I would like to begin this review with a brief introduction.

I am a Chiropractic Physician who practices in Chicago, Illinois, and has been utilizing the principles of Dynamic Neuromuscular Stabilization (DNS) since 2007. I have taken all formal DNS courses (A-C) multiple times, as well as many Advanced Skills Courses over the years, and after visiting Prague in September of this year, will become the only Chiropractor in Illinois to be formally recognized as a DNS Certified Practitioner. I have also taken multiple Vojta Therapy courses offered by Dr. Richard Cohen, in addition to Dr. Ryan Van Matres Pediatric Rehabilitation courses which are also devoted primarily to Vojta Therapy. While I do not consider myself an expert, I have received a considerable education regarding Developmental Kinesiology (DK) and natural movement patterns, which is why I decided to write this review. After viewing Dr. Chengs Prehab-Rehab 101 DVDs (this series contains two, 60-minute disks) in their entirety, my initial impression was that I generally agreed with almost all of the principles he detailed throughout the series. I found that most of his statements and ideas regarding the process and goals of rehabilitation were rational and practical. However, even though I tended to concur with many of Dr. Chengs sentiments, I found myself utterly disagreeing with most, if not all, of the methods he utilized to attain things like Cervical spine mobility or shoulder stabilization. Having thoroughly examined Dr. Chengs material, I found that there were many fundamental, basic faults with Dr. Chengs exercise and movement prescription, which stem from the fact that he is simply mistaken about how posture, muscle function, and movement develops over the first year of life. Unfortunately for Dr. Cheng, this is a huge problem, if, as he states, he is attempting to base his exercises on the natural movement patterns of the baby. The fact is that the exercises he demonstrates either miss key components of stabilization necessary for movement, or he is just utterly wrong about particular postures. For example, in the 2nd DVD he attempts to use a developmental position known as Bear position. This position is well known and documented in the field of motor development, and is typically observed in the 11th month of life. Dr. Cheng introduces this concept by saying, This is something I like to call Bear position, which is slightly offensive in tone, but truly egregious because he goes on to demonstrate a position that is not found in any known textbook of motor development and completely negates what actually defines the true Bear position. Specifically, he makes a point of stating that the patients hips must remain below the shoulders, when in fact, in true Bear position, the hips are found above the shoulders, much like the pictures found below.

Another example of a supposedly natural movement pattern which Dr. Cheng purports that babies use is the initial Cervical spine exercise he describes within the first ten minutes of the first DVD. Essentially, what Dr. Cheng demonstrates is what is known as the Superman exercise, as shown below, although in the DVD, his patients arms remain lying on the floor, alongside their bodies

He then instructs them to look forwards and then upwards as high as they can, and to also look over their shoulders using cervical spine rotation. I do not even know where to begin. Evidently the purpose of this exercise, as purported by Dr. Cheng, is to train stability in the Cervical spine, and assuming that Dr. Chengs primary motivation in doing this is to facilitate deep neck flexor activity (a primary goal of C/S stabilization), I cannot understand why he would instruct his patients to assume this position or perform this movement. Cervical spine retraction and hyperextension essentially make it impossible to contract the very muscles he is attempting to train. Not to mention there is not one, single aspect of this position that even comes close to mimicking the natural movement and stabilization patterns of the baby. In fact, if any baby were ever to present using this as their primary movement pattern, at worst, they would be diagnosed with a central coordination disorder, and at best, they would be exercised and guided out of this pattern. If Dr. Cheng wanted to utilize a basic movement pattern for C/S stabilization that actually mimics how infants initially develop C/S and shoulder stabilization he can again look to the milestones of developmental kinesiology. Particularly, the very first time a baby actually raises their head voluntarily is at approximately the 6-week stage. At this point, in prone, the infant has the ability to support itself and bear weight through its distal forearms and upper abdominal quadrants, which facilitates deep neck flexor activity along with a complex muscular synergy which allows for head raising as shown below

