Anthony Gurule  00:00

Hey what’s up guys, welcome back to another episode of the Live Loud Life Podcast. I’m Antonio, I’m your host of the Live Loud Life podcast. Today we’re going to be talking about some training principles here. And we’re just gonna dive right into it, we don’t have a lot of housekeeping or anything like that.

Anthony Gurule  00:26

Oh, just a small note, has nothing to do with training. But we do have a short mini course out for those of you who are pregnant right now, or if your partner’s pregnant, we have a little mini course on teaching you how to not suck at giving your pregnant partner a massage. We believe heavily on being able to offer some body work at home, to help with the aches and pains that your partner might be having. But not only that, like it really helps you guys increase your relationship and your bond during this time, which sometimes things can feel a little weird or a little odd being pregnant. But not only that, it helps with the birth preparation process. So having additional hands on care in between our sessions, or if you’re not even seeing a chiropractor and acupuncturist or prenatal massage, having that hands on care really helps with the the preparation of labor and delivery. So if you are interested in that, if you’re pregnant now and you want your partner to not suck, you can get this for them and say, “Hey, watch this, it’ll literally tell you what to do.”

Anthony Gurule  01:30

If you want to be proactive and your partner is pregnant, you want to be able to facilitate and help out with that, then that’d be awesome thing for you to just get on your own and follow through. It’s short, it’s a two hour course we go through some anatomical landmarks that teach you, you know where to press how to press what to do, you know how to be safe and effective, so on and so forth. So if you’re curious about that, we’ll throw a link in the show notes for that. And we will also be will also put it up on our website, which is liveloudlife.com. And we have it spread across all of our social media accounts as well. We’re most active on Instagram, handle is @live.loud.life. And then obviously on Facebook, you can find us pretty easily as well.

Anthony Gurule  02:11

But today, what we’re gonna be talking about is accessory exercise. And so oftentimes, we get into this some referred to as like the rehab purgatory, or corrective exercise purgatory, so on and so forth. Meaning we over emphasize the importance of needing to be able to do basic things before you can do complex things now, in theory, and just from surface face value, that makes sense, right? That makes sense, we need to be able to handle a lighter load before heavier load or simple things before more complex things. But what we wanted to walk through today is, you know, how do you apply these accessory exercises, corrective exercises, and when should you be advancing these, and when should you be continuously, including them and kind of just more like the philosophical foundation as to like why we do a lot of these things.

Anthony Gurule  03:15

Now. As always, context is most important, right? When you’re talking about these exercises, being able to apply them at the right time, in the right place, with the right load, with the right intensity is what makes things really hard, right. And for many coaches or, or rehab professionals, that’s kind of the art behind it, of understanding the individual and where they’re at, so on and so forth. And so when you’re talking about applying it to yourself, it gets a little bit more not confusing, per se, but just a little bit more difficult, not having someone to kind of like have that external view of knowing what might be best for you. But as you start to learn your body more and more, you’ll start to understand where your deficits are and where your strengths are, and where we need to spend a little bit more time attention. But what we’re trying to provide here, if you will, is in giving these corrective exercises or these accessory movements.

Anthony Gurule  04:11

Often times we’re trying to enhance and improve the proprioceptive awareness that we have for our body. Now what is proprioception? Proprioception is essentially your body’s understanding of where it is in time and place. So for instance, right now, I, my body understands that I’m sitting on a bench. And right now I’m trying to be mindful of my posture. Not only because it’s a little bit more comfortable, but it also looks a little bit more pleasant than me just slumping in front of a microphone, right? So my body has this awareness of like kind of how I feel and what my posture and position is.

Anthony Gurule  04:51

Another example would be my shoulders down by my side, my shoulders up above overhead. Now, because I’ve done a good amount of shoulder rehab and strength, and, you know, focus and intention, I know that my range of motion outside of me hitting these massive earphones is pretty much at full flexion or AB duction where my biceps are pretty much at my ear. For a lot of us who don’t do that a lot, when we go through these range of motion exercises, and I say lift your hands up overhead, and they get to here. And you know, I might ask like, Hey, do you feel like your arms are reaching towards the ceiling, or as far up as they can? Or at full range of motion? You know, whatever the question might be. And they’ll say, Yeah, and I’m like, well, you’re actually only at about 100, and maybe 50 or 160 degrees, we want to be at 180. And so you show him that difference of 30 degrees of what they thought they actually had. And they they get very perplexed, you’re confused, because Oh, my gosh, I thought I thought my arm was straight up overhead, right?

Anthony Gurule  05:43

So we see that there’s a lack of understanding and proprioceptive awareness about their shoulder complex, at least in that context of moving the arm up overhead. So that’s, that’s just an example. Now, other ways we could think of proprioception is like a balancing exercise, right? doing like a single leg balance, we’ve taken off a point of contact. So now it’s more challenging for your body to balance  on a stable surface, such as the ground, which is one foot, so your body’s proprioceptive awareness feels itself tipping forward, backwards, and side to side. And it’s making these micro adjustments and corrections, to keep you balanced.

Anthony Gurule  06:23

Now, this is a really important concept, because oftentimes, these corrective exercises and accessory movements fall into this category, not just balance in general, but the greater concept of proprioception of how to fine tune our motor control to elicit the output that we want, right, because when we’re talking about fitness, or exercise, or working out or training room and sport, you are intentionally trying to do something, you’re intentionally trying to create a movement, you’re intentionally trying to push, pull, squat, you know, whatever as an outcome, right. So there is a motor control component to this. And the way in which we do that (control being the key word here) dictates efficiency, dictates strength, dictates power, dictates elegance, poise, whatever that might be, if you’re talking to you about something like dancing, right. And so the more repetitions you do, obviously, your ability to fine tune that motor control enhances. Now, if we’re at a deficit for whatever reason, let’s say easist example that you had an injury, right? The motor control component of that region in could, even globally, diminishes slightly, because you now have a broken kind of link in the chain, if you will. So when we’re talking about gross motor movement, gross, meaning like full body movements, and this goes beyond the thing that I get oftentimes irritated because it’s overused, it does make sense, but it is overused in the context of it is, everything’s connected to everything right, like, if your pinky toe’s broken, it’s going to affect the way that your left shoulder moves or something like that, you can make a strong argument for that.

