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  • 1 Dévény Anna Foundation, Hungary
  • 2 Pro Rekratione, Public Benefit Non-Profit Limited Liability Company (Pro Rekreatione, Közhasznú Nonprofit Kft. Tóparti Szakambulancia), Hungary
  • 3 Gymplex, Healthcare Provider and Consultancy Limited Liability Company (Egészségügyi, Tanácsadó és Szolgáltató Korlátolt Felelosségu Társaság), Hungary
  • 4 Human-Spektrum, Healthcare Education and Provider Limited Partnership (Human-Spektrum, Egészségügyi,Oktatási és Szolgáltató Bt), Hungary
  • 5 Heim Pál Children’s Hospital, Hungary
Open access

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Introduction

The Dévény Special Manual Technique and Gymnastics Method (DSGM) can be applied in all fields of motor rehabilitation (such as in neurology, orthopaedics, and traumatology) and its results are outstanding in cases of infants and toddlers. Anna Dévény, a physiotherapist and trainer of artistic gymnastics, developed this method based on her dual practical experiences. DSGM has 40 years of history and it has been developing continuously.

DSGM’s Spheres of Activity

DSGM includes two spheres of activity. They are (a) DSGM I – special manual technique (SMT), which is used individually and (b) DSGM II – special analytic gymnastics, which uses the approach and exercises of artistic gymnastics to correct, refine, and improve the previously started movements [1].

The development of the method was promoted by Anna Dévény’s conclusions that preceded her time and has been supported by today’s physiotherapy practice as well, i.e., the motor development cannot be merely solved with active exercises.

Injuries in the nervous system, inactivity, inflammation, trauma, or uneven load lead to a whole series of mechanical changes in the muscular, tendon, and connective tissue system. They cause decreased mobility, constant tension, worsening circulation, pain, and dysfunction. Furthermore, changes in proprioceptive and nociceptive sensitivity result in imbalance, which leads to the emergence of abnormal movement patterns. The consequences of any kind of injuries in the bones, joints, and muscles or in the nervous system affect, either primarily or secondarily, the quality and quantity of muscle function, thus limiting physiological movement.

According to the DSGM, the first step in the motor rehabilitation is releasing tightened muscles with the help of the SMT to allow for full range of motion and to create the possibility of biomechanically correct motion. The muscle is freed from constraints and becomes able to perform the physiologically coded movement patterns, making the appropriate proprioception possible. This is followed by active muscle work, namely muscle strengthening and muscle function improvement.

The Special Manual Technique

The DSGM SMT is a manual muscle mobilisation technique, which radically differs from massage both in its approach and its practice. Its goal is to prevent the consequences of inactivity, release existing contractures, and normalise muscle tone.

It has a dual effect: (a) mechanical effect that includes releasing contractures and normalising the position of muscles and (b) stimulation of the nervous system.

Theoretical Background – The Fascia

The great number of publications on fascia research published in recent years meant a big help for us in clarifying the effect mechanism of the method.

The fascial system is a continuous, three-dimensional network in the human body. The names given to its different parts (ligament, tendon, fascia, etc.) disguise the fact that the fascial system should be seen, examined, and treated as an integral whole [2]. Ontogenetically and anatomically, it developed from the mesoderm, like the other parts of our musculoskeletal system. Directly or indirectly, all parts of the system interact through the connective tissue connections. It encompasses and connects the functional units of the musculoskeletal apparatus of the human body [3, 4], supports the transmission of mechanical strain [5], and also has an important role in binding fat and fluids. Owing to the smooth muscle cells in the system, it is capable of contracting [6], its ability of transferring information is three times quicker than that of the nervous system, working at near-sound velocity of 340 m/s [3, 4].

Considering their location, fasciae appear in three main layers, such as superficial fascia, deep fascia (fascia profunda), and visceral fascia around the organs.

The target organ of the DSGM manual technique is the fascia profunda, where the collagen and elastin fibers are arranged at an angle of 45° corresponding to the lines of force affecting them. When applying SMT, we reach between the fascial strata at an angle of 45° and by doing so, we support their normal arrangement.

The fascial sensory nerve endings

Our muscles and their fasciae contain numerous mechanoreceptors. The central nervous system receives its greatest amount of sensory nerves from the myofascial tissues. About 20% of the sensory nerve fibers originating in muscle spindles, Golgi organs, Pacini corpuscles, and Ruffini endings belong to types I and II nerve fibers. About 80% of the fibers belong to types III and IV sensory nerve fibers and originate in interstitial receptors. These receptors function as mechanoreceptors and nociceptive receptors and also have autonomic functions [3, 4]. The fascia profunda is rich in the aforementioned receptors, so coordination, proprioception, balance, myofascial pain, and spasms can be associated with this area [7].

In the case of slow deep pressure, the most likely related mechanoreceptors are the slowly adapting Ruffini endings and some of the interstitial receptors, however, spindle receptors and some intrafascial Golgi receptors might be involved too. The manual stimulation of intrafascial mechanoreceptors leads to an altered proprioceptive input to the central nervous system, which then results in a changed tonus regulation of the motor units that are mechanically linked with the tissue under the practitioner’s hand. Both Ruffini organs and the interstitial receptors can trigger changes in the autonomic nervous system. The autonomic nervous system response includes the changes in global muscle tone and local tissue viscosity, as well as a lowered tone of intrafascial smooth muscle cells [3, 4].

The DSGM SMT reaches deep into the muscle-tendon layer, namely the fascia profunda with a slow, gradual display of strength. In our assumption, it can influence the muscle tone through the aforementioned mechanism.

