Peter Attia MD#152 - Michael Rintala, D.C.: Principles of Dynamic Neuromuscular Stabilization (DNS)
CHAPTERS
- 0:02 – 3:28
Michael Rintala's Background in Tennis and Sports Medicine
Peter welcomes Michael to Austin and asks about his upbringing. Michael describes growing up in Northern California, his passion for tennis, and his work as a San Diego chiropractor on the PGA Tour, the World Surf League and USA Surfing.
- •Grew up in Northern California and attended UC San Diego
- •Tennis was his passion and he played in college
- •Chiropractor in San Diego specializing in rehabilitation and sports medicine
- •Works with the PGA Tour, World Surf League and USA Surfing Performance Committee
- 3:28 – 14:39
Prague School Pioneers: Janda, Lewit and Vojta
Michael traces the Prague School of Rehabilitation to the 1950s and its three neurologist founders. He explains Janda's upper and lower cross syndromes, Lewit's joint and soft-tissue work, and Vojta's study of infant motor development.
- •Prague School was founded in the 1950s within Charles University's medical faculty
- •Janda described upper and lower cross syndromes, with some muscles tending toward tightness and others toward weakness
- •Imbalances overload the transitional areas of the spine and produce accumulated, non-traumatic degeneration
- •Lewit developed mobilization techniques for joints and soft tissue
- •Vojta used postural reactions and primitive reflexes to assess central nervous system maturation in infants
- 14:39 – 19:04
Pavel Kolář and the Move into Athletics
Peter asks how the Prague School was applied before Pavel Kolář. Michael describes Kolář's background and how, from the late 1990s, he applied these principles to athletes such as Jan Železný and Jaromir Jagr to reduce re-injury and potentially improve performance.
- •Early 1990s application was mainly rehabilitation, including cerebral palsy and the general population
- •Kolář was head clinician for Czech national teams and a former gymnast
- •He began applying the work to injured athletes in the late 1990s and early 2000s
- •Železný and Jagr were standout athletes he worked with
- 19:04 – 24:32
What 'Stabilization' Means: Developmental Kinesiology and the Diaphragm
Peter breaks down the words in DNS and asks Michael to explain stabilization. Michael describes newborn primitive reflexes, then the emerging coordination of the deep stabilizing group, and they describe the diaphragm's size and attachments.
- •Newborns are dominated by primitive reflexes such as sucking and grasping
- •Around three months, the diaphragm, pelvic floor, abdominal wall and spinal musculature begin to work in synergy
- •The diaphragm is a large muscle attaching to the lower six ribs, the xiphoid process and L1–L2
- •The diaphragm descends for respiration and also creates intra-abdominal pressure for posture
- 24:32 – 33:53
The Cylinder Model, Eccentric vs. Concentric Loading, and Centration
Using Peter's cylinder image, the two discuss the pelvic floor, abdominal wall and spinal muscles as the walls and base. They define eccentric and concentric contractions, and Michael explains centration as the goal of training the central nervous system.
- •The diaphragm is the top of the cylinder and the pelvic floor the bottom
- •The central nervous system must coordinate respiratory and postural functions of the diaphragm
- •Concentric means the muscle shortens under load, eccentric means it lengthens
- •Peter relates a story of Eastern European lifters counting up and down as two reps
- •Kolář defines centration as keeping ideal joint position through the full range of motion
- 33:53 – 46:27
Infant Developmental Milestones Through the Lens of DNS
Peter asks Michael to walk through normal milestones from three months onward. Michael describes how the fixed point lets infants turn their head, lift their legs and reach for their feet, and how they progress toward crawling, squatting and walking.
- •At three months infants can fix their gaze, lift their legs and bring their hands together
- •Reaching for the groin, knees, feet and mouth improves from months four to seven because of motor control, not flexibility
- •Rolling before the synergy is ready relies on compensatory patterns
- •Infants progress from side-lying and high oblique sit through crawling, kneeling and squatting to standing and walking
- •Maturation involves thousands of trials and errors and variability in timing
- 46:27 – 53:17
Why Development Goes Off Track: 70% Normal Maturation and Environmental Insults
Peter asks whether most toddlers move well. Michael cites the Prague observation that about 70% of infants mature normally, with a spectrum for the rest. They discuss environmental factors such as car seats, seated chairs, walkers and early shoes that interfere with development.
