- Gretchen Hawley is a Doctor of Physical Therapy and a Multiple Sclerosis Certified Specialist. Dr. Hawley utilizes the concept of neuroplasticity in her online MS wellness program, The MSing Link, to help her clients reduce fatigue, get stronger, improve their balance, and walk better. Her clients feel more energized, empowered, in control over their life with MS. Dr. Hawley has been a keynote speaker at several MS conferences, lectures frequently for MS support groups, and continues to keep herself up-to-date on the newest & best MS practices by attending the MS Consortium each year. Dr. Hawley also uses social media to create more awareness around neuroplasticity exercises that can help improve the quality of life for individuals living with MS worldwide.
Topics covered in this episode:
- Managing Multiple Sclerosis (MS)
- Exercise as a Therapy for MS
- Neuroplasticity and MS
- Functional Exercises for MS Patients
- The Importance of Intention in Exercise
- Using Neuroplasticity to Improve Strength
- Creating a Stronger Mind-Body Connection
- The Five-Day MS Strength Challenge
- Strategies for Staying Committed to Exercise
- Building Consistency in Fitness Routines
- The Impact of Low to Moderate Intensity Exercise
- Balancing Restorative and High-Intensity Exercise
- Real-Life Functional Goals for MS Patients
- Finding Hope and Inspiration with MS
- Stories of MS Patients' Progress and Improvement
To learn more about Dr. Gretchen Hawley and her work, head over to https://www.doctorgretchenhawley.com/
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-lindsey-elmore-show--5952903/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Multiple sclerosis is a chronic, immune mediated disease of the
central nervous system that affects the brain, spinal cord, and
optic tracts. It is characterized in the majority of people
by relapses also known as exacerbations and remission of neurological symptoms,
(00:22):
as well as a variable progression of disability over time.
In addition to the relapsing forms of MS, a small
subset of people have a disease course that is progressive
from onset, with few or no clinical relapses over time.
Rehabilitation is an essential component of the comprehensive care for
(00:45):
persons with multiple sclerosis. Multiple Sclerosis is unpredictable, it fluctuates,
and it progresses over time. Therefore, the rehabilitation team must
be knowledgeable about the range of symptoms that can occur
and be responsive to their variability between one person and another.
(01:08):
Unlike most neurological disorders, including spinal cord injury, traumatic brain injury,
and stroke, there is no fixed deficit in MS. The
symptom profile, disease activity, and MRI burden are all variable.
Therapists must be prepared to treat each patient individually with
(01:30):
flexibility throughout the disease course. Today, we're going to be
talking about how physical therapy in patients with MS is
fundamentally different from traditional physical therapies. We're going to be
talking about how functional physical therapy can help our bodies
to improve our neuroplasticity, improving not only muscle tone, but
(01:57):
improving the connections between the muscles and the neurons and
the brain. My guest today is doctor Gretchen Hawley. She
is a doctor of physical therapy and a multiple sclerosis
certified specialist, and we are going to dive in and
talk about how patients with multiple sclerosis can reduce fatigue,
(02:20):
get stronger, improve their balance, and walk better, all leading
them towards the greater goals in their life. That makes
it easier to stick to an exercise routine over time.
Speaker 2 (02:35):
This is The Lindsay Elmore Show.
Speaker 1 (02:37):
Welcome to The Lindsay Elmore Show, a podcast for people
who deserve to be healthy. With honest, open and enlightening
conversations with doctors, thought leaders, creatives and spiritual gurus. You'll
walk away with simple and tangible tips and tricks that
allow you to live your healthiest life so you can
(02:59):
pursue your dreams. Overcome obstacles and leave your market. Doctor
Gretchen Holly is a doctor of Physical therapy and a
Multiple sclerosis certified specialist. Doctor Holly utilizes the concept of
neuroplasticity in her online MS wellness program, The Missing Link
(03:22):
to help clients reduce fatigue, get stronger, improve their balance,
and walk better. Her clients feel more energized, empowered, and
in control of their own lives with MS. Doctor Holly
has been a keynote speaker at several MS conferences and
lectures frequently for MS support groups, and continues to keep
(03:45):
herself up to date on the newest and best MS
practices by attending the MS Consortium each year.
