Concussion recovery and updating the brain's software

This is the Performance Place Sports Care Podcast Session Number 42. No worries, they're coming, wiki-wiki. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everyone, this is Dr. Sebastian Gonzales with the Performance Place Sports Care Podcast, and today we have a really great guest. His name is Dr. Eric Reese, and he practices out in Minnesota, Minnesota. By the way, I don't, I think we're coming to the end of the Paul Rudd references in the beginning, so I don't know what to do next.

I feel like doing James Bond. So, if you feel like you have a good James Bond quote, please, you know, put it on one of my Instagram's feeds. That is at performancehb, and that's on Instagram. That's where I look at most of the stuff. So, just quote it and tell me which one it's from, because I love James Bond. He's such a badass. So, anyways, Eric Reese, I'm going to have him on in a second here. Just tell you a little bit about how I met him. It was funny, we actually did, I did a whole segment on some posters that are actually infographics, which you've probably seen throughout my pages. I did one on sports chiropractic. I did some on, you know, active release, shoulder conditions, shoulder movement, shoulder anatomy, sports hernias.

I mean, I really liked doing them. And when I put them out, I actually had so many docs ask, hey, can you format this thing so I can actually put it on my wall at the office? So, I did. Eric was one of them, and he was one of the few that actually, I mean, he saw through, I don't want to, because I asked for a little bit of a donation from the docs, just because I needed to put a little money into the formatting. And some of the docs reached out and they're like, gosh, this stuff is cool. Like, I like what you're doing with the podcast, and I like all the content and so on. And Eric was one of them where he said, you know, I think we have a lot in common, we should talk.

So, we called and talked, and we talked for 45 minutes, and it was, talking to him is like, you'll hear that he's very eloquent with his words. I told him he should do a podcast of his own, and he has a lot of information to share. So, I thought he'd be a good one to have on, and he's going to focus on not only his journey of like how he became to treat how he does, because he treats a little bit differently than some of the other chiropractors that I know, but we're going to talk about also neuro rehab too, which is something that I'm not fully knowledgeable on. So, I'm definitely going to learn a lot through this podcast.

So, his website, in case we don't mention it later, is mnfunctionalneurology.com. So, it's Minnesota Functional Neurology and Chiropractic, and they focus on functional neurology. So, let's have Eric on, and yeah, if you have questions, feel free to ask them on the podcast. Ask them on to the p2sportscare.com button on the side with a voicemail. At some point, we're going to have live shows, by the way. I haven't figured out how to do it and coordinate everything yet, but we will. And also, too, if you're listening on someone else's website, I forgot, I need to mention this more, because I've had people email me and say, hey, I don't know how to find all of your podcasts.

Well, probably the easiest way is go to p2sportscare.com slash podcast, and you'll see all of them listed, maybe minus the most recent one on there. I usually try to do it right as they're released and put it up on there on Wednesday, but sometimes I'm a little slow with it by about a day. But you go on there, and all of the buttons will have links to iTunes, which will take you directly to there, and you can subscribe and get all of them right there. So, that's the easiest way, rather than searching through iTunes, to find it. So, p2sportscare.com slash podcast will get you to what you need. And by the way, any of the links that we talk about today or any of the references, I will make links in the show notes on that same link on my website.

So, here we have Eric. Okay, so this is Eric then, and Eric, go ahead and, or sorry, Dr. Reese, and go ahead and tell us about yourself and, you know, your journey through your education and whatnot. And, yeah, say hi. Awesome. Well, first off, Sebastian, thanks for having me on the podcast. Excited to chat and hopefully spit some knowledge and learn something from you as well, too. So, as you had mentioned, my name is Dr. Eric Reese. I am a chiropractic neurologist in Minneapolis, Minnesota at Minnesota Functional Neurology Chiropractic. And I also have a board-certified brain injury specialty certification from the Brain Injury Alliance of America.

And my education kind of started when I was a child, I guess, curiosity, playing sports, getting injured, going through different stages of development. I've always been intrigued by the brain and the body and how they relate to each other. And so, when I got into college, I went through the exercise physiology program at the University of Minnesota. I was fortunate enough to do a little bit of research underneath Dr. Juergen Koncheck in the Sensory Motor Laboratory at the University of Minnesota, which looked at sensory inputs into the brain, understanding how they work with motor locomotion and what helps people move, what facilitates movement.

And I was fortunate enough to have a small undergrad research opportunity to work underneath him. That's kind of what triggered me to really get a part into neurology and neuroscience. And I took that with me into chiropractic school at Northwestern in Bloomington, Minnesota, which then started my spiral down the rabbit hole of neurology, the brain, how it relates to structural integration and how nutrition plays a role and all of this so together. And so, long story short, did a two-and-a-half-year stint out in Oregon at a very cool, unique clinic with Dr. Glenn Zielinski at Northwest Functional Raleigh.

And I made my way back to the Midwest about a year ago, and now I am with Dr. Jeremy Schmo. And I am seeing patients and pretty much trying to take my model and see how I can benefit those who may or may not have had, you know, the ability to make changes with the kind of symptoms that they've been dealing with. So using, you know, a little bit of a different or unique approach to try and see if I can make true neuroplastic changes in the brain and using the body and any type of therapy possible. So use a lot of big words, a lot of big words. And I'm just going to act like there's a patient looking over our shoulder and listening to this conversation.

And what's your patient population? Or what's your population for podcasts? Are they just like normal people or are they all practitioners? You know, this is a lot of—we're still live, by the way. That's fine. We can start it over. Oh, no, no, no. We're not starting it over. No, we're good. I'm just going to play the part where—so I'm just going to ask questions. Even if I know the answer, I'm going to ask them, okay? Okay, cool. So, hey, everyone can see now how the podcast works. Or no, we're not deleting any of this. So, yeah, you said neuroplastic changes. You saw a lot of big words. But, like, so I guess what it comes down to right now is a patient listening to this or a client listening to this, they're wondering, like, I have no idea if this would help me.

