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

FAKTR, 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 consume. to digest with actionable information that you can implement into practice right away. Let's get started.

Hey guys, welcome to The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. In today's episode, we finish up our 2-part training with Dr. Michael Lovick titled Muscle Memory: How Your Brain Uses Muscle Tone to Map the World. Now, muscle tone— or muscle memory, rather— is the ability of muscles to perform actions without neuronal input. It's related to the brain's ability to map out the body using muscle tone and integrates with vestibular and visual inputs. Today, Dr. Lovick will discuss the importance of understanding the interplay between the brain and body to help determine the root cause of seemingly unrelated symptoms in your patients. We will also chat about the relationship between muscle memory and chronic pain and how reflexogenic systems can be used to treat musculoskeletal cases that are not responding to care. Today's guest speaker helping us navigate this topic is Dr. Michael Lovick, 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 medical director and a member of the medical staff for various organizations and events in professional, amateur, collegiate, and high school athletics. He specializes in integrating the physical aspects of sports medicine and chiropractic care with the brain's neurological and physiological systems that are often overlooked. He's a partner of Delta S Performance, Functional neurology and sports medicine with clinics in the Denver and Boulder metro areas and clinical adjunct faculty for evidence-based concussion management and care for the University of Western States Sports Medicine Program. All of that being said, with all of the accolades and the functional neurology designations that Dr. Lovick has earned over the years, we are super excited to have him tackling this very important and very cerebral, may I say, topic for us today. So let's cue the intro music and get started.

So we talked about a couple of these artificial compensations that happen. So balance and hypertonicity, if you have an issue with vestibular input to— through your vestibulospinal tract to your core muscles, No matter how much balance training you do, it's not gonna fix the vestibular issue. So you're gonna constantly be fighting against input. So vestibular systems are always paired, right? You have your right anterior, left posterior canal. You have your left horizontal and your right horizontal canal. If the left horizontal isn't working well, your right one relative to it will be overfiring. We use the term escaping, which means that you're gonna get the constant perception of your rotating to the left. If you're always rotating to the left, even if you're physically not, but your brain thinks you are, because remember vestibular drives into proprioceptive, that means all the muscles on the right posterior side of your body are gonna be pulling back and you're gonna be creating muscular imbalances, and that is home. So you can have pain and patterns associated with that, and you can do it yourself.

Slightly turn.

