In this episode, Dr. John Marchese D.C. talks with us about Functional Neurology. We discuss how to precisely identify overactive or underactive brain areas and to guide them to optimal levels, what impact that can have on patient outcomes (even in “orthopedic” cases), how he uses the Neubie through the lens of functional neurology, his thoughts on asymmetrical training, and some common strength and conditioning tools that can actually create some problems when you look at them from a neurological perspective (including a bit about foam rolling, assault bikes, and more).
Dr. John: We took these VHS tape. That’s how old it was of Ted Cara. We put them in there, we saw him doing things and we’re all just sitting around thinking this guy’s nuts, but he’s doing it neurologically evaluation. And within moments, he’s changing a neurological evaluation.
Intro: I’m Garrett Salpeter. And I believe that the most powerful and transformative way to help people recover from pain and injury, heal from trauma and reach their highest levels of fitness and performance is to focus on the nervous system. In this podcast. We’ll share knowledge from the frontiers of neuroscience and inspirational stories of how applying that knowledge has empowered people from all walks of life to heal, adapt, and grow.
Garrett: Welcome back to the NeuFit Undercurrent podcast. Our guest today is Dr. John Marchese, a chiropractor who’s at a practice in the Boston area for 26 years as of the date of this recording, even though he looks very young, he’s got a lot of experience there.
Dr. John: Oh, you’re so kind. I wish I had your hair.
Garrett: And Dr. Marchese’s got a lot of experience and very deep knowledge in a few areas that I’m excited to dive into, including functional neurology. Well both in the realm of rehabilitation, sports medicine, helping people with various neurological diagnoses and challenges, and then also athletic performance. So there’s a lot we can talk about along the whole continuum of care here and Dr. Marchese, thanks for joining us.
Dr. John: Well, thanks for having, it’s going to be fun.
Garrett: Yes. Yes. So you have learned a lot, studied a lot of different curriculums and worked with a lot of different leaders in rehabilitation and performance and as a kind of way to lead in here, can you let us know for you, what has really stood the test of time and what principles or approaches really have become your go-to approaches?
Dr. John: Oh boy. Well started off a long time ago at this point and undergraduate, chiropractic school, postgraduate work, I’d say learning the difference between, I should say schooling and learning. Going into the collegiate experience, going into the graduate school experience and knowing that as soon as you start learning something, having it being almost passionate, then you kind of can look at that and say, well, maybe that’s the most important thing. And then for me, the most important thing was probably going into the world of neurology as it is applicable to healthcare and neurology, as it’s applicable to performance, injury, recovery, et cetera. So for me, it’s been neurology. It’s just an incredibly fascinating open-ended topic that we could talk about for hours, but maybe we’ll just get about one hour on it.
Garrett: Let’s talk specifically about functional neurology for our audience. Many people know the terms, some know some of the tests and interventions. Just for people who are in need of an introduction, how would you define or describe functional neurology?
Dr. John: So functional neurology. We rewind a little bit back in probably 1994, 95 when I was in chiropractic school, me and a few other guys, we were all into checking out different techniques, because you’re trying to learn what you want to do for the rest of your life. And people think chiropractic, you’re just going to manipulate a few bones and move on. But the different techniques associated with delivering input into the body as far as chiropractic is concerned can be chiropractic biophysics, neurology, power package, so many different things. So we took these VHS tapes, that’s how old it was of Ted Cara. We put them in there and we saw him doing things and we’re all just sitting around thinking this guy is nuts, but he’s doing it neurological evaluation. And within moments he’s changing a neurological evaluation.
So for people that don’t know when you do a neurological evaluation, look at it saying, alright we’re going to find a particular lesion, particular part of the brain, and we’re going to write that down. And then we’re going to go ahead and send them out for further evaluation or further testing, et cetera. Or Dr. Cara showed that you can just go ahead and actually make a real time change to reevaluate and show that neurological change. Well that’s functional neurology, and just watching him doing everything from different types of manipulation to the ribs, adjustments to the neck, back, from a whole different perspective, meaning you’re doing nothing more than putting input into the system in order to change the neurological evaluation. And so that’s when the test becomes a treatment. When you think about it, if I have a dismetric finding right, my hands to my nose, and then I put an intervention in and you think, well, what am I really doing there?
Because if it’s distrio, past pointing, I’m thinking, well, I have a cerebellar disorder, but then you put an intervention in there and you change the finding instantaneously. Did I now just fix the Cerebellar disorder? Okay. So that’s how functional neurology works. Did I fix it or did I just open up a pathway through which I can now have a therapeutic exercise intervention, a training intervention, eye movements, pick your modalities, some type of multimodal input into the central nervous system that makes that change. And it gives them the ability to go ahead and keep driving that change until it becomes a permanency. So functional neurology is just an evaluation that everybody else would do from a neurological perspective, but then keeping in mind all the time, how that you can change it using interventions, multimodal, exercise, vibration, whatever you want to, NeuFit, different frequencies, et cetera, and then changing it and making those changes last and become plastic.
Garrett: That’s awesome. That’s a great, great description. Thank you for that. And I really like the part of your description where you talk about how the tests can be the same as what a traditional neurologist might do or traditional neurological evaluation might be, or assessment might be, but then to make those changes in real time, that does seem like the big step forward in functional neurology. And to be able to get precise where the test becomes a treatment. If you’re doing a test for the left cerebellum and you should have some sort of deficit and then you can do that to drive more activity, increased function in that same left cerebellum, it creates the opportunity to make changes there. So that’s great. And the test, you mentioned a few, you could be looking at eye movements, you could be looking at different things. What types of testing are you doing on the neurological evaluation? I know it’s a very broad question, but what are some of the kind of main or most common ones?
