Here at Gallagher Performance we not only strive to provide the best in chiropractic, rehabilitation and manual medicine treatments for our patients, but we also utilize comprehensive diagnostic methods and tools to help determine which treatment is best for you. This allows us to apply to most ideal therapeutic interventions. At GP, this could include any combination of the following: chiropractic manipulative therapy, manual therapy according to Lewit and Janda, Vojta Therapy, myofascial release, trigger point therapy, neuromobilizations, and dynamic neuromuscular stabilization (DNS).

Despite many of our patients having previous experience with chiropractic or physical therapy, they are unfamiliar with DNS. Gallagher Performance specializes in DNS therapy. Dr. Gallagher has been studying and utilizing DNS since 2007. His extensive training and background allows him to provide a level of care that is unique to the Pittsburgh area.

Since DNS has implications in both physical rehabilitation and training, we spend a great deal of time educating our patients and clients on DNS and answering some frequency asked questions. With that in mind, the goal of this article is to help educate our readers about DNS and the significance this intervention has as it relates to pain or sports performance.

What is DNS therapy?
DNS is a revolutionary European approach in the treatment of back pain and several neuromuscular conditions. DNS therapy is based on the neuroplasticity of the Central Nervous System and targets the cause of pain/dysfunction rather than its manifestations. DNS therapy evokes ideal movement patterns by manual stimulation of developmental reflex zones and utilizes specific exercises to improve neuromuscular control. The therapeutic benefits become significantly expanded from previous standards of rehabilitation. Any one from infants to adolescents, chronic pain patients to athletes can all benefit from DNS therapy.

How does DNS compliment chiropractic adjustments? 
DNS therapy favorably compliments traditional chiropractic adjustments in several ways. When patients may be apprehensive about receiving an aggressive or forceful chiropractic adjustment, DNS offers gentle, non-forceful, low velocity manipulation that is well tolerated and safe. For those that receive traditional chiropractic adjustments, DNS works in concert to normalize joint function and restore muscular balance, leading to more sustainable improvements in reduced pain and improved function.

Often times, symptom relief experienced from a chiropractic adjustment can be short-lived with symptoms returning rather quickly. In contrast, when DNS is applied in a chiropractic setting, the approach allows for longer-lasting symptom relief due to therapy’s ability to improve Central Nervous System (CNS) coordination and joint stability which is then maintained by performing prescribed home exercises.

DNS therapy simply enables a chiropractor to effectively treat and manage a broad range of musculoskeletal and neurological disorders. While traditional chiropractic may be limited in what can be done through chiropractic adjustments and passive modalities, DNS represents a powerful alternative to chiropractic care when dealing with pain syndromes and more complex structural pathologies where the effectiveness of traditional chiropractic is highly limited.

How is DNS therapy able to get me out of pain and moving better when other conservative therapies have failed?
The results achieved by DNS therapy are often difficult to achieve with traditional methods used by chiropractors and physical therapists due to the physiological phenomenon that occurs during treatment to minimize muscular imbalances, relieving painful protective muscle spasms, resulting in a more stable musculoskeletal system with improved spinal stability and postural awareness.

During DNS therapy, induced movements are controlled not locally, but by the higher levels of the Central Nervous System. This then results in faster and longer-lasting improvement in function and pain relief.  When combined with exercise, the promotion of joint stability and ideal movement becomes habitual and independent of conscious effort.

How are DNS exercises different from traditional physical therapy or physical training exercises?
In the majority of physical therapy and chiropractic clinics, as well as in personal training settings, exercises are performed that simply train muscles in isolation. The patient who has shoulder pain and is only prescribed shoulder exercises illustrates this concept. The fault in strengthening weakened muscles through isolation training is that isolation training will fail to unify the painful or problematic joint with the entire locomotor system. Sure you can perform all the isolation exercises you wish, but this does not guarantee that the strength or coordination gained will automatically transform into adequate performance.

