If you missed Part 1 last week, we discussed:
1 – What is DNS
2 – How is our “Perfection” of Movement Lost
3 – How is DNS related to Exercise?
4 – Sports Example: DNS and Golf
Let’s take for example a golf swing. The ability to bring the club into the back swing not only requires strength and coordination of the shoulder muscles, it also requires a “relative stiffness or flexibility” in the abdominals and hip muscles to allow the rotation – but in an eccentric manner to control that amount of rotation.
Shirley Sahrmann (2002) uses the term “compensatory relative flexibility” to describe how the amount of stiffness (or tension) in one area of soft tissue results in compensatory movement in an adjoining joint that is controlled by less stiffness.
Musculature can be likened to springs, the bigger a muscle is, the stiffer it is. Relative stiffness or flexibility in a muscle affects the path of least resistance.
For example, if your hamstrings are over trained or shortened, they may become resistant to movement; thus, compensatory movement occurs at the lumbar spine. The major implication is that as the lumbar spine is now subjected to further movement, further stress forces are imposed on the joint and surrounding tissues, creating susceptibility to movement dysfunction.
5 – Finding the Source of Pain, Not the Location of Pain
Continuing with the example of the golf swing: You begin to develop pain in the elbow; physicians diagnose this is as “golfer’s elbow” or medial epicondylitis. Now you plan on treating this with rest, ice, and strengthening of the wrist/forearm muscles and even the shoulder muscles. Taking time off from golf and allowing it to heal in your mind will solve the problem. All of which are great, but you’re not tracing the elbow pain back to the “WHY.”
“Why did I develop this medial elbow pain?”
“Why did this pain just start now if I’ve been playing golf for over five years?”
So the pain subsides and you go back to golfing and 2-3 months later your elbow pain returns! The CAUSE of the pain is NOT in your elbow. The pain site (elbow) is only the source and the cause of the pain needs to be investigated. The goal is to explore, analyze and eliminate the true cause of the elbow pain.
If this scenario sounds like you, then take a step back and look at the bigger picture of how you can control your body in a dynamic movement such as golf rather than the where the pain is directed.
“He who treats the site of pain is often lost.” –Karel Lewit, MD
The cause of the pain is most likely related to the movement of your golf swing, and narrowing down where the faulty pattern is occurring is critical. It is not always the best situation to change your golf swing, but having the proper muscle synergy and activation is key. Problems in your lower extremity can lead to compensations in your upper extremity and vice versa. Without having stable intra-abdominal pressure across the trunk, the ability to move your extremities in correct anatomical alignment (more specifically the joints related to the movement) is physiologically difficult to control. Without a stable foundation the rest will collapse.
6 – How is DNS Related to the Throwing Motion?
Now, moving in conjunction with the golf swing, we begin to look at the throwing rotational movement. This movement is what is called an “ipsilateral pattern.” When discussing an ipsilateral pattern or the same side pattern, we look further into what is happening on the same side of the upper and lower extremities. When a left-handed pitcher throws a baseball, for example, the left upper extremity and the left lower extremity are considered the stepping-forward limbs. Conversely, the pitcher’s right upper extremity and right lower extremity are considered the stabilizing limb (see image).
As you can see in the diagram below, when the pitcher is at the release point, his left arm is moving in space as well as his left leg. The right leg is stabilizing into the ground and his right arm is stabilizing in space to create force production through our oblique chains of movement. As the left arm continues through the throwing motion, the right arm maintains stability against gravity to allow the left arm to follow through.
Without this stabilization of the stabilizing arm (right arm) the speed and velocity of the throw will be greatly altered. It is a combination of open kinetic chain (left extremities) and closed kinetic chain movement patterns (right extremities) that allow us to throw with great power.
The support and stepping forward extremities always perform in equal but opposite movement of the joints. As the stabilizing extremity moves into internal rotation, adduction and extension, the stepping forward extremity moves into external rotation, abduction and flexion.
7 – How can this be Related to My Pain?
The approach to strengthening and recovering from injury needs to be assessed as a whole movement pattern, not by isolating single muscle groups. Exercises to regain functional strength needs to be related to what is happening mechanically to allow them for the best possible recovery and to reduce the “WHY” factor. It is key to strengthen weak muscles in primitive patterns since these body weight positions are engrained in our brains. This way the entire oblique chains through the trunk are constantly firing to elicit maximal strength. Breathing and core stabilization is imperative in the overall strengthening of our extremities.
Kobesova, A. Kolar, P. Developmental Kinesiology: Three levels of motor control in the assessement and treatment of the motor system. Journal of Bodywork and Movement Therapies. 2013
Kolar, P., et al. Clinical Rehabilitation. 1st Edition. Rehabilitation Prague School. 2013
Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. 1st Edition. Mosby, Inc. 2002.