I don't know, like, so what is the type of person that will benefit the most from this? Like, is there three types of people that are like your classic? You're like, oh, all the time. Like, this is going to work. Sure. Well, let's take a look at it from this standpoint. You know, all of the large Latin medical terms aside, let's take a look at it from a standpoint of how humans have kind of evolved. So, when we're developing and we're growing and we're inside the womb, we start moving. And there are some theories out there that are, you know, more researchers coming out talking about what is movement?

Why is movement so important? There's a tiny organism in the ocean called a sea squirt. And early in its development and early in its adolescent stages, it has a nervous system and it floats around the ocean and it's growing and it's doing all these different things to get around. And it finally finds a spot to attach itself to rocks for the rest of its life. And the first thing that it does is it instantly digests its nervous system and its brain. So, why is that relevant to humans? Well, your brain, just like the brain of the sea squirt, is primarily developed and therefore movement. Now, classically, as, you know, a chiropractor or a PT or somebody in society in general will say, thinks of movement as some sort of physical movement where you're lifting a weight or you're bending over or you're walking.

But when it comes down to it, movement can be a magnitude of different things. Thoughts are movement. If you look at a thought, you're going from one spot or one area to another or one concept to another. And that's still considered movement. Take a look at emotions. I mean, motion is in the word emotion. Emotions are some sort of neurological outcome that you experience, whether that's sadness, happiness, frustration. It can be an array of stuff. So, when it comes down to what I try and do in my big picture of an assessment of somebody coming into me, I'm assessing movement. And that movement can be neurological outcomes, whether that's them having a tremor or them having weakness or some sort of, you know, movement disorder.

That could be me looking at how well they move while assessing the squats or looking at different types of joint mechanics. Are they having adequate movement in their upper extremity versus their lower extremity? There can be a range of things. So, the population that I see is anybody who really struggles with movement. And like I had stated, that could be a physical movement. That could be some sort of outcome neurologically. It can be an array of stuff. I don't like to pigeonhole myself with the population that I see, but I do see a lot of people who have issues with the actual physical movement, which could be issues with the structural components or issues with the neurological components or a combination of both.

How many times do you run into the realm where they're purely physical or purely, I guess we said mental or emotional, and then a combination? Yeah, I think it's always a combination. I think it's always a spectrum. I have rarely seen somebody have a simply structural issue that hasn't had a neurological outcome or a secondary neurological outcome because of it. And the same is true. I have yet to see anybody who has a truly genuine neurological issue that isn't mediated by some sort of structural abnormality or issue. Now, that doesn't mean that, you know, one leg is longer than the other because of some sort of developmental issue.

It's more so saying that, you know, structure dictates function and function also dictates structure. And I look at those two things as function can be analogous to the neurology. So, I mean, when you look at an individual in front of you, you have one person, you have one brain, they have all these muscles and tissues and organs. And if you go try and have a conversation with a cadaver, you'll find out very quickly that they have all the muscles, they have all the tissues, they have all the organs. They just don't have an intact nervous system. Now, my goal is always to try and assess that nervous system and how that nervous system affects their ability to move, to navigate their worlds, to properly process information using their brain.

I think they all go hand in hand. I rarely have ever seen, and I'm more than happy to be wrong with this, I rarely seen somebody just truly have a structural issue that hasn't had a secondary neurological outcome with it. I think the interesting component of that is, and Gray Cook is famous for talking about this, talking about your software versus the hardware. If I see something structural, I look at that as some component of hardware. If I see something neurological, I look at that as some component of software. I have to assess both of them. It's not a chicken or egg scenario. I don't know when somebody presents to me which came first.

All that I know is I have to make some sort of change to benefit that person's life, whether that's them moving well so they can get into a D1 school to play hockey, or if that's somebody who just wants to be able to pick up their kid at the end of the day. It doesn't matter to me. All I'm trying to do is get them to have some sort of benefit to help their life and get a better quality of life. So let's just say, let's talk specifics on it. We'll talk case-specific. Say I came in with a, let's just say, an IT band syndrome, quote-unquote, or lateral knee pain. Is there, explain that software and hardware analogy in that realm as well.

Sure. So if I had somebody come in with issues with their IT, first of all, I would check, you know, classic chiropractic. I would check them structurally. Say, hey, why is this going on? Let's compare both sides. Any previous trauma, any history of scar tissue, any developmental issues that you had. And I would look for the classic chiropractic range of motion, you know, palpation. You'd look at how well they move. And I would do both passive-active range of motion to see what kind of mechanics they're actually possessing at that point. But on top of that, I would also take a look and say, okay, what does your balance look like?

Let's do some cerebellar tests. Let's do some neurological testing to try and further assess what's going on with that. Case in point, I had a patient about two months ago who had hit pain, a left-sided hit pain for most of her life. She's seen all sorts of therapists, chiros, PTs, MDs, trainers, you name it, she's seen them. Even Alexander Technique practitioners. She got sent over to me by a fellow colleague of mine who just couldn't figure her out. And what I did is I did a full-scale structural examination on her, and I also did a full-scale neurological examination on her. And I found some subtle issues of inner ear vestibular issues.

And for those of you who don't know what that is, just know this. Anytime you're in an elevator and the elevator is moving up or down, your body might not be moving physically, but you're moving in relation to gravity. Your vestibular system is just a big term that says, hey, I understand, and I just take in inputs based off of gravity and the way that you move, okay, simply. So I found that she had vestibular issues. I found some subtle other issues of inner nervous system that, you know, may or may not have been relevant. So I started doing different types of exercises based off of her vestibular system.

We started doing visual exercises. We started doing some gluteal activation exercises paired with different types of brain-based exercises of trying to make her vestibular system function better. And she started to show changes. Her trainer started noticing that she was showing changes. Her Alexander practitioner started noticing changes. She started noticing changes, like better balance, better stability. She wasn't falling over and tripping as much. Her coordination had improved. Her tone in her neck had improved as well. She also saw a little bit of a decrease in her scapular weight. Now, intuitively, that didn't make any sense whatsoever.

But if you understand that the brain is the final frontier in the last outcome of that therapy, then all that makes sense because your brain dictates tone. It dictates coordination. It dictates gait. It dictates everything that you have in relation to movement. And so she was a perfect case study. I got a lot of people scratching their heads saying, well, that's interesting because we've done all this strength training with her. We've done all this mobility and stability, and she's been through DNS and SMS and all these different techniques. And that's not belittling them, but what I'm talking about is there's something else that people were missing, and I had to dig deep for it.