DNS exercises are applied in accordance with development kinesiology or essentially how we develop motor function during childhood. As we develop, reflexive movements (primitive, postural, locomotor) become more refined and coordinated, ultimately leading to specific movements we produce later in life such as walking, running, jumping, reaching, throwing, etc.

However, developing these skills does not happen magically.  Learning to control the body and developing fundamental skills make up our motor milestones.  These milestones mark critical points in our development and there is a progression that these milestones follow.  This is known as developmental kinesiology. In simplistic terms, we need to be able to lift our head and support it, roll over, crawl, support ourselves upright, walk with assistance, and then walk without support.

The understanding of developmental kinesiology and critical motor milestones allows the provider to make exercise progressions and regressions during the course of therapy in order to appropriately address the underlying locomotor system dysfunction(s).

These exercises are applicable for patients with variety of acute and chronic conditions as well as for athletes who are trying to improve their performance and also prevent or rehabilitate injuries.

Often DNS exercises are conducted with active support from the clinician to insure that the patient maintains proper support and executes ideal movement. DNS exercises could include the use of stability balls or bands to further facilitate the desired response of the exercise.  These exercises are not only used to improve the stability of the spine, muscle coordination, balance and strength, but also to increase the body’s awareness and sensory integration.

Conclusion
All of a sudden, conservative management and treatment of patients and training of athletes looks a lot different than what is traditional accepted.

DNS is not only a magnificent approach for preventing and rehabilitating pain syndromes in the movement system it is also becoming extremely popular in sports performance circles. The same ideal patterns that keep an individual out of pain also maximize the efficiency of the movements, which not only reduces risk of injury but improves performance.

When you consider the principles of DNS, it truly is not about what exercises we prescribe or what exercises we perform, but rather what we are actually getting from those exercises when we perform them that is important. DNS provides a system of evaluation and treatment which follows motor development, thus providing an effective way to help our patients get the most out of therapy and our clients get the most out of training.

Sources:
Dynamic Neuromuscular Stabilization & Sports Rehabilitation, Frank C, Kobesova A, Kolar P. Int J Sports Phys Ther. , 2013 Feb;8(1):62-73.
A case study utilizing Vojta/Dynamic Neuromuscular Stabilization therapy to control symptoms of a chronic migraine sufferer, Juehring DD, Barber MR. J Bodyw Mov Ther, 2011 Oct;15(4):538-41.
Cerebellar function and hypermobility in patients with idiopathic scoliosis, Kobesova A, Drdakova L, Andel R, Kolar P. International Musculoskeletal Medicine. , 2013, 35(3): 99-105.
Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength., Kobesova A, Dzvonik J, Kolar P, Sardina A, Andel R. Isokinetics and exercise Science. , 2015;23:21-32, 
Developmental Kinesiology: Three Levels of Motor Control i the Assessment and Treatment of the Motor System. Kobesova A, Kolar P. Journal of Bodywork and Movement Therapies., 2014;18(1):23-33.
The Prague School of Rehabilitation, Kobesova A, Osborne N. International Musculoskeletal Medicine, 2012;34(2):39-41.
Postural - Locomotion Function in the Diagnosis and Treatment of Movement Disorders, Kolar P, Kobesova A. Clinical Chiropractic, 2010;13(1):58-68.
Analysis of Diaphragm Movement during Tidal Breathing and during its Activation while Breath Holding Using MRI Synchronized with Spirometry. Kolar P, Neuwirth J, Sanda J, Suchanek V, Svata Z, Volejnik J, Pivec M. Physiol Res, 2009;58(3):383-92.
Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. J Orthop Sports Phys Ther, 2012;42:352-362.
Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment, Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A. J Appl Physiol. , 2012;42(4):352-62.
Importance of Developmental Kinesiology for Manual Medicine, Kolar P. translated from Czech Journal of Rehabilitation and Physical Therapy, 1996;4:139-143.
Surgical treatment and motor development in patients suffering from cerebral palsy, Kolar P. Translated from Czech Journal of Rehabilitation and Physical Therapy, 2001;8(4):165-168.
Long-Term Efficacy of Dynamic Neuromuscular Stabilization in Treatment of Chronic Musculoskeletal Pain, Bokarius AV, Bokarius V. 12th World Congress on Pain. Glasgow, Scotland. Aug 17-22, 2008. Presentation # PF225.
A case study utilizing spinal manipulation and dynamic neuromuscular stabilization care to enhance function of a post cerebrovascular accident patient, Oppelt M,Juehring D,Sorgenfrey G, Harvey PJ, Larkin-Thier SM. Journal of Bodywork and Movement Therapies., 2014;18:17-22.
More related reading:

https://gallagherperformance.com/solving-pain-influence-czech-rehabilitation-techniques/

GP: Please introduce yourself and give our readers some information on your professional, educational, and athletic background and achievements.
To all the readers out there, my name is Ryan Gallagher and I’m the Head Performance Coach at Gallagher Performance. Along with that I’m a licensed massage therapist, corrective exercise specialist, and nutritional consultant. My undergrad education was in Sports Management with a concentration in Wellness and Fitness and was completed at California University of Pennsylvania. I attended Hocking College in Ohio for massage.

Most of my childhood was spent participating in almost every sport imaginable. Around my mid-teen years, I decided to fully commit to ice-hockey. I was fortunate enough to play at the junior level, but through high school and after, I had a number of different injuries that derailed my playing career. Once I was done with hockey, I committed myself to strength athletics and I have since been competitive in powerlifting, strongman and bodybuilding. While I have competed with success, my eyes are on bigger goals that I have set for myself. My plans are to continue to compete for as long as I can. As far as competing goes, I have some plans but will keep that quiet for now.

GP: When and how did you become interested in sports performance, fitness, and nutrition? What have you found to be the most rewarding?
It all started with the influence of my parents and older brothers. Growing up, hockey was an expensive sport to play. My parents were willing to sacrifice a lot of their time and money in order to let me play a sport I deeply loved (and still do). I can clearly recall hearing both of them say, “If you want to play normal, club hockey you can. You can just have fun and take it easy. But, if you want to play juniors, if you want to travel and get exposure, then you need to meet us half way. You will need to work for it.” Essentially what I was committing myself to was a part-time job of training for hockey. Three-a-day training sessions in the summer were the norm and hitting the gym throughout the season was standard. My parents were willing to support me, so I wanted to push myself to say thank you. Once the training and sports performance aspect began, training became more than just a “thank you”. For me, it became an immediate love. Having brothers that came before me and were highly successful didn’t hurt at all either. They provided a great influence and had years of know-how under their belts to help direct me from the get-go.

The most rewarding part of it all is the process. Everyone wants the outcomes, and they want them immediately. But, the process of working towards your specific goal will tell you more about yourself than anything. Those who can grind and stick with something for an extended period of time will often realize far more significant results than others. Notice I said significant, not necessarily successful. There is a major difference.

GP: As a trainer and performance coach, you have had the opportunity to work with a wide range of clients. You have worked extensively with youth athletes, as well as high school, collegiate, and professional athletes. You have worked with competitive strength athletes in powerlifting and Strongman, and physique athletes (bodybuilding, figure, and bikini). And you have done so with tremendous success. It’s uncommon to meet a trainer who is competent in handling such a diverse client base while providing them with the guidance needed for successful outcomes. What allows you to handle such a diverse client base with success?
This answer could be long winded and boring, so I will try to keep it short and sweet (kind of like me!). The obvious component is the understanding and education on how to properly address each individual and their specific needs. Despite all the accolades, degrees, or certifications one may have, it is my opinion that an incredibly invaluable skill set is the ability to read your client. To know when to push them, when to back off and how various external and internal stressors may be at play. These are lessons that no textbook can teach you. You either have that x-factor or you don’t.

