Functional Neurology Roundtable: The Brain Behind Movement

This is session number 81 of the Performance Place Sports Care Podcast. Superstar! 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, it's Dr. Sebastian Gonzales again. Coming at you again. Superstar! So, Superstar, I think that was a movie, right? That was a movie back in, I think, 95, 96. I remember when I was in high school, we just whispered Superstar. Was that Tina? It wasn't Tina Fey.

I forget who the other one, the lady from SNL, the Superstar lady was. Anyways, so today, we are doing our very first Functional Neurology Roundtable. Actually, it's the very first Roundtable conversation. I'm excited to do it. And I have on three guys who have been on before, and we will have roundtables coming up on different topics with different people. But I thought it'd be really nice to put them, not against each other, but mainly let them feed off each other. Because I think that, I know when I listen to the podcast afterwards, I think, well, I could have elaborated a little bit more on that.

And he could have, or she could have, and so on. But sometimes we have the best technical as well as theory-based conversations, I think, when it's just kind of a group of people just chatting things out, you know, and not being afraid to ask questions and clarify and so on. So I thought this would be a really good thing for the topic of just surrounding functional neurology today. Eric Ries, Dr. Eric Ries has been on session number 42. You can, by the way, you can find these at p2sportscare.com slash podcast slash pound 42 or the session number. Dr. Michael Lovitch was 45. Dr. Colby Kondos was 75.

So those will all be on the show notes as well. Some of the topics we're going to go through today are some of the brain-based therapies and reactive or central nervous system-based therapies that you can use to really up your game or improve the way you move, either before you play, at halftime, and so on. So they're going to make some references of some techniques that they like to use, but obviously this is really based upon what the people need. Actually, there's a section in the video, actually, because I did do a video on this, by the way. It's on YouTube. That link's in the show notes. It came out today as well.

I didn't get all of it, but I'm really bummed that towards the very end, we started into an exercise called Go No Go, which it was kind of funny. One guy was testing the other, and it was funny to watch, but the video shut off. I had run out of memory on that card. So we will have some correlated videos in there as well. Now, before we start into it, I want you guys to go to iTunes, review this podcast from me, tell them what you like and don't like, and do a screenshot. Just do the screenshot, send it to the info at p2sportscare.com email, and I will put you in the running for a Performance Place t-shirt.

One of the softest, smoothest, silkiest t-shirts that you ever, ever had. And I wear them every day, and I would continue to wear them every day, even if I didn't do this anymore. So next is if you are, especially if you are a functional neurologist, I want you to share this with some of your patients or your colleagues, because that's why we do it. I want to get good information out there. Lastly, and I know that I've said this over the last few weeks, but I really want you guys to get engaged, especially those new docs with the modern sports medicine patient education stuff. Okay? The podcasts are included on those.

I will categorize them for you. Go on and get a poster. They're awesome in your office for getting your clients to realize what else you actually work on, because who knows? Maybe they came in for their back, but they didn't know you worked on shoulders. So that is all fun and good. So ptsportscare.com slash shop. Now I want to thank everybody for spending the next hour with me. Thank you so much. You could easily be listening to Joe Rogan or somebody else. And here we go with the guest. I will put any contact information for them or stuff we speak about on the show notes. Here we go. All right.

So here is the first functional neurology roundtable. Everyone, can you introduce yourselves? And by the way, we do have this on video format, so don't pick your nose. Why don't we go first with Colby? All right. I'm Dr. Colby Condis. I live in Grand Rapids, Minnesota. Chiropractor and functional neurologist. Okay. Let's Eric next. I'm Dr. Eric Grease. I'm a chiropractor as well, neurology specialty, and I practice in Minnetonka, Minnesota. Okay. And Mike, last. I'm also a chiropractic functional neurologist, and I practice in Boston, Massachusetts. Okay. So we're going to play this like a game show right now.

So the first person to buzz in gets to answer the question. So first off, who can define functional neurology for all the people out there who don't know what the hell this is even? Go ahead, Reese. No one's even buzzing in. Nice. Where do you buzz in? That's the first question. You can do an arm raise. As soon as you want to answer it, let's do an arm raise. Nice. Yeah. So it looks like we're having a myoclonic jerk. That's even better. When I get patients in my office who ask me what functional neurology is, it's really just the application of understanding what the brain really is there to do.

And that is to promote and mediate movement. That is to promote your ability to function in your world. And so functional neurology is essentially every single type of therapy, modality that we have out there, and it's outcome on the brain. That's the simplest terms that I usually equate it to with people who ask me that question. In a non-academic standpoint, it's essentially trying to figure out ways to get your brain to function at a higher level. If you equate it to a computing system, it's like, how can I update my software to be more functional and a little higher quality of life? I feel like we're going down.

Go ahead. That's essentially the most terms that I use. I just want to also add, so functional neurology isn't just for chiropractors. It's a multidisciplinary field that people use. So there's PTs, there's MDs that do it as well. It's not necessarily a treatment per se, but it is a diagnostic entity that you can use to when you're looking through your examination to see how things are working, you're not looking to see, okay, does it work? Does it not work on or off? You're looking to see how well is it working. And through that examination process, when you look into patterns, you can figure out when you move up, when you line up all of these moving parts together, you can figure out exactly what structures in the brain and what loops in the brain need a little more attention.

Okay. Clean that up, Colby. I mean, I don't know if it gets much cleaner than that. Yeah. I mean, it's not, it isn't just one specific treatment. Like Eric said, everything, you can use anything as a treatment if it's applied appropriately. The way I kind of bring it full circle is that they don't necessarily look for pathologies because pathologies would be something that showed up on like an MRI or through a blood test or something like that. Whereas you can look at the system as a whole, whether that's the endocrine, the circulatory, everything's linked. So everything influences everything.

