#54 - Muscle Memory: How Your Brain Maps the World with Muscle Tone with Dr. Michael Lovich, Part 2

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 and 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, guys A 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 finish up our two part training with doctor Michael Lovick titled Muscle Memory. How your brain uses muscle tone to map the world. Now, muscle tone or muscle memory rather is the ability of muscles to perform actions without neuronal input. It's related to the brain's ability to map out the body using muscle tone and integrates with vestibular and visual inputs. Today, Doctor Loovic will discuss the importance of understanding the innerplay between the brain and body to help determine the root cause of seemingly unrelated symptoms in your patients. We will also chat about the relationship between muscle memory and chronic pain and how reflexogenic systems can be used to treat musculoskeletal cases that are not responding to care. Today's guest speaker helping us navigate this topic is doctor Michael Lovick, a Board certified chiropractic, functional neurologist and Board certified chiropractic sports physician. He holds Masters of Science in sports Medicine with additional training in brain based functional medicine and functional movement based rehabilitation. He has served as 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 systems that are often overlooked. He's a partner of Delta S Performance Functional Neurology and Sports Medicine with clinics in the Denver and Boulder metro areas, and clinical adjunct faculty for Evidence space, concussion Management and care for the University of Western States Sports Medicine program. All of that being said, with all of the accolades and the functionalrology designations that doctor Lovic has earned over the years, we are super excited to have him tackling this very important and very cerebral, may I say, topic for us today, So let's cue the intro music and get started. So we talk about a couple of these artificial compensations that happen, so balance and hypertenicity. If you have an issue with vestibular input through your vestibular spinal tract to your core muscles, no matter how much balance training you do, it's not going to fix the vestibular issue, So you're going to constantly be fighting against vestibular systems are always paired. Right, you have your right end to your left post here and now give your left horizontal and your right horizontal. Now if the left horizontal isn't working well, your right one relative to it will be overfiring, which use the term escaping, which means that you're going to get the constant perception of your rotating to the left if you're always rotating to the left, even if you're physically not, but your brain thinks you are. Because remember, vestibular drives into appropriceptive. That means all the muscles on the right post to your side of your body are going to be pulling back and you're going to be creating muscular imbalances, and that is home. So you can have pain in patterns associated with that, and you can do it yourself. Slightly turn your body to the left and then rotate your trunk to the right and find the areas in your body. You can feel a little bit more tension building and next time the patient comes in with a pain in that area, start to think, hey, maybe there's a vestibular component. How can I test for this or how can I co manage someone who contest for this muscle splinting. We talked about that pretty straightforward joint dysfunction. So if you work in any sort of pt or chiropractic mindset, where you're using mobilizations or manipulations. The whole concept of joint dysfunction in an area might not be due to an area due to a problem in that area could be especially if it's post whiplash or post concussion or developmental if they've had it forever. It could be due to that increase in hypertenicity in that localized segmental area because it's a segmental sensory apraxia, which means the brain can't feel it well enough, so forgets how to move it, which locks it down, creating a restricted area. So when you motion palpated or you try to say, oh is this working, how's that doing? And you start moving things around, adjust in that area may not be the most appropriate thing to do, because it could be coming from an area where the brain is needs that to figure out where the body is in space. So what do I recommend if it's on the same side. So let's say you're looking at it from a cerebellum perspective and you're like, Okay, the right cerebellum's not like I found that seems to be doing a little bit rougher, And I'm finding all these areas on the left side of the body that are hypertonic. Maybe hypertenicity is more of a compensation. I want to put input through to that right cerebellum instead, I'm going to only hit the stuff on the right side. I'm only going to move and motion palaply this stuff on the right side of the body, and so the left side of the body I'm just gonna leave alone and see what happens. More often than not, if you're using this approach, you'll find that hey, like two three days later, that just kind of like quietly disappeared, and the patient when you ask them about it next time, you're like, oh, yeah, I guess that's gone. But you can use this through this sort of concept through a number of different ways. And this is where I put all those reflexes down there. For people who like to read up on things will read up on all these reflexes and you'll start to say, like, oh wait, there's a connection there. There's a thing there that might be causitive correlated that where my more musculo skeletal based approach might stop and not be able to go that far, because essentially we're just kind of beating it into submission. One of the problems is so, especially like with like deep tissue, is you're creating a ton of sensory stimulus into an area that might be one of those compensations. And if you're putting sensory stimulus into the brain on the opposite side of where you find the deficit, you might be furthering that deficit. Where