Anthony Gurule  08:19

But what we what we mean realistically, though, is just like our body feeds off of other regions, right, so an example would be, if I’m going to kick a soccer ball, I’m running. So both feet are running so you know, classic movement that everyone does. But as I come to approach the ball based on the target, so now I have visual acuity problems here, like I have to fine tune and focus on something. So I now have to look at the ball and look at my target. And I have to know where the ball is while the ball is moving. And I have to be able to place my foot in the position that I wanted to hit based on where I want it to go against the target all of while, I have to be able to plant the opposite foot in a position that allows me to be stabilized so that I can torque about my stance leg, my hip, and then my torso pivots around. So you can see there’s a lot of moving parts when you’re talking about these kind of complex movements.

Anthony Gurule  09:17

And if I had an ankle sprain on either side, more importantly, if it was on my plant side, which is where I’m going to be absorbing all of my force, as I’m decelerating from running. That’s going to affect how all of this stuff comes into play. So when you have an injury, or we revert back oftentimes to these quote unquote, corrective exercises or accessory movements, to regain what was lost as a result of the injury. Now, it doesn’t always have to be an injury. It could be compliancy, right? I go through based on the season of life, I do a lot of the same things over and over because it’s effective for what I need right now. There’s a lot of holes in gaps within that, because I don’t do a lot of extra accessory correctives, I kind of do, you know, main compound lifts to suffice for what I need right now based on time, you know, goals on and so forth, or maintenance. And now, when, because of that compliancy of doing the same thing over and over, which is not wrong, right, there’s no wrong or right here, I will develop tightness in certain areas, because I may be sitting down filming more content or editing content, I might develop, you know, hyper mobility in some areas, because I’m doing the same thing over and over. And I get compliant with the movement and not having as much intention into it. This is just, you know, kind of rough examples, if you will. And so we see, oftentimes, we get this like creep of situations coming in, whether it’s hypermobility, or tightness or something like that. And thus, then we need to address those.

Anthony Gurule  10:59

So oftentimes, that’s what we see in our office. And oftentimes, because these aren’t really like overuse injuries, although they can be, we see someone come into our office with these like kind of dull aches and pains, it’s nothing really significant, that would elicit like, hey, we have significant tissue damage or an injury. But because of the compliance of what we’ve been doing, more times than not really, it’s tension, we’ve developed tension in certain areas, and then that tension affects how we’re able to move with the activities that we like to do. Thus, we create altered movement patterns that allow us to still achieve the task. But now we’re kind of taking shortcuts, whereas what we were able to do is very efficient, and very congruent with how maybe that movement should have been done. And now taking that shortcut, we’re trying to just work around the stiffness rather than dealing with it. And now we’re creating potentially even more issues down the road. So you got to kind of really re scrape everything down, and kind of build that back up.

Anthony Gurule  11:57

So that’s where these accessories or corrective exercises can come back into play. But what happens is, we oftentimes focus on the need to be correct in order for you to then progress to the next level. And in my mind, while that is true and beneficial, we do need to go to that next level, I think sooner than we think, to give the body context of to why the corrective, or the exercise, or the accessories are important and how it’s how it’s building that path or that step stone to the thing that you actually want to do. And so very often, and that’s where we look at progressions and regressions within, you know, movement patterns. So, you know, as an example, we could say, Hey, someone wanted to get back to, you know, Olympic lifting and doing like a barbell snatch, well, there’s an overhead squat component, there’s obviously an element of being able to be stable with your arm overhead, while you’re descending into overhead squat, which means that barbell is going to be shifting and your center mass is gonna be changing. So obviously, there’s a lot of complex things in that. And if you’ve suffered a shoulder injury, and that’s what you want to get back to, we have to find some ways in which the corrective exercises are going to help build you up to that. So, you know, it might not be overhead snatching right away, but a landmine press might feel fantastic and not elicit any pain. And that is similar to us being able to have a locked out overhead shoulder position, and I can transition my body into in a way in which I my arm feels like it’s more overhead, creating that compressive stability through the shoulder, and we can add that with, you know, a half lunge position or something like that. So it’s not the same, right? It’s not the same, but this can be considered an accessory or a corrective exercise leading up then to overhead squats and snatches and things like that, right. So the the nomenclature of accessories and corrective exercises doesn’t simply just mean, you know, foam rolling or, you know, isolated banded exercises or things like that, while that is a component of it and good, those could almost be more considered as like,  warm up exercises where we’re priming the nervous system, we’re releasing tension within certain areas so that the joints can move to the range of motion that we want to then perform the exercises that we need. Right. So and I don’t want people to get caught up in the you know, this, the semantics of like, what we’re trying to name these things, right, because I think that gets confusing.

Anthony Gurule  14:42

What I want you to moreso focus on is what were the real deficits that you that you need, and can we build right like a ladder or stepping stones to help you rebuild from that. And it is a constant game of going up and down.  I use the concept is like the game Chutes and Ladders, commonly you’re going to climb up and then you’re going to come down, because you’re always trying to find out, like where that next threshold is of being able of your capabilities. And when you when you’re knocking on that door, there’s gonna be a few times where you backslide a little bit, and you’ll get a little bit of aches and pains or, or, you know, whatever that is, and, and that’s okay, because then you know, okay, well, that path got me there fairly quickly. So I can recreate that path. Again, go back to the corrective exercises, the lifting patterns, the intensity, the sets and reps, things that I did. And then you just need a micro adjust whatever possibly causes you go down. And that could just be simply recovery or something like that, doesn’t mean you did necessarily anything wrong from a lifting or training perspective, might just been a recovery perspective.

Anthony Gurule  15:45

But I think adding these accessories and corrective exercises consistently throughout is beneficial, because the compliance factor that we had indicated before, and all of this, again, comes back down to goals, right? What are the goals that you want to be able to do? What are the pain points that you actually have, and if there’s things that are limiting you from being able to progress to those goals, and so on, and so forth, then yeah, those are the things you need to address.