And if you know how to apply certain modalities or whatever appropriately, then you can get the long-term desired effect that you want. Okay. So then I think then, I guess a good question might be that, so Mike was talking about diagnostics then. So if we're not really looking at pathology or structural problems, then what is something that you would test possibly with functional neurology and say, hey, this is something we can affect or something that would be like, hey, this is a top tier thing you want to deal with, you know? I would like to say that we are doing a full exam. So we are looking for pathology, ablated pathology, because those things should be screened for every time regardless.

Once you figure out that there's no big, bad, uglies, no tumors, no trauma, no bleeds, then you can start looking at these more functional things. So you'll hear a lot of people in our profession talking about eye movements. And eye movements are a big part of what we do because they are correlated directly to brain function and specific areas of the brain. And we use certain software and hardware, so you can use just general bedside exam. You can say, hey, follow my finger. And you can, when you're trained to look for these things, you get pretty good at it. Or you can use things like eye tracking software where you put goggles on a person.

It measures pupils and it tracks pupils as it moves through following targets or jumping from target to target. You can get quantitative data supporting that. Okay, so then let's just take a, like a, I know we're going to go down the route of weightlifting, hits training, boot camps, things like that. So how would someone who's a boot camp person, how would that type of testing and treatment or correction affect how they can do a better boot camp, I guess? Does that make sense? I'm trying to narrow it down a little bit to make sure everyone doesn't think we're getting too techie here. Let's apply it to that boot camp, mom.

I'll do a first comment on that one. So when I was an undergrad studying exercise science, going through, learning about the body, rehab and all that stuff, I was a trainer for a while in doing boot camps. And I always struggled with that because there were so many people at different levels in your class, right? So you get some people who are really fit, they want to get a really good workout, they want to try and, you know, achieve some accomplishment. And there's other people who are just like, I just want to move. Like I came to hang with my friend and, you know, I'm trying to just like get back in the swing of things.

So, you know, the hard question inherently is how do you appeal to all of those individuals and all of those people looking for something different? And it's the same inherent thing with like functional neurology. Like you could get 20 people who come into your office who, let's say, have migraines. You're going to need 20 completely different treatment plans because each one of those people may have a different reason for their migraines. So taking it back to like being a boot camp instructor, you know, it's not easy to say that this instantly would translate to say, oh, I know what you need to do and what you need to do and what you need to do.

But it kind of comes back to even the sports model of assessing like movement screens and looking through scapular motion with the shoulder. Like these things are important when you realize that there are other things to the system besides just the hardware, when there is software involved, controlling movement, coordination of these different patterns to be able to do, you know, without being a diagnostician for the lack of better term or having like, you know, a doctorate for you to be able to diagnose somebody, looking at simple patterns of people and just saying, oh, well, maybe they struggle a little more doing things when they turn to the left versus turn to the right.

Well, you know, what does that translate to? Is that functionality? Is that a lack of stability when they do that before or after? Those are questions they can kind of get from that. You know, it's not perfect. And without them being able to do a complete neuro exam and look at all these factors, it's not like you can just immediately translate. It's more so the thought process or the philosophy of functional neurology. And that is essentially saying that it's not a technique. It's more so your ability to critically think through a situation that somebody may be presenting to you with. Okay. So I'm thinking back to the podcast that we did together.

I think that was like 36 or something. That ain't sure. Do you remember your number? No, I don't. I didn't know this was going to be a pop quiz here, Sebastian. Well, you are raising your hand like a game show, for God's sake. But I remember one thing that we were talking about, and you guys have all kind of said software versus hardware. And so people listening to this podcast, they probably, a lot of them have not heard about the functional neurology aspect or even thinking about this central nervous system or any of that stuff. They think structure, you know, or movement patterns. And it seems like it's commonplace for them to all understand that now.

And they're like, even say the concept of mobility. It's like, well, we don't want to get mobile. So how could a functional neurology correction affect mobility? Colby, you want that? Yeah. So, I mean, think about it. Say you have a, you know, an individual has a chronically tight hamstring, right? You go in and you do like, you know, some post-isymmetric relaxation stuff. You go in and you really, really stretch it. You're like, oh, I'm just going to activate the antagonist group. But a week later, tight hamstring is back, right? Well, if you have aberrancies in your balance or your centers of pressure or whatever, you can absolutely get differences in tone in muscle groups.

So that's one way that you can look at it or use it as an adjunct therapy in relationship, not only to the muscle group, but also the stuff you're already doing, like stretching. If you can figure out why the tone of that muscle is being set at that specific frequency or why, you know, why it hasn't responded, that's when you can apply some of these interventions using the exam, figuring out, you know, what your findings are, and then applying something to stimulate that in the appropriate manner. Then you can make changes in muscle tone. Okay. Mike, you want that again? I raised his hand. Yeah.

I wanted to add on to that. So when you're looking at that aberrant muscle tone, how many times have you just done like a single leg stance with a client or a patient and you're looking at their sway patterns and you're like, oh, okay, their balance sucks on their left foot, balance sucks on their right foot individually. But they always fall to the right side or they always fall to the left side regardless of which foot you're on. And when you're looking at some of these other control systems, we use the term vestibular system often, which is your inner ear pretty much telling you where you are in relation to gravity.

Like if you're in the pool and you do a couple of spins, you don't know which way is up. That control actually is really huge on your ability to balance and your ability to lift weights, do a squat, to have tight muscles in one way or another could be directly associated with the actual functionality of your vestibular system over quality of muscle, quality of movement, quality of like muscle memory. Just to clarify, what's the vestibular system? So the vestibular system is a structural piece deep inside your ear that allows you to determine which way is up. It activates your brain and gives your brain information when you turn your head from side to side, up and down, translation side to side.

