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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.

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Hardware/Software: An Interdependent Relationship

There is an interdependent relationship at play that should be honored when working with our clients: hardware/software. Hardware is our structure. Trauma, injuries, and surgeries all alter that structure. The body then heals those parts with connective tissue. Our body’s software is the nervous system responding to the interaction of the structure with the environment. Hardware issues also alter software. Dynamic Neuromuscular Assessment™ explores the relationship of the body’s software interacting with the hardware. Hardware issues may require medical intervention that would need to be followed up with software integration.

Software hierarchy has many competing components. I use the word competing because the interdependence of various systems are competing for the available bandwidth and resources the brain has to cope with and respond to the environment.

Let’s explore some of the components of our software and how they can affect our hardware:

Emotions:

Emotions and psychological considerations are often an element that keeps people from healing. Sometimes it is a forgotten emotional trauma tape that is still running unconsciously. Other times there is a perceived benefit from remaining in pain or being injured. Finding the root cause of the emotional disturbance, whether an event or the perception of the event, would be a primary consideration. In a survival-based nervous system, the threat of emotionally charged perception, perpetuates the arousal state and an up-regulated sympathetic nervous system.

Physiology:

The squeezing and soaking action of coiling and uncoiling activates the abdominal viscera. If the organs are impeded in some way, then the autonomic nervous system will put the brakes on movement.

Structure:

Structure implies a hardware issue. Receptor response due to hardware issues will put the brakes on movement. The conscious and unconscious somatosensory afferent inputs trump motor control.

Motor Control:

Conscious motor control has many options for interacting with compensation and replacing maladaptive compensation with a beneficial coping strategy. DNA™ assessment strategies can address periosteum, joints, ligaments, tendons, retinaculum, muscles, fascia, and scars.

Periosteum wraps the bones, giving support for leverage of the structure to act on. In a tensegrity structure, the periosteum is the boundary for the inner bag. The bones act as compression struts so that the outer bag can leverage action. If the bones didn’t have the support of the muscles, the skeletal system would collapse.

Joints provide the movement fulcrum for the muscles to act on the bones. The position sense of the joint capsule informs neuromuscular sequencing.

Ligaments act as neuromuscular switches. The afferent signals inform the cerebellum which muscles to activate during movement.

Tendons transition muscle to attachment sites. The mechanoreceptors afferent signal inform the motor control center the load on the tendon.

Retinaculum wraps around tendons to provide mechanical support. The retinaculum supports the tendons so that as load is put into the tissues, the tendon stays in place. When the retinaculum rolls toward the joint, the mechanic support is reduced. Imagine socks rolling down the leg off the calf, retinaculum will bunch up. Active connective tissue strategies can unbunch and restore retinaculum width.

Muscles are for work production. They act on connective tissue to animate the structure. Without the support of muscles, the skeleton would collapse. The mechanoreceptors afferent signals inform length and speed of position change. The position sense of the muscles is an important contribution to conscious motor control and motor learning.

Fascia and skin complete the interpretation of position sense. Kinesthetic sense is the interpretation of conscious and unconscious somatosensory inputs. Those inputs are collated and prioritized.

Scars are a local disturbance that can create global confusion. Scars hold the emotional component of trauma as well as tissue memory. The mechanoreceptors in the tissue have become disrupted and need to have their afferent input reset.

Understanding the interdependence between our hardware and software informs the entry point while assessing and interacting with our patients/clients.

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Triangulation

This is an excerpt from the DNA™ Manual that will accompany upcoming Dynamic Neuromuscular Assessment™ Seminars.

The triangle is one of nature’s stronger structures. Triangulation is when three muscles, or a combination of muscles and connective tissue structures, form a kinetic chain. These are used primarily in force transmission systems, the manner the body organizes to produce work or absorb kinetic energy. The subsystem of the lateral kinetic chain employs a triangulation in the stance phase of the gait. The gluteus medius, adductor magnus, and contralateral quadratus lumborum are triangulating their efforts to keep the axis of the spine upright and vertical.

Triangulation shows up in many ways. It can be a combination of short lever and long lever muscles and/or it can be a combination of ligaments to muscles. Triangulation is the body balancing the need for both stability and mobility.