Dr. John: So the most common ones that I’ll probably start with. So going through all the coursework in chiropractic school you’re taught a neurologic evaluation. You’re taught to be productive. You’re not going to start with a person in lying down position, put them into a standing position, put them into a seated position. So you go through depending on the patient, of course, if they can stand. I know you’ve worked with a lot of MS patients as have we. So you put a person in the position of most comfort and you start with that. If they’re in seated position, you can test cerebellum you can test eye movements, you can test, how about just postural assessment from a standing position, you can test long tracks of the spinal cord, both ascending and descending. You can test cranial nerves. Through cranial nerves you can test eye movements.
You can test hearing, you can test sight, you can test well, how’s their sensation? How is it to find touch? How is it to stretch? How is the pressure? Checking all of these different mechanic receptors to find if the brain is actually, if the scouts for the body are actually giving the right Intel back to the brain and is it giving the right output, then there’s the whole idea of primitive reflexes, which I love. So I know a lot of people will be really fast to jump towards the vestibular aspect, the eye movements and all this stuff. But if you have a person that has retained primitive reflexes, that they’ve never actually suppressed and moved on from, you can’t really expect great things until you get rid of those first. And that’s a whole mitigation strategy that if you don’t test for it, you don’t know if they’re present, then how are you going to go ahead and move on from just primitive reflexes.
I mean, those can be huge, especially in people with MS, postsurgical. I just had a postsurgical lady who had two primitive reflexes pop up after her hip replacement. She wasn’t making any progress with physical therapy and go figure she had an, a tonic neck reflex and she had a spinal cord reflex retained and instantaneously she thought I was a voodoo guy because we just changed those reflexes. And all of a sudden she was able to hit AB duct in AD duct. When her therapist was saying, well, we just got to get these stronger. Well, you can’t outwork at dystonia. You can’t do it. So if you improve the tone by getting away from those primitive reflexes, all of a sudden the brain can make the contact without too much threatening going on. And well, she thought it was pretty cool and that’s probably why I do it because it’s A, cool, and it makes the rehab so much easier for me, but also for her therapist. So we can have a collision between two therapists.
Garrett: That’s awesome. Well, it’s great. I mean, one, it’s a good overview of what a neurological evaluation looks like. If people are listening to this and they’re more in the orthopedic and sports medicine realm, they certainly are not doing, most of them are not doing these types of evaluations or assessments on a daily basis. Or for people who are interested, but haven’t gotten the training. It’s good to hear the range of different tests that you can do. And the different types of things that you look at from different brain areas, cranial nerves, spinal primitive reflexes, spinal reflexes, I mean all the different layers and levels of the nervous system.
Dr. John: Test, retest and test, and just see your real time changes.
Garrett: Yeah. So in that sports medicine, orthopedic realm, for you this is going to be a bit of a silly question, but I want to ask.
Dr. John: There’s no silly questions.
Garrett: So how many of your “simple orthopedic patients,” like you mentioned this, post-op, hip replacement women. So for example, how many of your “typical orthopedic” pain patients come in have findings on a neurological assessment or neurological evaluation that are directly impacting their pain and orthopedic issue.
Dr. John: A hundred percent. Legitimate, a hundred percent. You can’t throw a person in here into this practice and not have us find something that will directly impact it because there’s nothing in the body that isn’t impacted by the brain. And is there such a thing as a simple orthopedic problem? So I love it when people come in and say, well, I jumped up, I went to head the soccer ball. I came down and my right ACL ruptured. Okay. Well, why did your right ACL rupture? Why didn’t your left ACL rupture? We already have a complicated neurological picture going on right there. Well, did you land more on your right leg? Did you land more on your left leg? It doesn’t matter because predictability of injury is neurological because your neurological pattern or the neurological pathways that you utilize the most are the ones that going to dictate what happens to you?
I mean, everyone’s trying to predict injuries. Ever since they came up with the FSM. I can’t remember the name of the guy who came up with it a long time ago. Ever since then, they’ve been trying to predict injury and ever since then, as far as I can tell injuries have gone up. We have endemic hamstring injuries, endemic ACL injuries, endemic, everything. Because listen, I have a small practice, I like to say I’m a bit of a ham and [11:47 inaudible], which means that essentially I see my patients and that’s it, I’m not affiliated with universities or anything like that. But for God’s sakes, would somebody please do a neurological evaluation with the predictability model for non-contact injuries and [12:09] injuries because somebody’s going to do it because as far as I’m concerned, that’s the missing link, is the neurological profile of an athlete gives you the predictability for the injury.
Garrett: So if someone were to do that, do you have a hypothesis on what would stand out the most in terms of what, if any particular deficits might lead to certain injuries or would it be a range of certain things? I mean, what do you hypothesize would happen in a study like that?
Dr. John: Well, I’m more of a cerebellum fan. I know some people have their favorite pots of the brain. My favorite pot is definitely to cerebellum, which is in other circles would be pretty goofy for someone to say you have a really favorite part of the brain. Because the cerebellum is, like that big and the rest of the cortex [12:56 inaudible] is much, much larger, but yet the cerebellum has more cells. Would that then tend it to be more important? The cerebellum has almost four times input towards the cerebellum as it does output front of cerebellum. So it’s always listening, it’s always gathering information and it basically makes us athletic as far as I’m concerned. Probably as far as a lot of other people are concerned. So I would look to a cerebellar examination and then get a formatted, I guess you could say evaluation where we can test for tonal output to the posterior chain, anterior chain, et cetera.