I like to see you do that. Also things like elevator, up and down. So it activates and it allows your body to react to the environment around it and you moving through that environment. Okay. So do people that are walking on the streets in Boston with all those terrible bricks, do they have better vestibular systems or? I don't know. I mean, if you want to talk about people from Boston, we can talk about like there's the way they talk and that might be more frontal lobe. Okay. We'll leave that to the end. Okay. So I know that originally when the email and I was asking you guys what you want to talk about on this, Eric, you had about four topics and then Mike said, Eric stole mine.

So it sounds like there's a really good one you want to talk about. Why don't you start it off then with that? And then all you kind of just start jabbing at the other one and we'll have just a brawl here of agreeing or disagreeing. A brawl of us yelling. Well, let me look here. We have so many emails, but there was a, the first one is the, you know, essentially like this, Sebastian, correct me if I'm wrong, the neurological mechanisms behind sports training and then kind of looking at fundamental training exercises with training programs that we can add in or look at it from a functional neurology standpoint.

Is that kind of where you're looking at? Yeah. Okay, cool. So, I mean, I think this is a really interesting topic and, you know, no matter what we say, I feel like everything is debatable, especially in 2017. And so, you know, when I look at trying to use these principles for improving athletic performance, right, you know, traditionally rehab has been focused on more of the hardware, right? So looking at tissue, tendons, ligaments, looking at muscle tone, you know, chiropractic, doing manipulations, PT, doing exercise, all this stuff together. There's nothing wrong with that. I mean, I still do that on a daily basis because it's super important.

But the thing on top of that that I find very interesting and what kind of brought me to this paradigm in chiropractic school is that I had a lot of questions about what else was there. I mean, I'll tell patients, you know, go try and have a conversation with a cadaver that has all the muscles, all the joints, all the tissues, all the organs. You're not going to get very far because you don't have an intact nervous system to control nearly every single function of that body, right? So when you look at functional neurology, you're really trying to assess all these layers of the brain, the cerebellum or the cortex of these different areas that are really important for just giving us functionality.

Now, a lot of the times when people come see us in the office, they come in because they have some deficit or they have some issue or some symptom that's manifesting, whether that's chronic pain, whether that's dizziness, whether you've had a concussion, I mean, the whole gamut of stuff. Looking on the flip side, if you have somebody coming in who's functioning decently well, for lack of a better term, are there things for them to be able to do to potentially improve their ability to be better at baseball or be a better soccer player? I mean, I would probably argue yes. You know, there's articles coming out now and we're finding more of them.

And I don't know if that's because I'm searching for them or that they're actually just coming out with more stuff, but, you know, just like training the eyes to be more accurate. What if you could get a wide receiver to be just a little bit better with judging depth, right? What if you could get a baseball player just to be a little bit more accurate when he has that ball come in and he wants to take a cut, right? Those are the things that I look at to say, well, there's other opportunities for us to improve athletic performance from a brain-based standpoint. And so instead of just only addressing structural modalities, what if we got these guys to engage in different exercises like timing frequencies or being able to, you know, I remember this interesting story somebody told me when I was in chiropractic school about Pele and what they were doing is they were doing some research on his ability to judge the distance and the depth of a soccer ball coming at him.

And what they would do is he was in a facility and they took corner kicks and right as the ball left the person's foot, they'd shut all the lights off. And Pele nearly every time was able to head that ball or hit that ball into the net. And that was because his ability to predict and his ability to judge that depth and distance from a brain standpoint was spot on. And unarguably, he's one of the best soccer players I've ever lived. Now, I can't say that I can turn somebody into that skill set. But what I do think there is is a capacity to improve brain function specifically based off of skill sets that each sport needs, right?

So for baseball, you got to be able to judge the depth and the distance and the speed of a baseball coming at you, whether that's you being in the batter's box or whether that's you having something hit at you in the outfield. Could you improve that functionality? Probably. I mean, we're not physically changing the end organ, the eyeball itself, but you're changing the neurological networks and connections of all the deep nuclei of the cerebellum. You're going after the midbrain and the pons. All these things are really important. And they're coming up with studies even talking about how theoretically it's almost, scientifically it's impossible for somebody to be able to judge a fastball, but yet we still have athletes who can hit it.

How is that? Well, there are these mechanisms that may be subcortical. Are functioning at a really high level and they're really accurate. How did they get there? Hours of training, being specific with what they're going after. And so, you know, I look at those modalities with when a patient comes in and says, okay, well, you have migraines. Let's really try and figure out what's going on with you, whether that's assessing structural, metabolic or neurological. If I get an athlete who's functioning at a decently high level, are there things that I can do for them, hopefully, potentially, I just have to figure out what the best way is going to be to do that.

Does that make sense? Yeah, it does. So I was laughing at it. I think me and Mike were having a drinking war. I saw that. Now I need to go get something to drink. Okay. No, that's good. So then, Colby, do you want to – let's all go down this route a little bit. And I know I had asked if you have examples of – we talked about things to do middle of the game to improve those abilities as well as pregame or warm-ups. What do you think, Colby? Yeah, I think that there's stuff that you can do to improve. Like prior to the start of an athletic activity, you can prime yourself with some specific eye movements.

You can do some vestibular stuff. I think when we look at athletics in general, whether it's football, basketball, baseball, whatever, right, your environment's always changing. And your perception of that environment and where you're interpreting yourself in that environment is really important. So if you have someone who has a bias or they don't have the complete picture, well, that's going to be kind of a game-changer for them. If you have an enlarged physiologic blind spot for, say, tight end going across the middle, probably not the best for protecting himself when he gets tackled, right?