Speaker 2 (03:53):
Doctor Holly uses.
Speaker 1 (03:55):
Social media to create more awareness around neuroplasticity exercises that
can help improve the quality of life for individuals living
with MS worldwide. Doctor Gretchen Holly, Welcome to the Lindsay
Elmore Show.
Speaker 3 (04:14):
Of course, thank you so much for having me.
Speaker 2 (04:16):
I am so excited.
Speaker 1 (04:17):
We have never talked about multiple sclerosis on the show,
and it really really makes a big, big impact on
so many people's lives. Start us out. What inspired you
to start working with patients who have multiple sclerosis and
(04:39):
how does it differ from other neuroconditions.
Speaker 3 (04:43):
Yeah, multiple sclerosis kind of came into my world pretty randomly. Fortunately,
at the time when I started working with people who
had MS, I didn't know anyone who had MS, whether
I grew up with them or went to school or anything,
which is that very rare because the town that I
live in is one of the top three areas in
(05:05):
the entire United States with highest population of MS. But
after physical therapy school, I was working in an outpatient
orthopedic clinic and I happened to have two patients around
the same time who both were diagnosed with MS, and
they were around the same age. They had the same
type of MS, yet their symptoms were vastly different, and
(05:29):
I loved that because my favorite part of being a
physical therapist is brainstorming and getting creative with each individual client,
and this was definitely a disease where you had to
do that because each individual person would have varying symptoms
each time I saw them, and even hour to hour,
(05:50):
their symptoms could change, so there's just a lot of diversity,
and I immediately fell in love with that, but also
realized that I didn't feel common fit in treating someone
with this type of disease because it is very different
than orthopedic. So that's when I took extra steps to
become an MS specialist.
Speaker 1 (06:09):
So talk to us about the natural course, what is
the history, what's the path of physiology of MS, what
are kind of the earliest symptoms, and then how does
ultimately once accumb to MS.
Speaker 3 (06:22):
So typically there is one symptom that someone will experience,
and oftentimes it's years before a diagnosis because so many
of the symptoms can be chalked up to other things.
And anytime I educate on this, people without MS are like,
oh my gosh, I need to go get tested because
there's so many things that just people without MS also experience.
(06:46):
And that could be random weakness in one leg or
pins and needles, or numbness in one side of your body.
It could be one leg, one foot, one hand, one arm.
Vision is another big one. Vision is actually reported to
be the number one first symptom of MS, but there's
(07:06):
also some debate around that, with the idea that when
our vision changes we take more serious action. But if
we have numbness and a leg, we might think it's
sciatica or back pain or something, so there's a little
bit of a debate there, but those are some of
the most common first symptoms, and for some people they
might have that symptom and then nothing for years and
(07:28):
years and years. For other people that might be the
start of other symptoms happening more frequently or maybe not
for a few months, but then another one comes back on,
and that really depends on the type of MS that
you have. So one type being you have a symptom
in the beginning, but then you pretty much recover even
(07:50):
fully or partially, and then you'll get another symptom, but
then you'll recover, and so this is called relapsing remitting,
where you're kind of off and on. But then there's
another type called secondary progressive, where it starts off with
the off and on with the relapsing remitting, but then
at some point, usually fifteen twenty years or so later,
it changes to just a progressive state, so slowly over
(08:13):
time it continues worsening. And then the third type is
primary progressive, meaning you have a flare in the beginning,
but it never really goes away. It's just progresses slowly
from the very start. And to make matters even more complicated,
everyone is so different. So for some people they might
(08:35):
go through these stages very fast, for others it might
take fifty years, and so it's different for each person.
Speaker 1 (08:42):
Okay, so we have three different types that all present uniquely,
and so I love what you said about vision changes,
that we take things more seriously when it's our vision.
