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

Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest with actionable information that you can implement into practice right away.

Let's get started. Hi everyone. Welcome to The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. In today's episode, we kick off a new 2-part training With Dr. Michael Lovich titled Muscle Memory: How Your Brain Uses Muscle Tone to Map the World. I find the inner workings of the human brain absolutely fascinating. And when it comes to pain science, the healthcare community has barely even scratched the surface when it comes to understanding the multifaceted aspects of a very complex interaction between the brain and the body. In this training, Dr. Michael Lovich will discuss how the brain maps out the body using muscle tone and how that integrates with vestibular and visual inputs. A patient may come into your office with several seemingly unrelated symptoms, and understanding this interplay between the brain and the body can really help you better determine the root cause. Today's guest speaker helping us tackle this topic is Dr. Michael Lovich, a board-certified chiropractic functional neurologist and board-certified chiropractic sports physician. He holds a Master of Science in Sports Medicine with additional training in brain-based functional medicine and functional movement-based rehabilitation. He has served as both a medical director and a member of the medical staff for various organizations and events in professional, amateur, collegiate, and high school athletics. He specializes in integrating the physical aspects of sports medicine and chiropractic care with the brain's neurological and physiological symptoms that are often overlooked. He is a partner of Delta S Performance, Functional Neurology and Sports Medicine, with clinics in the Denver and Boulder metro areas, and clinical adjunct faculty and a course designer for evidence-based concussion management and care for University of Western States Sports Medicine Program. Let's cue the intro music and get started.

So today we're gonna be talking about muscle memory. I know that muscle memory seems to be a little bit of a— I wouldn't call it a hot topic by any means because it doesn't really have that much controversy behind it, but you do see it used a lot in more layperson settings, and you see it used more like thrown around the gym all the time, especially if you go on any sort of— go on Instagram, start going through the reels, and you'll hear somebody talk about muscle memory every few times. Or maybe that's just the algorithm. Algorithm throws me working in sports medicine. So one of the things that we want to look at is, okay, well, let's dive into that. How can we use these concepts of muscle memory? And specifically, how does your brain map out the world and you in it so that way you can essentially create better outcomes with your patients or clients or whoever you're working with by having a better understanding of how it works? You may have seen that I started with a poll. Just to say, just to kind of see what this group tends to do. I typically teach, I've taught a lot of CEUs for state chiropractic associations and have taught like in-services for PTs working with specialized— because this is specialized in concussions and neurological rehab. And I'm always curious to see when you get neurological symptoms, do people do a cranial nerve exam or do people kind of say, all right, well, let me check everything else. And see if we get any improvement. So I'm generally interested in seeing that stuff. And we're going to be going through things that you might want to be looking for during a cranial nerve exam, at least from a musculoskeletal perspective. So one of the things is my presentation is made to answer questions as we go. If it's a longer, more involved answer, I may say, hey, we'll get back to that during the Q&A. But part of that is I like interacting with people as I'm talking because I like to make sure that this is tailored to the audience of people listening. So let's start. We're going to start off with just a quick overview of who's this talking head, why do I feel like I would be qualified to even speak on a topic like this. This is my office. This is what I've been doing for, I guess, 7 years now. My office is called Delta S Performance. We are a functional neurology and sports medicine office. We specialize in neurological rehab. We do neuro rehab of concussions, POTS, post-COVID syndrome. We work with a lot of neurodegenerative conditions. We work with some neurodevelopmental conditions as well. Smaller segment of the business. The name Delta S comes from entropy. The whole idea is that if you have a messy bedroom, if you have a bedroom, everything in life goes into a state of more disorder. So if you don't spend time putting energy into it, it's going to get messier. Messier, there's gonna be more disorder. And essentially, health can be viewed the same way. If you're not actively making your health better, it will get worse. So that's why I chose to name my business a little bit more complicated of a name, but I think it works well with our whole mission and approach. We specialize and pride ourselves on patient experience, patient education, and just doing an Ethical treatment model, in my opinion. We don't take advantage of patients. We don't do overtreating, overselling, or overcharging. We focus on being experts at our craft, and we're more focused on— we're not afraid for people to shadow and learn from us because we're going to keep moving forward, and we say, hey, come on, keep up. We have a collaborative approach. We try to work with other practitioners in the field because we're not experts at everything. And we also know that sometimes patient care works better when you have a different person focusing on a different piece, because if you have one person who's trying to do all of it, you're gonna— the patient education and communication is going to sort of silo you into what can you do. This is more of what we talked about, what I was saying before, the types of cases we see. And this is our current team. We're growing. We have another doctor joining the team later this year. So if you're looking to collaborate with us or anything like that or have any questions, please reach out. We're located in New England in 2, in 3 locations and Colorado here in 2 locations. So muscle memory, gamma motor systems. Now from my perspective, I used to always say muscle memory isn't in the muscle, it's in the brain. But it's way more nuanced than that when you start diving into the details, when you start diving into The actual pathways controlling it because there are physiological changes at the muscle. So if we talk about just basic exercise physiology textbook, it says it right in there that in order for you to make changes, if you teach somebody anything new, in the book it says right there, the first 6 weeks of any new motor pathway or any new motor engram is pure alpha motor activation.