Turn your body to the left and then rotate your trunk to the right and find the areas in your body where you can feel a little bit more tension building. And next time the patient comes in with a pain in that area, start to think, hey, maybe there's a vestibular component. How can I test for this? Or how can I co-manage someone who can test for this? Muscle splinting, we talked about that. Pretty straightforward. Joint dysfunction. So if you work in any sort of PT or chiropractic mindset where you're using mobilizations or Manipulations. The whole concept of joint dysfunction in an area might not be due to an area— due to a problem in that area. It could be, especially if it's post-whiplash or post-concussion, or developmental if they've had it forever, it could be due to that increase in hypertonicity in that localized segmental area because it's a segmental sensory apraxia, which means the brain Can't feel it well enough, so forgets how to move it, which locks it down, creating a restricted area. So when you motion palpate it or you try to say, oh, is this working? How's that doing? And you start moving things around, adjusting that area may not be the most appropriate thing to do because it could be coming from an area where the brain needs that to figure out where the body is in space. So what do I recommend? If it's on the same side, so let's say you're looking at it from a cerebellar perspective, and you're like, okay, the right cerebellum's not— like, I found that seems to be doing a little bit rougher, and I'm finding all these areas on the left side of the body that are hypertonic. Maybe that hypertonicity is more of a compensation. I want to put input through to that right cerebellum instead. I'm gonna only hit the stuff on the right side. I'm only gonna move and motion palpate the stuff on the right side of the body. And so the left side of the body, I'm just gonna leave alone and see what happens. More often than not, if you're using this approach, you'll find that, hey, like 2, 3 days later, that just kind of like quietly disappeared. And the patient, when they— when you ask them about it next time, they're like, oh yeah, I guess it's gone. But you can use this through this sort of concept through a number of different ways. And this is where I put all those reflexes down there for people who like to read up on things. Read up on all these reflexes. And you'll start to say like, oh wait, there's a connection there. There's this thing there that might be causative, correlated, that where my more musculoskeletal-based approach might stop and not be able to go that far because essentially we're just kind of beating it into submission. One of the problems is, so especially like with like deep tissue, is you're creating a ton of sensory stimulus into an area that might be one of those compensations. And if you're putting sensory stimulus into the brain, On the opposite side of where you find the deficit, you might be furthering that deficit where they'll feel better in the moment. They'll get up off of the table, you— the muscle is longer because you manually made it longer. But what's going to happen as soon as they try to use it? It's going to shrink back up again because the brain still needs that compensation to navigate the world appropriately. So I hope this created a little bit of a paradigm shift for some people to think maybe there is a little more of the brain to look into. I always offer consults, case reviews, anything like that with anybody who's interested. I'm always happy to chat about it. It's— the goal is I feel like patient— I want patients to have the best patient care they have. And if somebody needs to ask a question and doesn't want to feel like it's a weakness to ask for help, then I'm always there to help. So for anybody who wants to refer a patient my way, go to the Contact Us page on our website and click under New Patient Info, have them fill out the Get Started form. For everybody else, anybody who's a practitioner of any sort, has questions and wants to hop on a phone call with me to go over something you're working with, or at least to ask a question of like, hey, this is— I'm trying to figure this system out, how do I figure it out? Practitioner referrals and case reviews. And then if you want to come shadow an office either in Massachusetts, Rhode Island, Or Colorado, fill out the form under Shadowing Our Offices, and we're more than happy to have you in here. And that's all I got.

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

Thank you so much, Dr. Lovich. If you have questions, please chat those in through the chat feature there. We would love to hear from you. And we'll start kind of the live Q&A portion here. Going back to what you were saying earlier about your practice, could you give us kind of a little idea about what your intensives look like? I know sometimes you work with patients. in these intensive programs and do a lot of different things. Could you tell us first what type of patients are better suited for an intensive, and then walk us a little bit through, like, what that process looks like in your office in terms of length of time, exams, things like that?

So when you're looking at an intensive, it actually gets a little complicated because you look at more psychosocial factors as well. So let's say ideal, which means No financial concerns, no time concerns, and we can get a person better. If we want to create neuroplasticity in a brain, the best way to do that is intensity and repetition, right? When you're working with the brain, you don't have to rest as long as when you're working with a muscle. So let's say ideally, or a ton of hand waving here, we'll go when doing a workout with somebody like 2 a day. If you do 2 a day every day for a while, 5 days straight, that's pretty, like, the body typically needs to recover. People usually poop that evening and hopefully sleep well that night. When we're talking about neurological rehab, if you give them 10, 15 minutes of actual, like, full-on rest, like, hey, you lie down, you get nap time in the dark, close your eyes, I'll be back in 15 minutes. We do 30 minutes for most intensives here. Then we can continue to build neuroplasticity. At a rate where we have a controlled environment so that way they don't go back into the world, move weird, do things weird, throw off the stuff that we worked on, and then they come back and say, all right, I felt better and then it came back. We can continue them rehabbing and getting better and better. I had a patient in here this week. So what an intensive is, is 2-hour examination, 28 rehab sessions, and then a 1-hour re-exam. Monday through Friday. And so I have a patient in here from the Los Angeles area and came in thinking like it might be some sort of dysautonomia, some sort of POTS, some sort of weird thing that just creates musculoskeletal issues, including like some sort of cogwheel rigidity in the legs where you're like, okay, there's some weird neuro stuff going on. And as we started working on her, we realized it was a vestibular issue. There was a left posterior canal, or we'll call it a right anterior canal escape That was really like creating a lot of haywire. So right anterior canal escape, you think that you're constantly falling forward. What is your body gonna do to compensate? It's constantly gonna pull you backwards into the left. Your left posterior hip is gonna be super tight. What also counts as a posterior muscle, your psoas. And so you're gonna be creating these artificial compensations where if I went in there and I tried it a couple times, I was like, all right, I'm just gonna loosen up your psoas. I'm gonna loosen up your glutes. We're gonna do some glute activation type stuff. And do all like the functional movement rehab type stuff and say, hey, if we— we're just gonna see what happens. I even did one single drop on a drop table separately, not all at the same time, to say, I'm gonna do this, throw you on a balance platform and see what happens, see what changes. And every time we did anything with the muscles, it destabilized her.