And fortunately, I found something that benefited her. Now, is she 100% perfect? No. She has some work to do. She's had this since she was young. I mean, I'm working against many years of compensations. But the cool thing is that she's making changes with that, and I have to continuously challenge her on a daily and weekly basis to try and make more changes with that. That's a classic example of saying, okay, let's look at this structurally. Let's look at this neurologically. Are there correlations with this? I would argue always yes. Let's try and figure out a way to use both her structure and her neurology to benefit her overall so she can move more efficiently and have some sort of trait that she wants to improve, a.k.a. her left-sided hip pain.

So how does that relate to an IT band? Same process. I look at it structurally. Then I look neurologically to say, what other structures dictate balance, muscle tone, posture, and coordination? Well, that's essentially what your brain does, like I initially talked about, is movement. So she's no different than the example that you asked. It's just a different body part. And so with that, you have to have knowledge of the joint itself, but you also have an understanding of what neurologically, what software kind of components are in charge or correlate with controlling this joint, and then what can you do about it therapeutically.

Now, everyone's going to respond to things differently. Fortunately, I got very lucky with the patient I had, and I made the right decisions, and I continue to make educated decisions based off of what she was presenting with. But the classic cookie-cut approach to say, oh, all you need is strengthening, or all you need is this sort of modality, you know, didn't work for her, unfortunately, at that time. It very well could have worked for her at one point, and we just don't know. And that was the first time that I saw her, so that was the outcome that I got fortunate enough to have. So does that kind of make sense, how I integrate those different components, look at it from that big picture versus just saying, oh, it must be the joint, it must be the muscle?

Yeah, yeah, it makes complete sense. I think that, yeah, I think the brain's super important. I've never tested a bunch of vestibular stuff, but it's funny, when you're going through the whole process of your exam, I keep thinking about all the notes you'd have to take. Yeah. Is there a lot of note-taking? How long is your first exam? I spend an hour and a half with my patients for the first exam. So, you know, that's probably longer than most people are going to be able to spend or afford or, you know, whatever you want to argue with that. But it's an investment that I'm willing to make because it's like any relationship.

I got to get some information. I got to figure things out. I got to ask some hard questions. And so it starts with quality intake. I take a good history. But most of my time is spent on me examining. And the difference with my exam is I'm examining somebody, but I'm also trying to find ways to make their findings change. For instance, with the patient that I was just talking about, she had issues with simple tracking of her eyes, convergence and divergence. So when we look at that, and for those of you who don't know what that is, that's just you taking your thumb and bringing your thumb closer to your nose and then pulling it away from your nose.

Your eyes should be able to keep that as one image. And then they'll come in together closer to your nose, and then they'll go far apart when you go away from your nose. So simply, that is your brain's ability to judge depth perception. If you have double vision, if you get the rarity of having triple vision or even blurry vision, there's some sort of calibration that's off with your eyes being able to keep that image as one. So I found simple things with that. Now, when I found that during the examination, sure, I noted it, but I also looked at her balance before and after I did that. After I did that, her balance got worse.

So I knew that there was some sort of area of her brain that may or may not function well if she gets challenged with that. I look at that as the equivalent classically of like a weak muscle, right? If you have a weak biceps in the gym, trainer is going to say, okay, we got to start doing some bicep curls, or we got to start doing some specific exercises based off that. It's no different than the brain. It's just I have to understand that to a higher center. So when I'm examining somebody, I look at them, but I also have a capability and the capacity to try and make changes with that too. So that hour and a half that I spend with them really is just me trying to find other ways to get into their brain to make their brain function at a higher level.

And that hour and a half is, you know, some days I wish I could spend three hours. Now, I don't think I could afford it, and I don't think my employer would be very happy with that. But that's what gets me the ability to make those tough decisions a little easier because I have a trial and error built in with my examination. Yeah, that's good. I've always told people that the, I mean, my exam, my first exam is about an hour or so. And I know I get sidetracked a little bit with people's questions and so on. And I finally, actually, the podcast here is one of my ways to remedy that to make sure that if someone says, well, what is the, can you talk about functional neurology?

I'll be like, yeah, I got a whole podcast on it. We'll talk about that later. But, you know, like the, like you want to be able to test and retest and so on. And I think that if we're going to do rehab or correct an injury properly, we need to find the right direction first. We don't want to go the wrong direction and just keep going down it because you assess poorly in the beginning, you know? Agreed. Yeah. I think it's interesting because there is this new way. And speaking of dysfunctional neurology, I mean, all we're essentially doing, and, you know, we've been doing this for many years in the rehabilitation model, is we're really just assessing how neurological function dictates structural outcomes, how structural function can dictate neurological outcomes.

I mean, how many of you feel better after exercising? You're using some structural inputs, whatever exercise it is, to change your neurology. Tony Robbins is very open about when he gets frustrated or he's in a funk cognitively, he just goes out and does something physical, whether that's a run, whether that's a submersion in freezing water, anything that he, yeah, absolutely, right? He uses his body to change his mind and vice versa, I would argue. So we've been doing it for a long time. It's just modern neuroscience has started to catch up with that, kind of validate the thing that we've known anecdotally.

So, you know, why does that make sense? Well, it goes back to that first initial notion we talked about is movement. And movement can be an array of stuff, but what we've noticed, and one of the reasons why we've gotten involved in this field of musculoskeletal exercises and rehabilitation, is because we've noticed that movement can dictate and change your nervous system. And it's the same thing, vice versa. So anytime I look at that, I say, okay, what's going on here? And what can I do to try and get this person to function at a higher level? So you mentioned last time that we spoke about, actually, I had another, I had a patient actually comment.

I was talking to him about our conversation. He had a friend who had a concussion, and they went to a doc that said, and I thought this was probably the same style as what you do, but they said that they're, because they got, say, they got hit from the right side. Sure. Anytime they looked to the right, basically all their movements turned to crap. Does that sound? You know, I think, I think when we initially started looking into this field and this realm of how we assess concussions, people always thought, oh, I got hit on the left side or the right side. So that must be the side that's dysfunctional.

