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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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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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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!

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Ask The Right Question to Optimally Engage the Nervous System

There are a few misconceptions in the movement/bodywork community about manual muscle testing. The first being the term itself. Manual muscle testing is not testing muscles. Manual muscle testing is asking a question. Can the nervous system/structure respond appropriately to a particular stimulus. This is having a conversation with an input / output feedback loop.

The manner in which we engage in the conversation makes a difference. I like to think of the conversation as having two separate aspects. The first aspect is the conversation with nervous system. We are engaging the proprioceptive feedback loop. Can the nervous system respond to the stimulus at the periphery? The second aspect of the conversation is structure. Can the various connective tissue structures respond to vector, load, and duration?

Nervous system response and structural durability are interdependent. Without the nervous system’s capacity to respond appropriately, durability would be compromised. Motor control and neuromuscular coordination are tangible responses of our body’s ability to cope with a changing movement environment. When we feel safe during movement, we have the capacity to optimally thrive.

There is a specific attribute of the kinesthetic conversation that occurs during movement. When we appropriately cue the nervous system to the neurological disorganization of maladaptation, the opportunity to learn, or upload input /output response becomes available.  There are optimal ways and less than optimal ways this happens.

I’ve created a progression – Dynamic Neuromuscular Assessment™ — for the therapist to learn an optimal process for engaging with the nervous system of their client. There are three layers to this process.

The first layer starts with deconstructing and refining manual muscle testing. Movement assessment has the potential to accurately interpret the input/output of nervous system response. This has several sub levels and nuances.

The second layer is mapping. Mapping is a format to understand the unique presentation of our client. The symptom / causation relationship is investigated to arrive at the primary causation, or the primary layer to start employing a corrective strategy.

After we have the global picture mapped of our clients, we can employ the third layer of the DNA™ process, corrective strategies. Caution must be used when employing corrective strategies. Keeping the container safe is a primary concern when “do no harm” is the imperative. We cannot apply a corrective technique until we understand the causation and its source. If we remove a coping strategy or compensation, the nervous system will fill that void in the container. That something will more than likely be maladaptive. Instead, we need to displace a maladaptive compensation with a positive adaptive coping strategy.

Engaging the nervous system is a process of inquiry. As therapists we are learning to ask the right question.  When we ask the right question, the nervous system can be appropriately cued to the symptom causation relationship. This keeps the container safe so that the potential for change is fully realized.  Dynamic Neuromuscular Assessment™ is an assessment protocol that allows the therapist to optimally utilize the corrective techniques they already have by asking the right questions.

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Anatomy and Kinesiology: Moving Beyond the Obvious to the Profound

I’d like to talk with you about an anecdotal experience I recently had with a client.

I had a runner come to me who was experiencing knee pain. If I had stopped in my assessment at simply looking at the function of the knee, I would have missed the primary driver of the compensation pattern.  Because I linked the relationship of the Anterior Kinetic Chain, and the core cylinder, I was able to correlate an internal oblique issue to the medial knee.  It’s not uncommon for ligaments to compensate for the burden when muscular function is impaired.  My ability to move beyond the obvious to a deeper level of inquiry – which is what we learn in Dynamic Neuromuscular Assessment™ Seminars –  allowed me to get to the more profound root issue for my client.

Anatomy and kinesiology are two disciplines that give clarity to the interdependence of the structure and movement of the body.

Anatomy is the language used to describe the parts. These parts then fit together into systems that synergistically make up the whole organism.

Kinesiology is the language of movement. Through kinesiology, anatomy is given a context. If the language of movement is a symphony, the role of anatomy is to describe the source of each note of music.

Anatomy charts provide the fundamental foundation for understanding the names of bones, joints, ligaments, tendons, muscles, fascia, and so forth – the structure. Kinesiology then defines how each aspect of structure works together to create movement.

One of my teachers, early on in my career, imparted the importance of the breath, movement, and structure as being interdependent.

Movement is a translator to how the structure organizes, movement can’t lie. When the body is experiencing pain, the brain reorganizes movement so that we move around our pain instead of through it. This avoidance is a compensation to keep us in a perceived safe zone. As practitioners, our ability to see deviation in movement is paramount to assisting our clients. Often the walking gait is the lens through which we look during assessment. The 5 Primary Kinetic Chains provide a map of the gait.

The use of color in The 5 Primary Kinetic Chains illustrations imparts upon the teacher/student or practitioner/client, how the body organizes during movement. The kinetic chain charts further define how the body organizes in the optimal manner during gait.  Why the gait?  The gait is universal to human movement. From birth, our nervous system is prewired for developmental movement with the intention to get us upright and biped.  If you have interest in a more in-depth conversation on the walking gait, see my blog on the Master Template.  The synergistic organization, or sequential muscular activation, gives context to efficient movement and helps us to identify potential dysfunctional relationships that may not be obvious at first impression to the client or practitioner.

When the synergistic organization of our movement becomes less than optimal, or compensated, the result are over and underworked players. Synergistic dominance is the relationship between these over and under worked players. As a practitioner it is useful to have reference tools – like The 5 Primary Kinetic Chains Poster Set or Desktop Edition to help us dig deeper into the function and dysfunction presented by our clients.

Please leave a comment below about a powerful experience you had either as a client or practitioner where you or they went beyond the obvious to the profound!

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Putting the “Dynamic” into Dynamic Neuromuscular Assessment – DNA

While manual muscle testing can be a powerful tool, movement is infinitely variable.  Because manual muscle testing attempts to put movement into a confined box with fixed positions, it has limitations. I have a problem with classical conventions that say “this movement is xyz muscle.”  Muscles do not work in isolation. Muscles work synergistically with bones, joints, ligaments, tendons, muscles, fascia, and skin. We can isolate movement; we cannot isolate structure.

 

The idea that if you put the body in a specific position you are testing xyz muscle is limiting. Some 15+ years ago I was seeing a Physical Therapist for a shoulder injury. My colleague brought out a two volume encyclopedia of manual muscle tests. Each muscle had three divisions. Each division had three positions: open, closed, and middle. That equates to nine possibilities to assess a particular muscle in the structure.

 

In the assessment process of DNA™, we take the process a step further. Instead of merely taking a “snap shot” of movement, we assess the complete “movie” of movement.

 

Movement has three components of players. One side of the tissues are in concentric action. This is the work production phase. The other side are the tissues that are lengthening. This is the eccentric phase of movement. This is often referred as the deceleration phase of movement. The third aspect of movement are the stabilizers that provide support for the movement. This is analogous to isometric movement though it is dynamic in application.

 

These three aspects of movement form a dynamic triangle that can respond to a changing environment. For example, the core subsystem in the Lateral Kinetic Chain creates a dynamic triangle that supports the pelvis/lumbar. The lateral hip stabilizers, adductors, and the opposite quadratus lumborum work together synergistically to maintain an upright axis of the spine when load bearing in the stance phase of gait.

 

Would you like to learn this paradigm shift in movement assessment? Please join us at a DNA™ seminar.