Movement requires a base, or a platform, from which to act on and off. Without a base, the ability to generate work production would be impaired. This would be the same principle as the dynamic platform of the axial spine providing a base of appendicular movement. This is a global perspective.

Triangulation occurs in all three planes of movement: pitch, roll, and yaw. Let’s look at the movement of the scapula to illustrate this. This is a local perspective.

Pitch~ pectoralis minor/lower trapezius/levator scapula

Roll ~ rhomboid/serattus anterior/levator scapula

Yaw~ pectoralis minor/middle & upper trapezius /levator scapula

 

Note: The levator scapula triangulates with scapular stability in each plane of movement. This long lever, multi-segmented muscle is often overworked and underappreciated in its key role in movement and the dynamic stability of the scapula

*Illustration Credit:

Robinson, J. (n.d.). Schuenke, M., Ross, L. M., Lamperti, E. D., Schulte, E., & Schumacher, U. (2006). Atlas of anatomy: general anatomy and musculoskeletal system. Stuttgart, NY: Thieme

 

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FAQ: Why Dynamic Neuromuscular Assessment™ Is For You

Within my athletic performance practice, the framework and methodology of Dynamic Neuromuscular Assessment™ has become key in assessing my clients and leading them back to their desired performance levels.

DNA™ integrates with multiple treatment modalities including PDTR, NKT, NMR, etc. – which combine with soft tissue and movement practices to help restore client’s health, movement, and performance.  The development of DNA™ has provided the framework and tools to find often hidden dysfunctions and causes of pain, even when the cause might be tied to old traumas. – Mark Kendall

Who would benefit from taking the DNA™ seminar?

Any professional who includes manual muscle testing in their therapeutic practice.

How is this seminar different than other modalities being offered?

DNA™ is the only manual muscle testing workshop that teaches a format I call Hybrid Movement Assessment. Hybrid Movement Assessment is the overarching skill you will learn in Dynamic Neuromuscular Assessment (DNA™).  This Essential Skill informs the other four (The Five Essential Skills).

By learning to seamlessly transition between direct muscle testing strategies and indirect muscle testing, you will increase your ability to make change in the nervous system of your clients. You will find that in DNA we redefine manual muscle testing by changing the paradigm of testing muscles to assessing the response to movement.  We will be asking ourselves, “Can the nervous system and the structure appropriately respond to the movement environment?”

Hybrid Movement Assessment strategies are essential for evaluating the players in respiration.  For example, the Intrinsic Kinetic Chain has many players that cannot be evaluated with direct muscle testing strategies.

Hybrid movement assessment is exceptionally powerful because it is not testing muscles.  Instead, it is about having a kinesthetic conversation and asking a foundational question whether the nervous system/structure can respond appropriately to movement stimulus.

DNA™ is a distillation of my 25 years’ experience using manual muscle testing as a diagnostic strategy. I developed this hybrid movement assessment nearly 20 years ago in my search to a short cut to find the quickest way possible to get the most results.  I had many insights along the way that form the basis of DNA.

Insight highlights from 25 years of practice:

  • The bodies intelligence already contains the answers to what the body needs to be healthy, whole, and complete. It then becomes a communication strategy to ask the body the right question.
  • The body doesn’t know individual muscles; the body only knows functional movement to accomplish the movement goal at hand. The body’s solution for accomplishing the movement goal is based on what functional components are available to assemble into the global movement.
  • Concentric muscle testing is taking a mere snap shot of movement.
  • Eccentric muscle testing is a loading/cueing of the whole movie.
  • Eccentric movement assessment can only be fully evaluated with hybrid movement assessment.
  • The SAID principle, specific adaptation to imposed demand, is one of the most important principles to consider when employing corrective strategies.

What can I expect to learn during the DNA™ Seminar?

In addition to hybrid muscle testing, you’ll also learn an integration of The Five Essential Skills that will have a quantum effect on the outcome of your work with clients. You will learn nuances in manual muscle testing that will refine your assessment skills.