And whether there are feedback, feedforward, copy type, issues going on with the cerebellum. If I know a movement and I go to perform a movement, then it should happen the way it was programmed into my brain with the communication between, I guess the frontal cortices, as well as the cerebellum. So that should happen. But why all of a sudden doesn’t it happen and why all of a sudden does a person step, turn their head and blow their ACL? Why does a person step, get a rebound, turn their head and rupture their achilles? Little things like that. So if I look at the neurological evaluation and I look at the down regulation of the brain and what it’s supposed to be doing to our, let’s say ventral horn, where you send a message down, crosses over, hits the ventral horn, goes into the end organ.
And if that end organ is a muscle and it has to respond quickly. So if I step and I move and my hamstring is supposed to go ahead and fire with my quadricep, push me off into a particular direction. Why is it that that hamstring would go and fail and allow for that anterior translation of tibia to blow the ACL? Well, if we look at some of our neurological evaluation, predictive modeling, if we have a reduction in, let’s say neocortical activity on one side of my brain. Neocordal frontal structures and vital structures, et cetera, things that make us human. I can have a reduction in volitional activity on the opposite side of my body.
So if I go to perform a volitional movement and I can’t access those vental horns very well because of, let’s say I head the ball with the right side all the time, and I’ve had multiple concussive activities or events on the right side of my brain. And it’s just a little bit slower. So that generation of increased activity in the vental horn on the left hand side, can’t transmit the message fast enough that it needs in real time to play a sport, to get those hamstrings on fire to decelerate that tibia. Well, I’ve got an ACL injury or from a sprinter, the same thing happens if I can’t decelerate my hip flexors on the hips lateral side, pushing off, pushing off all of a sudden pop, I have a labral tear.
And then we start fixing these areas, surgically rehabilitative [15:45 inaudible] and the way to go ahead and fix those usually is to perform some type of invasive procedure, that invasive procedure now cuts through the layer of the fascia. Your stiffness is now gone. And where do you have to put the emphasis of that incision? It’s got to go up or down.
And if it’s in the back, it’s got to up or down.A little bit to the side to side, but it depends on the person’s major movement. So then we start having a predictability model of about the hockey players that have their labral tears, go in, get it repaired. Next thing you know, hernia, lumbar spine injury, [16:18 inaudible] keeps happening. So if things keep happening, study those, look at the evaluation, correlate the evaluation to the injury process.
It really can’t be that difficult. If we’ve been doing it for a long time other people should be able to do it. If you don’t measure something, you don’t have an evaluation, then you can’t see if it’s going to get better. And then you can’t go and have any predictive model based on that. So that’s kind of what I would like to do, but we’ll see, we have our own little case studies here.
Garrett: Yeah, for sure. I mean the big theme that really emerges for me, hearing you speak is the concept of really getting to the root cause that if someone has an underlying neurological deficit, is not engaging in muscles properly, then they’re at risk of these injuries. And that’s part of why we see these non-contact injuries that you describe. And this is a way, so you mentioned you’ve been doing it in the functional neurology community for years and we teach elements of this. I mean in NeuFit to all practitioners, we don’t have as.
Dr. John: Level two. Is that a level two seminar?
Garrett: We have? Yeah. I mean, there’s elements of this. It’s not nearly as sophisticated as what you’re teaching and the scope of a functional neurology evaluation or the scope of what you need to know to be able to evaluate people in different circumstances is a lot. Do you think that is the barrier for why it’s not more widely adopted? Is it the amount of material information or is it something else? What do you think?
Dr. John: I don’t think so. I think it could be really simplified, as most of the athletes. I mean, why does everybody want to take care of athletes as far as rehabilitation goes? Because they’re so easy, you’ve got this incredible central nervous system. I mean, what’s easier working on a person who’s had MS for three years or a person who’s had, let’s say, chronic knee pain for three years? Give me the chronic knee pain any day because the neurological pathways is still intact. There’s no white matter lesions or anything that are going on. So chronic knee pain just find the reason for it. So as far as your question goes, the evaluation for an athlete doesn’t have to be as extensive as the evaluation for a person with MS. The evaluation for an athlete, doesn’t have to be extensive for the person who ha ALS.
So you can bring it into a combinated system where you’re looking for particular traits of that athlete, and you can modify it a little bit for a hockey person. You can modify it a little bit for a track and field person based upon their [18:47 inaudible] explosive activity, more of a multiplayer athletic pursuit. So our evaluations, I mean, I could do a full evaluation, in an half hour an athlete have good idea as to what’s going on their brain and people do personal training. They’ll take a half hour with an FMS. Like the FMS is okay, it’s going to give you an idea of how high they can lift their leg. How far they can go ahead. And what’s another one? The overhead squad, all that stuff. I did it many years ago. And if you look at it from a perspective of just how well they move, that’s fine.
But if I’m looking at it a perspective of what’s wrong with my proximal hip flexes on this right side, is it, oh, do I just have a little volitional weakness here? Or is it, maybe a red nucleus thing on the contralateral side? Because all the muscles are in response to a part of the brain. My hip AB duct is if I’m going into a lateral lunge or like when we do muscle testing, I think muscle testing is an incredible tool that is so misunderstood because everybody says, well, there’s no injury and injury examiner, reliability, blah, blah, blah. Well, if you get good at it. God forbid you have to practice something, you get good at it. Then all of a sudden you can pick up the subtleties. What’s the difference between testing someone for resistance and having someone push into you? What’s the difference between total output and volition output.
So everybody should be doing two types of muscle and everybody should be doing muscle testing as far as I’m concerned. But if you can go ahead and figure out whether a person has an input, contralateral input issue from volitional activity or lateral tonic input, you’re way ahead of 99% of therapists right now and trainers. And then you can send your program in the direction that you have to, like I listened to your podcast. I think it was a couple podcasts ago when you were talking about the McMaster study and not having to load the body so much in order to go ahead and generate muscle hyper. And then, but why don’t people do that now? Why is it that every training center that you go into is doing heavy weighted bilateral movements.
