Pavel Kolar's applicability to the usual patient.

[rgarbell]

I just completed Craig's course in San Francisco and have become very intrigued by Pavel Kolar's work. As I consider studying Kolar’s work I am wondering about it’s applicability to the common and usual musculo skeletal patients. I do seem to be able to help my patients improve breath and core function with what I am currently doing. I see very few pediatric or neurologic patients. I am curious to learn what members have found the value of his work to be for the run of the mill low back and other patients. Do you do his assessments on most patients and how often does the application of his work help?

[gregorykeilman]

I was at the S.F. seminar as well and am really looking forward to the seminar at the end of this month as well.

I specifically remember Craig saying that he does 3 things with every patient.

1. He adjusts what needs to be adjusted.
2. He uses Kolar's techniques where they are needed. I also remmeber him saying that 30% of the population never develops proper movement
patterns from birth during the first year. I would also expect that a large number of people develop improper/weak/inhibited movement patterns
that due to some injury or disease process.
3. He prescribes the appropriate exercises for that particular patient according to thier condition and thier goals.

I don't remember if he said this in class or if it was a response to one of my questions during a break, but that is what I remember him saying.

[tyler]

I think Kolar's treatment approach to the so called "usual patient" is very applicable. If you are familiar with Janda's approach to treatment, which is commonly used in treating usual patients, you will see the similarities. However, Kolar uses the aspects of developmental kinesiology to determine muscle imbalances and the associated treatments that correlate with the noted imbalances. For example, a baby first develops supine sagittal stabilization of the spine at approximately 4.5 months, then frontal plane movement at approximately 5 months, then transverse plane stabilization in order for the baby can complete the turning process from supine to prone at 6 months, and so on until the baby is able to stand with total body synergy and appropriate centration of all joints. After learning from Kolar, you will be able to see where the adult patient breaks down and which developmental age the dysfunction corresponds with. From this point we are able to find the patient's key dysfunction and start treatment from that point. For example, treating scapular stability, before core stability would be less than perfect. In addition, you may have a patient with low back pain that needs spinal stabilization, however every time the patient does a core exercise he/she is likely using a compensatory pattern that is less than ideal such as overactivity of the erectors and upper part of the rectus ab. Ideal stabilization requires balanced activity of the diaphragm, pelvic floor and all the abdominal muscles. In some cases patients do not have the cortical capacity to actively brace the core in such a pattern. With DNS you will be able to take that usual patient and teach him/her the most ideal way to stabilize the spine. This assessment and treatment is obviously used with palpations, adjustments/mobilizations, soft-tissue mobizations ect. I also believe that after taking a course on Dynamic Neuromuscular Stabilization according to Kolar you will understand that nearly every patient is a neurological patient.

Hope this helps.

[Craig]

Interesting thread.

"For example, treating scapular stability, before core stability would be less than perfect. In addition, you may have a patient with low back pain that needs spinal stabilization, however every time the patient does a core exercise he/she is likely using a compensatory pattern...With DNS you will be able to take that usual patient and teach him/her the most ideal way to stabilize the spine."

I agree & disagree w/ this statement. Neither Janda or McGill would ever recommend an exercise w/ a poor pattern. Certainly, DNS is a great catalyst to normalize movement patterns, but many pts can be "peeled back" to exercises in their functional range (painless & appropriate range for the task at hand) w/ simple advice & exercise selection. An example - a pt has trouble w/ side bridge on knees. Try squat w/ 2 X 4 or window pane squat, then return to side bridge on knees. Since both movements require a hip hinge the squat often faciltates the mind-muscle link required to perform the side bridge on knees better.

Normally, I use DNS on pts to facilitate the diaphgragm. I find it very useful. It is relaxing for the patient. Easy & time efficient for the Doc. However, there are many options. Active exhalation which involves the abd wall in respiration appears to work the CNS program as well. It usually promotes an automatic improvement in diaphgramatic breathing as well.

I think the goal is to tx the CNS. Cortical cueing is a good way to retard compliance. As Gary Gray taught "attack success". This is his "tweakology". Once you find a dysfunction, then find the most functional movement which is related to the dysfunction that the pt does well. Groove that, then return to the dysfunction. It is usually better. When stuck DNS is an excellent way to breakthrough, but DNS will not change motor patterns. It only allows for a change in motor patterns. Active exercise is required to change motor patterns. I think this is why Kolar not includes exercise. Only a few years ago he did not.

I hope this helps.
Craig L

[cwagon]

A very simplistic view of DNS could be a meticulous and ideal setting of the stage.
The show must still go on after the stage is set, and that is through volitional movement.