And I just want to reiterate, like, don't ignore pins
and needles, and don't ignore neuropathy, and don't ignore all
the other symptoms until they get worse. And so you
(09:05):
mentioned testing, talk to us about how this gets diagnosed.
Speaker 3 (09:10):
So unfortunately, there's no one test that diagnoses MS, so
oftentimes it does start with a visit to your primary
care physician, who then will hopefully send you to a neurologist,
and from there it's a medical exam, medical history, going
through all of your information. There's no big link between
(09:31):
genetics and MS. I believe the most recent number I
heard was up to four percent, so not a lot,
but that's where they would start. And then the next
most common test done is an MRI because when you
have MS, and if you're having active symptoms, you will
usually see scars or allsions in the brain or spinal
(09:53):
cord on an MRI, so that would be next and
sometimes most of the time that's really all it requires.
But if they're trying to rule out other diagnoses, which
is also common, then they might do other types of
blood tests evoked potential looking at your nerves. So those
are some of the most common ones. It's usually a combination,
(10:14):
not just one or the other.
Speaker 1 (10:15):
So talk to us about the lesions and the scars.
How are they similar and different to other brain lesions
such as the amyloid plaques that people are familiar with
from Alzheimer's disease. How do they resemble or differ and
do they occur only in one area of the brain
or do they occur in multiple areas.
Speaker 3 (10:35):
Yeah, that's a great question. So they differ from amyloid
plaques in the sense that the reason that they are
occurring is due to demyelination. So for those that don't
know what that means is we have a mielin sheath
that covers our nerves and it protects our nerves so
that our body can function normally, so that if you say,
(10:57):
pick up your leg, you pick up your leg. When
the myelin withers away. You might have the thought of
pick up your leg, but that connection isn't working as
well or maybe not at all, and so you think
to yourself, pick up your leg, and it just doesn't
lift either at all or not as much as you
would hoped. So when that myelin withers away and it's demiolinated,
(11:21):
that's what results in the scars and plaques. Where it
occurs is often a different place, and in fact, to
be diagnosed with MS, you have to have at proof
of at least two lesions that occurred at different times,
and they are in different places within the brain and
or the spinal cord. And it also can affect the
(11:43):
optic nerves as well, which is why vision could be affected.
Speaker 1 (11:47):
So when I think of myelin, I think of kind
of it wraps around the nerves and it allows the
nerve signals to move faster, you know, because it causes
them to jump from place to place instead of having
to go down the entire length of the neuron. Which
makes sense with what you're saying about how you say,
lift your leg and it just kind of doesn't. It
(12:10):
just kind of is slow. So talk to us about
some of the root causes of MS. What do we
know about what causes it?
Speaker 3 (12:18):
Yeah, so this is another one where unfortunately there's not
any major causes. It's usually a combination of things, and
that could range from obesity or growing up around industrial toxins.
Smoking is definitely not going to help anything, especially if
that's genetically already there, or if you also are around
(12:38):
industrial toxins. One newer piece of research that came out
within the last year and a half or so was
that having the epstein bar virus, which is also mono,
was a huge predictor of multiple sclerosis. And so there's
lots of people who get the epstein bar virus and
don't get MS in this test or in this study. Rather,
(13:03):
everyone who had MS also had antibodies for the epstein
bar virus. So that's kind of newest on the radar.
It's been thought about for the last twenty plus years,
but now there's actual research showing that that might be
one of the causes. And then low vitamin D level,
so living further away from the equator is also a
(13:24):
big one.
Speaker 1 (13:26):
I mean, it's interesting. Epstein bar is a great example
of what is now being taken more seriously, this idea
of latent infections that can cause all kinds of broad
reaching problems throughout the body.
Speaker 2 (13:43):
I mean, epstein bar.
Speaker 1 (13:45):
It used to just be okay, so you have mono
or you get the you get the hairy tongue or whatever.
But now we're seeing epstein bar just kind of correlated.
But you know, it's it's that classic debate of you know,
is it cause a or is it just correlation?