they'll feel better in the moment they'll get up off of the table. The muscle is longer because you've manually made it longer, But what's going to happen as soon they try to use it, It's going to shrink back up again because the brain still needs that compensation to navigate the world appropriately. So I hope this created a little bit of a paradigm shift for some people to think maybe there is a little more of the brain to look into. I always offer consoles, case reviews, anything like that with anybody was interested. I'm always happy to chat about it. It's the goal is I feel like patient, but I want patients to have the best patient care they have. And if somebody needs to ask a question, doesn't want to feel like it's a weakness to ask for help that I'm always there to help. So for anybody who wants to refer a patient my way go to contact us page on our website and click under new patient info have them fill out to get started for him. For everybody else, anybody who's a practitioner of any sort has questions, I wants to have hop up a phone call with me to go over something you're working with, or at least to ask a question of like, Hey, this is I'm trying to figure this system out. How do I figure it out? Practitioner referrals and case reviews. And then if you want to come shadow in office, either in Massachusetts, Rhode Island, or Colorado, fill out the form under shadowing our offices and we're more than happy to have you in here. And that's all I got. I've tried a lot of different rubs and different types of ointments and lotions before I used to use other top goals 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 effectual. Thank you so much, doctor Levic. If you have questions, please chat those in through the chat feature there. We would love to hear from you, and we'll start kind of the live Q and A portion here. Going back to what you saying earlier about your practice, could you give us kind of a little idea about what your intensives look like. I know sometimes you work with patients in these intensive programs and do a lot of different things. Could you tell us first what type of patients are better suited for and intensive and then walk us a little bit through like what that process looks like in your office in terms of length of time, zams, things like that. So when you're looking at it, intensive actually gets a little complicated because you look at more psychosocial factors as well. So let's say ideal, which means no financial concerns, no time concerns, and we can get a person better. If we want to create neuroplasticity and your brain, the best way to do that is intensity and repetition. Right when you're working with the brain, you don't have to rest as long as when you're working with a muscle. So let's say it ideally or a ton of hand waving gear, we'll go when doing a workout with like two A days. If you do two A days every day for a while, five days straight, that's pretty like the body typically needs to recover. People are usually pooped that evening and hopefully sleep well that night. When we're talking about neurological rehab, if you give them ten fifteen minutes of actual, like full on rest, like hey, you lie down, you get naptime in the dark, close your eyes. I'll be back in fifteen minutes. We do thirty minutes for most intensives here. Then we can continue to build neuroplasticity at a rate where we have a controlled environment so that they don't go back into the world, move weird, do things weird, throw off the stuff that we worked on, and then they come back and say, all right, I felt better, and then it came back. We can continue them rehabbing and getting better and better. I had a patient in here this week. So what an intensive is is two hour examination, twenty eight rehab sessions, and then a one hour reexam Monday through Friday. And so I have a patient in here from the Los Angeles area and came in thinking like it might be some sort of disononomia, some sort of pots, some sort of weird thing that just creates muscule scaltle issues, including like some sort of cog wheel rigidity in the legs where you're like, okay, there's some weird nerrow stuff going on. And as we started working on it, we realized it was a vestibular issue. There was a left postier canal, or we'll call it a right end tier canal escape that was really like creating a lot of haywire right endtier canal escape. You think that you're constantly falling forward, what is your body going to do the compensation it's constantly going to pull your backwards into the left. Your left post or a hip is gonna be super tight. What also counts as a posterior muscle your soas and so you're going to be creating these artificial compensations where if I went in there and I tried it a couple of times, I was like, all right, I'm just gonna loosen up your so as. I'm gonna loosen up your glutes. We're gonna do some glute activation type stuff and do all like the functional movement rehab type stuff and say, hey, if we we're just gonna see what happens. I even did one single drop on a drop table, separately, not all at the same time, to say I'm going to do this, throw you on a balance platform and see what happens, see what changes. And every time we did anything with the muscles, it destabilized it, which created an increase of symptoms until I was like, okay, well we're going to move your leg out like this a few times to activate those left glued stabilizers and like, oh, pain went away. So we were going through this cycle and we realized that there was a vestibular issue that had to be taken care of first and foremost, and we got that knocked out in like a day and a half. That was easy, but then we spent the rest of the week incorporating more of a functional movement thing. How do you relearn how to use your hips, how to use your lower core, how do you turn it into the appropriate motor and grams? And for people who don't know what an end gram is, it's a code of your brain that says this is how you move and coordinate a group of muscles to to do a certain function. So we're trying to do is create a new motor and