Anthony Gurule  16:13

But from a timing perspective, you know, corrective exercises might be the thing that you need to focus on the most. Right, when you’re dealing with a certain season of life, in a certain area, and you’re having more pain or discomfort, or whatever that is, but yet you need quote, unquote, you need to train, and we hear this a lot, which is, which is there’s nothing wrong with it. Like, for my mental sanity, I need to go train. That is great. But we have to also, you know, take into consideration what training really is, right. training from a, from a global scheme involves a lot of things, it’s not just, you know, rubber hitting the road and pounding it, right, that is an element. And it’s great to do intense workouts and push yourself to the edge. But there might be a time and a place where you need to focus a little bit more on the collective and the accessories to help clean up some of the gaps or the limitations or some of the sticky spots, that’s then not allowing your rubber to the road training to be as effective. Right?

Anthony Gurule  17:20

And what is it going to be? Well, I mean, you could go on Google or YouTube and type in “accessory exercises for the shoulder” or “corrective exercises for the back of the hip, and you will get bombarded with a ton of exercises and information. That might be an awesome place to start. I mean, we post that same content on YouTube, to hopefully help someone find a little piece of nugget of information out there that could make all the difference wonderful, saves you a ton of time, money from going in. But that might not always be the case, right? Like we throw that out there just like hey, you know, this is something to try. But if you’re really, at this breakpoint, have mentally struggling with what to do or anything like that, it really helps having someone just go through an evaluation and realistically the the cost and the time that it takes to get that pinpoint evaluation, and then the exact information that you need to make the change really saves you a lot of time and money in the end as well. So you know, it really just kind of depends on the person like I am, I am guilty to a fault of being a DIY er and trying to tell I just run my head into a wall. And then I’m like, Okay, I can’t do it, I need to reach out to professional, right. Nothing wrong with that. And if you want to try that with your body, I love that like exploring, and trying to figure it out that again, comes back to the whole concept of proprioception, and awareness, the more you can explore your own body’s range of motion, strength capabilities, proprioceptive, balance, you know, all those things, the more input you’re going to have, and the more general awareness you’re going to have. So that when something is awry, you know, well, I can fix this or I can’t fix this or I know what to at least try and know, like kind of what avenue to at least go down so that when you then hit up a professional if you need it, you can say Hey, this is what’s going on. And I know what’s going on because of this, this, this and this and like that makes my life awesome. That makes my life so much easier, and that’s awesome, I get a sweet, I see where you’re at. Let me see if there’s anything else that you might have missed from just like, you know, because I can do more motion palpation and trying to figure out like specific joint range of motion limitation, so on and so forth if you’re in the office, and then we just kind of combine all that information together. But I’m a huge fan of that. And that’s that’s, you know, half the reason why we’re having this exact same conversation again, coming back to the awareness, the proprioception model, and using correctives or accessories to help facilitate that.

Anthony Gurule  19:52

now, again, very broad examples, but let’s use some examples here of or philosophy principles or philosophies, zero, but let’s use some specific examples to see if that helps kind of clear things up. So the shoulder, right, one of the more obviously, complex joints out there. So what would some accessory or corrections look like? Well, traditionally, we see, and this gets demonized, so I apologize, because I’m going to then kind of do that again. But banded exercises where we’re simply just doing like external rotation with a band pulling like this internal rotation point like this. And then it might be there, those are really good actually. Right, they can be fantastic for priming, the nervous system that’s activating the rotator cuff.

Anthony Gurule  20:41

It creates torsion and some compressive load, depending on the angle, and distractive load in the shoulder complex, which can help build up the resiliency of the tendons in the connective tissue, which again, fantastic, but it cannot be like the only thing, it needs to be expanded upon. So for instance, we can take that same concept, and crossover cemetery, or just wall mounted bands, or cable machines are great, because now I can do more complex movements where I might be doing like a face pull. So I’m grabbing cables that might be crossed, and I’m going to pull them up kind of towards my face. So I’m creating external rotation as I’m coming into AB duction and a little bit of flexion on my shoulder. So that’s a really good way to take that same concept and then add on to another level.

Anthony Gurule  21:28

Now going above and beyond that is how do we again, continue to strengthen the rotator cuff? Well, the rotator cuff is expanded upon and strengthened through compressive and distractive load. So we can then take that same concept and then maybe add it to like a TRX, where I’m using my body weight, and that body weight is trying to traction my arm. So I’m strengthening the rotator cuff through that. And I can do a face pole there. So I’m taking a higher load from the cables or the bands, and doing it more complex because now I’m adding a dynamic plank as I’m holding my body, you know, still, and I’m pulling that up through from their compressive loads, right? Why don’t need to go through an external rotation per se, but I can then add a crawling movement where I’m going through translation as I’m crawling against the ground, and I’m going to be having a compressive force. And as I’m crawling one hand has to go through kind of flexion and AB duction as I go above my head. And then it’s going to pull down using a little bit more lats than the upper back per se. But it’s going to be activating the rotator cuff to maintain good shoulder centration as I translate and pivot over my body over my shoulder, right? So it’s a completely different type of movement. Now this would all be indicative of like, well, what would I need something like this for? Well, it would depend very much on the sport. These are very common things that we do for bootcamp goers, CrossFitters, so on and so forth. Even just weekend warriors, as you’re talking about activities that you might be doing outdoors, right, like rock climbing, or mountain biking or anything like that. These are great just proprioceptive movements that can be used as accessories and/or correctives to enhance your awareness and capabilities around the shoulders, then of course, we would want to strengthen the shoulders through you know, push ups or TRX rows or pull ups or military press so on and so forth. But we sprinkled some of these in, to make it challenging, but to again, just put your body in a position in which it does not have a choice but to get that information and enhance upon it proprioception and again, awareness coming back to that same thing. So oftentimes, when we’re programming or giving these, they’re kind of just sometimes they seem silly, but they’re sometimes they’re just fun. But again, they’re they’re intended to be kind of challenging and novel, because that’s where you’re going to be getting new information. that compliancy coming back to that when you do the same thing over that information comes back to your head. And your body’s like, oh, yeah, I’ve seen that before. This is all good. I know what to do. Which is great. Because when you get to that subconscious level, when you’re looking at like the learning model, you don’t know what you don’t know, you now know that you don’t know you’re making intentional decisions to change that. And then it becomes subconscious, where you the changes that you were trying to elicit now are just done automatically.