So if you can do things to improve their visual fields or improve their spatial awareness, then you're going to get improved athletic performance. Now, what that is depends on the individual. But I think that there's definitely some aspects of functional neurology that could be carried over into game-time situations and stuff like that. Okay. So what do we need to do then, since you guys are spearheading this whole thing? What do we need to do to get this as a mainstream sporting technique? Everybody should have an exam prior, just the baseline. I think that that's something that not just athletes but everybody in general could benefit from.

That way you have a baseline to know where you're at, you know, that way you can improve the deficits. And then also if there was some event like a concussion or an injury, then you have something to compare that to prior to that specific incident. So I think that that's probably one of the best ways that you could implement some of this stuff is have everyone do, you know, have an in-depth exam done on them prior to the start of the season. Okay. What does Mike need to know about this topic that you think he doesn't know already? I would say that I'm better looking as far as stuff that he needs to know and about this topic.

I don't know. Mike's pretty smart, dude. Mike, what do I know that you don't know? I would say sport-specific. So one of the main things that I, when I was in chiropractic school, I was part of the sports medicine club, and we were trying to figure out how training and how therapies and preventative measures should be different depending on which sport you play. So I know, Colby, you're a pretty high-level wrestler. Eric's a pretty high-level hockey player, if I remember correctly. And what we're looking for is all those sports are different. When you're playing baseball, it's a unilateral sport.

If you train somebody to be perfectly symmetrical and they're trying to hit a ball coming at them, looking one way, then they're going to have asymmetries that may come more into play. Now, the question is, from our perspective, do you want to train that person to improve their baseball performance in asymmetries, or are you chasing after other things? So that's where a little bit of the complexity comes in. But when you want to take an individual sport, like a wrestler, for example, his experience with knowing the game should allow him to have a little more understanding of the intricate details and ways to train, and not only ways to train specifically, but how to train the brain to be able to respond to the stresses of the sport.

For example, if you're playing volleyball, which I have a little more experience with, when you are searching for the ball overhead, and you have to not only have an idea of where your feet are on the ground in sand, where you're already having a reduced feedback from your feet and from your joints and muscles for balance and knowing which way is up, you can train the brain to specifically have advantageous adaptions for that sport, for that ability to have ankle, knee, hip proprioception and have more appropriate and quicker responses to whatever the play may be. The idea is when they jump into the air and when they hit the ball, then they still land or they still have an idea of where they are or they still hit the ball even if they fall on their ass afterwards.

But the idea is they have it all planned out and their mapping systems for the sport and repetition that they've done in practice for the sport has trained those neurological systems to be more advantageous. I can tell Eric wants to chime in here. No, I just, no. You know, it's interesting because, you know, I get these questions a lot. And to a point, I still struggle with them because, once again, like with functional neurology, this isn't a technique. It's really an ability or a philosophical mindset or an ability to critically think through what's going on with the individual in front of you.

And so, you know, using Mike's example with, like, baseball, I mean, you could get 20 guys who play baseball who maybe have, you know, Tommy John's issues or something along the lines where it's something consistent through the league. They might need different things to benefit them with regards to that. And the hard part with a lot of this is, you know, looking at it from a standpoint of improving athletic performance, there's just not something that we can cookie cut across the board. And even in rehab, right, we want to put people into different categories or we want to say, oh, this is the movement screen you should use or this is the technique that we should use.

But there's always anomalies to it. And, you know, when it really comes down to it, with functional neurology and athletic performance, I do think there is a significant opportunity for us to be able to improve functionality. It's just – it's always a case-by-case basis. And 20 baseball players, two of them might need visual therapy. One of them may need to change his diet and decrease inflammation because he's got things going on neurologically that he can't – one guy might really struggle with, like, brain fog or chronic neck pain. You know, those are things that could maybe improve their functionality that may not necessarily just be a structural issue.

It could be modulation through different brain circuitry. So, I don't know, I struggle with answering those questions. And I don't know if I'm the only one on that. But that's kind of the hard part with me is it's just such a philosophical or an ability to critically think that. Every person that comes through the exam that we do is comprehensive. But, you know, I don't check cranial nerves on somebody who comes in with, like, a really hot, low disc issue, right? I'll do different cerebellar tests and things like that. But if I don't think it's warranted to investigate, I won't look at it. So, I don't know.

There's some things there that are difficult to kind of communicate. But when it comes down to it, we're just really trying to assess the brain and trying to improve brain functionality. That's the simplest form that I can kind of put that out for. Okay. So, knowing by what you're seeing right now from Colby, and he's trying to kill more elk today, what type of correction would he need to have better coordination to have that arrow go where it needs to go? No one wants that one, huh? There's so many components of bow hunting, man. It's like you've got to be able to hold, you know, your arm steady when you're aiming.

You've got to have that, you know, that fine motor skill to hit your release, you know. You've got to have the proper mechanics when you're breathing, all that stuff. You have to have, you know, your blind spots can't be huge, otherwise you miss that giant 350 bull. So, I mean, that's the thing. You can relate this to anything. And when we say sports, it's not just like, you know, football or basketball or track or whatever. I mean, someone who wants to be a better downhill skier, you know, someone who wants to be better at pickleball, badminton, you know, darts, all this stuff. You can make changes in people's central nervous system by applying the appropriate modalities.

And then it's not like it only works for some people. Like, there might be someone who doesn't respond necessarily to that specific treatment, but that doesn't mean that the treatment doesn't work. It just might not work for that one specific person. That's where kind of the art form of this comes into play is that you have to know what to apply and when to apply it and then look for the changes that you want to see. And if it's not working, then you don't do it. Then you find something else. Tell me, do you have a thought of just a case that you think is interesting? I know that, actually, I'll let anyone answer this.