Speaker 2 (14:02):
And so but it is interesting.
Speaker 1 (14:04):
The concordance there that you have one hundred percent of
people who have an MS have the antibodies to epstein bar,
and there's got to be something there. And you know,
it's also that fascinating discussion of like, well, so many
other people had epstein bar but did not have MS,
(14:24):
and so it's interesting what that trigger might be that
kind of turns it on because like you said, it's
not necessarily genetics. And what easy tests that people can
do to like get your vitamin D checked.
Speaker 2 (14:40):
I mean, that is such an easy, easy, easy thing
to do.
Speaker 1 (14:43):
So let's talk about how you approach exercise, because you
are a physical therapist and your approach to exercise is
helping to reduce fatigue and help people to get stronger,
improve their balance, walk better, and it also uses this
concept of neuroplasticity.
Speaker 2 (15:06):
So talk to us.
Speaker 1 (15:07):
We've talked about neuroplasticity a little bit on the show,
but tell us your understanding of it and how it
specifically applies to MS, and then how does it inform
the way that you teach your patients to exercise.
Speaker 3 (15:20):
Yeah, neuroplasticity is so important to understand because it's the
reason that someone with MS can still have the ability
to improve their strength, walking, balance, everything that you just
listed even though they have this demilinating progressive disease. So
neuroplasticity is the ability of our brain to either do
(15:42):
one of two things. One strengthen those neural pathways, so
those neural pathways that have the demyelination, they can actually
be strengthened. Or Neuroplasticity is also the ability to rewire itself.
So if there's just no chance, if that demyelination is
so intense, there's very little likelihood that it will actually
(16:03):
get stronger, your brain can rewire itself, which is great
because in MS, that rewiring is what can actually find
a new neural pathway to improve your muscle strength. So
the biggest difference between orthopedic exercise, which is what most
people do. If you're looking to go to a gym
(16:25):
lose weight like back pain, should or whatever it is,
it's probably orthopedic exercises which are focused on the muscle.
It's focused on muscle toning, muscle strength. But when you
have ms, your muscles are affected. So it might think
you might think that focusing on your muscles is the
way to go, but that's not where the issue is
(16:46):
starting from the issues and the nerves. And so when
you're exercising, you have to do strengthening and balance and
stretching exercises in a way that promotes neuroplasticity, not just
promoting muscle strength. Because if we can strengthen those neural
pathways or rewire a neural pathway through neuroplasticity, that's what
(17:09):
will actually result in change in function and daily living.
Speaker 1 (17:14):
So it's that in functional medicine, it's the concept of
going further upstream. You know, where people are not working
at the end result of weakened muscles, but.
Speaker 2 (17:25):
You're actually working.
Speaker 1 (17:27):
You know, you're not mopping up the water that's on
the floor, you're turning off the faucet in a way,
So teach us how these nervous system conditioning exercises. I
mean they sound like they have to be fundamentally different
from muscle based exercises.
Speaker 3 (17:46):
So sometimes yes and sometimes no. Sometimes it's very similar exercises,
but you are just implementing alertness and urgency and some
of these strategies that are shown to promote neuroplasticity. So,
for example, attention focused attention is a big one, and
so the more focused you are on what you're doing
(18:08):
and what your intention is, the more likely you'll strengthen
or find those new neural pathways. Same with urgency, So
if you can somehow create urgency into your exercise routine, again,
you're more likely to find or strengthen those neural pathways.
Urgency could mean a challenge, maybe you're standing on something
(18:28):
that's a little squishy and you don't want to fall off,
Or it could be timing yourself. Maybe you're trying to
do a certain number of repetitions before the song ends.
So something that feels a little bit urgent can significantly
help improve neuroplasticity. Alertness, salience, having it means something. All
those things matter, But another big, big difference is the
(18:50):
position that you're in. Because when you have MS, you
don't have the same carryover as someone without MS. So
if you were to go to regular traditional orthopedic physical
therapy and you're looking to improve your hip strength, a
lot of the exercises that they would probably have you
(19:10):
do initially are lying on the plinth table and maybe
it's a straight leg raise or a clamshell sideline leg raise.