Anthony Gurule  24:08

So yeah, there’s a certain element of skill and knowledge that you’ve just done it so many times. But it’s good to change the system, right? It’s good to shock the system and just give it a little bit of novel information, so that it becomes new, and then your body actually has to pay attention and process it. And that’s really what we’re looking at and what we’re trying to do. So if you’re adding corrective exercises or accessories in this manner, that’s fantastic. Keep going mix it up.

Anthony Gurule  24:34

If you’re not, this episode is again more for you. I think it’s a great thing to add. And again, if you don’t know what to do, you can start with Google. You can start with YouTube, you can start with a consult with someone and they can give you better suited movements for you, your goals, aches and pains, so on and so forth. But again, as I say before, as I said before, we love encouraging the exploration model of trying to figure out how your body actually moves, so on and so forth, and then see where you get and then, you know, ask for a little bit help to go above and beyond that, if you will. So, I hope this was beneficial. It was a reminder to myself that I need to add more of these correctives. And just kind of, you know, get back to the exploration play model of figuring out my body and then still, you know, reverting back to the basics and the foundation, the bread and butter of compound lifts, squats, deadlifts, swings, cleans, military press, so on and so forth. Because those offers so much bang for your buck, that if you’re doing those, you have more time to then go through this exploration model where, whereas not, again, not wrong, you’re kind of classic bodybuilding, where you’re hitting certain regions of your body with a lot of different exercises throughout, that takes a lot more time. If that’s your goal, nothing wrong with that, you know, bulk up, that’s awesome. But if you’re someone who’s trying to, which again, is more so speaking to the population that we treat, family, kids, busy, if you’re trying to like kind of pack these things in, the compound lifts that we just described, you get a lot more out of those full body movements, and then you have a little bit more extra time to spend on the correctives and accessories if you will.

Anthony Gurule  26:15

So I hope this was beneficial. Please make sure to like subscribe and share if you’re diggin this. Make sure to follow us on social media as we indicated on Instagram, @live.loud.life. You check out our website as well where we have a lot of this content also in blog form, depending on how you just want to consume the information that’s gonna be helping you and that’s www.liveloudlife.com.  no dots in between. Liveloudlife.com So thanks for tuning in, guys. We’ll see you next time.

Anthony Gurule  00:09

All right, welcome back guys to the Live Loud Life podcast. My name’s Dr. Antonio, your host of the Live Loud Life podcast, and today we have our good friend, Mary Finck.

Mary Finck  00:19

Hello, yep, yep.

Anthony Gurule  00:21

Talking about brain injuries and concussion rehab. So she’s a physical therapist, I’m gonna let her obviously spew her credentials, her specialty, so on and so forth. But I think this is going to be an awesome episode. This is not anything that we we deal with here as far as a rehabilitative process. So I think it’s going to be a lot of great information. And interestingly enough, which I don’t know if you have any specific statistics on this, but how many just head injuries we get. I know for me playing sports, talking about before the podcast, how many adolescents and kids actually suffer from brain injuries, brain injuries, concussions, so on and so forth. But we’re gonna dive into it. So welcome.

Mary Finck  00:59

Great, thanks. Yeah. Thanks for having me. Business credit. Yeah, yeah, so. So I’m Mary Finck. I’m a Doctor of Physical Therapy. And I’m actually a certified brain injury specialist through the American Brain Injury Association, which pretty much meant you just had to do a lot of training and experience and hours to be able to like take a test and say that you provide specialty care to this population. So I originally got into treating brain injuries because my dad had a TBI, which is a traumatic brain injury from a rollover car accident when I was in high school, and it changed his personality, and he had headaches, and we unfortunately lost our business and our home. So it was quite an impact. Yeah. So that’s how I kind of got into this. And then I realized we started understanding what was going on with him and what happened and the loss that we suffered, because we call this like an invisible injury. Because you can’t see that anything’s wrong with you. It’s just our brain controls everything about our body. So if it’s injured, it can affect a lot of things. So then I kind of, you know, went to college, played basketball, blew my knee out, got to do PT myself, and then around the same time, started understanding what injuries my dad had sustained, and that like PTs helped people with brain injury. So that was kind of when I went that direction, like 2006 to 2009. So just kind of worked in all different settings and like rehab at Craig Hospital, literally like helping people walk again and get out of like a vegetative state, more severe injuries. And then the past seven or eight years, I’ve been more in like outpatient and helping with people with like kids with concussions and car accidents and stuff like that.

Anthony Gurule  02:51

And what’s your…? In case I forget. I will forget to ask at the end. Business Name plug.

Mary Finck  02:57

Oh, yeah, yeah. So my new business is Roots Physical Therapy and Wellness. And we’re in Louisville, Colorado, and the website’s rootsptandwellnessco.com. So Colorado. So I’m really excited to get this up and running and help like more of the community and a diverse population.

Anthony Gurule  03:18

So first question, I wanted to spin off of  and plug, or spin off and come back to some of you had said is the silent injuries, right. So these are the big things. And obviously, a rollover accident. Pretty clear to see especially if someone has an abrasion or something on their head. Right. Okay, you hit your head, you probably suffered from some sort of injury right? Outside of those. And obviously, there’s a range of, you know, severe versus to acute, but yet small. What are some of the silent symptoms and things that you see, see or hear, you know, or evaluate or assess that you look for? Yeah. And that someone who is not as versed at understanding those silent signs, what should people be looking for?