GP: With the extensive amount of information available today, nutrition and nutritional advice can become extremely frustrating and confusing. What is your philosophy when it comes to nutrition? 
Perhaps it’s because I’m only familiar with the fitness industry, but there is a strong correlation with confusion and the fitness industry. I don’t think there’s an industry out there that is more confusing and frustrating. People love to create confusion because confusion creates dependency. So he or she that yells the loudest will more than likely make the most money. Especially if it goes against the grain of what is traditionally applied.

When it comes to nutrition and my “philosophy”, I guess you could say I don’t really have one. My end goal with clients is to establish a plan that is sustainable for them. If any one client can’t stick with a plan that is set forth, the success rate of that plan is drastically reduced. The approach is similar to the quote, “The person who goes 90% for years will go much further than the person who goes 110%, burns out, and quits.” That essentially sums up the approach I take with my clients.

Most clients just need direction. Whether that is a set plan to give them absolute direction or whether it is step-by-step process of educating them on healthy habits for long-term success. At the end of the day it comes back to knowing your client and how you need to tailor their program(s) to their needs at any given moment.

GP: As a massage therapist and corrective exercise specialist, you have integrated recovery and corrective strategies for your clients and athletes. What are your thoughts on the importance of movement quality and recovery strategies in client progress?
Pushing the limits of the human body and sport performance doesn’t necessarily come without paying a price. Our goal is to keep our athletes and general clients healthy through the process, but aches and pains inevitably settle in. Some people may be baffled by that, but take your squat from 500 lbs to 600 lbs or your 40-yard dash time from 4.50 down to 4.40 and, trust me, your body is going to be feeling it. Wanting to minimize the effects of hard training, most of our athletes partake in an in-season care plan that is set forth to include weekly treatments to injured areas or general recovery work to help them stay fresh. These guys and girls are getting the snot kicked out of them sometimes during their athletic events. Once they feel the difference in how taking care of their body helps their performance and overall well-being, they’re hooked. Some of them come in anticipating an hour massage on their low back because their low back is sore, but we may do an hour of extensive hip and abdominal exercises instead. That is a judgement call. That client will end up leaving with no low back pain and in a much better place both physically and mentally. Some will need more focused soft tissue work, others there may be other factors at play. Again, it comes back to knowing what your client needs and what will truly benefit them.

Establishing proper movement is critical and the foundational element in determining long-term development of the client you’re working with. If they don’t move well for them, then really, it’s all for not. I emphasize moving well for them because it’s different for everyone based on individual physical traits and characteristics. There is not a textbook way of performing any movement. Yes, there are obvious technicalities to each movement, but how it’s applied to everyone is different, and often not textbook.

I could go on about how the whole fitness industry can be it’s own worst enemy, but that would be more of a rant than anything. People need to get off their high horses and realize that because a movement isn’t done to their personal specifics, it is not necessarily wrong for that individual and the goals that they have.

So proper movement for the individual has to be established first. Once that is established you would be surprised at how many issues are removed. Especially once that client becomes stronger. Strength never hurt anybody.

GP: You have become sought after by both athletes and coaches for your ability to develop speed. If anyone would doubt it, your results speak for themselves. You have had the ability to further develop athletes who have either plateaued or failed to achieve results in other training programs. What do you attribute this ability to?
You won’t get anywhere without a substantial amount of knowledge and experience backing up your intentions. I was fortunate enough to start training and working with athletes at a very young age. So even at my age, I’ve been able to put in close to 10 years of professional experience working with clients from various demographics with an array of end-goals. The good trainers eventually make it to the top while, unfortunately, some really poor trainers are there too. The education, and arguably experience, only take you so far. It goes back to my earlier answers. Understanding your client, knowing them almost better than they know themselves, and being aware of how to direct them will set the framework for continual development.

More related reading:

https://gallagherperformance.com/3-simple-steps-to-reduce-your-risk-of-sports-injuries/

https://gallagherperformance.com/3-benefits-of-integrated-training-and-therapy/

https://gallagherperformance.com/faqs-frequency-avoided-questions-of-strength-conditioning/