And, you know, unfortunately, that doesn't hold much weight. And the reason why is because if you take a hit to the head on the right side, you might have damage to the right side of the head, you know, depending on whether or not you're wearing a helmet. And even if you do, your helmet is just there to protect the superficial bruising, scarring, bleeding damage to the skull. But that doesn't stop your brain from sloshing around inside your skull. Your brain is suspended in a fluid. And anytime you move your head, your brain is floating in that fluid. When you take a hit to the head, your brain is going to hit some component of the skull.

Even if you hit it on the right side, that doesn't necessarily mean that you're going to have right-sided brain issues. You can have a range of issues. And this is kind of where we find ourselves in the conundrum of the medical model is that we are trying to say, well, if you have this symptom, this is the rehab that you need. And if you have this symptom, this is the rehab that you're going to need. But that has failed us ethically because why doesn't everybody respond to the exact same protocol for a specific symptom? Well, the individuality of the brain itself is the reason why. So if you take a hit to the head on the right side, that by no means means that you're going to have right-sided issues, right-sided visual issues, right-sided body issues.

And if you look at it from a right brain controls left side of your body, if you hit the right side, you're not just going to have issues with the left side of your body because that's not the way your brain works. Your brain is always communicating to different parts back and forth. And so it's important to understand what brains do well when they function well and then what happens when brains don't function well. And that's my assessment is to say, okay, how can I assess this brain? What is this brain doing well? What is it not doing well? What can I do during my examination or my rehabilitation or my treatment sessions to try and get those areas that aren't functioning well to function even better?

And I equate it to, how can I update this person's software, right? Everybody wants to be the computer from 2017 where you can do 20, 30 things at once in your phone or your tablet or whatever. It doesn't slow down. Nobody wants to go back to 1990 where it takes you 20 minutes to upload AOL. How old are you? You probably had experience with that, right? I did. I'm an 88 baby. So I would have been probably like six or seven when the internet started getting popular and everybody started having computers where you could go on the internet. But I remember dial-up days and those days were absolutely boring and those were discouraging.

So I was like, why would I wait around for this? Like, you know, go play outside and do something, you know? But it was so exciting for that song to finally stop downloading after 30 minutes where you want to hit the other one immediately so you can get a whole disc made. Absolutely. So tell me more about concussions because actually that is, I mean, it's a huge topic right now. I know that it's not extremely well understood, but they're learning more and more every year. Right. But it is something where I'm sure you've had people come in your office with concussions that they've tried everything.

Maybe give us some guidance. Yeah. I mean, I unfortunately get a lot of those patients. And the hardest thing with concussions is that, you know, the awareness has really grown over the past five years about concussions and how concussions are equivalent to a brain injury. You know, these are truly things that can change the quality of life and the outcomes of the individual who suffers from that. I think the pendulum has swung pretty far to say, oh my gosh, everybody has a concussion now. But I think it's kind of coming back and this just comes with literature and clinical experience to say, well, let's take a look at it from the standpoint.

I mean, we've all had trauma in our life. I mean, look at babies and how many falls they've taken. And my first concussion came when I was five, six months old when I jumped out of my crib. Right. Obviously, I was stubborn back then and I still have a little bit of that now. And so you could argue that that was my first concussion. Well, sure, maybe it did. But, you know, could I have been a baby genius if I wouldn't have had that? We'll never know. Concussion to me is synonymous with a brain injury. There are always different severities with that. The hardest thing with a concussion is finding that practitioner who is looking at you from all different facets.

And when I get patients in my office, I'm looking at them from my big three pillars. And that is I'm looking at you structurally. That's the classic chiropractic physical therapy rehabilitative model. I'm looking at you neurologically saying, what's your brain doing? What is it not doing? How can I explain your symptoms? And then I also look at them nutritionally. I think this is a big component for a lot of people because very few people are knowledgeable or aware that you can have concomitant metabolic changes because of a concussion. For instance, there are cells in your brain called glia. And they're Latin for glue is kind of what the term is for.

Glia can cause significant issues for people down the road if they become that kid on the playground who doesn't have a supervisor. They just start killing cells that they don't know are good guys or bad guys. They become primed. It's called glial priming. And what can happen is you start losing cells at a faster rate than what you should be used to or what you're supposed to. Well, that classically right there is defined as a neurodegenerative disease. Now, I'm not saying that concussions cause neurodegenerative disease. What I'm saying is they're probably not going to help you out very much.

There's a really cool study published in 2009 in the Journal of Neurotrauma. And what they showed was after a traumatic brain injury, after about six hours post-traumatic brain injury, you have changes in the mucosa of your gut lining. And the issue with that is your gut is where 70% of your immune system sits. Your gut is where you produce 70% of your serotonin. It's the feel-good, happy neurotransmitter that everybody's always chasing. So these metabolic issues can come as a result of a brain injury or head trauma. Now, to what extent that is all individual and dependent on the person and their status prior to the head injury.

The better your brain was before that, the better chance you have of maintaining those barriers. Having abnormalities in your gut mucosa or your intestinal lining can set you up for a host of things. That's classically seen with autoimmunities. It's seen with just immune issues as well. It's seen with allergies, hypersensitivities to specific foods or specific allergens out in our environment. Those can have profound effects on people. And when you take a look at that, that can really impact quality of life. Why do these individuals who get concussions, why do they feel nausea? Why are they now having stomach issues?

What's up with the puking and all this light and sound to the tippy? Well, those are neurological outcomes. And they also are having immune and digestive outcomes as a result of that. The gut-brain axis is something, kind of a buzzword that's kind of come out over the past couple of years, and it's a two-way street. So your gut influences your brain, and your brain influences your gut. And all of this gut microbiome research that we're doing on the bacteria in your gut is really showing that your gut bacterial diversity or the colonies that you possess inside your gut are actually very important.