Mary Finck  04:03

Sure yeah, that’s a great question. I mean, just to kind of give more of a broad answer, because this could be something you could look for in your children that might have like a concussion or a spouse that was in a car accident or someone fell off the ladder or whatever. But I would say a lot of fatigue headaches, blurry vision, dizziness, balance, like difficulty speaking or like memory issues. We kind of sub categorize head injury into physical, emotional and cognitive. And then there’s like a huge energy reserve and when your brain isn’t functioning and all those areas, your energy reserve gets tapped, and then there’s like extreme fatigue. Like acutely after a concussion, why someone would vomit is more of like a labyrinthine concussion, which is what I treat as a vestibular therapist, is your inner ear organ has all these really fancy hair follicles and things that stimulate like your brain to know where your your head is in space. So that just gets like super shook up. And then people feel like they got off a roller coaster. So if you’re vomiting, like, consistently after a concussion, you have a pretty substantial labyrinthine concussion. But definitely, it can be kind of minor. My daughter unfortunately has had like four. And it, you know, affected her ability to read because it can affect like the eye movements, which is part of what I retrain. your ability to focus attention. So kids with like ADHD, many of them have had history of concussions, and there’s no correlation there. And like overstimulation, like kids with like sensory processing issues like just getting like hyperacusis or overstimulated. So I mean, everything, if it’s a very severe injury, it’s going to like cause weakness or paralysis on one side of the body, or you wouldn’t be able to, like, walk without a walker, or, you know, like more severe and more visually obvious symptoms. But that’s usually not the case. And most people in that situation got help quickly, which is part of the problem is that people do not get help, because they don’t know that there’s something wrong.

Anthony Gurule  06:15

Yeah, so they’re, I mean, that’s hence the the silent thing. Because you’re just going about your everyday life. What um, I’m just trying to think back too, because I started going through the rolodex of how many concussions I think I’ve probably had. a number from micro–and this is the question I wanted to bring up–is how do you see micro traumas come into play? So for instance, my my sport I played was soccer. Headers. One after the other and you get some of those–call it ring your bell, right? We kind of just hit. and I didn’t I didn’t lose, vomiting or anything substantial. But how do you see micro trauma or the micro dosing of the sub level injuries add up? Or is it not as significant?

Mary Finck  06:58

Well that’s what CTE is, or Chronic Traumatic Encephalopathy is like these accumulative sub concussive blows and like football, soccer, fighting, whatever, hockey. but it’s not necessarily like reported incidents of concussions. But these repetitive sub concussive like quick lead, quick stars, and then it got better. that we’re seeing, usually an athlete’s like within 10 years of stopping playing their sport, that then there’s like headaches and anger, and dysregulation of emotions and memory issues. So that is something that is like, more growing awareness of that there is like a pretty substantial problem here. And it’s causing people, you know, a lot of these guys end up, you know, physically abusive, in jail, or committing suicide, unfortunately.

Anthony Gurule  07:52

So on that note, because if you’re dealing with cognitive issues, which obviously could fall into the category, or should fall into the category of PT, but oftentimes people go to neuro, or PCP, and then you’re dealing with emotional things, so people go to a therapist, or something like that. What are some of the big tells outside of Yes, I played a sport or Yes, I think I’ve had trauma, that would indicate that a post, sorry, a previous concussion might be the actual leading factor. as opposed to an actual issue that can be handled with therappy. Make sense? Like, what are the things that you’re trying to diagnose? Or look at right? Say, this is the reason why I think it’s more so from the concussion?

Mary Finck  08:39

I mean, a lot of that kind of twofold answer would be diagnostic. So like making sure you get a brain image, there’s no tumor or MS, or something else that can affect brain function. And like cause and effect, like mechanism of injury like this is when things started changing in my life. But sometimes it can be such an accumulation of concussion and like after one concussion, you’re two times as likely to get another and after a second, you’re like eight times as likely to get a third. So like, it just becomes like this terrible snowball effect. But statistically, it just grows and grows and grows. So some people don’t know, a second sub concussive blow if the first one didn’t heal is going to result in additional or worsening or even new symptoms and like even more of a longer recovery.

Anthony Gurule  09:31

and that was so that was gonna be the question, which I think you answered. So because the brain tissue has not adequately healed, that makes you more susceptible to the next, just like another just like an injury we would see on the body. What is healing really look like outside of just, outside of just time? What are some things that you’re doing to help healing? What are some of the outside resources that you promote for healing ie nutrition or something like that?

Mary Finck  09:58

Right. Absolutely. Nutrition and like any anti-inflammatory diet, and there’s certain supplements that are good. trying to just get like a healthy. like you, I always tell patients you got to put good gasoline in the car to drive the car, right? So and then just identifying the areas of deficit because we call this like a snowflake injury not one is the same and each person is a different person. So then add an injured brain. So trying to if there are like severe emotional issues, was there, is this a result of like abuse or a car accident? Do we need to do like trauma therapy? so making sure people get like the right emotional therapy. cognitive therapy is usually done by like either a speech therapist or occupational therapist. And that’s more helping with like getting back to school and getting back to work and memory issues at tension like why usually say more of the marbles, what I do is more the physical dimension of retraining, vision, dizziness, balance, coordination, and then trying to get all of the systems working together. Because even though that brain lesion might be like a disconnected nerve, we know neuroplasticity has the ability to heal. So we just kind of find out. I always tell my patients like find a way around the traffic jam. So we’re just trying to find a new way. And sometimes after enough time, you’re just like, Okay, this is how it is, how can you modify or change your life around that?

Anthony Gurule  11:28

that’s a good point, I use a very similar concept where it’s just like multiple roads to Rome, or sometimes you run into a roadblock. You have to just switch how you’re doing something temporarily. Hopefully we can get back on the main highway. Not always. So one thing I have heard, and I don’t know any sorts of amounts or numbers, but using obviously goes within the anti inflammatory conversation, like omegas and high fat diets, not diets per se, sorry, adding higher fat content, good, healthy fat, right? How does that come into play?

Mary Finck  11:59

Yeah, so there’s a lot of research with like ketogenic diet and stuff like that with like brain recovery. The hardest thing for someone that is like truly injured is like, there’s so many elements about their life, like sometimes I can’t go to school, I can’t go to work. And so adding like some, like more complex diet is hard. So I usually just try to tell people like, you know, limit soda, limit sugar, or try to eat foods that come from the earth, and like trying to make it more basic, because it’s just too hard to then also add a huge dietary change on top of like, manage the rest of their life. Just like a general way in this population, specifically, because you could get into like, a lot of nitty gritty with that, and the research and everything, but just trying to keep people like generally eating healthier. And drinking enough water too.

