#53 - Muscle Memory with Dr. Micheal Lovich, Part 1

Factor spelled FA k t R stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on six continents, serving as a framework that guides clinical decision making and patient visits around the globe on a daily basis. With this podcast, our goal is simple to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting edge, evidence based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest, with actionable information that you can implement into practice right away. Let's get started. Hi, everyone, Welcome to the Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. In today's episode, we kick off a new two part training with doctor Michael Lovitch titled Muscle Memory. How your brain uses muscle tone to map the world. I find the inner workings of the human brain absolutely fascinating and when it comes to pain science, the healthcare community has barely even scratched the surface when it comes to understanding the multifaceted aspects of a very complex interaction between the brain and the body. In this training, doctor Michael Lovitch will discuss how the brain maps out the body using muscle tone and how that integrates with vestibular and visual inputs. A patient may come into your office with several seemingly unrelated symptoms, and understanding this interplay between the brain and the body can really help you better determine the root cause. Today's guest speaker helping us tackle this topic is doctor Michael Lovitch, a Board certified chiropractic, functional neurologist and Board certified chiropractic sports physician. He holds the Masters of Science in Sports Medicine with additional training in brain based functional medicine and functional movement based rehabilitation. He has served as both a medical director and a member of the medical staff for various organizations and events in professional, amateur, collegiate, and high school athletics. He specializes in integrating the physical aspects of sports medicine and chiropractic care with the brain's neurological and physiological symptoms that are often overlooked. He is a partner of Delta S Performance Functional Neurology and Sports Medicine with clinics in the Denver and Boulder metro areas, clinical adjunct faculty, and a course designer for evidence based concussion management and care for University of Western States Sports Medicine program. Let's cue the intro music and get started. So today we're gonna be talking about muscle memory. I know that muscle memory seems to be a little bit of a I want to call it a hot topic by any means, because it doesn't really have that much controversy behind it. But you do see it used a lot in more lay person settings, and you see it use more like throw and run in the gym all the time, especially if you go on any sort of go on Instagram starts going through the reels and you'll hear somebody talking about muscle memory every few times. Or maybe that's just the algorithm throws me working in sports medicine. So one of the things that we want to look at is okay, well, let's dive into that. How can we use these concepts of muscle memory and specifically how does your brain map out the world and you in it, So that way you can and essentially create better outcomes with your patients or clients or whoever you're working with by having a better understanding of how it works. You may have seen that I started with a poll just to say, just to kind of see what this group tends to do. I typically teach. I've taught a lot of CEUs for state chiropractic associations and have taught like in services for pts working with special specializing concussions and neurological rehab. And I'm always curious to see when you get neurological symptoms do people do a cranial nerve example, where do people kind of say, all right, well let me check everything else and see if we get any improvement. So I'm generally interested in seeing that stuff, and we're going to be going through things that you might want to be looking for during a cranial nerve exam, at least from a muscule scalable perspective. So one of the things is my presentation is made to answer questions as we go. If it's a longer and more involved answer, I may say hey, we'll get back to that during the Q. And a part of that is I like interacting with people as I'm talking, because I like to make sure that this is tailored to the audience of people listening. So let's start. We're going to start up with just a quick overview of who's this talking head? Why do I feel like I would be qualified to even speaking on a topic like this. This is my office. This is what I've been doing for I guess seven years now. My office is called Delta's Performance. We are a functional neurology and sports medicine office. We specialize in neurological rehab. We do NERD rehab of concussions, pots post COVID syndrome. We work with a lot of nerve degenerative conditions. We work with some nerve developmental conditions as well. Smaller segment of the business. The name Delta S comes from entropy. The whole idea is that if you have a messy bedroom. If you have a bedroom, everything in life goes into a state of more disorder. So if you don't spend time putting energy into it, it's going to get messier, messier, there's gonna be more disorder, and essentially health can be viewed the same way. If you're not actively making your health better, it will get worse. So that's why I chose to name my business a little bit more complicated of a name, but I think it works well with our whole mission and approach. We specialize and pride ourselves on patient experience, patient education, and just doing an ethical treatment model. In my opinion, we don't take advantage of patients. We don't do overtreating, overselling, or overcharging. We focus on being experts at our craft and we're