This movement pattern matures at the 3-month stage when the first real base of support is established at the medial epicondyles of the elbows and the pubic symphysis, where elongation of the spine occurs somewhere between the mid-Thoracic spine and T/L junction and the head is lifted as pictured below

Notice how in both milestones of development, support through the extremities is absolutely necessary for proper C/S and upper T/S movement, as well as activation of the shoulder and C/S supporting musculature. The baby never utilizes an unsupported position as a primary mode of training his shoulder and Cervical spine. If Dr. Cheng would like to initiate Cervical spine stabilization using natural movement patterns, I suggest he look to the actual developmental milestones of DK.

On a more general note, throughout the entire series, Dr. Cheng also instructs his patients to look up with their eyes and head as high as they can, and while maintaining that maximally extended position of the Cervical spine, rotate their heads to the right and left. This is the primary instruction given to every position (sphinx, quadruped, bear, tall kneeling, etc.) that Dr. Cheng demonstrates. This suggestion is validated because he says that, of course, if you watch a baby crawl, their neck is typically extended since they must watch where they are going (as seen in the picture below). This instruction is further substantiated by Dr. Cheng because it is well known that babies are generally very curious about their environment, and are often searching with their eyes. This typical head position can be observed in the picture below and can be recalled from our own general experience with infants we have handled.

While it is true that babies must look up and forward to see where they are going, to utilize maximum C/S hyperextension and rotation as method to facilitate stability in movement for adults misses the entire point of motor development, not to mention goes against key features of our evolved, primate morphology. To take this in reverse order, other closely related primates that primarily crawl as a means of locomotion, have foramen magnum that are located in the back of their skulls, rather than underneath their skulls. This foramen m. position allows these animals to crawl and maintain perfect symmetry of their spines, while at the same time providing them with the ability to be effortlessly looking forward. On the other hand, due to the altered position of a humans foramen m., we are put at a slight musculoskeletal disadvantage during crawling. I say slight because while the infant most definitely does extend their C/S in many positions, they are also elongating and lengthening through their necks and upper backs as well, and that is the major difference. In Dr. Chengs demonstration there is no mention of uprighting, lengthening, or elongation of the spine, he simply instructs them to look upwards as high as you can, ultimately promoting C/S hyperextension and overuse of the C/S paraspinal musculature. Remember, quadruped crawling is essentially identical to, and is the precursor for, upright walking you dont see anybody walking around with their necks maintained in a hyperextended position, so why train that position??

One final comment is that Dr. Cheng rarely mentions the importance of hand or forearm position in any of these postures, and in some exercises, unfortunately promotes abnormal hand placement. Basically, the principles of motor development dictate that the entire hand, and when practical, the entire forearm, must be in contact with the ground for proper stabilization and facilitation of shoulder and neck musculature. If this full support from the hand/forearm is not present, unnatural, compensatory movement patterns will be engrained into the neuromusculoskeletal system. However, when Dr. Cheng takes the time to mention hand/forearm support, he promotes weight bearing through the ulnar surfaces of the upper extremities. This instruction completely negates the patients ability to properly support himself, and in point of fact, is used diagnostically as an abnormal support mechanism in the motor development of infants. A true analogy can be made to the supporting function of our feet...if you were attempting to train hip stabilization, would you allow your patients to invert their feet and bear weight through only the lateral structures of their lower extremities??

In summary, while I admire Dr. Chengs motivation and thought process in attempting to use natural movement patterns as the basis for exercise and rehab, he is simply mistaken in most of the exercises he prescribes. There is rarely a mention of support/stabilization points for movement, and when they are mentioned, they are incorrect. Positions and postures are defined as natural and how babies move, when in fact, they are not. Finally, I want to emphasize that the principles that I have described here are not my opinions, these are documented milestones of developmental kinesiology that can be found in any textbook of motor development.