You can do the hand raise. I know Colby had the upper extremity, what did you have, reflex sympathetic. Oh, yeah. Yeah, the complex regional pain syndrome patient. So they started out, it was tennis elbow, you know. Started out as tennis elbow and manifested as complex regional pain syndrome. And what had ended up with her, she just really had no idea where her whole right upper extremity was. You know, we would do a, like, two-point discriminating touch, couldn't tell. You know, you'd do, like, the whole up or down joint bend, couldn't tell. Her autonomics were all over the place. So what I ended up doing was a lot of vestibular rehab because your vestibular system fires really strongly into your autonomics.

And then we did some, like, mapping with her, you know, with vision, with some collicular mapping stuff. We did some parietal stimulation through, like, graphesthesia and stuff like that. And after about, and she'd had it for, like, two years. And after six months, it was completely gone. So, I mean, this stuff isn't just started out as tennis elbow and ended up as complex regional pain syndrome and, like, a frozen shoulder. Can you describe graphesthesia? Because I think that probably went by people. Yeah, so it's basically just, like, writing a letter or number on someone's skin and having them, with their eyes closed, tell you what you were drawing.

Okay. So you drew it on her. She didn't draw it on you. Yeah, correct. Just checking. Mike, you got any good cases? Yeah, I was actually going to take a different tack with it. Because one of the things that Colby and Eric said about sports performance, have you ever been playing a game and then, like, second half or third period or fourth quarter, you just start making dumb moves? Like, you know what you should have done afterwards and you're just like, why did that even happen? Like, how did I make that decision when clearly there would have been a better choice? One of my patients that I've been working with for a while now isn't necessarily, like, he works out.

He's a weekend warrior type athlete. He's not going to – he used to be a competitive sailor, but I think he still does that. But the idea is we were working with him for just general brain performance. And starting with that, it then spread out to everything else. He was working 60 hours a week as a consulting job and then an extra 20 to 30 hours a week doing an MBA. And that was really slowing him down. His ability to just – for his body to function in general wasn't working so well. So we started doing things just generally for brain performance. So we were saying that he didn't have an actual problem to start with.

We just had a goal for him to get to that he can cope with those high stresses and high brain demand. And by doing – by looking through a nutritional approach and then by giving some specific brain exercises, all of that became much easier. And he was able to function and not have those 2 p.m., 3 p.m. crashes. He was able to pretty much get off coffee altogether and function really well. So it was really cool to see that this isn't just – you can take anybody and get them towards any goal that the brain has an influence on. And if you name a part of the body that the brain doesn't have an influence on, there's not many out there.

Yeah. Eric, what do you got? I put the fifth. My brain doesn't have an influence on Eric's body. You know, I think all – you know, most of what we're communicating is kind of the same thing is that they're – you know, we know that the brain changes. You know, neuroplasticity is essentially why nearly every therapist or practitioner out there has a job. And that's because we know that the brain changes. People can change their mentality on food, on their body image, on what they're doing on a daily basis. You know, athletes are always changing up their workouts. You know, I was taught when I was in college that, you know, the first six months of any workout don't really manifest as structural changes.

They all actually manifest as neurological changes. And you see changes in the gray matter and an ability to output more force exertion for muscles to be able to, you know, lift more weights and things like that. I think that's a really important caveat because with a lot of training programs and when we get to the elite level of these, you know, athletic performance situations, where are you going to hand these guys if they haven't been handed before, right? I mean, they've lifted. They've done all the exercises. They've done all these different variables that have been thrown in there to get them to be where they're at.

What if we combine that with simple things as in, you know, talking about pre-workout performance, doing things like getting the eyes to be accurate, getting simple reflexes to be active, and getting some areas of the brain at least primed, right? Everyone needs a good pre-workout or a pre-warmup. You know, now we know that, you know, stretching may be not as effective as just having increased blood flow and getting muscles warm. Well, what if it's the same thing neurologically? What if you, you know, doing different aspects of you moving your body and getting your vestibular system to be ready?

What if it's doing specific eye tasks or eye movements to get your brain ready cognitively and also just perception-wise? Those are the things that I would like to see more research on. I don't know how effective that will be, but those are the theoretical models that I look at to say there's got to be more things out there for us to be able to do. Case-by-case basis always, of course, but there has to be ways to improve that, and there are some universities doing research on looking at those aspects. You know, how would, how do you, how would, you know, people like feel like their hip isn't warm and they'll warm their hip up, but they can feel it, right?

Is there any way to feel that your neurological system or eyes or anything is not warmed up? Brain fog. The brain fog? Like brain fog. Like, well, that's one of the biggest things that, so when I'm working with patients, it's the first thing that they notice usually is when we start to do these exercises that they just feel like, oh, I'm awake now. When, when you, what you thought was awake before, it wasn't, wasn't as clear as it could have been. So that's one of the main things that people report to me as changes that they felt. Okay. Um, what is brain fog actually? So that's a little bit complex.

Brain fog, I would say is a, is a symptom. It's a, um, it's a perception of, of, uh, mental clarity that people have described as moving, like they're walking, like they're trying to walk through mud or soup or trying, like motions are slowed, feeling slowed down with their thoughts. Uh, the causes of brain fog can be from a neurological standpoint where their eyes are, we can go into a little more detail later when we talk about the exercises, but their eyes are jerking all over the place. So their ability to lock their eyes or train their eyes on a single target, their brain is not able to get that information appropriately.