If you’ve got an imbalance that hasn’t been detected in a neurological evaluation and you load both sides and you’re driving both sides of the brain, you ever think that the one that’s a little bit better might overstimulate compared to the other one a little bit. And if you’ve got a great cerebellum on one side and maybe a cerebellum that’s a little reduced in his firing on the other side, you ever think that functional training might be causing dysfunctional athletes and contributing to our injury process? So that’s why I think every trainer, every therapist, every what have you, athletic trainer should do at least a baseline neurological evaluation to find out what their athlete client, patient, ecetera should be doing from point A to point B to point C. You can’t guess because it’s not your body. So I guess people don’t mind if they’re just doing it to somebody else, but if it was your body, I would want to know, like knowing what I know from my history of learning, et cetera, I would want to know. So to have that baseline neurological evaluation can direct your care.
Plus it also directs what you’re going to strengthen, different parts of brain, different types of exercise work better for different parts of the brain. If I’ve got a kid who’s got ADHD that’s just through a neurological term, a reduction of psychotic activity from let’s say left to right. Do I want to do some type of an exercise that’s going to stimulate his frontal structures? Well, yeah. So what exercise stimulates frontal structures, what exercises stimulate parietal structures? Then there are actual resources out there where you can look that stuff up. Frontal structures, I’m looking at what do you guys like doing? Isometrics, right? You got to do a [22:37 inaudible] and people are like, well, why would isometric or why would a focusing activity work on a kid with ADHD? And what is an isometric? Or should I say a micro, what’s the new word? Micro eccentric concept.
Just leave it, [22:53 inaudible], what heck, you don’t have to be that clever? So why would that work for them? Because you’re stimulating their frontal structures because you’re getting them focus. So that’s what I’m talking about as far as the neurological evaluation, being able to go into multiple systems.
Garrett: That’s awesome. One point. There’s so many good ones, so many gems in there. One good one I just want to make sure to emphasize is the notion of training symmetrically or bilaterally. I think there’s a good saying that you have to earn the right to train symmetrically or earn the right to train bilaterally. And if also, if someone has an asymmetric issue, it does need to be addressed asymmetrically. And so doing unilateral training and being more intelligent about this, I think is a really, really kind of low hanging fruit way to make training safer and more effective. And if you couple that with, like you said, with a basic neurological evaluation, that can be a recipe for changing population wide, like averages among athletes, among sports and age groups. There could be a recipe for really making some major demographic changes. So I like that a lot.
Dr. John: Well, if you train unilaterally right, then you want to do, let’s say a single-leg squadron. Right leg in front, and we think, alright, we do an evaluation. And we notice that there’s a right side hemispheric, which in functional neurology, we mean just a reduced frequency of firing in particular structures on the right hand side. So do we then utilize like a bulgarian squat concentrically? Do we hold an high symmetric on that right side? Like what part of this right leg that we consider to be, let’s say deficient, measurements, et cetera. What exercise do we use on that single leg because you can do a single leg exercise and still further the imbalances because you don’t know what that leg needs, what track, what end organ that you’re trying to stimulate. So the unilateral training is better, but also having the knowledge of what that limb needs as far as its stimulation to the opposite side and ipsilateral side is even more important. So we can take it even further.
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Garrett: And it’s incredible to me the precision with which you can, like one of the things you mentioned, at the beginning of our conversation here was when you were watching these videos of Dr. Cara back on the, back on the VHS tapes about yeah. About how he was making adjustments and a lot of people in chiropractic and outside of chiropractic, look at that and think, oh, we’re physically moving these structures here and there. But one of the breakthroughs is no when we’re giving that input, it’s actually giving very precise neurological input to certain parts, certain pathways in the spinal cord. Certain areas of the brain are change changing activity there.
So these adjustments are more than just physical or tissue, more than just affecting tissue, they’re affecting the neurology and the same thing with exercise, you can get very precise in terms of different movements, loike you mentioned a lunge versus a split squat versus a unilateral pistol squat. Those can all have different effects in different parts of the brain, which could enhance or depress certain areas of the brain. And the precision there is amazing. So if people are hearing this and thinking, I would like to learn more about this, about how to really add in functional neurology, what are your go to resources of a couple thoughts there? I’d like to hear from you, for sure.
Dr. John: How to find out more about it. Well, functional neurology doctors love to talk as you can tell by listening to this podcast at this point. Call a guy, look up on their websites, find out what they do. If you have any questions, I’m sure they’d be more than happy to talk to you about it. As far as other resources go, I mean, YouTube is another resource. I’m sure people are always showing things online in order to go ahead and promote their practices and such on social media, I guess. But I would always go to the source first. I would just call up a functional neurology practitioner and there’s functional neurology chiropractor, but there are also some physical therapists that have learned it, some athletic trainers.
And now there’s personal trainers that have learned some information on it as well and acupuncturists. So you can go ahead and speak to any of these people at any time, if you want to talk to people about it. And it’s really, it’s a very small world. It’s like the hockey world. You and I have talked about this before, the hockey world is a very small world and they’re very willing to help each other out. The functional neurology world is the same way. It’s a small world of always looking to help each other out. So that’s what I would try.
Garrett: Absolutely. And I know you and I have talked a little bit in the past. We haven’t seen each other in person since pre COVID.
Dr. John: Yeah, second to last trip before COVID too.
Garrett: Yeah. That’s right. So we might have to replant the seed of doing a continuing education course together here on some of this stuff.
