Dynamic Neuromuscular Stability (by Mark McGrath)

Big Picture View / Breathing and Stability

The topic of Core Stability divides all systems of exercise training; why is this so?

What are the key aspects of our integrated systems functioning that I need to be aware of, and how do I learn to attend to the information arising from this functioning?

Understanding the 3 Containers of Experience:

  1. Body (sensation and feeling)
  2. Mind (thoughts and images)
  3. World/Task (sense perceptions)

Our most basic perception is up/down and the bidirectionality of the spine is the key organising principle for movement and stability, integrated with breathing.

There are four information-rich areas of the body that allow us to organise the living information which comes from gravity perception.

  • The head/neck articulation (occipital condyles, sub-occipitals, deep neck flexors)
  • Thoracic Diaphragm T4 articulation which includes the shoulder blades and shoulder function
  • Pelvic floor and hips
  • The feet

Overview of Key Principles

  • Importance of Central Nervous System (CNS) control in dynamic neuromuscular stabilisation.
  • Understanding inter-connections of function/dysfunction; trigger points in muscles, joint blockages as lock-down strategies.  Lock-down is a non-preferred strategy because of insufficiency in the stabilising strategy.  Lock-down is caused by multi-segmental muscles providing information regarding perception of vertical.  This is a compensatory action usually caused by chronic injury, and needs to be re-educated.  The best analogy for compensations is that of training wheels on a bike.  We bring awareness to the compensation in order to be free of it.  Riding the bike freely without the need for training wheels, is to have a body free of restriction.
  • This has 3 aspects; 1.  How the head is stabilised and balanced on the neck and shoulders, 2. How the trunk is stabilised on the pelvis,  3.  The bi-directionality of the spine (up and down perception)
  • Functional joint centration: position of joints is controlled by coordinated co-contraction of antagonists.  Well balanced activity of antagonists ensures well-centrated joints and this depends on healthy functioning of the Central Nervous System (CNS).  Coordination of anatagonists is the preferred strategy of the brain and nervous system, yet we continue to train by strengthening agonist function!  Muscular synergy always depends on body posture as a whole and not of a particular segment
  • The build up of internal forces within individuals own muscles creates over-stress.  In other words we are creating harm in the way we are compensating to move.
  • Muscle chains are pulling towards the base of support, never a local insufficiency but always in chains of activation.
  • Spine lengthening, chest position is energetically directed toward the sacrum, which horizontalises the thoracic diaphragm.  Imagine a horizontal diaphragm being over the centre of your pelvic floor and ankles, with your head reaching away and balancing on the top.
  • Intra-abdominal pressure (IAP) is activated and modulated interdependent with the task.  (IAP) is the key informational element that is organising awareness of movement and the recruitment pattern of muscles because of the way this happens from inside.  Imagine a large self-inflating balloon that allowed you to know what your shoulders and hips were doing because of internal positive pressure.

Baryshnikov vertical expression

Breathing is Contextual

Gravity, posture, habit and patterns of activity are key factors that affect the shape-changing activities of the trunk cavities (breathing-stability)

The goal of breath-stability is to free the system from habitual, dysfunctional restrictions. Functional breathing means that the breathing mechanism is able to freely respond to the demands that we place on it in the wide variety of situations and activities that constitute daily living.

Breathing Shape Change is Three-Dimensional

The lungs occupy a 3-dimensional space in the thoracic cavity, and when this space changes shape to cause air movement, it changes shape 3-dimensionally. Specifically, an inhalation involves the chest cavity increasing its volume from top-to-bottom, from side-to-side and from front-to-back, and an exhale involves a reduction of volume in those same three dimensions.

Because thoracic shape change is inextricably linked to abdominal shape change, we can also say that the abdominal cavity changes shape (not volume) in three dimensions – when it is pushed from top-to-bottom, from side-to-side and from front-to-back we see a widening in the overall volume of the trunk cylinder. In a living, breathing body, there can be no thoracic shape change without abdominal shape change. This is why the stabilizing strategy of the CNS has such an influence on the quality of our breathing, and why the quality of our breathing has a powerful effect on the health of our abdominal organs.

“The diaphragm is the principal muscle that causes three dimensional shape change in the thoracic and abdominal cavities.” L Kaminoff

The Diaphragm – location

The diaphragm divides the torso into the thoracic and abdominal cavities. It is the floor of the thoracic cavity and the roof of the abdominal cavity. Its structure extends through a wide section of the body – the uppermost part reaches the space between the third and fourth ribs, and its lowest fibers attach to the front of the third lumbar vertebra; “nipple to navel” is an easy way to appreciate the size and influence of the diaphragm.

Diaphragm and TA are one functional unit

The Diaphragm’s Action

The diaphragm acts as a pressure regulator, its dome-shape separates the thoracic and abdominal cavities and is the principal muscle of respiration.  During inspiration, the diaphragm contracts and the dome descends increasing the volume and decreasing the pressure of the thoracic cavity.  The descent of the dome is limited by the abdominal viscera.

During expiration, the diaphragm relaxes and the dome ascends decreasing the volume and increasing the pressure of the thoracic cavity.

Core Stability:  What does Developmental Kinesiology Tell us?

The head, neck and shoulders are stabilised via balanced activity between deep neck flexors and spinal extensors of the cervical and upper thoracic regions.

Stability of the lower thoracic and lumbar region is dependent upon the proportional activity of the diaphragm, pelvic floor, all sections of the abdominal wall and spinal extensors.  Postural insufficiency of a single muscle within this group will compromise the entire stabilisation chain, resulting in muscular dysfunction, trigger points and postural instability.