graham And what's the easiest way to do that? Repetition and intensity where we have her doing more fundamental movements and you can go to like DNS in that kind of style, And I did, but I was using it, but I was changing the exercise to bias. It based off a vestibular input, so we can continue winding left post your canal into lower brain stem activation into motor court of a spinal output. Does that make sense at all? Yeah, I know that's interesting. And I think another important question too is like, if I'm a doc in practice and I have a patient that might need to be referred for further neurotreatment than I offer in my practice, what does that typically look like? When should their kind of red flags start going off where they say, hey, this is something that might be outside of what we can off here. That's the toughest part right now, because a straight up algorithm is at a functional model of when you draw this line, that's when this is functional neurology. And before that can be we'll call it functional movement. I would say when there are neurologically related symptoms, easy way to know if it's a neurologically related symptom, go to the subjective symptom and out with the subjective symptom form on the SCAT five. Any of those things, including neck pain, could be neurologically related. And so when you see anything there, first step is to start putting a little closer eye on there and say, okay, is there something deeper happening? Do I want to start looking for things? So what you want to look for is ocular movements. Can they keep their eye on a target when they're looking at you or do they jump their eyes all over the place. And if you ask them to look at something like a thumb, make sure it's outside of their convergence on this. Number one error that I see in most people doing rehab is they put the thumb right here or even here. You want the thumb to be further than they could reach, because you want their eyes to be as at least converged as possible within reason. Have them look at your thumb. If they can keep their eye on a target, that doesn't mean that they have ocular stability, because that's where these things come in. When you can keep your eye on a target, you can use your frontelobe to inhibit the vestibular error. So there's two ways to look into this, and they're a little bit tough to do. You can throw them in goggles like that which put them in the dark, and you can see how the eyes move when they don't know where they are in space, they don't know where the world is, and you can see ocular instability. Or you can use an opthalmoscope and you can look in the eye and you can have them cover the other eye. The light blocks out, the hand blocks out, so you can see a spontaneous pystagmus. Sometimes you can see a bunch of ocular instability, like if you're like, if you practice your up homoscope and you're having trouble getting into the eye, it might not be your error. It might be their eyes moving all over the place that they can control it. And then The other thing you can do is have them line their back and then close your eyes and you can put your like I use my thumbs like this. You can put your thumbs on their eyelid and you can feel the lens as a differentiation. You can feel the motion of the eyes. So there are ways that you can look at ocular stability without having them look at something where they can use their frontelope to suppress all the issues that are going on. One. I think you made an important point there too. You don't have to have complicated equipment sometimes to make these determinations or to do these exams, which is some people use a vibra pastor that costs fifteen hundred bucks. I'd take a gilette raisor and take the sharp part off. That's a great way to do that. Someone else wrote in with a question and said they're curious if there's a neurocomponent in scoliosis cases. They said, the point you made to work on the opposite side of the symptoms. Do you think or know if there is a relationship to idiopathic scoliosis without clear structural ediology with the compensatory mechanisms you mentioned, Yes, so scolios I'm not going to talk about congenital scoliosis, or we're not going to call about a structural scoliosis, but let's talk about a functional scoliosis where everything is not structurally asymmetrical. They just have that Remember what I was talking about before, where you could have structural asymmetry in just the angle in which the interior is sitting. If you think of walking as a series of controlled falls moving constantly throughout the world, You're constantly getting more input into one side than the other, which is going to create differences in neuroplasticity along the appropriate path associated pathways, which is going to create changes in head tilt, which is going to create changes in rotation. It's going to create changes in your cortical stability. If you have less will call approp receptive awareness of the left side of your body, you make collapse into that. It can also change based off of your comfort and balance. For example, me personally, I have less awareness on the left side of my body based off of like concussions and stuff. And so now is it less awareness, Like you can do a neuroexam on me and be like, oh, yeah, there's a deficit. No, it's when you take all these like real functional things and you put it under stress, that left side of the body is just not going to be as aware. So if I was going to default to a more stable side, I'm going to default to my right side. Where are all my sports injuries? Right shoulder, right hip, right knee. I tore my PCL skiing because I lost the ski on the left side and I defaulted to the strong side and all the four went through it. So these injuries that use sports related injuries you can get may be associated with a vestibular or visual deficit, and for me, it was a vestibular deficit that created changes with that. So yes, when you have these neurocomponents, they can be related to a more of a functional scoliosis because they just think that this is home because their heads like this make your eyes