Dr. John: That would be a blast.
Garrett: Yeah. I know we talked about it a little bit before and then both got busy with other things. So let’s shift and talk a little bit. Kind of already in the last few minutes here talked a little bit, progressing along the continuum of care from rehabilitation into training and performance. From a neurological perspective, it’s really interesting you mentioned one example of how bilateral training can potentially reinforce imbalances and problems. What are some other things that stand out to you that are commonly done, but actually can be detrimental or can reduce performance or increase the risk of injury?
Dr. John: Okay. So if we’re looking at increasing risk of injury, again, looking for a good predictive model, well the biggest predictor of injury is previous injury. So if you can figure out why that previous injury occurred and why that previous injury keeps occuring over and over and over again. See people are funny. One of the facilities that I worked with up here, back in the late nineties, early two thousands is where a lot of the, let’s say self soft tissue manipulation world started. Form rolling, lacrosse balls, tennis balls, hit your head over the bat, that kind of thing. One thing that people have to understand is that pain isn’t good. And that’s really hard for people to understand because we’ve been now conditioned that tightness is bad and pain, as long as you’re doing it to yourself can be a good pain.
As far as I’m concerned. There’s a thing in neurology called the labeled line principle. If I press button A, it goes into a part of the brain where button A goes to, and that’s it. There’ll be a little bit of an offshoot. Maybe 25 to 30% of it’ll go to other places. But if I’m pressing this receptor is going to this part of the brain. If I cause pain, there will be a specific reaction to that pain. And it’s never really good. You don’t go in and get maybe an aggressive soft tissue massage for example. Oh yeah I sweated through two t-shirts during that session and I was sore for like three, four days. But after that, oh boy, did I feel good? Well, did you, or did you maybe activate an injury process at this point? So when you go into a gym and every day you form roll and you got to suffer through your form rolling, or you got to suffer through your lacrosse ball work. And then after that, you go ahead and you just do an aggressive stretch that is just again, miserable.
You’re coupling pain on top of pain on top of pain. To me, this is what has caused the majority of, I don’t want to say injuries because to say injuries would say that you form roll, you stretch your hand, you go out there and you plug your knee. That’s not necessarily always true. But to go ahead and cause the nagging injuries that cause us to compensate from one bad pattern to the next bad pattern, to the next bad pattern to injury. You see what I’m saying? Guys like [31:58 inaudible] used to say it was six to eight weeks approximately to go ahead and develop a compensatory pattern. Well, if your quad’s is always tight and you’re rolling out your quad all the time, then you’re stretching out your quad all the time.
So your quads not tightening. So the form really must have worked or the cross ball must have worked and the stretching must have worked, but then all of a sudden, gee, now my [32:20 inaudible] seems always tight. Oh, and now I can’t go ahead and get that 40 time that I got six weeks ago or now let’s look at the gate. Now my left shoulder hurts or now my neck hurts and now I can’t expand my rib cage. Little things like that can occur. Was the form really good or did it lead into a compensatory pattern? So pain to me and previous injury are both, probably the biggest ones that are going to contribute to a person having an injury. And if people would just. So I grew up in the 80s when everything [32:53 inaudible], look at that tight, but nowadays, so tight, let me roll the heck out of that thing so I can get my bicep to, oh, look at that my range of motions back again.
So if I do things like that all the time and every, whenever anything’s tight, instead of listening to it I just cause it pain. And of course it’s going to be [33:13 inaudible] because what happens when you cause pain to a muscle, what’s the reflexive activity that’s going to cause. You increase nociceptive activity, whether it’s type C fibers or WAS1A deltas. And when all that information goes up to the brain, it’s constantly going up to the brain. I know that when you press there and it cause pain, it’s not going to cause a reaction up here. It’s actually a lifting of the down regulation of paying attention to those nociceptive fibers.
But if you’re always driving it, the brain’s going to pay attention. It’s going to say, well maybe something’s going on over there and I going to pay attention to this thing and what’s it going to do to that muscle? It’s going to assume the worst, because that’s what the brain does and it’s going to protect you. And how’s it going to protect you? It’s probably going to reduce your frequency of firing of that muscle. If it reduces the frequency of firing of that muscle and you don’t use it as much, whether it’s consciously or unconsciously, what happens to that muscle and the cerebellar and the prefrontal strip molecules? It goes down a little, that frequency you’re firing. And next thing you know, I’m out there and I’m a pitcher and I’m throwing it. I’m like, oh God, I’m getting a little tightness in my shoulder now.
Throwing again and what do people do? Well, stretch it out. Let’s get those posterior shoulder muscles working again. And in reality it has nothing to do with the posterior shoulder capsule, but it has everything to do with the fact that someone thinks they’re tight and they’ve got to keep rolling out their bicep, form, et cetera. And then that will be your predictive model. And instead of going ahead and then looking at that arm and I mean, how many pitchers you’re going to have to see that can’t throw six innings anymore before you figure out a neurologically predictive model for data? We got a guy up here that should have been seen by you guys a long time ago. Hopefully he will be seen by you guys because you went ahead and you made the trip up to Boston. So hopefully he’ll be looking at this and listening and saying, oh Garrett, thank you very much. You’re going to get us another 22 wins this year. But that’s the whole thing for me. It’s pain, causing yourself pain. Nobody should ever cause themself pain and looking at previous injury. I don’t know if that helps at all.
Garrett: Yeah, for sure, for sure. That’s interesting. On the topic of also things that we do, that might have unintended consequences. Tell me your thoughts on the Airdyne bike too.
