I often get asked by other fitness professionals that are studying neuromuscular techniques or are thinking about studying neuromuscular techniques if I use it. "Yes," I always reply, "all of the time." The inevitable follow up question is how? How is it implemented into sessions that are supposed to be strength and mobility based? How do you find the time to test/re-test and actually use some of the correctives when really, our job as trainers is to get people strong? Below are four examples of clients that I use the techniques with often. The principles of DNS/PRI are utilized in every session I perform; the depth to which I use it depends on both the client's goals and how the client wants to use the session. I should caveat this with a little about my clientele. I do not have individuals walk into my studio that have absolutely nothing wrong. This just doesn't happen. Even if the person says he has no musculoskeletal issues, after 30 minutes it isn't unusual for there to be references to car accidents, shoulder surgeries, migraines, and my favorite, open heart surgery (while not a musculoskeletal injury, it still seems something worth mentioning to your trainer at the initial intake, but apparently not everyone shares that sentiment). And, despite what some might think, I do train people under the age of 60. They have things going on as well (degenerative disc disease at 40? I am totally your girl). The take home message is many of my clients have tried traditional exercise programs and have either been injured or had the feeling they were going to get injured if they continued on that path. And so they end up in my studio, looking to me for guidance, for a safe program that will make them strong and able to do the things they enjoy in the real world.
Kate* is a 70 year old former professional dancer. She has had chronic neck pain for the last year (diagnosed OA), suffered from a bout of spondololythesis about 16 months ago, and wants to gain functional fitness. She walks regularly and has participated in a variety of fitness programs over the years (her dance career ended in her late 20s). She is also missing something structural in each foot (fairly certain it is a bone, but not 100 percent). As a result, she has never been stable standing on one foot. The very first session, I used DNS techniques to activate her SA (supine and prone 3 month model). I also taught her how to bring her ribs to her shoulder blades, drop her ribs down, and activate her IOs and TA using PRI breathing techniques. I did run her through some of the PRI tests, and she has instability issues in her hips. After we worked on those things, I taught her how to stabilize standing, using her "center." She was able to stand on one foot for the first time in decades without pain or unsteadiness. We have since progressed to dynamic balance using stepping sequences. We discussed breathing and I showed her a handful of breathing techniques to help shut off her neck. I have learned the hard way not to load an overactive upper trapezius. Bad things happen. Fast forward 6 weeks. She walked in for her weekly appointment and said to me, "before we start, I have to understand what we are doing." "What do you mean?" I asked. "For the first time in a year, my neck pain has subsided. You haven't touched my neck. What are you doing?" This is the power of beginning to understand reciprocal inhibition and facilitation, coupled with the client having the awareness to notice breathing patterns. She has also told me repeatedly how excited she is to stand on one leg. It's empowering to be able to do something that has alluded you for most of your life. We are slowly progressing to a more strength based routine with an emphasis on proper alignment and breathing.