The passive stretched position

An important part of the DSGM SMT is the treatment in a special position in the so-called passive stretched position. The therapist stretches the treated muscle or muscle group in the opposite direction of its function. We can see the place and extent of the contracture from where the movement stops. Latent defects and muscle tightness become light during the treatment. Mechanoreceptors in fascia profunda can be reached more easily in this position. The stretched position transfers stimuli to the nervous system through the receptors sensitive to stretch stimulus. The stretching expands the elastic elements connected sequentially and in parallel, and they accumulate energy that can be regained during the movement. This is a slow and fine stretching, and it does not reach the stimulus threshold of the stretch (myotatic) reflex.

The DSGM treatment is carried out in a static position with either active or passive mobilisation. Local treatments are carried out on topographic and functional units primarily with the aim of releasing contractures. The different body positions are continuously changed, so that the muscles work together in different manners. When applying whole body treatment, several muscle groups can be affected simultaneously. We experience the effectiveness of the treatment mainly when starting gross motor movements.

Development of the nervous system

During our birth, we have a large number of neurons. The formation of synapses between the neurons and myelination occurs during the postnatal period. This is partly not only based on a genetically defined plan but can also be influenced by the stimuli of the outside world. A large part of the neurons – those cells that have inappropriate and defective connections and therefore do not receive vital growth factors – die by apoptosis. The neurons that have established good or fairly good connections are retained [8]. In our opinion, the stimuli provoked by the DSGM SMT are able to influence the development of synaptic connections.

The Effects of the DSGM Treatment

In DSGM treatment, infants are treated in a static position according to their age, either during movement or being moved. Stimuli of the mechanoreceptors and nerve endings in the muscle-fascia system, which make up the movement, become fixed in the corresponding brain areas. The repetitive movements during the treatment reinforce the nerve track running between the body and the brain. The series of functional movements can stabilise the synaptic connections. The stimulation of a part of the cerebral cortex affects the neighboring parts as well. We allow only normal, biomechanically correct movements to be carried out, with which we prevent abnormal positions to be fixed and abnormal movements that would originate from them. The stimuli from the visual and vestibular system reinforce these neural connections as well.

When treating myofascial structures, not only one muscle is affected, but also the ones found along the myofascial meridian get affected. The movements exercised can be corrected in a complex way, which then can be directly built into the function.

DSGM can be effectively used in several conditions, such as muscle tone disorders (spasticity and hypotonia), cerebral palsy, congenital or acquired orthopaedic diseases, e.g., asymmetric postures, torticollis, pes valgus, pes varus, pes equinovarus, arthrogryposis, developmental abnormalities of extremities, careless posture, Scheuermann’s disease, scoliosis, syndromes with muscle tone disorders, peripheral nerve injury, suckling difficulties, speech disorders, and orofacial problems.

Areas of Application and Conclusions

DSGM is a functional physiotherapy treatment method. It applies a deep fascial technique, which overcomes the mechanical obstacles in the muscle-tendon system. It leads children along the stations of movement development according to their age; it is static and is carried out with either active or passive mobilisation. It exercises the biomechanically correct, functional movements. It promotes the development and stabilisation of nerve tracks and neural connections that are required for the given function.

References

  • 1.

    Dévény A. DSM – Dévény-módszer. A mozgásterápia új útja [DSMG – The Dévény Method. A New Approach in Movement Therapy]. Budapest: Semmelweis Kiadó; 2017.

    • Search Google Scholar
    • Export Citation
  • 2.

    Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. London: Churchill Livingstone, Elsevier Health Sciences; 2009.

    • Search Google Scholar
    • Export Citation
  • 3.

    Schleip R. Fascial plasticity – a new neurobiological explanation: Part 1. J Bodyw Mov Ther. 2003;7(1):1119.

  • 4.

    Schleip R. Fascial plasticity – a new neurobiological explanation: Part 2. J Bodyw Mov Ther. 2003;7(2):10416.

  • 5.

    Huijing PA. Muscle as collagen fiber reinforced composite material: a review of force transmission in muscle and whole limb. J Biomech. 1999;32(4):32945.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Yahia L , Rhalmi S , Newman N , Isler M. Sensory innervation of human thoracolumbar fascia. An immunohistochemical study. Acta Orthop Scand. 1992;63(2):1957.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Schleip R , Klinger W , Lehmann-Horn F. Active fascial contactility: fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 2005;65:2737.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Hámori J. Az emberi agy plaszticitása [Plasticity of the human brain]. Magyar Tudomány [Hungarian Science]. 2005;1:4552.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1.

    Dévény A. DSM – Dévény-módszer. A mozgásterápia új útja [DSMG – The Dévény Method. A New Approach in Movement Therapy]. Budapest: Semmelweis Kiadó; 2017.

    • Search Google Scholar
    • Export Citation
  • 2.

    Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. London: Churchill Livingstone, Elsevier Health Sciences; 2009.

    • Search Google Scholar
    • Export Citation
  • 3.

    Schleip R. Fascial plasticity – a new neurobiological explanation: Part 1. J Bodyw Mov Ther. 2003;7(1):1119.

  • 4.

    Schleip R. Fascial plasticity – a new neurobiological explanation: Part 2. J Bodyw Mov Ther. 2003;7(2):10416.

  • 5.

    Huijing PA. Muscle as collagen fiber reinforced composite material: a review of force transmission in muscle and whole limb. J Biomech. 1999;32(4):32945.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Yahia L , Rhalmi S , Newman N , Isler M. Sensory innervation of human thoracolumbar fascia. An immunohistochemical study. Acta Orthop Scand. 1992;63(2):1957.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Schleip R , Klinger W , Lehmann-Horn F. Active fascial contactility: fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 2005;65:2737.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Hámori J. Az emberi agy plaszticitása [Plasticity of the human brain]. Magyar Tudomány [Hungarian Science]. 2005;1:4552.