Wow.

Which created an increase of symptoms until I was like, okay, well, we're gonna move your leg out like this a few times to activate those left glute stabilizers, and like, oh, pain went away. So we were going through this cycle and we realized that there was a vestibular issue that had to be taken care of first and foremost. And we got that knocked out in like a day and a half. That was easy. But then we spent the rest of the week incorporating more of a functional movement thing. How do you relearn how to use your hips? How do you use your lower core? How do you turn it into the appropriate motor engrams And for people who don't know what an engram is, it's a code that— of your brain that says this is how you move and coordinate a group of muscles to provide— to do a certain function. So what we're trying to do is create a new motor engram. And what's the easiest way to do that? Repetition and intensity, where we have her doing more fundamental movements. And you can go to like DNS and that kind of style, and I did, but I was using it But I was changing the exercises to bias it based off of vestibular input so we can continue winding left posterior canal into lower brainstem activation into motor corticospinal output. Does that make sense at all?

Yeah, no, that's interesting. And I think another important question too is like, if I'm a doc in practice and I have a patient that might need to be referred For further neuro treatment than I offer in my practice, what does that typically look like? When, when should their kind of red flags start going off where they say, hey, this is something that might be outside of what we can offer here?

That's the toughest part right now because a straight-up algorithm is not a functional model of when you draw this line, that's when this is functional neurology, and before that can be, we'll call it functional movement. I would say when there are neurologically related symptoms, easy way to know if it's a neurologically related symptom, go to the subjective symptom and now like what the subjective symptom form on the SCAT-5, any of those things including neck pain could be neurologically related. And so when you see anything there, first step is to start putting a little closer eye on there and say, okay, Is there something deeper happening? Do I want to start looking for things? So what you want to look for is ocular movements. Can they keep their eye on a target when they're looking at you, or do they jump their eyes all over the place? And if you ask them to look at something like a thumb, make sure it's outside of their convergence zone. That's the number one error that I see in most people doing rehab is they put the thumb right here. Or even here, you want the thumb to be further than they could reach because you want their eyes to be as least converged as possible within reason. Have them look at your thumb. If they can keep their eye on a target, that doesn't mean that they have ocular stability because that's where these things come in. When you can keep your eye on a target, you can use your frontal lobe to inhibit the vestibular error. So there's 2 ways to look into this, and they're a little bit tough to do. You can throw them in goggles like that, which put them in the dark, and you can see how the eyes move when they don't know where they are in space. They don't know where the world is, and you can see ocular instability. Or you can use an ophthalmoscope, and you can look in the eye, and you can have them cover the other eye. The light blocks out, the hand blocks out, so you can see Spontaneous nystagmus sometimes. You can see a bunch of ocular instability. Like if you're having— like if you practice your ophthalmoscope and you're having trouble getting into the eye, it might not be your error. It might be their eyes moving all over the place. They can't control it. And then the other thing you can do is have them lie on their back and then close your eyes. And you can put your— like I use my thumbs like this. You can put your thumbs on their eyelid and you can feel the lens as a differentiation. You can feel the motion of the eyes. So there are ways that you can look at ocular stability without having them look at something where they can use their frontal lobe to suppress all the issues that are going on.

Well, and I think you made an important point there too. You don't have to have complicated equipment sometimes to make these determinations or to do these exams, which is important.