And they're actually linking some of those to diseases such as multiple sclerosis and Parkinson's, which is crazy. And so the classic question comes up, chicken or egg? Is it the gut or is it the brain? To me, I care. But what I need to do is I need to be able to make changes to both. So this is a classic thing that I see with kids who have concussion, especially with the ones who have been suffering with concussions for years, is they haven't had both of those areas addressed. And I think it needs to be the two-way street approach of saying, let's try and fix your brain and your gut slash immune system at the same time.

Because if I can do that, I know that I probably have a higher probability or greater chance to get you better. Now, is that an end-all be-all? No. Anybody who tells you they can get everybody better over the time is a liar and you should run the exact opposite way. But the ones who can give you that honest appraisal or at least the ability to critically think through that are the ones who probably are going to give you a better chance to probably get some changes and be able to have some symptomatic relief. So then with concussions, then, is there, you said within six hours, all the gut lining changes and what, like, is there something nutritionally that you would ideally, not that you're recommending right now because we don't know who has what out there.

But if your son had a concussion, what would you do in the first day? Well, the first day, I mean, I'm still a fan of giving people adequate rest. I know that sleep has powerful effects on your immune system. Sleep has powerful effects on regulating cerebral spinal flow in your brain, which is essentially helping you clear the trash out. The classic model of letting somebody rest after a concussion is appropriate for the most part, but I will give a large asterisk. Anything over about a week or two is actually leading to brain changes that could possibly be for worse. I think of it as like a deconditioning, right?

If you stop a workout program and you don't go for two weeks and then you get back in the gym and expect yourself to do the same exact reps and sets, it's probably not going to be fun for you because you're going to realize you lost a little bit, right? You didn't lose the muscle. You lost the neurological component and the integrity that controls those muscles to give you the outputs of the reps and sets that you had. So when I look at that and if I had a child and he got a concussion, rest, adequate nutrition, proper hydration, and just letting him go through those stages of being able to recover is important.

There are some theories out there looking at different types of supplementation, looking at different types of IV therapies. I don't necessarily want to get into that because I think that the jury is still out about what is going to be a good protocol for that. But rest is always going to be your best friend for the initial stages. After that, it's time to get an assessment. I think the earlier to do it, the better, but I rarely take anybody who's had a concussion before about a week or two. Now, the reason why is because, hey, maybe they're going to recover on their own. Maybe their brain is doing better than we thought.

You know, you got to let the body heal and see what the outcomes are and symptoms change too. So, I don't necessarily know if I do an exam day of, if those are going to be genuine exam findings that are going to be something I can work with in two weeks down the road because the body and the brain are changing. So, I usually wait a little bit. I think rest is important. Like I said, hydration and adequate food intake because you're always going to be good doing that no matter what. But then after that, I do an assessment. I look at their nutrition. Maybe I'll run some blood. I'll do some diagnostics with them, looking at their balance, their stability, reaction times.

I'll do, you know, video destagmography, checking their eyes, vestibular testing, and then away we go. So, I don't think there's an end-all be-all that there's a right or wrong way to do it. I think that there's better ways to go about assessing that. But for me, what I've found in kind of this literature is pointing to is anything after a week and a half or two weeks, if somebody's still dealing with symptoms, there needs to be some sort of intervention to try and manage those symptoms to get that person back to where they were before, if not even better. Yeah. I really hope they start, I hope they know that they're actually dealing with a concussion because those things can, they can last a while, like you said, one, two years, you know?

And what I think is the biggest issue with our current system is that a lot of people just either expect them to get better or they don't necessarily perceive a concussion. So, for instance, I gave a talk to a high school on Monday and I asked the kids to raise their hand if they'd had a concussion. One kid didn't raise his hand and I asked him, you know, do you play any sports? He says, yeah, I play football. And I said, okay, so you've never had a concussion or anything like that? He goes, no, I've had my bell rung a couple of times where I've been really dizzy and stuff, but I never really considered a concussion.

Well, from my standpoint, you know, I'd say it had some sort of neurological outcome with that. A concussion isn't an all or none thing. I think it's on the spectrum. But I would argue that that kid probably had some sort of concussion. Now, did he recover and did he, you know, turn out okay? Absolutely, and I'm grateful for that. I would never wish a full-blown chronic concussion on anybody. But it's a perception that needs to change. And I think it's a social norm to say, oh, you got a concussion. Well, if you know your name and you know where you're playing at, you can go back out there and you can skate or you can go out there and make the next play.

But that's not always true. And the issue with that is if you're not knowledgeable or educated on symptoms or early signs and symptoms of concussion, you can have an even more severe concussion if you put that kid back out to play. That's classically known as second impact. You're setting them up for failure if that brain is a few milliseconds off of activating specific muscles to help you stabilize. What if you're getting a concussion that sets you up for that ACL tear that you've been trying to avoid for the entire year? Just because it wasn't the muscular or the actual hardware issue, it was the software issue that broke down at that time when you made that play and you had to take that tackle.

That's the stuff that we need to figure out. And I think that the literature is getting closer, but I by no means think we have a specific answer to those questions. And I would love to see some more studies come out talking about that. Yeah, go ahead. I was going to say, I think the only, I was actually pulling up while you were talking, there was, I know there was a, so the consensus statement on concussions in sports, it was, I think they did the last one in 2012. It was a Zurich one. That's the one actually that, I don't know if I told you, so I got to go to the sports chiropractic symposium every year and they spend a lot of time with concussion and that's what they go off of, which from what I recall, I didn't remember hearing anything about, you know, like nutrition and like, you don't talk about like the software as much, but they have mainly just like the assessment forms, like the, they call the scat.

By the way, everyone, I'm going to put, I'll put any of Dr. Reese's in our, my references onto the show notes. So, um, but I, but it's mainly a graduated return to play protocol with, um, right. So I'm sure you've looked at that as well, but I thought I'd just mention it since we're covering some concussion stuff. Yeah. And I think it is relevant. You know, I, I struggle with some of the metrics that we use and I don't think that they're bad by any means. I think that they were based off of good intentions, but I know kids who I've played sports with and who are growing up now, who will purposely fail their testing, their scat and neurological testing so that if they get a concussion during the season, they still have the exact same scores as they did preseason.