Dynamic Neuromuscular Assessment™ is informed by The Five Principal Actions.  The Five Principal Actions have two primary attributes. One, developing the dynamic platform. And two, the storing & releasing elastic energy. Three elements are necessary to complete the dynamic platform: integration of the breathing apparatus, the ability to respond appropriately to gravity, and converting the absorption of load into ground force reaction. When the structure can respond appropriately to breath, shock absorption, and ground force reaction, then the generation of stored elastic energy and the translation of that stored elastic energy can be expressed optimally.

Is there support materials being provided for the workshop?

Absolutely! You will receive a printed DNA™ manual chocked full of information.  You will also receive access to a private discussion group on Facebook for therapists employing the DNA™ modality in their practice.  I am always happy to meet one-on-one to answer questions as well.

Do you have more questions?

DNA Seminar: Live Q&A next Wednesday, September 13th, 2017, 10am MT

https://zoom.us/j/750798913

Upcoming DNA™ Seminars

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DNA Demystified

Dynamic Neuromuscular AssessmentTM seminars take the skills you already possess and puts them into a context that will make 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.

Essential Skill #1 – Hybrid Movement Assessment:

  • Learn to seamlessly transition between direct muscle testing strategies and indirect muscle testing – Manual Muscle Testing redefined
  • We will change the paradigm of testing muscles by assessing the response to movement. Can the nervous system and structure appropriately respond to the movement environment?

The Intrinsic Kinetic Chain has many players that cannot be evaluated with direct muscle testing strategies. Hybrid Movement Assessment strategies are essential for evaluating the players in respiration – a key element in assessing clients.

Essential Skill #2 – Completing the Feed-back Loop:

  • Afferent sensory neurons relay information about how movement is responding to the movement environment: this is feed-back motor control
  • Efferent motor neurons are the motor instructions to the periphery: this is feed-forward motor control
  • Using both feed-back and feed-forward movement completes the proprioceptive feed-back loop

Compensation is learned through the feed-back loop. Adaptation is need and response, two sides of the movement equation. Motor learning requires the integration of both feed-back and feed-forward communication to and from the brain.  Feed-forward motor instructions allow the motor control center of the brain to capitalize on compensation patterns. DNA’s movement assessment strategies uncover hidden compensation.

Essential Skill #3 – The Functional Compass:

  • The functional compass provides a map for movement potential
  • Movement happens through non-linear spirals
  • Joints act in compression and distraction
  • Joint assessment using the functional compass evaluates the spectrum of movement potential

Shock Absorption of the Deep Longitudinal Kinetic Chain is interdependent with the ability of the joint capsule to translate compression to distraction over its range of motion. When the joint loses its ability to respond appropriately, compensation will show up as a symptom in ligaments, tendons, muscle and fascia.  DNA’s joint by joint assessment strategies give laser focus attention on the root cause rather than the symptom.

Essential Skill #4 – Functional Dysfunctional Movement:

  • This is analogous to non-painful dysfunctional movement
  • Movement functions can appear to be available with direct testing strategies
  • Hybrid Movement Assessment uncovers hidden layers of compensation

Movement functions can appear to be available with direct testing strategies. Challenging those movements with Hybrid Movement Assessment will uncover hidden layers of compensation: “just because you can doesn’t mean you should.”

Often, our clients are reinforcing compensation through their daily movement. DNA’s assessment strategies identify these patterns so they may be appropriately addressed.

Essential Skill #5 – Eccentric Movement Assessment:

  • Direct Concentric muscle testing is a mere snapshot of movement
  • Eccentric Movement Assessment challenges movement over a range rather than a snapshot
  • Eccentric Movement Assessment incorporates the SAID principle into assessment strategies

The rules of the SAID principle states that adaptation is specific to demand. If the motor program is not cued into the corrective strategy, it may not respond to the correction. Eccentric Movement Assessment cues the motor control center to a larger context of information. This brings up compensatory patterns that would not be revealed in standard concentric testing strategies.

DNA’s assessment strategies are unique as they incorporate both sides of the movement equation.  Concentric activation must be balanced with Eccentric stabilization. This skill set can be explored through the core subsystems of The 5 Primary Kinetic Chains.