- •Subcortical maturation lays postural foundations from three to twelve months, followed by cortical maturation
- •Around 70% of infants are said to have healthy central nervous system maturation, with a spectrum of dysfunction in the rest
- •Car seats, chairs that prop infants, walkers and early shoes can interfere with development
- •Ideally children explore their environment and find their own points of support
- 53:17 – 57:54
Sitting at School and the Breakdown of Breathing Patterns
Peter asks how school sitting affects children. Michael explains how slumping inhibits diaphragm descent and the brain recruits accessory breathing muscles, which can become the default pattern. Peter contrasts this with the abdominal breathing of his young son.
- •Sustained sitting begins the postural syndromes
- •Slumping inhibits the diaphragm's descent needed for respiration and stabilization
- •The sternocleidomastoid, upper traps, scalenes and pec minor take over as accessory breathing muscles
- •Over time this becomes the go-to breathing pattern
- •Healthy young children breathe with abdominal expansion rather than accessory muscles
- 57:54 – 1:03:50
Inside-Out Stabilization, Bracing, and the Functional Gap
Peter asks about creating intra-abdominal pressure, and Michael contrasts dynamic inside-out stabilization with bracing. He introduces the functional threshold and the functional gap, and explains why athletes spend a lot of time beyond their threshold.
- •Inside-out stabilization creates intra-abdominal pressure that loads the abdominal wall and scales with the task
- •Dynamic stability should be maintained through full extension, rotation and flexion
- •Bracing is a concentric strategy useful for impact or excessive loads
- •The functional gap is the zone beyond one's functional threshold where compensatory patterns appear
- •The goal is to raise the threshold so compensatory patterns are not used all the time
- 1:03:50 – 1:09:08
Elite Athletes, Longevity and Time in the Functional Gap
Peter raises elite athletes like Federer and asks how often they are in the functional gap. Michael discusses Federer, Jagr and Železný, and describes how programming and training choices relate to longevity, injury frequency and recovery.
- •Federer is used as an example of longevity and quick recovery
- •Kolář emphasized quality over quantity with Jagr and Železný
- •Good programming, dosing, loading and recovery keep players within functional capacity
- •Overtraining and time in the functional gap are linked to more injuries and longer recovery
- 1:09:08 – 1:16:17
Rehab vs. Prehab: Patient Adherence and Using DNS Day to Day
Peter asks what share of patients come with injuries versus for performance, and how many stay with the program. Michael says most come with pain and that 10–20% maybe stay long term, while prehabilitation programs and MLB interest are growing.
- •Most patients come because of pain and injury
- •Michael estimates 10–20% maybe stick with the approach
- •Once out of pain, many patients go back to old patterns
- •Prehabilitation sequences are built from developmental milestones
- •Major League Baseball is increasingly integrating DNS
- 1:16:17 – 1:23:38
Etiology of Low Back Pain and the Anatomy Behind It
Asked about the most common complaint, Michael says it is low back pain, usually from chronic overload rather than acute injury. With Peter he reviews lumbar anatomy and explains how poor deep stabilization leads to extension, facet compression and disc damage.
- •Low back pain is the majority complaint and usually reflects chronic overload
- •Inefficient deep stabilization leads to overactive flexor and extensor muscles and hinging at the lumbosacral region
- •The psoas and quadratus lumborum anchor off the fixed point created by intra-abdominal pressure
- •Excessive extension tips the pelvis forward and loads the facet joints
- •Repetitive hinging weakens disc fibers and can lead to protrusion, spasm and facet hypertrophy
- 1:23:38 – 1:28:28
Michael's Stress Fracture and Path to the Prague School
Michael tells how a spondylolysis in his lower back in college led him into the profession. He describes finding Janda and Lewit's teaching in chiropractic school and later traveling to Prague, where he first met Pavel Kolář.
- •Michael developed a stress fracture in his L4–L5 region from overtraining and poor postural foundations
- •Orthopedists, physical therapists and chiropractors helped but something was missing
- •Prague School concepts made intuitive sense when he learned them in his second year of school
- •He attended an eight-day intensive in Prague after graduating and met Kolář
- •He has watched DNS evolve into a named curriculum since 2003
- 1:28:28 – 1:44:55
DNS Certification Tracks, Integration and Why Feeling It Matters
Peter asks about certification levels, and Michael describes the clinical, exercise and sport, and pediatric tracks. They discuss the need to experience DNS directly, adherence challenges, and specialty courses meant to integrate it into sports and training.
- •Three tracks: clinical (A–D), exercise and sport, and pediatrics, with culminating courses in Prague
- •DNS is meant to be integrated with other techniques rather than being a standalone technique
- •Peter describes DNS as very efficacious but wonders about its real-world effectiveness
- •Specialty courses cover running, dance, golf, baseball, lifting and hockey
- •Both say experiencing the movements is the gold standard for understanding them