more focused on We're not afraid for people to shadow and learn from us because we're going to keep moving forward and we say, hey, come on, keep up. We have a collaborative approach. We try to work with other practitioners in the field because we're not experts at everything. And we also know that sometimes patient care works better when you have a different person focusing on a different piece, because if you have one person who's trying to do all of it, you're gonna the patient education and communication is going to sort of silo you into what can you do? This is more of what we talked about. What I'm saying before types of cases we see and this is our current team. We're growing. We have another doctor joined the team later this year, So if you're looking to collaborate with us or anything like that, or have any questions, please reach out. We're located in New England in three locations and Colorado here in two locations. So muscle memory GAMA motor systems. Now. From my perspective, I used to always say muscle memory isn't in the muscle, it's in the brain. But it's way more nuanceding that when you start diving into the details, we start diving into the actual pathways controlling it because there are physiological changes at the muscle. So if we talk about just basic exercise physiology textbook, it says it right in there that in order for you to make changes, if you teach somebody anything new in the book, it says right there, the first six weeks of any new motor pathway or made a new motor angram is pure alpha motor activation. In other words, you're not training the muscle for hypertrophy at that point. What you're doing is you're training the muscle for control from the brain. But at the same time, what we're looking at is how do things change physiologically at the muscle level that because there are studies that show, hey, when you stop using something for six months, it comes back faster than it did before. So there's a couple of questions that we have to answer, and how can we use that in a clinical model is the most important part. So this is where I always start with every presentation, is how do you build a brain? Because what we think the brain is there for isn't really what it's there for. It's really very simple. It's there to answer two questions, where are you in relation to the world around you? Where's the world around you in relation to you? And it doesn't care about anything other than answering those two questions. And that's why certain symptoms come out. And some of these symptoms start making a lot more sense when you view it from this perspective because there's less deeper meaning behind it, and it's more about, hey, my brain is just trying to stay upright and navigate the world. And so when I have pain, when I have symptoms of any type, those aren't seen as problems by the brain. Those are seen as, oh, this is what I'm supposed to make. This is the conscious experience you're supposed to have so I can stay upright and navigate the world. So here is my simple schematic of how your brain works. Might have seen these things before back in third grade when you're learning math, and this is a function box. In a function box in third grade, it's like the rule is plus three, and so if your input is four, your output is seven. Right, So quick and easy input are all your sensory systems, the five senses, plus your vestibular system. Most importantly is a vestibular system, because that's evolutionarily the base system that everything is plastered on top of. So if that thing's not working right, then all the other senses are going to be doing their best, but it's going to be skewed. All that information goes into your brain, and brainstem creates an interpretation of the world around you, and that interpretation is then fed outward into your motor outputs and your psychological outputs. So yes, it does get more complicated than this. Psychological and motor outputs can feed forward back into the brain and brain sem to say, hey, did I do this correctly? Or this is the conscious experience. Let me affect this interpretation. But at the same time, if you're trying to make long term changes in the way the brain is working, you have to start with the sensory systems coming in. That's time zero, and you have to continue with how the brain and brains them integrates that information, because if we're not working with that part, then it's going to be three steps forward, two steps back every step of the way if it's not full three steps back. I've tried a lot of different rubs and different types of ointments and lotions. Before I used to use other topicals and never had the success that I now have with China Gel. China Gel is my pain reliever of choice. We use it in the office because of its consistency and the response that I get from the patients is what my goal is. I want to get people better. China Gel allows me as the practitioner to use instrument assisted techniques, me as the practitioner to do ultrasound and do many different techniques that I've learned over the years in conjunction with China Gel to get the maximum benefit for a patient. It's the combination of my skills as a chiropractor and what China Gel has in it that allows the patient to get better, faster, and more effectively. What is muscle memory When you talk about it from a strength and conditioning perspective, it's that muscles can drive behavior without an ronal input. You can react to things without thinking about it. You can make a very large case for how muscles and information coming from the muscles can create patterns and maybe you're just activating a pattern that is already predetermined instead of the muscle itself saying Okay, this is what I'm deciding to do. It's more I have a collection of things. This is the information that I've