Anthony Gurule  12:47

for sure, which is so funny to say don’t drink soda, don’t eat excessive amounts of sugar.

Mary Finck  12:51

Right? Just so easy to just do that. But some people don’t even know that’s a problem. And then you talk about inflammation. And you talk about like, limiting to less than 20 grams of sugar. And a lot of people don’t even know that the soda they’re drinking at 76 grams of sugar. So it’s just education.

Anthony Gurule  13:08

So as a side note, which, Nichelle always (my wife) always kind of points out for people that are consuming or having trouble with sugar just to put it in content, context, how much a gram of sugar is, so four grams of sugar is essentially like one sugar cube. So when you’re looking at the sugar content of anything you’re eating, divide that by four and that’s how many sugar cubes you’re consuming, right? So when you look at literally whether a bottle of soda, and it’s like 76 grams, right? Just literally how many sugarcubesyou’re just drinking down. And that’s the and that’s the that’s the big killer for so many things. It’s just liquid calories, but like liquid sugar. just so much easier to consume and just guzzle down. Imaging. so I came across, I don’t know if it’s wavy or walk– Is it WAVi?  Yeah. So boulder-based group. I did a scan. Obviously, it didn’t have a post scan before. They said I passed with flying colors. I don’t know what that meant, per se. What are some of the scans people should be looking at getting? Obviously, you mentioned the MRI, you know, looking at lesions, tumors, different major space occupying thing, but what are some of the other scans that provide you the good information of how cognitive brain function is actually performing.

Mary Finck  14:23

There aren’t really a lot to be honest, like there’s your answer. I mean, a lot of the times people get in an accident or they have more severe head injury, they went to the emergency room, they’ll do a CT to make sure there’s no bleed. Then usually neurology or primary care if there’s more substantial red flags, which would be like severe loss of control, double vision, severe memory loss, like more significant symptoms would order an MRI to get more detail of the brain tissue. But these are like cellular level changes. So it’s not showing up on a lot of imaging. So the WAVi I believe is showing like EEG signaling. But a lot of what I do is visual and vestibular. So there’s something called a V and G–video and a stagger gram. So we order that a lot to check like ocular tracking, because your eyes are controlled and controlled by your cranial nerves, and only that comes from your brain. So if there’s dysfunction in the eye, or there’s a dysfunctional like eighth, the eighth cranial nerve to the vestibular system is not working, then we can use those objectives to test for that. But a lot of the times, we don’t need the testing to like treat the patient, we just like treat the patient, not the image, but we’re trying to rule out anything more severe going on, you know, because I have had patients like, well, they had this brain tumor they didn’t know of, because they got in a car accident, they got a brain MRI, never would have known that was there before because they were functioning pretty well, right? Or, you know, MS come up like a time or two. So it’s just trying to rule out something else. But even like with my dad, his imaging was all normal. And then three years later, that like diffuse axonal injury showed up on a scan. So that the biggest thing is just as is not showing up.

Anthony Gurule  16:13

So are there any? Are there any blood marker indicators?

Mary Finck  16:18

I know they’re doing research for don’t using that as an indicator in the emergency room. But I don’t think that’s mainstream yet to my knowledge, but

Anthony Gurule  16:27

I didn’t know if there’s a sort of like specific thing that would be leaching out that would indicate…

Mary Finck  16:31

they’re trying to test for emergency room like protein levels, I think or something but I’m not sure. Because I don’t work in that acute setting. Like what is standard. Usually, most of the time these patients don’t even have imaging done in the emergency room unless there’s like significant symptoms.

Anthony Gurule  16:48

So that makes sense. So I’m curious, and I know you had mentioned kind of piggybacking and going a little bit deeper into the therapies you provide, right? So obviously, you’d mentioned, it’s a multifactorial approach, right? You got to look at this, you got to look at this, because there’s so many elements, and there’s only so much you can do from one end, but you focus on the physical. What does that retraining really look like? Yeah, especially when you’re dealing with eye movements, and so forth. I know, you had mentioned previously like balance, so on and so forth.

Mary Finck  17:20

Depends on the patient.

Anthony Gurule  17:22

Let’s use a.. Um

Mary Finck  17:24

I give you like a pediatric, like a kid example. And like an adult example or something.

Anthony Gurule  17:29

If you’re okay with sharing, like, how you’ve been treating your daughter.  Kind of like what have you been doing for her? Because obviously reading if you’re having trouble tracking with your eyes, that can make it more challenging.

Mary Finck  17:39

So my daughter is a perfect example of like childhood concussions going on notice, especially because I was like, Okay, I’m not going to blow this out of proportion because of what I do. And I kind of just pushed her to go back. The research shows like this group of kids goes back to school, this group of kids sits in a quiet room in the dark. And the group of kids that goes back to school gets better faster. Like you use the brain to heal the brain. Still, these days, people are getting advice, like sit in a dark room. And like, yes, for the first day or two of mental rest. Yes, appropriate. But that is not like how you treat a brain injury these days.

Anthony Gurule  18:17

Because that still is a common suggestions, When, and it’s no different than like someone saying like rest like the right protocol for an ankle injury. It ould be beneficial for the very acute, right? When would somebody know that they are okay to get out of the dark room and start being reintegrated?

Mary Finck  18:36

Just trying to do that and see how the body responds, like trying to add…

Anthony Gurule  18:41

Like the body’s response would be like dizziness…

Mary Finck  18:43

…headaches, stuff like that. Yeah. So just trying to slowly add back life in. Knowing that it’s not going to just be like it was, you know, most concussions clear in like seven to 10 days and then more pos concussion is like two to four weeks. So if we’re going longer then to a month, then you have more like substantial, lingering symptoms. But that’s only 10% of the population like most concussions heal. But that’s like the 10% of the population I treat, for sure. Yeah. Which I really think that that data might be different. It’s just because it’s not recognized. It’s not a recognizable injury.