level to the horizon. It's fascinating. It's really fascinating to think about. And I think you made a very salient point there as well, Like, if you're seeing athletes who continue to have injuries on one side of their body versus another, is that something to look at? Is that something to kind of dig a little bit deeper with? But if you're seeing all the athletes with the injury on the same side of the body, and you start rehabbing and really doing a ton of soft tissue work or joint manipulation on that side of the body, and it's due to the other side of the body not having the appropriate activation. You could be creating further brain and balance which is going to create other issues. So if you're working on one thing and you're like, oh, now I'm getting less like headache coming out of nowhere, there might be a time to look back and say like, Okay, do we have multiple problems going on? Do we need to rehab a neurocomponent, which for our office, like when we get referrals from other practitioners, they're usually back in the other doctor's office within two to four weeks because we work what we do works quick. We do many intenses with people where we see people like three sessions in a day. We said three times a week, We'll see him three times in a day, and we'll stack them and put them all in a morning. So it works quick. But that but going along with that same idea is they gets sent to us for more of that neuro rehab perspective, and then we send them back for the muscile skeletal because we don't need to do everything, and it's also a little more expensive, so there for the patient to pay our prices for something that they can get quality someplace else. But from back to a clinical perspective, yes, if you start seeing injuries all on the same side of the body, start looking at the other side. I have a story about this. A colleague of mine, Tyler, out in Idaho, he called me once because he had a violinist who was having a bunch of forearm pain and he did he did, like he went to school with me, so he did factor, he did a number of other techniques and he was like trying to work on it and he was like, nothing's changing. And I was like, do the same exact thing, but on the other side of the body and it went away. He was like mind blown. Yeah. Yeah. He called me with more expectives than I'd ever expected to set say in his life, and I laughed. That's fascinating though, And it's it's interesting because we do talk about this in our soft tissue courses as well in terms of what we're doing to the body. And obviously doctor Riddle can speak much more eloquently about this than I can. But there is so much input that's being You're inputting into the CNS, affecting the central nervous system with what you're doing every time you touch the body. And I think you're right if you just stop and only think through the muscular skeletal, but then don't even consider the entire nervous system that's also a part of that, you're really kind of missing the boat on some things there. That was my favorite part actually, what I was like entire proctic school learning about because I was learning neurostuff at the same time because apparently I don't like having a life. But while I was going through it, we were I remember going to class and being in class that we all palpated the yes side. We had a one person and everybody went through and palpated it. We all were talking about what side do we think restrictions were on? What did we think we were was going on? And I'm sitting there thinking about it as I'm watching this, I was like, every time we palpated, we're creating motion in there, and that motion is creating sensory awareness to the brain, which is changing the activation which is going to send back down and change where the restrictions are. And I think the purpose of it was very good, which was there's variability just to what people feel. But I'm sitting here thinking like every time you just test to figure out what's going on you're applying a treatment. Absolutely, it's fascinating to think through. And you would spoke a little bit earlier about working with other offices and how someone might refer to you for a short period of time and then you send them back. What type of other healthcare practitioners are you most often getting referrals from? How do you all fit with what you do specifically into that sports medicine team, let's say for a college athlete or even a professional or an elite athlete where they may have a lot of cooks in the kitchen, so to speak, trying to make sure that they're in prime playing condition. How do you guys fit into that with what you do. We get more referrals actually from neurologists, which is really fun to say but also interesting because we get we get like almost no referrals from chiropractors. Well get referrals from pts in chiropractic offices. It's like part of it is the paradigm where we're so locked in into a certain way that we don't really like see what else is available, and we're like, well, I know that if I keep on doing it. I was at was the ACBSP Sports Symposium years ago and I was looking at a case study and somebody got a concussion better in six months, and I was like talking about it. He was like super Jazz, like, hey, look look who we did. And I'm sitting here like, we do that in like two weeks, and so the I didn't say that that we wrote, but the but the idea is what I was saying before at the beginning. We don't overtreat, we don't oversell. What we do is we're here to get people out of our office and make good connections with people in the community. So what does it look like when somebody sees something that may look like a history of concussion or and it goes past the ten days that have to put into post concussion syndrome, or or there might be associated neuroimmune stuff going on like post COVID, or they might have a dis autonomia going on at the same time. Those are the cases to get and over just to get checked out. I've sent people back saying this is not a case that we can fix because there I've been to s seminars where one guy in particular, we says chiropractors