Yeah.

In other words, you're not training the muscle for hypertrophy at that point. What you're doing is you're training the muscle for control from the brain. But at the same time, what we're looking at is how do things change physiologically at the muscle level that— because there are studies that show, hey, when you stop using something for 6 months, it comes back faster than it did before? So there's a couple questions that we have to answer, and how can we use that in a clinical model is the most important part. So this is where I always start with every presentation, is how do you build a brain? Because what we think the brain is there for isn't really what it's there for. It's really very simple. It's there to answer 2 questions: where are you in relation to the world around you, Where's the world around you in relation to you? And it doesn't care about anything other than answering those 2 questions. And that's why certain symptoms come out. And some of these symptoms start making a lot more sense when you view it from this perspective, because there's less deeper meaning behind it. And it's more about, hey, my brain is just trying to stay upright and navigate the world. And so when I have pain, when I have symptoms of any type, those aren't seen as problems by the brain. Those are seen as, oh, this is what I'm supposed to make. This is the conscious experience you're supposed to have so I can stay upright and navigate the world. So here is my simple schematic of how your brain works. You might've seen these things before back in 3rd grade when you're learning math and you have this function box. The— in a function box in 3rd grade, it's like the rule is plus 3. And so if your input is 4, your output is 7, right? So quick and easy. The input are all your sensory systems, the 5 senses plus your vestibular system. Most importantly is the vestibular system because that's evolutionarily the base system that everything is plastered on top of. So if that thing's not working right, then all the other senses are going to be doing their best, but it's going to be skewed. All that information goes into your brain and brainstem, creates an interpretation of the world around you. In the way the brain is working, you have to start with the sensory systems coming in. That's time zero. And you have to continue with how the brain and brainstem integrates that information, because if we're not working with that part, then it's going to be 3 steps forward, 2 steps back every step of the way, if it's not full 3 steps back.

I've tried a lot of different rubs and, and different types of ointments and lotions before. I used to use other topicals and and never had the success that I now have with China Gel. China Gel is my pain reliever of choice. We use it in the office because of its consistency, and the response that I get from the patients is what my goal is. I, I want to get people better. China Gel allows me as the practitioner to use instrument-assisted techniques, me as the practitioner to do ultrasound. and do many different techniques that I've learned over the years in conjunction with China Gel to get the maximum benefit for a patient. It's the combination of my skills as a chiropractor and what China Gel has in it that allows the patient to get better, faster, and more effectively.