Now that's an issue on so many different facets, but the, the thing that I continuously come back to is that if they would have had a true structural neurological baseline examination performed by somebody who has had adequate training in that, you can't fail those metrics. You can't tell me that a kid could just convince himself to have convergence issues preseason and then get those back right away. And then when he gets concussion, they have them and they're the same thing, same thing with balance, same thing with the different types of tests that we do bedside neurologically. And I think that that's the chunk that we're really missing is to get our trainers, our practitioners, our therapists trained in neurological and structural integration assessments for baseline testing for concussions.

I think the scat is great. I think that all of those testing parameters have a time and a place. Absolutely. But I do think that we are missing components that are, uh, profound to being able to accurately assess and also diagnose and also give a quality prognosis of what's going to be actually happening to those kids who suffer from those concussions. So I still think we have a long way to go. I think that we're in a good spot right now. I think we have some really smart people doing some good research, trying to answer those questions. I just don't think we know everything about them yet. And I'll be the first to tell you that even though that's the majority of the patients I see, I still don't have all the answers to the questions.

And I feel like the more that I know, the less I really know and the more questions that I have about that. Yeah. We were talking about that last time. It's like, at what point do you not want to know anymore? Because it just hurts to confuse you when you deal with people. It's a double-edged sword, isn't it? That's just a double-edged sword of clinical practice and trying to advance your knowledge in all of those different avenues. So I don't know if I have a good answer for you yet. And I don't know if I will. Yeah. Well, it's all right. I thought we, we haven't hit concussions on this podcast before.

And I know that you would, you've had extensive experience with them. Um, but I know you got to, I know you got to experience with other things, but I knew I was going to drop it in there at some point today. So, um, let's, do you have actually a, do you have a reference you can send me on some of the, you mentioned that the gut lining one on? I do. Okay, cool. I can, I can send you papers. I can send you slides. Um, and for those that are listening, uh, you know, if anybody wants to reach out to me, I'm always an open book. So I'm more than happy to have conversation and send literature that I have.

I'm actually looking through, I did a, uh, seminar for the chiropractor. That was certified through the chiropractic board, Minnesota. Um, and I have a whole slideshow talking about the neurometabolic cascade of concussions. And so I have a ton of stuff for literature for people if they want to check it out. Cool. Oh, you know, I should probably hit on this as well. So some people listening might be, might be thinking, how can a chiropractor manage a concussion? Yeah, sure. Okay. That's a valid, valid question. Um, you know, my answer to that is it all depends. It all depends on the training that you've had.

It all depends on your thought process and then the experience that you've had. Um, when I was, uh, with Glenn Zielinski in Portland, Oregon, I had a, you know, first class experience of seeing very complex cases. And I was very fortunate to have the opportunity to go out there. Glenn is probably one of the smartest practitioners I've ever met in my life. And so for me to have that experience, to be underneath him, to watch him, to see how skillful he was with his ability to make assessments, to diagnose, but also to treat. And that was the biggest thing that I picked up is we're still good at giving a label, but we're not very skilled at being able to rehabilitate, to take it from a standpoint of how do we periodize this model to get them from point A to point B to either make it to that division one hockey team or to get their, them to be able to pick up their child at the end of the day?

How do we take each individual and get them from point A to point B? That's the beauty of it. And so when you take a look of asking the question, how can a chiropractor do this? Well, you know, I find it as an interesting question because there's so many different types of chiropractors out there, just like there's so many different types of dentists out there. Now, I think a lot of people are very quick to say, oh, well, if I had a bad experience with a dentist, well, of course, I'm just going to find another dentist because that's just what I have to do. I have to take care of my teeth, right?

But if somebody has a bad experience with a chiropractor, they're so quick to write off the entire profession. And I think that is so unfortunate because there's so many highly skilled, specialized chiropractors out there who know what they're talking about, who are working integratively with other types of practitioners. So the fortunate thing for me is I've had very good training. I've also had very good mentors in my life, but I also have really good colleagues who are in completely different professions. Some of my best friends are physical therapists. I have friends who are doing their neurology residencies.

And, you know, it's interesting to me because I have spread myself so far, so wide to find that network because I know how valuable it is. So the chiropractor, for me to treat those types of injuries, you know, I, of course, have a bias and know that there is a ton of information out there showing that, you know, not specifically just structural integration, but neurological integration exercises, nutrition, different types of therapies can have a great effect on the brain. It makes sense for me to be able to say that I can do that and that I at least have a good grip on that. But if I ever think that there's a case that is outside of my scope or is outside of something that I don't have knowledge on, the beauty of it is I have good colleagues who I can refer to.

So, you know, it doesn't just come down to saying, oh, you're a chiropractor, you have to stay in this lane or you're a PT, you stay in this lane. I know PTs who do manual manipulations. I know chiropractors who do a lot of nutrition. It all depends on the training that you have. But I think the biggest aspect of that is the experience and the ability to ask the critical questions and make sure you have colleagues who you can refer to who may not be in the same profession as you. I think that's really important. That will take people so far in life anyway, because it will keep you honest and it won't let you develop a bias where you're always going to think it's just one technique that's going to be able to cure everything.

Yeah, I totally agree. I know that with, everyone's probably heard, hopefully they've heard more than this one podcast, but they can tell that you are, you know, like you speak differently than probably most chiropractors or at least the ones that are, we get pigeonholed. I know that you probably get it too, like, you know, like when you say you're a chiropractor, all of a sudden people start talking about their spine. But we're talking about completely different things here. And if people have heard my other podcasts, we talk about the hip and the knee and like, you know, it doesn't always have to do with like spinal adjustments, it has to do with many different avenues of correction.

So I know that around here, actually funny, like part when I was going through some postgraduate stuff, I was supposed to go to, to shadow a, one of the teams here in my area, it was for football. So they actually wouldn't let you do any physicals. They wouldn't let you do anything on the field unless you had an MD behind your name. I was really surprised. And we actually, during that time, like when I first started getting out of school, we offered to do free physicals. I don't anymore, but even so now they still have this policy here to my knowledge is that if one of these kids gets a physical from me because of my degree, even though we work in sports medicine, it doesn't count.