Dr. John: Ah, airdyne, this lost me a lot of fans, let’s put it that way. Not that I ever had. So if you look, let’s look at, let’s take hockey, where is the fan bike for [35:47 inaudible], mostly. It’s probably going to be in hockey, in small training centers. So I go ahead and I take a guy whose gate center is already disrupted. Because when the foot hits the ground, that’s when the ball stops. And as you know being a hockey guy, when you play hockey, you have to get your foot into a position of pronation to get that inside edge, to push off of. And the boots that you put your foot into are pretty tight, but you can still get that [36:09 inaudible] flattened down. We usually start skating between ages three to five. My kid will probably be at five, but three to five. You get that foot pronated down there. Get that inside edge and push off. Well in mechanics, when you’re running on the ground, like a normal [36:24 inaudible] human that we are instead of an abnormal hockey player, you’re going to use a subernating foot to push off with.
So you’re generating force with a pronated foot or subernated foot. So the gate is already disrupted. Then you take these guys and you put them on an airdyne bike or a fan bike where they do this. And I don’t know if you can see that, but this right here, push, push, push. And what does that look like? That looks like a muppet walk. This is what we call when patients come in and we do a Fukuda test part of our neurologically evaluation. And a Fukuda test is evaluating gate center integrity and gate center, you get brain stem and spinal fluid. You’ve got mid-brain and you get cerebellum. You’ve got a whole bunch of different places that you’re looking at. So when a person closes their eyes and they say, okay, match [37:15 inaudible] place for, and I see this.
Garrett: So for people who are just listening, what he is demonstrating is, we should have a contralateral gate, right? When the left leg comes forward, the right arm comes forward, opposite arm, opposite leg. And he’s showing an ipsilateral. The opposite where the same arm and same leg are moving. So yeah, like a muppet walk and that is a problem is less energetically, efficient, less biomechanically, efficient and effective, creates an issue. So please continue. I just wanted to make sure everyone listening.
Dr. John: So if we lose that, then you start talking about things. I’m a big [37:55 Graco] Besky fan. Ever since I heard him talk back at the first fascial conference here in Boston and his idea of the spinal engine and keeping the integrity of the core musculature going via contralateral patterns. And he goes into the idea that the ipsilateral patterns are great as long as we’re quadruplets but for biplets we need, and quadruplets is obviously walking on four legs. Biplets we’re human. We’re bipedal. We should be walking on two legs with two arms, reciprocally moving in ways that are going to go ahead and mirror our lower extremities. In kinesiology or in neurology we call these the gates. So when you get on a fan bike and you keep perpetuating and the key is if you go on a fan bike and you’re just going for a nice little easy ride, no big deal, not a lot of strength of stimulus and not a lot of frequency, because that’s what drives neurological changes.
But if you get on there and you’re using that as your primary source of conditioning at a high frequency, because you’re doing a lot of reps and a very, very high strength and stimulus, you’re making a neurological change. If you’re teaching the body that it’s okay to go into that ipsilateral pattern and make those changes all the time. You’re going to lose a lot of integrity of proximal hip flexors, proximal hip extensors, proximal shoulder flexors, proximal shoulder extensors, and how they coordinate through the core musculature. And that’s a given. And you want to see an epidemic of injuries in hockey, is hip and lower back. Do you know a hockey player that doesn’t have a hip issue? I mean, I think you even have a hip issue.
Garrett: That’s right. Yeah. Absolutely.
Dr. John: And if you want to break that habit, getting people off of that Ipsilateral pattern, the fan bike might be a good idea. I mean, how hard is it? If you’re going to buy six bikes. This goes back to the conversation we were having before. Yeah. Six bikes are great. Go ahead and put them in there, but just don’t use them all the time. Use them for warmups, et cetera. But don’t use them for your high intensity activity. There’s no need for it. And then the other [39:59 inaudible] is, fix the feet. If you get a guy going from skating all the time and you want to give him some higher intensity activity, as hockey player, I mean you ever watch hockey players run? It’s painful. They all look terrible. Not all of them. Most of them look terrible.
So if you go ahead and you start getting into, like we were talking about the 4 different techniques and such, we’ve been working on hockey players feet in preparation for off season training, just so they can do a high intensity work, like sprinting and running and intervals and such like that. So that way they can get into that contralateral pattern, keep their proximal muscles working well with their core muscles, with good integrity within the feet. It’s not a easy way of doing it. It’s a little bit more involved, but that way you don’t keep hurting athletes.
Garrett: Yeah. That’s a great insight there. And it’s really interesting when you look through a neurological lens, how some things that we may take for granted or that are very commonly practiced turn out to have some other issues. There’s another side, another perspective there for sure.
Dr. John: But there’s a major perspective when it comes to looking at things from a neurological lens and it’s a beautiful thing, but it’s also a curse. Now you see a lot of things that are consistent practice for 30, 40 years and strength and conditioning and you wonder why people keep doing it, whether you’ve spoken with them and you’ve pointed things out, et cetera, but people will still stick with what they’ve always done because sometimes it’s just really difficult to change. And I like to say we can’t really blame people for not wanting to change because they’ve always done it that way. But sometimes when you start seeing that one kid, that’s a soccer player that, when you talk to her and you talk to her strength coach and you told them to limit certain things and they say, well, you’re just a bleep and manual therapist and they go ahead and do it.
And then a few weeks later she blows her ACL and non contact injury. When you get 26 years of that crap, you get a little sick of it. I mean, after a while these poor kids, they’re trusting these professionals and they’re paying a lot of money to these professionals and maybe they should just go ahead and do a little bit more of their due diligence and taking care of these kids. I could tell I’m getting older and I could tell I’m a new father and all that stuff, relatively new father, because I’m getting a little more out of it, about getting these kids to speak up for themselves.