What is muscle memory? When you talk about it from a strength and conditioning perspective, It's that muscles can drive behavior without neuronal input. You can react to things without thinking about it. You can make a very large case for how muscles and information coming from the muscles can create patterns. And maybe you're just activating a pattern that is already predetermined instead of the muscle itself saying, okay, this is what I'm deciding to do. It's more, I have a collection of things. This is the information that I've received. I've seen this, something similar to this before, I'm gonna react to it. But there is some evidence to show that there is an end organ input because muscle-related tests are easier to perform with practice. Observations is that there are rapid return of muscle mass following periods of inactivity, supposed to say inactivity. And then you actually have increased quantity of sarcomere nuclei. For those who don't know sarcomere, the muscle cell itself, you can have increased nuclei that do not get lost with inactivity. The muscle will atrophy and/or shrink, but the number of nuclei in the cell does not, which is what is thought to be the reason why the muscle memory of, hey, I haven't done this for a little bit, let me do it again, and then it comes back pretty quick. So what I've noticed, and this is the part that's my opinion, is I've noticed, at least in for popular science and popular culture, it's swung muscle memory through a strength training filter, promoting a popular belief that's housed in the muscle. But I'm here to tell you that taking care of your brain and using a neurologically based approach may make better results faster. What is the point of your muscles? If the point— if the whole point of the brain is to navigate the world, And to stand upright. The point of your muscles are there to tell you where you are in space, and you have large muscles to move you around that space. But what's the point of all those tiny muscles? So a lot of the tiny muscles are there for proprioception. And when I'm teaching this, I use this example of a rubber band. So let's say you had a rubber band around your thumb and forefinger, as the picture implies, and you pluck it. You're gonna hear a sound, right? If you do not hear it and you want to make it louder, you make it tighter, right? You can pluck it, makes a more resonant sound. The issue that we have here is that what if the issue is not in the muscle and the issue is in the brain? So for example, somebody comes over and decides that they're going to be funny and punch you in the shoulder, give you a dead arm. That muscle is going to tighten up. Why does that happen? Because you've had some sort of blunt force trauma to the muscle. It changes the signaling To the brain, the brain no longer can hear what is going on in the muscle as clearly, and there's more static. This is a very outdated analogy, but it's the only thing I can think of at this point. When you were watching on an old TV, like when I was like a young kid and there was static, what did you do? You just made it louder and listened through the static. That's what your brain's doing. There's Aberrant sensory information coming in from the muscle, it's got a lot of static going on. It makes the muscle tighter through gamma motor activation, which then creates better awareness of where that muscle is from a proprioceptive standpoint. Because again, your brain only cares about where your muscle is so it can use it to stand upright. And then that muscle will— maybe it's sore, maybe it has tightness, maybe it has a trigger point because of the exact individual That, that compensation is needed in order to make the brain function better and have awareness of the muscle might only be this big, and that's how you get your trigger point. What we're looking at here from a neurological perspective is essentially when you build this map of where your body is, a lot of times the symptom that you're chasing and even the soft tissue texture and hypertonicity that you're chasing Maybe a compensation used by your brain to better function in other areas. The same way when an injury happens, muscle splinting isn't to protect the muscle. Muscle splinting is a normal reflex. It's a reflexive action due to a couple different steps that stays there until your brain gets better awareness of the muscle. Or for some patients, it doesn't go— get better. It stays there because they never relearn how to move the muscle because the splinting created enough of an altered movement, altered kinematics. And why sometimes it's not so much about passive working on the muscle, and sometimes it could be active. We just need to teach the muscle how to move again. Oh, for those who don't know, not everybody has seen this, I've learned. So this is a sensory homunculus. This is a map of basically what your brain thinks your body looks at when you scale everything based off of the amount of real estate that your brain gives to the somatosensory cortex. If you look at that area, your thumbs, your hands, they're huge, your low back, your neck, the areas of— if you think of the areas of the most chronic pain, those are the tiniest areas. And you can get a lot of cortical smudging, get a lot of central sensitization in that area. But it doesn't necessarily mean that— but it could be a motor pathway and it could also be like A-beta neurons being interpreted. So A-beta are typically associated with proprioception. They can be interpreted as pain even though they're not nociceptive in nature typically. I put these pictures in here because I think it really shows all the tiny little muscles that— do you really think that those muscles are there to move the spine like, I don't know, half a centimeter? Or sorry, half a millimeter. In reality, those muscles are just there to create tension and vibration so that way you know where your spine is in space. And there are— so your rotatores longus and brevis, those are proprioceptive muscles. Your interspinatus, your intertransversarii, muscles that go 1 or 2 segments aren't really there to create motion and movement. They're there to show, hey, something did move because I'm being stretched. And then you also have all these receptors in your body that tell you where you are in space, like Pacinian corpuscles, the smaller