never find normal. We find normal. We find times that we are therapies are not appropriate and we need to send to a different location. But the purpose of what we do is we do a really thorough exam. I had an autonomic neurologist in the Boston area once I believe send yeah it was, he sent me a cardiac patient and I'm like, this isn't my wheelhouse. But the guy on the phone said, well, he said that I've seen enough people and if there was something going on, you'd figure it out. And so I was like, that's a really cool compliment, but I still think you're in the wrong place. But if you're open to paying for it, I'd be happy to do the exam and put this and see what I can put together and see where we can get you. And we we ended up just sending you up to like a different type of professional and I don't really know where it went with from there, but that's kind of what we do. We try this new thing in chiropractic called playing well with others. That's very true, and you hit on something just a second ago, and it actually segues really nicely with a question we had come in through the chat. Someone was asking about what commonalities you're seeing in post COVID cases as far as the cause of symptoms, if any, or are symptoms coming from where the virus affected the brains, So it's very individualized. Are you seeing any trends with your post COVID patients? For the sake of time, I was on a radio show on Wednesday of this week talking about post COVID. We kind of like spiral them is like different directions. But the first thing that we talked about really really dies into this, So I would highly recommend checking that out just you get a more full answer. But to make it quick. Post COVID so concussion, it's not just traumatic. It's an acquired brain injury. So you can get concussion symptoms from things like whiplash you don't actually get the head. You can get concussion symptoms from viral illnesses. We see a lot of patients coming through our office with an epstein bar, a chronic line, a site of megalovirus or a COVID how it changes. What's different about COVID in particular is it's there's a lot of weird stuff going on there, which is why there's so much variability. Some person can go online and say, hey, I had it was nothing as worse as the cold. If somebody else laying in a hospital it reads that and be like I wish. And so what it comes down to is your brain's adaptation. Your brain makes symptoms from different areas of the brain. If you're nuclear attracted, solitarius is firing too high, so it's revving too hot. That's where nauja comes from. Yes, you can have other things that can trigger nausea, but the pathway goes to that point and that's where the brain fires too high and now you feel the nausea if you had. And that same system is all your cardio respiratory systems and your gustatory systems as well, So you get all these weird neurological stuff all the same time. But in terms of what are the commonals and postcode patients, they look like incustipations who have chronic low level inflammation due to a virus as opposed to due to a knock to the head, and it's just from our perspective, it's a very very similar ideology. The only thing different is, especially if if there's somewhere near our Boston area, we use an violet colored laser that is shown to be helped with more anti viral antibiotic properties, so we'll use that in combination with it. But we do get postcode patients coming out to me here and I don't have a laser again for some reason, I'm just like a simple office, but we still get good benefits because it's vestibular input. Two more quick notes there are there's a paper out there that shows that unilateral mist good deficits create chronic inflammation, so people who are chasing the guns all the time look the interear. And then there's also what was that other thing I was going to say, You can get the same microglial ramification in a viral in this that you can in a concussion, which could create those long term effects, which is why, especially with what came out in the NFL, there's it's so important to accurately diagnose and not just say well, it's not that bad, because if you can look beyond the subjective questions. If you can do a proper, full cranial nerve exam for subjective complaints like headaches and dizziness, then you might pick up a lot of things that other people are missing because they're kind of rushing through because they already have an idea in their head of what they think it is. I think that's very true, and I think practitioners are. I'm sure you guys are constantly having to kind of check yourself in the examine and be like, okay, like I don't just need to let my bias come into this about A plus B doesn't always equal. See every persons an individual, and I'm sure you see a ton of that in your practice, as do the other practitioners on here. Do you have the link for the radio interview that you were on that you might be able to email me and I can email that to everyone afterwards. Yeah, I can send you that link. I can also send you We'll get them listed. We'll get him post it up on the website and the resource page as well soon. Yeah, can get you that link as well. Okay, that would be wonderful and everyone. That way you can have the full conversation and the full explanation. As doctor Lovich was saying about long COVID. We certainly want to be respectful of everyone's time. We do try to keep two one hour, but this has been incredibly informative. I think even just our Q and A segment could probably go on for a whole another hour just with the questions that have been coming in and the conversation. So thank you again so much. We really appreciate you coming on today. So again, thank you so much, Doctor Lovich. Thank you everyone for joining us, and we will see you next time. Thank you, thank you. That's it for today's episode. Be sure to tune in for episode fifty five, where we kick off a new training with doctor Ben Fergus, where he'll teach you how to supercharge your skill set for clinical and financial success. 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