Pete* is a 58 year old executive. He has been active his entire life and has a bit of a type A personality. He had low back surgery 16 months ago (disc repair), and, unfortunately, a negative physical therapy experience. He began seeing me 12 months ago to regain fitness and get back to the activities he enjoys. We started with working on DNS principles of getting the rib cage more neutral and engaging the SA. We also worked on the external rotators of the hips and on the integration of the foot and hip using DNS techniques. We got a bit stuck (he was plateauing, and I wasn't really sure where to go), so a PRI physical therapist assessed him and gave me some ideas. We had one more set back, involving a very bad adductor drop test that I didn't address at the end of the session and a back spasm the next day (pretty sure it was related to moving furniture, but I didn't tend to my details when I should have, so I placed much of the blame on myself), and are now working towards neutrality by testing at the beginning of the session, repositioning, emphasizing breathing during the core work between the circuits, and re-testing at the end. He also has breathing homework that he might be doing sometimes (I am not really sure how often, but I know that he is at least more aware of his breathing and knows how to get his ribs down). He began playing golf 4-6 months after we started working together, walks regularly, and says he is the most fit he has ever been. He made an interesting comment recently. He has been working out with trainers off and on for the last 30 years, and he said he noticed that while he got older and his needs changed, the techniques the trainers used stayed the same. I am the first trainer he has had that approaches things differently. While I think more and more trainers that are serious about training as a profession are starting to use different techniques, I thought it was a fascinating glimpse into an industry that is slow to adopt new ideas. I am hopeful that in the next 4 months I will be able to help Pete move even more efficiently and enable him to continue doing the things he enjoys.**
Jess* is a 33 year old professional. She is extremely active and movement keeps her sane. I have worked her off and on for about 5 years. We have always done more traditional strength training sessions, using primarily body weight, suspension trainers, and some weights. She e-mailed me 4 months ago before one of our sessions to ask if we could just spend the hour stretching. She was experiencing a lot of pain in her mid back, her hips were killing her, and she was sure she was going to have to give up running, which was making her sad. When she arrived the next morning, I told her I was happy to spend the hour stretching if she thought that's what she needed, but I suggested we try some other, out of the box, things first. She said that would be okay, so I ran her through some of the PRI tests (which made it pretty apparent why her mid back was bothering her), and we spent the next hour working thoracic mobility with breathing, engaging her IOs and TA, and helping her shut off some the things that were in a state of overactivity. I told her to not make any declarations regarding running yet; rather, see if she felt better after our session, and see how things went. She e-mailed to say she felt much better, and over the next 4 months we worked on activation with breath and have recently begun working on balancing out her frontal plane. She is feeling much better, her mid back pain is gone, her hips only bother her when she does too much and throws herself back into an extension pattern, and she is running pain free (not everyday, but every other day). We are back to devoting most of our session to strength and mobility work, but spend time in the warm-up on activation/inhibition techniques, and I make sure position is encouraged throughout our workout.
Jenn is a 33 year old personal trainer. She loves all things movement, and has been active for as long as she can remember. She runs and bikes (often), swims (a little), practices yoga, and spends some time in the weight room working primarily on body weight drills with a little bit of kettlebell work thrown in. She pulled her hamstring in the gym 5 years ago and while the pain went away, she never really addressed the root of the problem. She re-injured it a year ago during a daily yoga regimen that wasn't really that mindful and coincided with running a trail 1/2 marathon. She began implementing some of the DNS positioning techniques and also began using a regular DNS flow as part of her daily warm-up. It began to heal, and she noticed things were feeling a little bit better, but than she got a bit stuck. She began learning PRI and it became obvious that she needed to address some major extension issues if she wanted to continue playing hard. She began doing PRI every day with DNS as part of her warm-up (about 10 minutes) and implemented some of the PRI exercises during her 3 days/week gym routine. She utilized the philosophies of both DNS and PRI in her yoga practice, and noticed a change in how she moved and how she felt. One day, while running herself through some self PRI tests, she discovered she was actually in a state of neutrality. This made her want to jump for joy, but instead she used it as an opportunity to progress to learning some of the PRI standing exercises. Her low back no longer feels any sense of compression in back bends, her shoulder blades don't feel a sense of "tightness," and her hamstring feels wonderful. She strongly believes DNS and PRI together are powerful tools.
Below is a link to a plank sequence I use when I want to activate IOs and TA. It emphasizes breath to activate the abdominals and focuses on the ribs being in a state of exhalation.
*All names have been changed except for the last one. Jenn, as you probably guessed, is me.
**Two days after I published this blog, I received a phone call from Pete's doctor. He was impressed by Pete's mobility, strength, and overall fitness, and was wondering if he could refer people to me. He has been looking for a fitness professional that "gets it" and is able to work with more difficult conditions for some time. I am grateful I found methodologies that make sense to me and have such a profound affect on people's wellbeing.
Yours in health and wellness,