Garrett: Yeah. Well, it’s interesting, when you talk about this notion of, well, we’ve always done it this way. It’s difficult to change. There’s a couple of elements in order to change, one, there has to be enough pain with how things are going currently to motivate change. And I think that is present. There also has to be the knowledge that something can be done differently or the openness to possibility, understanding that there is a possibility to do things in a different way. So I think it’s finding people who are dealing with these non contact injuries or coaches who are frustrated with the endemic of non contact and the trends there, and then being able to reach those people who have the frustration to let them know there’s a better way. It seems like that’s got to be some of the recipe, but in terms.
Dr. John: When you see a guy on the biggest football stage, right, going and run across a field and turn his head and have a non-contact ACL, you ever think that there might be something towards the turning of their head, that may have led towards that non-contact ACL. Why not at least test for it? How hard can it be? I was at a conference. This is going way back. This is when a guy named [43:46 name] was doing this Boston performance, whatever it was, seminar series. I remember talking in front of all these big strength coaches from all over the world. What I was doing there I have no idea? But I was talking to them anyways. I go through the whole idea of testing the cerebrellum etc. This guy comes up, raises his hand. He says, I will not do this with my patients. And he was from a foreign country.
And I said, well why not? He said, well, because I don’t believe it will help them or anything like that. I said, that’s perfectly fine. You can do it or not do it. And he’s telling me about how he has this great soccer player and he’s never going to do a test with him. Well, that greatest soccer player, a few weeks later blew his ACL. And in one way, I thought, how long would it have taken this guy to just do that little bit of testing? That little tiny bit of testing, maybe seven minutes worth of cerebellar testing to find out whether or not maybe he should focus on one side or the other for this one person. That seven minutes could have changed one poor fellow’s care as opposed to just, I would never do this. You got to subvert your ego sometimes, and just allow for people to, I guess, succeed even without you necessarily having to say, I’m the person that made them succeed.
Most people succeed because it’s intrinsically within us, within an athlete. They’re going to succeed whether or not they’ve got the greatest strength coach or not. We talked about that too. You could be a great hockey player, get a mediocre program, you’re still a great hockey player. So why not give them a little something that might keep them playing a sport for a long period of time, just invert your ego and learn something new, that’s all. Look at the NeuFit. I mean, how many people? Everybody should have a NeuFit unit, everybody, there’s no question in my mind after doing this stuff for 26 years, the neurology obviously is a huge part of it. But the addition of direct current therapy, it makes it almost easy. I feel like I’m cheating. I go to work and I’m like, alright, what horrible thing is going to walk into the office today that we’re going to fix in like three days, in three visits?
And I don’t want to say that because they’re not all like that, but for the most part, it’s like cheating. That’s how good it works. And for people not to have it in their clinic, I mean, God knows I don’t want a lot of people in Boston to get it because competition’s competition, but there are a few million people here. I don’t have to worry about that. I’m only one person I can only see, 15, 16 people a day, but there’s no doubt in my mind that has been one of the biggest additions that I could have ever asked for is getting into the direct current therapies, going all the way back to the old units, the old chiropractic units back in the late eighties, early nineties. Granted there were some mishaps. It might have been a little burning here and there with those units, because they’re not as safe as yours, but the results were great.
So I just wanted to throw that in for sure, because that makes the idea of functional neurology that much easier as well, because if we’re trying to access a particular mechanoreceptor and change these dynamic range mechanoreceptors within the spine and into the brain, cetera. What better way to do it than finding a particular frequency to go ahead and stimulate the brain, the end organs, everything else it’s just so much easier. So it’s been invaluable as far as my function neurology practice goes, is utilizing it. And the old FSM protocols that you guys use, people think that’s crazy but the results speak for themselves. So if I’m going to make my job easier. I’m glad you made it [47:35 inaudible], that’s all.
Garrett: Well, it’s a wonderful collaborative effort here and thank you for that. I agree, every clinic should have a neubie certainly. And picking up on that, what you described there about using the neubie device and then also the theme from earlier about how, when you look at things neurologically, you have to do things differently. With the neubie, there already is an element of functional neurology because we’re trying to look for where the nervous system, where these compensatory movement patterns are with mapping, trying to find where there’s excessive tension or inhibition, trying to reset those protective and guarding mechanisms. So there’s an element of functional neurology inherent already in kind of what we call our level one or our basic programming. But for people who are using the neubie out there specifically already have, using basics with mapping and doing foot baths and doing different things, how would you say that you apply it differently? You already touched on it a little bit, but how would you say you apply it differently or in a more detailed or precise or effective way by combining it with some of these deeper understandings of functional neurology?
Dr. John: That’s a good question because the same way, any interventional device like the neubie or any other type of exercise, et cetera, biofeedback, neurofeedback, that we’re going to use, where you can make somebody that much better that quickly, you can make them that much worse that quickly as well. So if I have a typical, one of the orthopedics that we work with says, he goes, I don’t really know what he does, but you’re going to go in there and I know your right knee hurts, but it’ll probably work on something on the opposite side of your body. So let’s say you go to a practitioner and they map that right knee without doing a neurological evaluation. They find the hot spots, they give it the exercise and then you go back, they come back the next time and say, geez, my knee is terribly sore for a couple of days now, is that supposed to be how it happens?