Anthony Gurule  19:17

The one thing we always say to is like when you’re looking at statistics, right? And we’re slightly biased because we work in specialty fields. But for the patient, when you’re looking at a statistic, you are that statistic, right? So it feels like it’s 100% because that is you.

Mary Finck  19:31

That’s right, that’s right.

Anthony Gurule  19:32

And that in it sometimes feels a little bit more skewed because they’re just like, oh my gosh, I’m one out of 10 people, this must be really bad.

Mary Finck  19:40

Right? Right. Right.

Anthony Gurule  19:40

Yeah. On this spectrum, higher. But it doesn’t also mean it’s horrible.

Mary Finck  19:47

Right, right. And yes, and like trying to get people to identify with like, who they are as a human being and not identify with like their injury or their brain injury or their back injury but like, trying to make sure people don’t know I’ll identify with this new diagnosis. And that they put themselves in their human first is like super important, I think in general. But going back to like the testing and stuff, yeah.

Mary Finck  20:13

But so she initially was climbing and she hit her head on a bar and like got really dizzy and that that lasted about a week of like a lot of dizzy and like I couldn’t take her in the grocery store because all the visual stimulation, she was getting like super dizzy and seemed to clear pretty well. And then only a few weeks later, my son who was, I don’t know, 15, 16 months like threw a glass vase that shattered on her head. It was about like a centimeter thick base. Luckily, she wasn’t like cut. But that was like sunglasses on for days. Like she slowly seemed to get better. And then she just tanked in school. And it was like her reading levels went down and she couldn’t focus because she said the kids it sounded like the kids were hammering her head because she couldn’t focus on all the noises coming in. And her attention was worse. So she actually wrote a book. It’s called my invisible injury, a story of kid concussions. it is not published, So if anybody is a publisher, I got a good book. There’s not another kid concussion book out there. So mommy published it on Shutterfly and sells like cash copies. Yeah, but we’ve sold probably, like 80 copies of this book, but I just I just, it’s not like mainstream yet. Yeah. But her story was to tell other kids like that this is what happened. And this is what a concussion is about. And this her last concussion, she then maybe a year later flipped out of the hammock and fell right on her head. And she couldn’t walk for two hours. So like that was substantial, like there was motor loss, right? But then she kind of cleared, so trying to retrain like the eye tracking and the convergence and the balance and trying to like, recreate the pathways that are injured is just more part of like how what I test and then that kind of helped guide my treatment. But when people get more advanced, you’re integrating balance with vision exercises and having them do cognitive things at the same time, like make a list of fruits and vegetables. That’s like high level vestibular concussive therapy, like you’re getting back to normal at that point. Because the multitasking can pretty much tank like in the research, the multitasking gets really hard. And when you start doing more than two things with a head injury, so

Anthony Gurule  22:30

Do you start to see changes? Also just thinking because your background with CrossFit and everything else. Or people start to see changes based on their metabolic, I guess, output changing? If they get back to exercising, breathing harder, How does that come into play?

Mary Finck  22:50

So that’s like a huge piece, because there’s something called like the buffalo concussion protocol, which is trying to like get hyperperfusion of oxygen to the brain through exercise for healing. And that’s kind of the concept of like hyperbaric oxygen treatments. And like why people go to sea level and feel like a normal person. Again, there’s just like, more oxygen, because we’re at Mile High here. But yeah, like, as soon as we can get exercise back in like that is ideal, because it will help the brain like in an athlete is going to naturally just heal better, because they already have such a high function of vestibular system and cardiac output and all of that. But yes, and so in this protocol, we measure like heart rate and symptom response and oxygen levels, and like, take them through, like progressing, getting every minute, a little bit harder. And then there’s just like a threshold, we call that like, your, your sub Max threshold is when you got symptoms. So then we have people exercise it like 80 to 90% of that heart rate. So trying to get people back to exercise.

Anthony Gurule  23:54

And on top of that, outside of maybe that, do you see, do you do you give any specific breathing exercises to help facilitate that?

Mary Finck  24:04

Absolutely. Antonio.

Anthony Gurule  24:09

That was not a question we asked before. But do you then help coach that through the metabolic efficiency as well? Like, does that help if they start that sub, or that that threshold? Right, right, oftentimes, that threshold, at least when someone’s clean, clear, it’s it’s almost your aerobic capacity threshold when you switch to more hyperventilation right? So if someone’s starting to get symptoms, assuming that that heart rate is at a sub threshold from their arobic capacity, cueing breathing, so that they’re more efficient, allowing them to maximize that heart rate?

Mary Finck  24:41

Absolutely. I mean, part of how that pulls in so much is like because when you have a trauma to the head, you’re gonna go into sympathetic, you have your sympathetic and your parasympathetic. So you’re going to be sympathetically over driven and a lot of head trauma is a result of direct trauma like an accident or something hit my head or, so the body’s like going to get stuck in that state. Yes. So trying to teach people, I actually give breathing stickers out. So I have people put stickers like on their wall, on their phone, in their car. So they’re like visually reminded to like, do the “in your nose for four, hold for a second, out of your mouth for six,” or whatever, however you teach your breathing, like, just just breathe. but mindful breathing will calm and activate the parasympathetics to be able to because a lot of, this is kind of a whole nother topic, But like Postural Orthostatic Tachycardia Syndrome–POTS, or dysautonomiam, is very common with concussion, because like the brain-heart regulation is off. So people get like, heart palpitations, they get like, they can’t regulate temperature. So there’s this huge, like weird body response, and people don’t know what’s happening or that that has anything to do with a concussion. So trying to like retrain the parasympathetics. And exercise will help reset the parasympathetic.  It’s pretty, pretty complicated topic of concussion. But yes, essentially, like if you’re breathing more mindfully throughout the day, you’re going to have a better response, like when you’re trying to exercise for sure.