received, I've seen this something similar to this before. I'm going to react to it. But there is some evidence to show that there is an end organ input because muscle related tests are easier to perform with practice. Observations is that there are rapid return of muscle mass following periods of inactivity supposed to say inactivity, and then you actually have increased quantity of sarcomare nuclei for those who don't know sarcermare the muscle cell itself. You can have increased nuclei that do not get lost within activity. The muscle will atrophy or shrink, but the number of nuclei in this cell does not, which is what is thought to be the reason why the muscle memory of hey, I haven't done this for a little bit, let me do it again, and then it comes back for the muick. So what I've noticed, and this is the part that's my opinion, is I've noticed, at least for popular science and popular culture, it's swung muscle memory through a strength training filter, promoting it popularly as housing the muscle. But I'm here to tell you that taking care of your brain and using a neurologically based approach may make better results faster. What is the point of your muscles? The point if the whole point of the brain is to navigate the world and to stand up, the point of your muscles are there to tell you where you are in space, and do you have large muscles to move you around that space? But what's the point of all those tiny muscles? So a lot of the tiny muscles are there for appropriate reception. And when I'm teaching this, I use this example of a rubber band. So let's say you had a rubber band around your thumb and fore finger, as a picture implies, and you pluck it. You're going to hear a sound. Right, If you do not hear it and you want to make it louder, you make it tighter, right, you can pluck it makes a more resonant sound. The issue that we have here is that what if the issue is not in the muscle and the issues in the brain. So, for example, somebody comes over and decides that they're going to be funny and punching the shoulder, give you a dead arm. That muscle is going to tighten up. Why does that happen? Because you've had some sort of blunt force trauma to the muscle. It changes the signaling to the brain. The brain no longer can hear what is going on in the muscle as clearly, and there's more static. This is a very outdated analogy, but it's the only thing I can think of at this point. When you were watching on an old TV, like when I was like a young kid, and there was static, what did you do? You just made it louder and listened through the static. That's what your brain's doing. There's avern sensory information coming in front the muscle. It's got a lot of static going on. It makes the muscle tighter through gamma motor activation, which then creates better awareness of where that muscle is from appropriate receptive standpoint, because again, your brain only cares about where your muscle is, so can use it a stands up right and then that muscle will maybe it's sore, maybe as tightness, maybe it as a trigger point because of the exact individual point that that compensation is needed in order to make the brain function better and have awareness of the muscle might only be this big, and that's to get your trigger point. What we're looking at here from a neurological perspective is essentially, when you build this map of where your body is, a lot of times, the symptom that you're chasing, and even the soft tissue texture and hypertenicity that you're chasing maybe a compensation used by your brain to better function in other areas the same way when an injury happens. Muscle splinting isn't to protect the muscle. Muscle splinting is a normal reflex. It's a reflexive action due to a couple different steps that stays there until your brain gets better awareness of the muscle, or for some patients it doesn't get better. It stays there because they never relearn how to move the muscle, because the splinting created enough of an altered movement, alter kinematics, and why sometimes it's not so much about passive working on the muscle, and sometimes it could be active. We just need to teach the muscle how to move again. Oh, for those who don't know, not everybody has seen this. I've learned. So this is a sensory homoculous This is a map of basically what your brain thinks your body looks at when you scale everything based off of the amount of real estate that your brain gives to the somatosensory cortex. If you look at that area your thumbs, your hands, they're huge, your low back, your neck, the areas of if you think of the areas of the most chronic pain, those are the tiniest areas, and you can get a lot of cortical smudging and get a lot of central sesstimization in that area. But it doesn't necessarily mean that. But it could be a motor pathway and it could also be like a beta neurons being interpreted. So a beta typically associated with appropriate reception, they could be interpreted as pain even though they're not no susceptive in nature. Typically, I put these pictures in here because I think it really shows all the tiny little muscles that do you really think that those muscles are there to move the spine like I don't know half a centimeter or it's are half a millimeter. In reality, those muscles are just there to create tension and vibration, so that way you know where your spine is in space, and there are so your rotatory's longest and breadst those are proper receptive muscles. Your inner spinalis your inner transfer seraide. Muscles that owe one or two segments aren't really there to create motion and movement. They're there to show, hey, something did move because I'm being stretched. And then you also have all these receptors in your body that tell you where you are in space, like proceeding in core muscles too, smaller