Intra-abdominal pressure (IAP) is generated and maintained by the diaphragm working with trunk and abdominal muscles to create internal positive pressure, which in turn creates functional strength and contributes to stability. Intra-abdominal regulators are the thoracic diaphragm, abdominal and pelvic floor muscles.

The contraction and subsequent flattening of the diaphragm needs to be able to happen interdependently with breathing in order to maintain intra-abdominal pressure.  What this means is that you can still breathe and have the diaphragm return the lungs on an exhalation, while maintaining an increase in IAP (this is where the breath-stability re-education kicks in).

The ability that needs to be trained is to maintain an increase in the circumference of the abdominal cavity while the diaphragm works eccentrically on an exhalation.  The increase in IAP can be modulated dependent on practice and the stability required by the task.

From a functional and biomechanical perspective a horizontal diaphragm position is necessary for the diaphragm to flatten and to have abdominal muscles support its activity eccentrically or isometrically.  For ideal stabilisation and respiration the chest position must be aligned above the pelvis with their axes close to horizontal and parallel to each other.  This principle links with Janda’s view of the dysfunction that arises in the upper and lower crossed syndromes of the shoulder and pelvic girdles respectively, with muscle imbalance.

Janda Muscle Imbalance Syndromes

The position of the shoulder blades is another key factor in stabilisation.  The medial borders of the scapulae should be parallel with the spine, with the inferior angle fixated on the rib wall.   The instruction for the shoulder blades to be ‘back and down’ can be problematic if the scapular adductors are dominant or if the instruction causes the chest position to go up, therefore increasing the load on the lower paraspinal muscles.

Stabilising activity of the serratus anterior is dependant upon the position of the chest and shoulderblades with the overall length of the spine and involves coordination between diaphragm and abdominal muscles which act as a fixed point for serratus anterior activation.

The Breathing mechanism is regulated and efficiently coordinated by the Autonomic Nervous System (ANS).  Relaxed breathing is important unless the demands of a task or a threat to the organism is present.  This is where learning to check-in with breathing and posture routinely is important.  This way of working is challenging initially from the point of view of attending to breathing and posture, but also increasingly rewarding.  It is very satisfying when body, mind, breath and attention are integrated in daily living.

Our breathing anatomy is layered from inside to outside in both cavities of breathing.  Our cortical map of posture needs inputs to grow the felt sense of expanding from centre to influence moving.  This perspective of our layered anatomy is a very important living principle to understand the role of proximal awareness in exercise education.  This is clearly illustrated in the cross-sectional views below.

 

Cross-section view of the abdominal cavity

 

Cross-section of thorax

How do I create the causes and conditions for optimal breath-stability?

Improve Relaxation

Relaxation brings about a decrease in oxygen consumption of skeletal muscles and an increase in compliance of the chest wall.  Clear understanding of the location, action and energetics of the diaphragm enhances relaxation and embodied attention.

Improve Postural Stability

Optimal breathing capability is interdependent with a postural stability, muscle balance and recruitment.  A balanced body is most efficient in terms of energy expenditure.

The image of the Nuba Tribesman embodies ease, alignment and presence.

Improve Coordination of Breathing and Movement

Paying attention to breath, posture and movement while being clear on the information being worked with, is a pathway to higher levels of functioning and well-being.  Being able to sit, stand, move and lie with awareness of the integrated spinal stabilizing system, will establish body-balance,  joint centration, and act as an organizing principle for speed and quality of movement.

Improve Overall Fitness through Whole of Body Movement Tasks

Walking, running, cycling, swimming, functional load training, yoga and exploring in nature will ensure an enjoyment of activity that will strengthen breathing capability and efficiency, while being deeply satisfying for itself.  The art of moving well implies functional breathing, embodying this in daily living is both the strong enough reason and the reward.

The intrinsic posture of the child is undisturbed by the task

Living Exercise Principles

The following principles will be helpful in paying attention in daily living.

  1. Stabilisation in a sagittal plane is a basic foundation of any movement
  2. 3 points of support at the feet is our connection with the ground,
  3. Deep System Awareness provides information for the bi-directionality of the spine.  This is the basic perception of up and down.
  4. Spine is long with the chest position remaining in the expiratory position (not going up on an in-breath)
  5. Diaphragm horizontal and ribs aligned vertically
  6. Diaphragm and pelvic floor work in coordination when the axes are aligned horizontally.
  7. Head balancing with a whole body up, and the sense of the head slightly nodding forward on its axis when it is free of tension.
  8. Breathing down into the pelvic basin, into the front-side ribs and the kidneys to widen cylindrically.  The low back is stabilised via intra-abdominal pressure.
  9. Ideal Model for Breath-Stability showing how the low-back is stabilised from inside

    Ideal Model for Breath-Stability showing how the low-back is stabilised from inside
  10. Lengthen the out-breath consciously and breathe in and out through the nose as much as is possible.
  11. Controlling the eccentric return of the diaphragm during exhalation is the most effective way to strengthen the breathing/stability component of the diaphragm necessary for optimal breathing/stability.

Call Mark for:

  1. Bodywork sessions based on these principles to change the perception of the body in re-education.
  2. Individual exercise programs based on Functional Movement integrated with Breath-Stability so you can finally be free of your compensatory patterns
  3. Breath-Stability Courses run with Capno-Trainer Biofeedback so that you can see your breathing function in real-time feedback.
  4. Check out the calendar for Classes Sessions so you can learn to exercise using these principles.
  5. I am currently working on a range of educational products that will allow you to learn how to integrate these principles into your current training and give you new ideas and enthusiasm for activity.

http://www.markmcgrath.com.au/