They could go to, they could actually go to a dermatologist before they go to us and get cleared for the same. It blew my mind. I couldn't believe it. And I think it all does really come down to, nothing against dermatologists, by the way. It all comes down to experience and, you know, who you surround yourself with and what you've learned, you know? Agreed. And I think, you know, there's a component to it too, where we really need to be challenging the status quo, not only professionally, but also law and statute wise. Now, I'm not saying that chiropractors should be able to do everything. I'm not saying that any profession should be able to just do everything because that's going to get really muddy really quick.

But I think that we should be working together. I think we should be asking the same questions. I think we should be giving different answers. And I think we should be challenging individuals' thought processes on how we treat, but also ask the question about why we treat. Simon Sinek wrote an amazing book called, To Start With Why. And the big thing that I took out of that is just really figuring out why we do the thing that we do. Are we doing this just because we've been taught it this way? And we are just going to be those robots who just do the same thing over and over again. I don't want to be that.

I've never been one of those people to just sit back and have somebody tell me something and just leave. I want to know why. And that's what got me involved in the neurology and asking those questions because I've always been curious as to why people do the things they do. Why do they move the way they do? Why do they think the way they do? Why do they make the decisions the way they do? And I think it's important for us to take that and challenge those status quo. I don't think there should be any reason why a quality, experienced, certified practitioner who's a chiropractor, a PT, an MD, whatever field they're in, as long as they have the requirements and certifications and the experience to do sports physical, concussion screening, concussion rehabilitation, there's no reason they shouldn't be able to do that.

It's just we have to jump through different hoops, not only from a state legislature, but also from a national legislative standpoint to talk about that and to make sure that we're taking our precautions and our steps necessary to make sure that patients have access to quality practitioners. I'm a big fan of every other field of medicine. Absolutely. I mean, I have to be. They've saved my life many, many times. So there's a time and place for everything. Let's do our due diligence as professionals, as those who are educated in the field of health care. So I'm making those decisions easier for our patients because I know a lot of patients who don't have access to a really good physical therapist or a really good neurologist.

There's a reason I have colleagues to refer them to, but I can't help every single person out. And that's why we need to really expand our knowledge base and get our networks to be there to facilitate those conversations. So I think it's an important question and, you know, I would love to see more movement in those fields. I think everybody needs to be active in their political party and with their political associations. I don't think a lot of people understand how important that is. And I think that I would love to see that shift in those social norms change very soon. Well, this is actually, I think I mentioned at the beginning, the reason why I wanted to have you on was because I think you definitely have, I mean, you have a lot of good experience with treating conditions, but also too, I think you have a good head on your shoulders about, you know, co-managing.

And I mean, just, I gave the example last time how we spoke for like 45 minutes. I felt like I knew you for years, you know, it just, it flows extremely well. So you told the Bob Dylan joke, that was amazing, or it wasn't a joke, it was a story. So, um, if you have another story about basically Northern Nebraska or wherever you're at, wait, where'd you grow up? No, I grew up in North Dakota, but I live in Minnesota now. So there you go. Same state though, right? Well, it is funny because I always get people, I can tell you last time I'll get people who ask me, they're like, I'll tell them that I'm from North Dakota and they're like, oh, we love Mount Rushmore.

And I'm like, I do too, but that's the wrong state. So do you, do you get to see the, do you get to see the backside of Mount Rushmore? Is there any, yeah, the heads look even better than the faces. Yep. So go for it. Yeah. You sit there on your front patio and you're just looking at them thinking, ah, I know the other side has faces on it. With my perfect vision. There you go. Right. Yeah. You know, it's, it is interesting and you know, it just goes to show you, and I appreciate those, those compliments. I mean, I, I, you know, I feel the same way towards you. I feel like we've known each other for one.

I think it's just because we connect on so many levels and our thought processes are the same of, you know, I, we all have biases and we all have egos, but once we can throw those out the door is when we can really start to get to work and, uh, to understand where someone else is coming from is very important. And to have that open line of communication is absolutely foundational for us to start, uh, solving the problems that we face, especially in healthcare, healthcare system is currently bankrupting us faster than any other industry out there. How are we going to make those changes? Well, intuitively it makes sense for us to just work together.

I would love to see more integrative facilities, research centers coming out, asking those questions, solving those problems, but also helping us as clinicians make quality decisions and not have us jump through so many hoops anymore to get somebody to go see somebody else. Yeah, it is. Um, I think, I think that's one of my most frustrating things that I feel like I'm doing more back office work, um, when I'm in the office versus being able to give my heart and energy and soul to my patients. Yeah. Well, that's what I was thinking when you brought up the exam. I'm like, geez, I'm like, this, this sounds like a lot.

And I don't know if you've had this experience as well, but like, I, I mean, I had people come in that are, um, like, I don't know if they, they were like friends from middle school or high school or in college. And so they're like, Hey, can I just bounce this, bounce this injury off you? You know, and they get in and all of a sudden they, they show you a lump on their back, which looks like it's, you know, cystic. And you're like, Oh God, okay. I got to do a whole exam now. And, and not that I don't want to help them and give them advice, but I'm like, how can I finagle this? So I don't have to write a whole essay after this, you know, it's, uh, it, it really does tire hands a little bit, I think, um, in, uh, in regards to helping more people.

Um, but I understand the whole need of that too, cause people like to sue. So, yeah. And you know, believe me, I would love to do less paperwork than I do right now. Um, I think the one thing for me is I'm okay investing my time in some of that to make sure that when another doctor gets my notes, they understand my thought process. So if I can't always have a conversation with them, at least what my notes can show them is that I look at these specific areas and this is what I found. If they can at least repeat some of those tests that I did to try and assess whether or not that patient still has those symptoms, or if I can give them a better ability to make a quality diagnosis and treatment plan, then I'm all for it.

I just wish it didn't take me so long to do it on our EHR system. So yeah, I always wish that they, uh, and I've had this, it's, it's gone well for, with some, uh, docs or Pete therapists and chiros and people that we co-manage with, but I just want to call them. Like, I just, I just want to wrap down and call them. I don't want to put it on paper and I mean, I can put it on paper, but it takes twice, three times as long. I mean, but you get the bounce back like this, you know? So, well, and I think with a simple conversation comes, uh, building trust too. So I am a huge fan of communication. I find it very unfortunate that, uh, younger generations, I wish, you know, I guess we're kind of classified as being millennials too.