So they just see, so it's just sort of trying to catch up every time that, uh, whenever they're looking at something. So they're never actually, they're looking at an image, but not seeing the image or it could be a nutritional thing. It could be an inflammatory component. It could be interleukins or cytokines that are involved with that. It's pretty complex. Um, there's no one answer, but there's a lot of avenues that have to be explored when you're looking into, into brain fog. It almost reminds me of when I'm working on my Mac and I have that spinning rainbow wheel that's kind of friendly, but it's not like, you realize you got to shut the whole goddamn thing down.

The wheel of death. And take a nap, right? That's right. Yeah. Um, okay. Well, you, you made a little tangent there. I know we had spoken about some exercises. I know it's going to be hard because there's not really a case here. You can make a, me can make up a fake case if you want to, but I, I wanted to see if we can correlate some of these videos of examples of what you believe would be beneficial for someone to improve their neuro function at halftime or before a game or so on. Um, and I'll put them on the YouTube channel and I'll link them to this podcast. Okay. Uh, who wants to be, I can just give you an example right now.

I was reading it the other day, like there's a, so Kenny Stills, wide receiver for the Miami Dolphins. He, he does vision therapy, not with any one of us, um, with another doctor. I think she's on a, like London or something. And, uh, you know, his completion percentage of, or his drop rate has dropped. Um, you know, he's catching more deep balls and stuff like that. So I think that even that, like that is becoming a little bit more mainstream and, and more explored by even professional athletes because they are looking for that extra little ump that, that competitive edge, so to speak. Um, so, you know, something like eye movements, Kenny Stills, I'm sure that they have him on doing eye movements at halftime.

I'm sure they have him doing like tracking exercises and saccades and, you know, saccades of rapid eye movements, um, doing exercises prior to the game. I, I'm sure they have him doing stuff with his peripheral vision. I'm sure that they, when they looked at him, I'm sure they were looking at his fobial vision. If he has any sort of like, you know, retinal smearing or if he has any drift or anything like that. So that's one application that, you know, is they can go and Google that, you know, Kenny Stills vision therapy, that's going to pop right up on Google. Um, that's just one application for this kind of stuff that even like the professional athletes are using.

Okay. Eric, give me some examples. Colby, that was a great example. And, uh, you know, it's kind of cool because there are more people coming out of, you know, these pro situations where they're looking at things that are more cutting edge. Um, and in our office, one of the things that we use is a called a D2, a Dyna vision board, and it essentially has circles. So it looks like the target, um, emblem and it's circles and circles and circles. And essentially there are all these lights that pop up. And what you can do is you're doing visual motor training. So visual motor training is essentially saying, Hey, you know, you, you pick a target out with the eyes and you, you know, can at least hit the target or you can train different aspects of your peripheral visual field.

Um, to hopefully become a little more accurate. Um, they're using these systems in occupational therapy clinics. They're using them, uh, in sports performance clinics. Some NFL teams are getting involved with them too. There's other systems out there that, that do that. But essentially what they're doing is they're training these different neurological circuits to become more accurate. And Colby mentioned saccades, you know, we have maps of our body, we have visual maps, we have maps of, uh, hearing, we have all these different maps in our body. And what happens sometimes is with injuries, poor development, inflammation, uh, things that just don't promote, you know, healthy function of the brain and body.

Those maps can become skewed. And that's essentially what happens in like phantom, phantom limb pain, right? You don't have a limb that's physically there anymore, but these people still perceive some input in, in that limb, the limb's gone. So there's, what's left is, is the brain representation. Um, and those maps change. We know that they do. Uh, we've seen on different brain scans that you can change functionality or at least glucose uptake or oxygenation in those areas. So that's their theory is that they're changing maps or functionality in that area. And so doing things from a brain-based standpoint to prime those systems could potentially be beneficial, uh, for improving accuracy of catches, your ability to maybe hit a fastball that you haven't been able to hit for a while, things like that.

Now, individual basis always, but, uh, simple things like engaging reflexes pre, um, game in the middle of the game and maybe even post game might be able to help you recover more, more efficiently or be able to stay in the game longer. And like Mike said, maybe not make those mental errors, uh, as frequently as you did before. I just, I, I'm just recalling, remember that game that you'd have with like with your hands and you try to move them quicker than the other person? It's a reflex game. Yeah, I know the one where you put your hands like this and get the, yeah, slap the other guy's hand. It's a hard game, man.

It's like bloody knuckles. Kinda, yeah, yeah. That was just the more, more grotesque version. So, so those games are actually similar to an exercise we use. Is it really? Yeah, for certain frontal lobe development. Now, I may not do bloody knuckles with the patient, but I'll do like Simon says with the child or I'll do, uh, what we call go, no go exercises. There's a simple one that we use that is relatively easy, but you get somebody else there. And so, uh, Eric, I'll play with you. So, when I show you one, you show me two. When I show you two, you show me one. If I show you three, you show me the same one that you just showed me.

Okay, ready? All right. So. Oh, no, I see you did that wrong. The last one? Two. Okay, so that should have been two. You show me a one. So, that was the one that you just showed me, not the one that I just had to give fruit. So, the idea is you want to have, um, you, those go, no, go exercises are very frontal lobe active, but even things so simple can have a powerful effect on neuroplasticity. You know, I'm really sad that actually the quick time video that I was recording stopped right as you did that demonstration. So, I'm going to need a video of that. I'm going to link. Eric, Eric, he left.

Sorry, I had to pull my computer in, otherwise I'm going to lose you guys. What do I call that? What's this test, or what's this exercise called? It's under a category of exercises known as go, no go. It's the Simon Says of brain activation games, and it really helps with frontal lobe processes, prefrontal cortex versus orbital frontal cortex. Red light, green light. Yeah. There's a bunch. Okay. There's a whole ton of exercises. It sounds like we could just do these to children. Like, it'd be like, you get 20 kids and just get them into camp and you do the same thing. You could. I mean, think about it.