ones, roufining like endings, neurotendus spindles if you're familiar with that is that's a goldie tendon organ a gto or neuromuscular spindles. All of these things that are housed within the muscle or the tendon of the muscle that tell you, hey, this is where you are in space. So let's get more complicated, just because why not not? Just is your sending cortical spinal pathways what control your muscles. You also have vestibular control of muscles. So your vestibular spinal tract are the fastest firing neurons in the human body, and its role is to respond to movement through a gravitational field and keep the body upright so it can continue to navigate the world. We already talked about earlier how your vestibular system is the system that things are plastered on top of. But what is the only sensory stimulus that is constant on your body at all times when you're here on Earth. It's gravity, So that means that gravity is always pulling in a direction. Your body is always trying to figure out where you are in relation to gravity. And from my clinical experience, when I get patients who have a vestibular deficit, I always ask them a couple of questions. First question is do you ever feel like you're falling backwards or forwards while you're laying down? And the second question is is when you toss and turned during the night, do you find you always rotate the same direction my personal opinion and hypothesis at this point. I'm not a full on researcher, but my guess is that when you have a vestibular deficit, let's call it a left horizontal conal deficit, and they're lying down, so their head is now less in the gravitational in the plane of gravity, which means you're reducing the amount of input coming into your brain while you're laying down sleeping at night. Now you need more activation because of that imbalance, So you continue to rotate yourself in the same direction and that's what's giving little bursts of energy to make things function a little better overnight. But down here on the this is taken so I post graduate training through the Character Institute, and they have I got this off of Google. This is something that's public on their website. Essentially, the whole purpose of what you're establish system does is it stabilizes you in space and allows you to figure out which way gravity is. So let's talk about that real quick. So if you think so, we talk about like how your brain makes maps of where your body is. What if there's a skew somewhere in those maps. What if your perception of where your body is in space. Has you mapped out as being slightly leading to the left, even though you will know you're standing straight up, You're going to create postural reflexigenic postural changes to pull you back over where your brain thinks gravity is, or it's going to get a couple of different things saying different messages. So, from a vestibular standpoint, if one vestibular system, and if you look in the mirror, everybody is asymmetric in some capacity. Let's say your face your head grew where half is half is like call it ideal and the other half is a is a little bit of skew. You're constantly getting changes or differences of the amount of activation coming through your vestibular system just from walking around the world. You'll see this in your patients than your clients because they're going to be talking to you, and they're gonna be talking to you like this. Or the head tilt usually your rotation a tilt and a little bit of a tilt backwards because one eyes higher than the other, they're balancing it out. But if you see that one eyes higher than the other and they're imbalancing out and making it worse, that usually means that the brain is not adapting well to vestibular information coming in and through reflexes cervical adaptations because your vestibular system connects directly to your upper cervical neck and through ocular adaptations through the vestibulo ocular reflex, you'll have an indirect change because the vestibulo ocular reflex connects and the cervico ocular reflex also connects, creating this little triangle of If everything says the same thing, it's all great. If it doesn't, then we have skews. So here's that ocular control of muscles the eyehead coordination. So every time you move your eyes to the left, you have those little proprioceptive muscles contract and control to stabilize your head on the top of your neck. If you have a ton of ocular errors where you have like I was asking during the question, do you do a full cranial nerve exam when you check age fields of gaze? Are you just like, hey, they can move their eyes in that direction, or are you looking at it like what is the quality of eye moving? Do they have a number of catchups of cots? Do they have a number of backups of cots? Do they do they have psychotic intrusions where their eyes are like jumping and then coming back. All of those things are errors that your brain has to adapt for and your brain has to correct for. And so when we're talking about creating errors, what is the muscular skeletal compensation based off this? Well, now you have a deficit or your muscles have to continuously correct and at a point your brain is going to be like, I'm continuous correcting so much just clamping down on these suboctipitals. This is why some patients will come in with claritag and his pain referral. But you go in and you work on their cervical sponsibility, You work on their shoulders, you work on the whole kinetic chain. But it doesn't touch it, or it makes it better, but it doesn't go away because the issue is ocular stability and we need to create And this is one of my questions of why do we for anything with the headache, do we check cranial nerve exam? Well, no, If you don't check the cranial nerve exam, how do you know this not an oculomote or generated