Um, you know, a text in an email is the fastest, quickest way for people to communicate or so they think, um, why not just give somebody a call, have a quick two, three minute conversation, let them know what you're thinking. Um, and then you can understand the context and the intent of the words that you're using. I think that's so important. That's such a lost art and you can tell so much about a referral or an individual or a patient by just having a conversation with them or with the practitioner that you're going to refer them to. So I'd love to see the channels open for just telecommunication, which sounds like such a weird term now that we say telecommunication, which is just using a phone.

Um, but I do think that there's, is some magic to just having a conversation with somebody about a patient's case. Absolutely. Well, I think definitely the, um, as long as I bet as long as the other providers knew that it's going to be like two minutes, go, you know, I can, it might work out more. I agree. I a hundred percent agree. I think setting yourself up for success is always being honest, but also setting limits as well. And that's, that's an important factor to decide. Cause you know, as practitioners, we don't have any more time in our day than what we already have put aside. Um, I would love to be able to buy more hours during my day, but I know it's not possible.

Mm-hmm. Um, so we are, we are well into this podcast now. I don't know if you take talking about how long having two minute phone calls. We've had about an hour here. Hey, it's all good. Time flies when you're having fun. Well, as we close up here, is there anything that you want to add? I know that, um, I already said your, your website before, but if you can give some ways for people to contact you or even how someone would find a doc that treats and evaluates like you, if they don't live there? Yeah. Um, well, that's a great question. I, you know, I think I struggle with that last answer because I am such a hybrid of so many, uh, different therapies.

Um, and that's just the beauty of me having colleagues who have kept me honest and helped me along the way. Um, you know, some of the techniques that I use daily in my office are, you know, concepts from DNS, which is dynamic neuromuscular stabilization. I'll use some different assessments using the SMS and the SSMA. Um, but my neurological training was through the Carrick Institute. Uh, Dr. Ted Carrick is the father of functional neurology. How do you spell Carrick? And so Dr. Ted Carrick. Yep. Uh, and how do you spell his last name? C A R R I C K. Um, on top of that, I've done a decent amount of functional medicine, um, series as well.

So I'm, I'm a big hybrid. If anybody has any questions, they're more than happy. Feel free to reach out to me. Um, I'm on Facebook. All you got to do is just type in Dr. Eric Reese. That's E R I K R E I S. You can find me at MN concussion.com. So that's just Minnesota concussion, just the acronym, just the MN concussion.com. Or you can find me at a MN functional neurology center.com. Um, and so those are just good resources. I'll leave those at, uh, with you, Sebastian. And, you know, if people need to get ahold of me or if they have issues, you can always reach out and I will follow up with that as well.

Cool. Yeah. I'll put, I'll put it all in the, uh, show notes on, if everyone wants it, p2sportscare.com slash podcast, then you can find everything on there. Um, perfect. And I'll follow up with you with those slides and things like that too. That's all easy. And that's already made. So cool. So then let me, um, just, just pause there. I'm going to, uh, just hold on. I'm going to, I'll close the podcast and make sure everyone knows the finishing touches. Then we'll talk for a second at the end. Sound good. Cool, man. Yeah. And, uh, do you want to keep that beginning part or do you want me to go through it again and just kind of explain it in a simpler term?

Cause I, I, I, here's the thing. I get, I get caught up cause I, I teach to practitioners and then I teach to like high school students. So when I know my intent, I'm good. And I didn't, I guess I should have thought through that a little more, but, um, I just don't want to sound like a, like that doctor who's talking over everybody and be like, I'm so smart, you know? No, no, no. I think it's okay. Like the really, uh, this happens on a lot of podcasts too. Everyone just kind of, they start with their, like, I do the same way. Like when I would talk to you differently on the phone is what I would talk to a patient versus a fifth grader.

So, um, but I think we got into the nitty gritty eventually. Um, I mean, I guess if you want to sum it up to, how would you say it to a high schooler? How would you say it? Yeah. So, um, do you want me to go through and say, my name's Dr. Eric Reese and stuff like that? No, no, no. It's funny. I'm going to keep all this by the way. You're horrible. You're evil, man. You're just getting blackmailed on me. So I can't run for public office anymore. I do it. Yeah. This would be, this would be good. This is fine. I would describe it. It's entertainment. You know, my, my, my training, uh, you know, started when I was young.

I've always been interested in the brain and the body and how it works together. I went to grad, I went to undergraduate, got my degree in exercise physiology, exercise science university of Minnesota. So they're doing research on how humans will move, why they move. And then what happens when they don't move? Well, I got into chiropractic school and I had more questions than I had answers to. So I started getting more involved in neurology and nutrition, uh, and along with my chiropractic, uh, education and, you know, the structure dictates function. I started learning more that, you know, neurology also dictates function too.

And that's kind of what took me down the path of really assessing people structurally and neurologically. What can I do about it? Do I need to give it a label? Yep. That's called a diagnosis, but what can I do therapeutically to try and intervene to get somebody to have a higher quality of life? That's essentially what I'm trying to do on a daily basis with every individual that I talk to and try and treat. I like it much better for a, uh, high schooler. Yeah. Okay. So just, um, just pause there. I'm going to close this out. Okay. Cool, man. Okay, everyone. That was Dr. Eric Reese. Again, I will put all the contact for him on the show notes.

That's P2 as in the number sports is plural care.com slash podcast. And if you want to know about any of the links and resources that we had on this podcast, it's going to be on there as well. Um, also, if you've not done it already, please, please go to iTunes and get this show. Um, iTunes is where you can review this. And I thank you for all your reviews and five stars, hopefully. Or if you have suggestions, I want honest feedback. You can contact me on the P2 site. There is a voicemail button right there. Send me, I think it's about a minute, minute and a half of whatever you got, whatever questions, whatever comments that you want me to answer or improve on in this podcast.

So this is all about you guys learning. Um, and it's also helping me, uh, say things in a better way. So all you can understand. So tune in next week. Um, and I will talk to you guys soon.