When kids play these games, they're developing motor pathways and developing skills. Adults can play these games, too, and develop those same pathways and skills as well. Okay. I feel like it should be, like, maybe part of a resume or interview process, so you just start playing these games to see how adaptable they are. To be honest, I would. I'm not a bad idea. It's just a questionnaire, yeah. You can see how well they adapt under pressure. They adapt to change. When you're hiring somebody, you want somebody who's going to be able to grow with the company and not be resistant to everything new.

And that area of the brain that we were just exercising with that is associated with it, for sure. Okay. So how long would it take Eric to actually pass that test every single time? He's a smart guy. Maybe, like, five more times. I'd probably take a little better instructions, too, I guess. That is the important part, huh? There you go. Okay. So I want to see, Mike, what do you – I was going to ask you each one individually and have the other ones kind of just – or the other guys kind of take a stab at it, too. What excites you in this field right now? Like, what is new and cool and you're reading on this week?

All right. So where to start? So just to give you a little background, when I was going through school, there's a lot of dots that people make. And it's in any program. You make a lot of dots. You try to connect the dots with lines. And I realized that there's a lot of lines that people use that are a little more inferences than actual lines. And part of being in the functional neurology world is you have to constantly look for more dots and more lines to connect these things. So I'm working on a – through a couple papers right now that are working on the gut-brain axis and how nutritionally you can change the functionality of it and how you can associate it with certain – with certain cortical areas.

There are – yeah, they're kind of going in a lot of directions at once. So there's a lot of different ways to build this knowledge. But the most important thing is having a concrete foundation that you can build upon. If you learn a bunch of applications of, okay, if you do this exercise, you activate this area, but you don't know where the connections for this area is, then you're just playing guess and check. And how many times are you going to play guess and check until something sticks? You could get lucky and it happens right away or it can take forever. So observationally, I would say that's the most important thing.

And when I'm learning, I'm learning observation. I'm trying to figure out what a certain pathway would present like, what a, like, higher midbrain activity on the right side, depending if it's in the front or the back of the midbrain, will depend – will change the pupil size, how to see those things. So that's sort of what I'm focusing on right now is how to be – how to always consistently improve my observational skills. Okay. Either one of you have a comment on that? No. Practice. He just covered an entire thing right there and you guys are like, yep, that's – we figured that out last week, man.

No, I think, Mike, you bring up a good point. I don't think you can ever be satisfied with your skill set and your ability to perform an examination. You know, I've kind of held a couple of things close to myself about, like, you know, if I'm still doing the same things I did six months ago, then I'm not maximizing my skill set or my patient's ability to improve. And that doesn't mean that – you know, there's a reason squats have been around for many, many years and things like that. There's not really a wrong exercise. There's more so a wrong application and the same thing with neurology too.

You know, one of the things that excites me heavily in this field is that there's always new stuff coming out about the brain. You know, we just found out about the brain's own lymphatic system like this year. You know, they have to rewrite all of the textbooks now. Like, it's 2017 and we're still finding out new things about the brain and, you know, it really is the final frontier and that's what gets me, you know, motivated to do what I do with my patients, to keep looking at literature and just trying to apply the stuff that we read about in clinical practice. And trying to bring the latest up-to-date technology and just clinical application to my patients, that's one of the reasons why they come to find and see us as functional neurologists.

But it's fun to be able to give people part of their life back that they may have never thought was able to actually be handed back to them. We know the brain changes and that's for better or for worse. My goal is always to get it to change for better. And unfortunately, if you're stuck in an old mindset, 15, 20, 30 years ago, you think that, you know, you're just stuck. And we know that that's not true. And functional neurology is kind of a theoretical application to that saying, let's try and change your brain for better and figure out ways to keep that long-term as a new habit for the lack of better term.

You said for better or for worse. I know that me and Mike had the whole podcast on positive and negative neuroplasticity. Is there, have you ever found that there's something you were doing, I guess, in practice where you're like, oh, crap, I'm beat. This is negative neuroplasticity. I've got to stop this real quick here. Like, how common is it or is it possible to, like, apply the wrong thing to the wrong person? Yeah, sure. I mean, I think even just, you know, they can look like not even like a physical modality but like having a conversation with a patient. If you always bring up pain, hey, what's your pain like today?

What's your pain like today? They're going to perseverate on their pain. If you ask them, hey, how are you, you know, functioning today? Or if you phrase things even differently, cortically, you're going to have them asking those different questions. And if we sit and hammer on a specific, you know, question of pain, pain, pain, a lot of pain science, people out there are kind of looking at the brain and the cortex and how this is involved. Even just your terminology with patients sometimes could be promoting negative plasticity or something that may not be benefiting them long term. I mean, that's one example.

But, you know, every chiropractor has a story about that adjustment that should have gone well that didn't. Well, could that be the same concept? Absolutely. I mean, I don't know. I would also jump in there and say there's a concept that there's a very fundamental concept that we use known as neurons that fire together, wire together. And if you are, so you need to have conversations with your patients. You need to, you need to activate serenaries. This, like we've been talking about the frontal lobe a lot today. With a frontal lobe, that's your, your limbic system is there. That's your emotionality.

That's your ability to, for good thoughts or bad thoughts. And if you look at, if you think about that from a perspective of an output of the brain, like psychology is an output of brain. And if you change the way the brain connects, then the output can change. So what ends up happening is you can actually create a negative neuroplastic response with certain patients if you talk about the wrong things with them, or if you bring certain things up at the wrong time. Or you can create a positive neuroplastic response if you're making them laugh while doing an exercise because then they have different areas connecting together.