issue. If you look at old movies, you'll see how did they show stress? And in an actor or actress, they focus on the eyes and they show the eyes darting in all directions at the same time. What if that's what's happening with the patient and that's something that we're missing, something to look into. Now. Fixing those things aren't necessarily straightforward all the time. Sometimes it's a huge vestibular component to it. But I mean, if you'll find it, at least that's the ball rolling with, things can get better. You also have cerebellar control of muscles as well. So the one that I'm going to focus on is down to the bottom called the flocculus, which is the flockum modular lobe. It's associated with vertical eye movements, but it's a modifiable accessory pathway through that vestibulocular reflex for adaptive control. So it's part of your learning mechanisms in the brain that say, okay, I did this. This is how I coordinate these muscles. And it's also associated with synaptic plasticity due to retinal errors your eyes. So in other words, when you have an eye movement error, your cerebellum is going to try and create corrections because it's going to remember things that have less errors, and that's associated with the next system we're talking about before we do. Here's a fun local activity that everybody can do. If you take your fingers like the pads of your I use the middle finger and you put it right over your subocipitals and you move your eyes around, you'll feel your subocxipitals these tiny little bursts, these tiny little twitches. That's your vestibulocular reflex. That's your cervico ocular reflex and your vestibulo cervical reflex all working together. Because when you move your eyes around, you can see how your muscles are twitching automatically as a reflex. Last system that we're gonna be talking about is I think the absolutely most important system, which is why it's plastered up on my whiteboard at all times. All five loop through the basil ganglia. This is the crude motor system that was paired to a thalamus, which is a crude sensory pathway. So what is why is that important? Because evolutionarily, things didn't start as complex as they are right now, and over millions of years they got more complex. But if you're going to take it and pare it down to the most simple, primal systems that we have. It's basil ganglia and thalamus. Sensory information comes in basil ganglia, error corrects for that sensory information and tries to make an output. It's associated with not just the error processing, but predictive movements, predictive circuits, efficiency of movement, and your dopaminergic pathways. One of the things that a lot of people think is like dopamine is all about reward and all that stuff from a psychological perspective, yes, but what happens in the basil ganglia, which is dopamine fires from your substantial nigra in the midbrain into the striatum and it's at a constant flow. When you predict that you're going to do something like I'm going to drink and it works, you get a little more dopamine to say, hey, that worked, do it more this way. Let's say I did this and I chucked it over my shoulder. A little less dopamine and that will train your brain to do it less this way. So the most important part to think of here is when you are creating any sort of change, when you are making any sort of movement with the body, if you're patterning in errors, we'll call that habituative therapy and vestibular rehab, or we'll call that, hey, forms not perfect, or let's just say form is completely often wrong, because it's okay to push through a form that's not perfect. But if you're training a person to move or an eye movement that has an error in there, you can plasticize over the error and sort of lock in the symptom that it might be causing, making it more difficult to then go and pull it off and rehab it. So from a movement perspective and bring this back down to muscles, your motor pathways are going to be learning through the basil ganglia how to build on it and make more and more efficient movements. But if the prediction doesn't match what happens, and they're putting in a situation where they're just left to figure it out over and over, they may create symnatic plasticity long term potentiation in a direction that's not effective, and in a direction that is actually more what it is called counterproductive, because you're basically training them to move inappropriately. And then you got to go back in a later date and say, okay, well, let's try this other approach where you have to sort of like pare down everything else. I've had that a few times in office where a patient has come in where they were put in a boot or a cast for something way too long because it was like a mile fascial issue that was looked at as like a stress issue. So they say, well, let's just rest it for ten months, and now they have a movement disorder there, So what do we have to do with put them back in the boot for a period of time and then remap it little by little, muscle by muscle because the issue of pain being that area isn't because there's a threat on that area. It's because the brain has plasta size it learned that pain in that area is normal and what you're supposed to feel through basil ganglionic pathways, specifically the ones that look through the frontal lobe. That's it for today's episode. Be sure to tune in for part two, where we will discuss how reflexogenic systems integrate with musculo skeletal cases that aren't responding to care. We'll also talk about how your brain decides to increase muscle tone and how to see pass the artificial compensations to understand where changes are needed for your patients. You won't want to miss it. Episode fifty four drops in two weeks. 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