ones, Ruffini-like endings, neurotendinous spindles. If you're familiar with that, is that's a Golgi tendon organ, a GTO, or neuromuscular spindles. All of these things that are housed within the muscle or the tendon of the muscle that tell you, hey, this is where you are in space. So let's get more complicated just because why not? Not just is your descending corticospinal pathways what control your muscles, you also have vestibular control of muscles. So, your vestibulospinal tract are the fastest firing neurons in the human body. And its role is to respond to movement through a gravitational field and keep the body upright so it can continue to navigate the world. We already talked about earlier how your vestibular system is the system That things are plastered on top of. But what is the only sensory stimulus that is constant on your body at all times when you're here on Earth? It's gravity. So that means that gravity is always pulling in a direction. Your body is always trying to figure out where you are in relation to gravity. And from my clinical experience, when I get patients who have a vestibular deficit, I always ask them a couple of questions. First question is, do you ever feel like you're falling backwards or forwards while you're laying down? And the second question is, when you toss and turn during the night, do you find that you always rotate in the same direction? My personal opinion and hypothesis at this point— I'm not a full-on researcher, but my guess is that when you have vestibular deficit, let's call it a left horizontal canal deficit, And they're lying down, so their head is now less in grav— in the gravitational— in the plane of gravity, which means you're reducing the amount of input coming into your brain while you're laying down sleeping at night. Now you need more activation because of that imbalance, so you continue to rotate yourself in the same direction, and that's what's giving little bursts of energy to make things function a little better overnight. But Down here on the— this is taken— so I have postgraduate training through the Carrick Institute, and they have— I got this off of Google. This is something that's public on their website. Essentially, the whole purpose of what your vestibular system does is it stabilizes you in space and allows you to figure out which way gravity is. So let's talk about that real quick. So if you think— so we talked about like how your brain makes maps of where your body is. What if there's a skew somewhere in those maps? What if your perception of where your body is in space has you mapped out as being slightly leaning to the left, even though you will know you're standing straight up? You're going to create postural— refluxogenic postural changes to pull you back over where your brain thinks gravity is, or it's going to get a couple different things saying different messages. So from a vestibular standpoint, if your— One vestibular system And if you look in the mirror, everybody is asymmetric in some capacity. Let's say your face, your head grew where half is— half is like, call it ideal, and the other half is a little bit askew. You're constantly getting changes or differences in the amount of activation coming through your vestibular system just from walking around the world. You'll see this in your patients and your clients because they're going to be talking to you and they're going to be talking to you like this, with a head tilt. Usually a rotation, a tilt, and a little bit of a tilt backwards because one eye is higher than the other. They're balancing it out. But if you see that one eye is higher than the other and they're imbalancing out and making it worse, that usually means that their brain is not adapting well to vestibular information coming in. And through reflexes, cervical adaptations, because your vestibular system connects directly to your Upper cervical neck, and through ocular adaptations, through the vestibulo-ocular reflex, you'll have an indirect change because the vestibulo-ocular reflex connects and the cervical ocular reflex also connects, creating this little triangle of if everything says the same thing, it's all great. If it doesn't, then we have skews. So here's that ocular control of muscles. The eye-head coordination So every time you move your eyes to the left, you have those little proprioceptive muscles contract and control to stabilize your head on the top of your neck. If you have a ton of ocular errors where you have— like I was asking during the question, do you do a full cranial nerve exam? When you check H-fields of gaze, are you just like, hey, they can move their eyes in that direction, or are you looking at it like, What is the quality of eye movement? Do they have a number of catch-up saccades? Do they have a number of backup saccades? Do they have, do they have saccadic intrusions where their eyes are like jumping and then coming back? All of those things are errors that your brain has to adapt for and your brain has to correct for. And so when we're talking about creating errors, what is the musculoskeletal compensation based off this? Well, now you have a deficit, or your muscles have to continuously correct. And at a point, your brain's going to be like, I'm continuously correcting so much that I'm just clamping down on these suboccipitals. This is why some patients will come in with sclerotogenous pain referral, but you go in and you work on their cervical spine stability, you work on their shoulders, you work on the whole kinetic chain, but it doesn't touch it, or it makes it better but doesn't go away because The issue is ocular stability, and we need to create— and this is one of my questions of why do we, for anything with a headache, do we check cranial nerve exam? Well, no. If you don't check the cranial nerve exam, how do you know that it's not an oculomotor-generated issue? If you look at old movies, you'll see how did they show stress in an actor or actress? They focus on the eyes, and they show the eyes darting in all directions at the same time. What if that's what's happening with the patient and that's something that we're missing? Something to look into. Now, fixing those things aren't necessarily straightforward all the time. Sometimes there's a huge vestibular component to it. But I mean, if you find it, at least that's the ball rolling where