Oh yeah, don’t worry about it, it’ll be fine. Then you get it done again. They come back again like, geez, my knee is really, really sore, is that’s supposed to be how it happens and this keeps going on? And then you realize that you didn’t do a neurological evaluation. And if a person has left cerebellum for example, and let’s say right parietal loop. So they’ve got this big, big, old representation of that right side because that’s the injured side. And then you keep increasing that activity. Well, if I increase upstream activity by putting, let’s say the NeuFit on my right side, beit’s a right [50:16 inaudible] problem. But I don’t know that they need input from the left side because I didn’t do my neurological diligence. Then I can actually take that right knee and all of a sudden, because this is what happened, it was a clinic up the street from us here. I won’t mention the name, but they had about a 40% success rate utilizing the direct [50:33 inaudible] device. Because they didn’t do their due diligence neurologically, putting it in the hands of a person that doesn’t know the nervous system. That’s why it’s great you guys did a level two, because you’re going to cut out a lot of that crap.
Garrett: For the record. The other clinic he’s mentioning was using a different device too. So I know.
Dr. John: Perfect. Yeah, absolutely. It had nothing to do with it. You knew who I’m talking about, right?
Dr. John: Feel miserable. Luckily we got a lot of those patient, but for example, if you don’t know that they need to, like when you guys talk about doing bilateral points. Well, the good thing about the neubie is you also get two channels. So you can use a specific frequency on one side and a different frequency on the other. Let’s say I have to drive this left side with a greater strength of stimulus and greater frequency in order to make a better change. Well, I can still put it on this side, lower strength of stimulus, lower frequency. So I’m not driving it as strong on the left side, I’m driving it stronger on the right side. Thus, I’m getting all of that down regulatory activity I want from the right side without boosting up the left side too much. So it’s kind of a win-win for both sides of the brain and both sides of the body. So that’s why also knowing the neurological system is kind of performing. So whatever you can do that makes great improvements you can also make great detrimental changes as well.
Garrett: So that’s right with great power comes great responsibility.
Dr. John: Huge responsibility.
Garrett: And that’s why mapping the uninjured side also and looking for asymmetries is a big part of what we teach because you will pick up some of that, of course.
Dr. John: When you got a muscle test, you test the right side, the knee hurts and everything you test is strong. Then you go to the other side. Well, put the current on the other side because that’s what the muscle testing is telling you. And then we talked earlier about different types of muscle testing. Testing for volitional action or testing for tonic action. That’s one of the big things that we learned in applied kinesiology and clinical kinesiology, is testing for that part of the brain. People think those techniques are kind of wooish, but they’re not because they’re actually looking at the neurology, from testing an AV duct, am I testing a [52:47 inaudible] or am I going to test the vestibular spinal tract?
If I’m testing the hip flex or am I testing the rectus femoris or am I testing the rubrospinal tract? There’s a difference. If I’m testing for a tonic output from the controlater side, or if I’m testing for just plain old [53:06 inaudible] activity, there’s a big difference. So you have to use different types of muscle testing for that. And then that can also direct your neubie replacement. So you don’t go ahead and make the wrong decision. You put something on the left shoulder, all of sudden the right hip pain goes away. People think it’s crazy, but it’s not. It’s neurologically based in reality.
Garrett: Yeah, absolutely. And it’s amazing when you work with the nervous system, how quickly you can make changes. Fortunately most of the time they’re positive changes and most of the time we’re doing this and it’s really powerful. And as we’re going through this, I imagine many of the people listening are going to want more. So we can talk offline, but I would be definitely interested in doing some more content together and being able to share this with people who can then take this and become even more effective by being able to do some of these neurological evaluations.
Dr. John: But I’m not so scattered.
Garrett: Going off in directions.
Dr. John: Well, I never said I didn’t have ADHD, so let’s put it down.
Garrett: Well get you doing some ISOs. And then you sit down with the computer and write out a few things. That’s good.
Dr. John: Yeah. I’ve had a lot of ISOs in the past few days, working out beautifully for me.
Garrett: That’s good. So that’s why you’re so dialed in right now. I love it.
Dr. John: It. Oh yeah. We also use some biofeedback machines, we use color, we use sound, light [54:34 inaudible] we use metronomic activities. So all that stuff is also contributing to good activity in our patients ourselves. You got to kind of practice what you preach and I know you do.
Garrett: Absolutely. Absolutely. Well this a wonderful conversation here and I think a very compelling tour around the universe and functional neurology. So I appreciate you coming on the show here. If people want to learn more about you, what’s the best thing to do. Look at your website. You do have a social media page. I know.
Dr. John: Yeah, we do. I get yelled at to put stuff on it every once in a while. Because I’m like that short of a boomer at this point. So yeah, we do some social media stuff. Let’s see. We have.
Garrett: Is it Marchese sports therapy?
Dr. John: Yep. And we have a website MarcheseSportsTherapy.com and I guess, look that stuff up there. And we’re always open to conversations for people and maybe someday we’ll and I keep saying this for the past 20 years, maybe someday we’ll do some teaching. We’ll see what we can do. Try to integrate all the stuff
Garrett: It’s at Marcheeesportstherapy, all one word, pulled it up here, make sure it wasn’t an underscore or anything.
Dr. John: Not that many Marchese out there.
Garrett: That’s right. That’s right. Certainly none as wonderful as you and knowledgeable in this realm for sure.
Dr. John: Well, I can, I can say a lot of big words, but sometimes you got to put it into the small words for people because that’s a better idea that you know what you’re talking about.
Garrett: Yeah, for sure. Well, I mean, we covered a lot of detail here and a lot of people may have questions. So I think there would be value in breaking it down and doing some more teaching here. So that’s something that we’ve planted the seed today. And we’ll talk more about, and in the meantime, thank you everybody for tuning in here. I hope you enjoyed the conversation with Dr. John Marchese.
Dr. John: Thanks everybody.
Garrett: We appreciate you. Appreciate you listening in and we’ll see you on the next episode of the NeuFit Undercurrent podcast.
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