. .

DNA™ Optimize Your Assessment  ~   Amplify Your Results

Upcoming Workshops and Seminars

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The Gift of Injury

I was working on Karuna’s toe this morning. Last year she injured her first digit in the back yard while playing with our fur babies. Karuna had kicked a tree root and substantially stubbed her big toe.

It has taken a long time to heal and we are still cleaning up the remaining ghost patterns. One reason why the toe has continued to be an issue is the emotional context of the event. More times than not, injuries happen because they indicate a lapse of mindfulness. From this place, our higher self is looking to get our attention through our body.

Let’s take a look at the emotional cognitive factors that Karuna was experiencing before she kicked her toe. The theme is busy-ness. It was a time of transition and there were a lot of tasks on hand that needed to be accomplished. This emotional context creates a level of anxiety that invokes the sympathetic nervous system response. The level of stress that an individual can respond to appropriately, with positive adaptation, is unique to them. This is why some people can appear to thrive in busy-ness stress loads while other people become overwhelmed.

Adaptation has a sweet spot similar to Flow-State Awareness. In Flow-State Awareness, the intersection of skills and challenge has an optimal range. This range is referred to as Flow. A simple explanation looks like this: We have our skill sets that meet a changing environment. When the challenge is not sufficient to tap into our skills, apathy is the result. We may experience lack of engagement. Conversely, when the challenge exceeds the capacity of our skill set, we are overwhelmed, and anxiety is the result. The sweet spot is the intersection when our engagement adequately challenges our skill. This balance of engagement to reach Flow-State creates a cascade of feel good emotions. No matter what activities or the skill requirements of our environment, from writing to athletics, and everything in between, stress is adaptation.

Adaptation has three basic outcomes; no change, beneficial change, and maladaptive change. Comparing this to the spectrum of flow-state awareness, no change would be in the apathetic spectrum. The challenge was not sufficient to invoke adaptation. When the challenge is sufficient to produce change, we experience either beneficial or maladaptive change. Beneficial change is the sweet spot when we are able to meet our challenges with appropriate skills. When our skills become overwhelmed by the challenge, the result is maladaptive change. Exceeding the capacity of beneficial change indicates that challenge has exceeded our skills or stress has turned into strain. This is a universal truth, and to mirror this truth, our emotional cognitive processing follows the same template.

The current of our emotional construct is perception, based on our experiences. Those experiences are either real or perceived. It’s like the movie that is running in our mind. It’s in constant motion 24/7. The mind is filling in the gaps between our memories with projected experience. We get lost in the ability to perceive what is real and what is not real. Our bodies are responding to the movie of our minds whether we are consciously aware of it or not.

The practice of mindfulness helps us to build up our capacity to recognize when the minded is projecting skewed information onto the movie screen. At a certain threshold, when the projected skewed information exceeds the capacity of emotional tolerance, the body sends SOS signals. These signals may be subtle, like low-level anxiety, or they may be overt to get our attention. In Karuna’s example, the level of busy-ness exceeded her stress threshold. Her body had been sending messages. The volume level of that message became substantial enough to pop her toe.

In this example, Karuna’s injury had a message. When that message is heard and acknowledged, then balance is restored, and parasympathetic healing can occur. The injury had a message. That message didn’t happen to her, that message happened for her.

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Keep the Container Safe: DNA™ Core Concepts

Let’s explore what sets Dynamic Neuromuscular Assessment apart from other modalities and how this assessment tool can complement the other modalities you already employ with your clients.

DNA™ Core Concepts

  • DNA™ recognizes the most important quality in a therapeutic intervention: keep the container safe. To do so, we honor the highest priority of the limbic system. Keeping the container safe has a fundamental premise: displace maladaptive compensation rather than remove. If that compensation was put in place by the nervous system as a means to keep us safe. When we remove it, then the nervous system will need to come up with another strategy to fulfill the perceived need. This occurs within any combination of the emotional, physiological and structural aspects of our nervous system’s main priority, keeping us safe.

 

  • DNA™ redefines muscle testing by combining both direct and indirect movement assessment strategies to provide a global picture of organization. Direct assessment strategies incorporate both the feed-back and feed-forward aspects of the proprioceptive feed-back loop. Indirect movement assessment, also known as indicator movement, allows the practitioner to assess movement, structure, physiological, and limbic functions that could not be accessed with direct testing strategies. When we combine Indicator movement with direct assessment, we can uncover hidden dysfunction within the neurological organization of the input/output feedback loop. Accurate evaluation of the response by the nervous system allows the practitioner to appropriately apply their corrective strategies.

 

  • DNA™ progressively challenges the structure to assess the response of the nervous system and structural integrity. Movement is a tangible benchmark, or yardstick, to evaluate the capacity of the nervous system and the ability of the structure to respond. There are two elements we are working with, the tangible and the non-tangible. The sensory motor system is non-tangible. The effects of the neurological inputs are affecting movement whether we are consciously aware of them or not. When we apply a corrective strategy to the sensory motor system, the only means we have to evaluate if that intervention is effective, is through movement. Movement will reveal three responses, whether:  the movement degraded, the movement stayed the same, or the movement improved. When the movement degrades or stays the same, we recognize that the corrective strategy is ineffective. However, when we see that the movement improves, we see a positive change resulting from a corrective strategy.

 

  • DNA™ uses the template of movement to compare how the involved players are working together in cooperation. The global/local/global model of assessment allows us to map the organization of the nervous system. Feed-forward movement assessment provides the opportunity for the nervous system to capitalize on compensation strategies. This allows the practitioner to then uncover maladaptive compensation. In DNA™ we introduce movement through the template of The 5 Primary Kinetic Chains. Both the kinetic chain organization and the governing principal action provide a lens to evaluate optimal movement.

 

  • DNA™ honors the symptom / causation relationship. DNA™ follows a line of reasoning that every symptom has a causation. And, that causation is then potentially a symptom of another causation. This line of reasoning allows the practitioner to follow the “causation bread crumbs” by using a laser-focused approach to identifying the source of dysfunction. The process of mapping dysfunctional movement provides the practitioner with the optimal entry point to introduce a corrective strategy.

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Assess the Global Picture First

An excerpt from the Dynamic Neuromuscular Assessment™ Manual:

It can’t be overstated how important it is to get the global picture of your client’s presentation before introducing correctives. The reason for this is in the nature of compensation itself.

Maladaptation is a response to stress. That stress could be emotional, physiological, or structural. The intelligence of the nervous system employs a coping strategy to meet the needs of the environment. If/when that coping strategy is unable to meet the need, then the nervous system will recruit another strategy to help. This is how multiple players become involved in dysfunctional movement patterns.

When there are multiple players involved in the compensation, there will be only one primary pair. There may be multiple secondary compensations. If we remove a secondary compensation, we are creating a void in the container. Then the nervous system will need to come up with new strategy to fill the void. This is why clients can have adverse response to treatments.

By understanding the global picture of your client’s presentation before introducing correctives, you are decreasing the risk of going down the rabbit hole.  More effective assessment equals more effective treatment!

DNA™ takes the skills you already possess and puts them into a context that makes those skills more effective. When you employ what Joseph calls The Five Essential Skills with the corrective strategies you already use, the results of your work will have a quantum effect with your clients.  Click here to learn more!