things can get better. You also have cerebellar control of muscles as well. So the one that I'm going to focus on is down at the bottom called the flocculus, which is the flocculonodular lobe. It's associated with vertical eye movements. But it's a modifiable accessory pathway through that vestibulo-ocular reflex for adaptive control. So it's part of your learning mechanisms in the brain that say, okay, I did this, this is how I coordinate these muscles. And it's also associated with synaptic plasticity due to retinal errors, your eyes. So in other words, when you have an eye movement error, your Cerebellum is going to try and create corrections because it's going to remember things that have less errors, and that's associated with the next system we're talking about. Before we do, here's a fun little activity that everybody can do. If you take your fingers, like the pads of your— I use the middle finger— and you put it right over your suboccipitals and you move your eyes around, you'll feel your suboccipitals making these tiny little bursts, these tiny little twitches. That's your vestibulo-ocular reflex. That's your cervico-ocular reflex and your vestibulo-cervical reflex all working together, because when you move your eyes around, you can see how your muscles are twitching automatically as a reflex. Last system that we're going to be talking about is, I think, the absolutely most important system, which is why it's plastered up on my whiteboard at all times. All 5 loop through the basal ganglia. This is the crude motor system That was paired to a thalamus, which is a crude sensory pathway. So what is— why is that important? Because evolutionarily, things didn't start as complex as they are right now, and over millions of years they got more complex. But if you were going to take it and pare it down to the most simple primal systems that we have, it's basal ganglia and thalamus. Sensory information comes in, basal ganglia Error corrects for that sensory information and tries to make an output. It's associated with not just the error processing, but predictive movements, predictive circuits, efficiency of movement, and your dopaminergic pathways. One of the things that a lot of people think is like dopamine is all about reward and all that stuff. From a psychological perspective, yes. But what happens in the basal ganglia Which is dopamine fires from your substantia nigra in the midbrain into the striatum, and it's at a constant flow. When you predict that you're going to do something like, I'm going to drink, and it works, you get a little more dopamine to say, hey, that worked, do it more this way. Let's say I did this and I chucked it over my shoulder, a little less dopamine. And it— that will train your brain to do it less this way. So the most important part to think of here is when you are creating any sort of change, when you are making any sort of movement with the body, if you're patterning in errors, we'll call that habituative therapy in vestibular rehab, or we'll call that, hey, form's not perfect, or let's just say form is completely off and wrong because It's okay to push through a form that's not perfect. But if you're training a person to move or an eye movement that has an error in there, you can plasticize over the error and sort of lock in the symptom that it might be causing, making it more difficult to then go and pull it off and rehab it. So from a movement perspective, and bring this back down to muscles, your motor pathways are going to be learning through the basal ganglia How to build on it and make more and more efficient movements. But if the prediction doesn't match what happens, and they're put in a situation where they're just left to figure it out over and over, they may create synaptic plasticity, long-term potentiation, in a direction that's not effective and in a direction that is actually more We'll just call it counterproductive because you're basically training them to move inappropriately, and then you got to go back at a later date and say, okay, well, let's try this other approach where you have to sort of like pare down everything else. I've had that a few times in office where a patient has come in where they were put in a boot or a cast for something way too long because it was a— it was like a myofascial issue that was looked at as like a stress issue. So they said, well, let's just rest it. For 10 months, and now they have a movement disorder there. So what do we have to do? We put them back in the boot for a period of time and then remap it little by little, muscle by muscle, because the issue of pain being in that area isn't because there's a threat on that area. It's because the brain has plasticized and learned that pain in that area is normal and what you're supposed to feel through basal ganglionic pathways. Specifically the ones that loop through the frontal lobe.

That's it for today's episode. Be sure to tune in for part 2, where we will discuss how reflexogenic systems integrate with musculoskeletal cases that aren't responding to care. We'll also talk about how your brain decides to increase muscle tone And how to see past the artificial compensations to understand where changes are needed for your patients. You won't wanna miss it. Episode 54 drops in 2 weeks. You can subscribe to the Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Give us a 5-star rating to help us grow the show. Every little bit helps. You can also subscribe to our Patreon channel for special discounts and member perks on Factor products, live trainings and online course offerings. To learn more, visit the Patreon link in our show notes. You'll also always find a link to download the PDF presentation from the training featured in each episode, along with a link to view the full video webinar recording if you're more of a visual learner. And last but certainly not least, we invite you to join us for a live Factor hands-on training in a city near you. Our hands-on courses are for chiropractors, physical therapists, PTAs, athletic trainers, and licensed massage therapists, and they offer up to 16 hours of continuing education credit. To view our full course calendar and register to attend a live course, visit factor-education.com. That's F-A-K-T-R education dot com. We'll see you next time.

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