Some people use a vibrocussor that costs $1,500. I take a Gillette razor and take the sharp part off.

That's a great way to do that. Someone else wrote in with a question and said they're curious if there's a neuro component in scoliosis cases. They said, the point you made to work on the opposite side of the symptoms, do you think or know if there is a relationship to idiopathic scoliosis without clear structural etiology with the compensatory mechanisms you mentioned?

Yes, so scoliosis— And that's a functional scoliosis. I'm not going to talk about congenital scoliosis, or we're not going to talk about a structural scoliosis, but let's talk about a functional scoliosis where everything is not structurally asymmetrical, they just have that. Remember what I was talking about before, where you could have structural asymmetry in just the angle in which the inner ear is sitting. If you think of walking as a series of controlled falls moving constantly throughout the world, You're constantly getting more input into one side than the other, which is going to create differences in neuroplasticity along the appropriate associated pathways, which is going to create changes in head tilt, which is going to create changes in rotation. It's going to create changes in your cortical stability. If you have less, we'll call it proprioceptive awareness of the left side of your body, you may collapse into that. It can also change based off of your comfort and balance. For example, me personally, I have less awareness on the left side of my body based off of like concussions and stuff. And so now, is it less awareness like you can do a neuro exam on me and be like, oh yeah, there's a deficit? No, it's when you take all these like real functional things and you put it under stress, that left side of the body is just not going to be as aware. So if I was going to default to a more stable side, I'm going to default to my right side. Where are all my sports injuries? Right shoulder, right hip, right knee. I tore my PCL skiing because I lost the ski on the left side, and I defaulted to the strong side, and all the forces went through it. So these injuries that— these sports-related injuries that you can get may be associated with a vestibular or visual deficit. And for me, it was a vestibular deficit. That created changes with that. So yes, when you have these neuro components, they can be related to more of a functional scoliosis because they just think that this is home because their heads like this make your eyes level to the horizon.

It's fascinating. It's really fascinating to think about. And I think you made a very salient point there as well. Like, if you're seeing athletes who continue to have injuries on one side of their body versus another, Is that something to look at? Is that something to kind of, to kind of dig a little bit deeper with?

But if you're seeing all the athletes with the injury on the same side of the body and you start rehabbing and really doing a ton of soft tissue work or joint manipulation on that side of the body, and it's due to the other side of the body not having the appropriate activation, you could be creating further brain imbalance, which is gonna create other issues. So if you're working on one thing and you're like, oh, now I'm getting this like headache coming out of nowhere, It might be a time to look back and say like, okay, do we have multiple problems going on? Do we need a rehab, a neuro component? Which for our office, like we— when we get referrals from other practitioners, they're usually back in the other doctor's office within 2 to 4 weeks because we work— or the— what we do works quick. We do mini intensives with people where we see people like 3 sessions in a day instead of 3 times a week. We'll see them 3 times in a day and we'll stack them and Put them all in a morning. So it works quick. But that— but going along with that same idea is they get sent to us for more of that neuro rehab perspective, and then we send them back for the musculoskeletal because we don't need to do everything. And it's also a little more expensive, so no reason for the patient to pay our prices for something that they can get quality someplace else. But from back to a clinical perspective, yes, if you start seeing injuries all on the same side of the body, Start looking at the other side. I have a story about this. A colleague of mine, Tyler, out in Idaho, he called me once because he had a violinist who was having a bunch of forearm pain. And he did— he did— like, he went to school with me, so he did FACTOR, he did a number of other techniques, and he was like trying to work on it. And he was like, nothing's changing. And I was like, do the same exact thing but on the other side of the body. And it went away.

He was like, mind blown.

Yeah, yeah, he called me with more expletives than I'd ever expected to say in his life, and I laughed.