Anthony Gurule  26:17

but I think it’s so important too, because most people want to get back to some sort of physical activity. And I could see that being a very strong rate limiting factor, because you know, and the fact that you integrate that in so very, very soon or suddenly, is very good, because we often see, right, it’s just like, and it’s the same we talked about, like don’t do anything for your low back until you feel like you’re healed. But then that gap from when you feel better to what you want to be able to do is too great. Yeah. And then you start just yo-yoing.

Mary Finck  26:47

Yeah, so I have a I have a good example of that one. So I had a girl that she was a veterinary surgeon was like traveling and a wild dog ran in front of her on her bike, and she crashed and got a head injury. Well she came for her hamstring injury. but she had her sunglasses on and she couldn’t be in the waiting room, she couldn’t fill out her paperwork. And so I was like, I think I can help you with your concussion too. And so this was like a very high level elite biker. But she was scared because of her PTSD, or getting on a bike to get back on a bicycle. So she decided to take up running, but she wanted to run Hundreds. So so what we did was like just slow integration, like and so she slowly added her miles, like she slowly, she couldn’t run in the dark, because she got so dizzy and disoriented. So I had her like, put a headlight on and just start walking around her neighborhood a few laps at night. So it’s just like, slowly, like that’s an extreme example of getting to like a sport. I think she’s done like seven or so Hundreds at this point. And she can like practice again, I don’t think she does surgery, but she practices as a vet again. But it was just like, sometimes it’s such a slow process, trying to give people hope that like not to give up because it can it can be really rough.

Anthony Gurule  28:07

But no, I think that’s actually, it’s funny. You mentioned like slow process. And obviously, when you’re talking about brain injuries, the processes, I’m assuming, much slower than like other outside tissue healing, just because they’re toleration for certain things a lot different. But the way you describe it, realistically, I think is important for everybody is that that’s that’s the rehab process for anyone. It’s the stepping stone mentality, we’re building a pyramid, the pyramid, the foundation of the pyramid, is all the boring shit that nobody likes to do. But it sets the foundation for everything else. Everyone assumes. And whether it’s 100 mile race or elite type of thing is the tip of the pyramid. For some people, for some of our patients, honestly, it’s gardening like yeah, like the thing that they want to be able to spend their time and do. But yet and what comes to mind is this patient who I have, who is 77, suffered from back injury. And everyone told her well don’t do anything that hurts your back. So for six months, she hasn’t done anything. Now she can’t even get out of chair, she can’t even kneel down and garden. Like we have to go back to our foundation. So the example you gave is beautiful because it’s the same for anything else. And it’s all about managing what’s tolerable. understanding the threshold of symptoms. And you laying out the symptoms that people should be mindful to think about is important for realizing what your threshold is.

Mary Finck  29:32

Yeah, I would say another really important note is like the emotional effects because just imagine like your brain not feeling right and your body not working and like the suicide rate and young kids with like multiple concussions like there’s absolutely correlation, so like just encouraging parents to like be very mindful what’s happening with their kids and sports and like getting people the right help because it just comes to a point where people just feel like they don’t I don’t know how to be in control anymore, right? They just can’t like, be, you know, have another day of headaches or be able to like, “I can’t focus” or whatever it is.

Anthony Gurule  30:09

And layering on top of that, right. The stress have already being, depending on the age, a student athlete, right, you know, playing college. This has been phenomenal. I learned a lot of great stuff to look out for. Any last little tips that you try to spread, as far as like brain health and awareness that we can leave people with?

Mary Finck  30:31

Yeah. How to check if your helmet fits right. You know this?

Anthony Gurule  30:36

I don’t.

Mary Finck  30:37

So if you’re putting on your kid’s helmet, and you put it on, and you tighten the back, then you have to strap it enough to pass the Shake, shake test. So if you shake your head and the helmets moving around, it’s not going to be very proficient, but helmet’s just gonna prevent a skull fracture, you can still get concussed within a helmet. But if the helmet’s just floating around all over the place, it’s probably going to be a little less effective. And then like finding a concussion, concussion provider, just looking for people that have the experience, because there’s a lot of people getting into concussion care, which is great. But if you don’t know exactly how to treat this population, you actually can make people feel a lot worse. So making sure people have like, extensive training in this area.

Anthony Gurule  31:23

So obviously, if people are local, you have that provider here in the Boulder County, Broomfield County, Weld County area. But if someone’s not local, Do you do telehealth?

Mary Finck  31:36

Yeah, telehealth within my licensed states. So I think I’m licensed in like five different states. But you can always just reach out and I can help someone fins. There’s Concussion Compass–is a good foundation. And then you can look for providers in that area.

Anthony Gurule  31:54

Now, I did have a question about the helmets real quick. Yeah. MIPS. You know, helmets have so MIPS technology, the part that attaches to your head, and the actual shell can actually slide and move a little bit. And it’s supposed to help disperse energy. Is that even…?

Mary Finck  32:11

I mean, it’s it’s propably how you fall, angle, force, the brain, whose brain? I would say it’s probably better than, like, not having that. But yeah, it’s just like jello floating around in there. And as soon as it shakes it, just yeah, it just can get injured. So just do the best you can do and gotta live life.

Anthony Gurule  32:34

Don’t be scared.

Mary Finck  32:35

Yeah. Don’t be scared. Just yeah. Because anything can happen at any time.

Anthony Gurule  32:39

Well, thank you again.

Mary Finck  32:40

Thank you. Yeah.

Anthony Gurule  32:43

And we’ll put again, we’ll put all the contact information. So if you guys are local, where you can find Mary here, Boulder County, Weld County, Broomfield County, so and so forth. But I mean, I just encourage you guys, I have healed from my injuries, took time off, did the things. And I’ve been, you know, trying to be mindful is if certain things come up, could it be a result of that? Fortunately from my injuries, I have not suffered from a lot of major things. But there are so many people that are dealing with the silent injuries. So hopefully this provides you guys with a little bit more context, a little bit more research, provides you also with some encouragement that something actually could be and is going on, because oftentimes, as you said, the silent things get swept under the rug. You didn’t see anything on this. We didn’t see any of this like, it must be in your head. Well it is! What are we gonna do about it?

Mary Finck  33:37

Thank you. Thank you. Yep, that was great.