So it gets really, that's one of the cool parts about what we do is because it does get complex. You can create new connections in an area and sort of have a more, you can sort of force a positive attitude through that by having positive experiences while you're doing the exercises versus feeling like it's a chore while you're doing the exercises. Will doing the exercises like a chore and being like pissed off while you're doing the exercises actually get you better? I would say no. And I would say if you're doing the exercise, do it like a minute of exercises. So it's like, okay, cool, I'm going to do this.

And then you do it. Then you get better because you're having these positive thought processes. You're activating prefrontal cortex with those areas. You're inhibiting orbital frontal cortex with those activities. And it ends up having a much more profound effect than you would, than you would have just by staring at a dot on a wall by itself with no emotional component or with that, or by trying to only work on the emotional component by itself. Is that why if you put a dot on the wall, it's got to be like a little emoji smiley face has an emotion back? Depending on the patient, it could be like, you know, a middle finger.

Just, just for fun. Okay. Anyone, anyone else that have a comment on that before I ask Colby what he's, he's excited about? Okay. I'm excited for what Colby's excited about. I'm excited to hear what Colby's excited about too. Other than he's going to get a sponsorship by Hoyt. That's right. I'm excited for rice fishing too. Yeah, man. As far as like what I'm excited about, I'm excited that, um, that this stuff, like, like Eric said, it's being investigated. It's being, um, you know, studied. And on top of that, that people are starting to really take note of it. You know, whether that's, um, other medical professionals, whether that's the general public and their utilization of it.

And I think that regardless of what your profession is, anyone in the healthcare field gets involved because they want to help people. You know what I mean? And I think that there's a lot of, um, possibilities with this type of care and with the use of these type of interventions and, uh, you know, applying it to certain people. So you can, you can really profoundly influence somebody's life. You know, if you have a stroke patient or post-concussive patient or, you know, whatever, there's really a lot that can be done for them that maybe they didn't think was possible previously. So I think that's what I'm most excited about is that you really, really, really have the ability to influence people's quality of life in really positive ways if you know what you're doing.

Good. All right. Well, gentlemen, we're starting to close up here. Anything else you think we missed and we, that you need to have on this podcast because, damn it, the public needs to know. Mike Lovitch is single and ready to mingle. BostonDates.com. So we need to go, probably, someone needs to go online right now and just figure out where all the meat is. All the meetups are, all the meetup groups in, uh, in the Boston area. Maybe, uh, you know, paper football groups or something of that nature. Darts. All the fun things in life. Okay, cool. Well, then, um, can you, let's see, why don't we start top, top to the right?

Um, let everyone know how to contact you guys and I will link that. Just make sure everyone, or I said, everyone should know that we, uh, we have done podcasts with each of these docs individually already. So, I will link those as well. Uh, so, Colby, can you tell everyone how to reach you? Yeah, you can reach us on our website, which is www.northlakeschiropractic.com. Um, you can email us at northlakeschiro at gmail, um, or you can give us a call at our clinic. It's, our number at the clinic is 218-999-7006. Let's, there you go. Eric? Yeah, so, you can, uh, find me on our office website. So, that's mnfunctionalneurology.com.

Uh, we have another website, mnconcussion.com. I'm on Facebook, Twitter, uh, Instagram. That's just D-R-E-R-I-K-R-E-I-S. You can reach me on any of those. And then my personal email is D-R-E-R-I-C-R-E-I-S at gmail.com. So, any of those. You know, I gotta, I gotta say, in this light, you don't look tan at all. I don't care what they say. And then, and then, the white. We're not supposed to be tan this time of year. Right. Well, I don't know Mike's excuses. You got back to, like, the Bahamas, dude, didn't you? Yeah, I need to keep fake baking, I guess. So, Mike's the widest guy here, it looks like.

I can't tell if it's the computer screen, or if he's actually blue. I've had the computer screen for a while. We don't really tan much outside of there. How do we reach you? So, um, if you're interested in, from a patient perspective, if you're interested in that, you can email me at info at deltasperformance.com. Or, if you're a practitioner, or just have questions about this kind of stuff, and are trying to, just, we, what we do is, uh, my business partner and I, we, uh, offer free consulting services for neurology cases. Or, if you have questions, or just like, hey, I have no idea what this means, you can also send us an email at info at neurologymadesimple.com.

It's a free consulting service for people to get their questions out and get good information back. Cool. Well, I'm looking on your back wall right there, and I can't tell if that's a baseball glove, or a lacrosse, yeah, over your, over your shoulder. What is that thing? Oh, it's a backpack. And I'm wondering what's so important on those two post-it notes on Colby's wall. They're probably dots. They're probably his passwords. Are they? That's my, uh, social security number and credit card number. Right on. Well, cool. Um, okay, so guys, just stay on real quick. I'll just close it out, okay? Okay, Rowan, that was Dr. Eric Reese, Dr. Michael Lovitch, and Dr. Colby Kondos.

So, if you want to see all the show notes and anything we spoke about, it is p2sportscare.com slash podcast slash pound, the session number, which this one is 81. And, if you are looking for those modern patient education posters, especially for sports medicine related topics, and how to categorize and give these podcasts out to your patients or colleagues or friends, you can find those at p2sportscare.com slash shop. And, remember, I made these things because I, there are things that I wanted when I got out of school, but I didn't have the time nor the money to buy them. So, I didn't have time to make them or the money to buy them.

So, I am here now to draw and create for you guys what we're missing in the sports medicine profession, I believe. So, anyways, I will talk to you guys soon. Leave each other better than you found them. See you soon.