That's fascinating though, and it's interesting because we do talk about this in our soft tissue courses as well in terms of what we're doing to the body. And obviously, Dr. Riddle can speak much more eloquently about this than I can, but there is So much input that's being— you're inputting into the CNS. You're affecting the central nervous system with what you're doing every time you touch the body. And, I think you're right. If you just stop and only think through the musculoskeletal but then don't even consider the entire nervous system that's also a part of that, you're really kind of missing the boat on some things there.

That was my favorite part actually when I was in chiropractic school learning about 'Cause I was learning neuro stuff at the same time, 'cause apparently I don't like having a life. But while I was going through it, we were— I remember going to class and being in class that we all palpated the SI. We had one person and everybody went through and palpated it. We all were talking about what side did we think restrictions were on? What did we think was going on? And I'm sitting there thinking about it as I'm watching this. I was like, every time we palpate it, we're creating motion in there. And that motion is creating sensory awareness to the brain, which is changing the activation, which is gonna— send back down and change where the restrictions are. And I think the purpose of it was very good, which was there's variability just in what people feel. But I'm sitting here thinking like every time you just test to figure out what's going on, you're applying a treatment.

Absolutely. It's, it's fascinating to think through. And you had spoke a little bit earlier about working with other offices and how someone might refer to you for a short period of time and then you send them back. What type of other healthcare practitioners are you most often getting referrals from? How do you all fit with what you do specifically into that sports medicine team? Let's say for a college athlete or even a professional or an elite athlete where they may have a lot of cooks in the kitchen, so to speak, trying to make sure that they're in prime playing condition. How do you guys fit into that with what you do?

We get more referrals actually from neurologists. Which is really fun to say, but also interesting because we get no ref— we get like almost no referrals from chiropractors. We get referrals from PTs in chiropractic offices, but it's like part of it is the paradigm where we're so locked in into a certain way that we don't really like see what else is available. And we're like, oh, I know that if I keep on doing it— I was at, was it the ACBSP Sports Symposium years ago? And I was looking at a case study and somebody got a concussion better in 6 months. And I was like talking about it. He was like, super jazzed like, hey, look, look what we did. And I'm sitting here like, we do that in like 2 weeks. And so the— I didn't say that, that would be rude. But the idea is what I was saying before at the beginning, we don't overtreat, we don't oversell. What we do is we're here to get people out of our office and make good connections with people in the community. So what does it look like when somebody sees something that may look like a history of concussion and it goes past the 10 days that puts them into post-concussion syndrome or Or there might be associated neuroimmune stuff going on like post-COVID, or they might have a dysautonomia going on at the same time. Those are the cases to get sent over just to get checked out. I've sent people back saying, this is not a case that we can fix because there— I've been to some seminars where one guy in particular, he says chiropractors never find normal. We find normal. We find times that we— our therapies are not appropriate and we need to send to a different location, but— The purpose of what we do is we do a really thorough exam. I had an autonomic neurologist in the Boston area once, I believe, send— yeah, it was him. He sent me a cardiac patient. And I'm like, this isn't my wheelhouse. But the guy on the phone said, well, he said that I've seen enough people and if there was something going on, you'd figure it out. And so I was like, that's a really cool compliment, but I still think you're in the wrong place. But if you're open to paying for it, I'd be happy to do the exam. Put this and see what I can put together and see where we can get you. And we just, we ended up just sending you off to like a different type of professional. And I don't really know where it went from there, but that's kind of what we do. We try this new thing in chiropractic called playing well with others.

That's very true. And you hit on something just a second ago, and it actually segues really nicely with a question we had come in through the chat. Someone was asking about what commonalities you're seeing in post-COVID cases. As far as the cause of symptoms, if any, or are symptoms coming from where the virus affected the brain? So it's very individualized. Are you seeing any trends with your post-COVID patients?

For the sake of time, I was on a radio show on Wednesday of this week talking about post-COVID. We kind of like spiraled into like different directions, but the first thing that we talked about really, really dives into This. So I would highly recommend checking that out just so you get a more full answer. But to make it quick, post-COVID is a— so concussion is not just traumatic, it's an acquired brain injury. So you can get concussion symptoms from things like whiplash where you don't actually hit the head. You can get concussion symptoms from viral illnesses. We see a lot of patients coming through our office with an Epstein-Barr, a chronic Lyme, a cytomegalovirus, or a COVID. How it changes, what's different about COVID in particular is it's— there's a lot of weird stuff going on there, which is why there's so much variability. Some person can go online and say, hey, I had it, was nothing as worse as a cold. If somebody else laying in a hospital reads that and be like, I wish. And so what it comes down to is your brain's adaptation.

Mm-hmm.

Your brain makes symptoms from different areas of the brain. If your nucleus tractus solitarius is firing too high, it's revving too hot. That's where nausea comes from. Yes, you can have other things that can trigger nausea, but the pathway goes to that point, and that's where the brain fires too high. Now you feel the nausea. If you had— and that same system is all your cardiorespiratory systems and your gustatory systems as well. So you get all these like weird neurological stuff all the same time.

Right.

But in terms of what are the commonalities in post-COVID patients, they look like concussed patients. who have chronic low-level inflammation due to a virus as opposed to due to a knock to the head. And it's just, from our perspective, it's a very, very similar etiology. The only thing different is, especially if they're somewhere near our Boston area, we use a violet-colored laser that is shown to help with more antiviral, antibiotic properties. So we'll use that in combination with it. But we do get post-COVID patients coming out to me here when I don't have a laser.

Okay.

Again, for some reason, I just like a simple office, but we still get good benefits because it's vestibular input. 2 more quick notes. There are— there's a paper out there that shows that unilateral vestibular deficits create chronic inflammation. So people who are chasing the guts all the time, look at the inner ear. And then there's also— what was that other thing I was going to say? You can get the same microglial ramification in a viral illness as you can in a concussion, which could create those long-term effects, which is why, especially with what came out in the NFL, there's— it's so important to accurately diagnose and not just say, well, it's not that bad. Because if you can look beyond the subjective questions, if you can do a proper full cranial nerve exam for subjective complaints like headaches and dizziness, then you might pick up a lot of things that other people are missing because they're kind of rushing through because they already have an idea in their head of what they think it is.

I think that's very true. And I think practitioners are— I'm sure you guys are constantly having to kind of check yourself in the exam room and be like, okay, like I don't just need to let my bias come into this about A plus B doesn't always equal C. Every person's an individual. And I'm sure you see a ton of that in your practice as do the other practitioners on here. Do you have the link for the radio interview that you were on that you might be able to email me and I can email that to everyone afterwards?

Yeah, I can send you that link. I can also send you— we'll get them listed up. We'll get them posted up on the website on the resource page as well soon. Yeah, I can get you that link as well. Okay.

That would be wonderful. And everyone, that way you can have the full conversation and the full explanation, as Dr. Lovich was saying about long COVID. We certainly want to be respectful of everyone's time. We do try to keep to 1 hour, but this has been incredibly informative. I think even just our Q&A segment could probably go on for a whole nother hour just with, with the questions that have been coming in and the conversation. So thank you again so much. We really appreciate you coming on today. So again, thank you so much, Dr. Lovich. Thank you everyone for joining us and we will see you next time.

Thank you.

Thank you.

That's it for today's episode. Be sure to tune in for episode 55, where we kick off a new training with Dr. Ben Fergus, where he'll teach you how to supercharge your skillset for clinical and financial success. As you know, from time to time, we like to take a break from clinical topics and focus on the business-related aspects of growing a successful practice. These next 2 episodes are ones you'll wanna be sure to bookmark and listen to more than once. You won't wanna miss it. Episode 55 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'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. So be sure to check out the show notes and download those today. And last, but certainly not least, we invite you to join us for a live hands-on Factor training in a city near you. Our hands-on courses are for chiropractors, physical therapists, and PTAs, athletic trainers, and licensed massage therapists, and offer up to 16 hours of continuing education credit. To view our full course schedule and register to attend a live hands-on course, visit factoreducation.com. That's faktereducation.com. We'll see you next time.

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