Those are all great orthopedic exercises. But if you have
a MASS, what's likely to happen is your hip will
get stronger. But then you go to stand up and
that hip strength is nowhere to be found because your
(19:31):
brain didn't carry over that that hip strength lying down
should also be used when you're standing. So it's really
important that when you have a MASS, you're exercising as
best as possible in the specific situation and the specific
position that you're looking for improvements in.
Speaker 1 (19:49):
Okay, So that is absolutely fascinating that we're what we're
looking at is an inability of the musculature to kind
of communicate back to the brain that this strength needs
to be in place no matter where I am.
Speaker 2 (20:05):
That is very very cool.
Speaker 1 (20:06):
So I want to know more about this alertness focus
and the salience that goes into it. So we'll be
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And now let's get back to the show. Teach us
how you teach your patients to I think urgency everybody
kind of understands. But when you say focus, when you
(22:02):
say alertness, and when you say salience, when you were
talking about the intention behind it, where are you putting
the focus and how are you training people to stay
in that in that brain thought pattern.
Speaker 3 (22:16):
So there's two ways that you can do it. One
is to implement those strategies during your exercise, and then
the second is to implement those strategies during your rest break,
so between your exercises. So if you wanted to implement
alertness during alertness and attention during an exercise, you would
want to make sure that you're fully focused on For example,
(22:40):
marching is a great exercise where you're practicing lifting your leg,
lifting your knee up towards the ceiling, So you could
be hyper focused on how high is your leg getting,
how many inches do you think is between the floor
and your foot, Where are you feeling the muscles, are
you feeling it in your hip or are you feeling
some compensation, maybe you're actually feeling it in your back.
(23:02):
So being hyper alert and focused of exactly what is happening.
But if you wanted to implement this between an exercise,
so during a rest break. One thing that I like
to do. Do you know the game the bop It? Yeah, yep,
so classic kids game. I actually never played it until
a few months ago, but I purchased a bop It
(23:24):
because it is the perfect thing to have you pay
attention and get that urgency and focus and alertness all
in one. And it's a game that tells you for
those that don't know, it tells you pull it, spin it,
bop it, twist it, and so you have to do
it and if you miss it, you lose the game.
(23:44):
And there's music playing and the music speeds up the
more you do, and so it really requires all of
that alertness, attention, urgency. So you could do something like
that between your exercises. As for salience, that is a
little bit different. So salience means it needs to mean
something to you. If you are exercising just because someone
(24:06):
told you to, you're less likely to get those neural
pathways working, and so it's really important that you're asking
yourself why is this important to me? And get really deep.
One exercise that I like to do with my clients
is I'll ask them what their goal is, And usually
they'll say something like I want to get stronger or
(24:26):
I want to walk better, and then I'll say, okay, why,
and I just keep asking why until we get to
a deeper meaning. And so often I'll give you an example
of someone recently. So I had a patient who said
that she wanted to walk better, and I said why,
and she said, because then she could do more things
(24:46):
with her son. I said, well, why does that matter, which,
of course that matters, but we're trying to get really deep.
So why do you want to do more things with
your son? And she said because she wants to be
able to go outside more than just stay in the house.
And we keep going deeper and deeper, and eventually we
end at she wants to go trick or treating with
her son. She wants her son to have that experience
(25:07):
because she was a single mom and no one else
would take him. And so her vision went from exercising
to walk better to exercising so that she can take
her son trick or treating. And how much more emotion
is that going to bring you when you're exercising, when
you're doing the silly exercise of marching, you're thinking about
(25:28):
trick or treating, and your brain wants that, it wants
to know the why, and so it's more likely to
promote neuroplasticity.
Speaker 1 (25:35):
It reminds me of the seven levels deep exercise, when
you're really trying to get at why am I doing
what I'm doing?
Speaker 2 (25:43):
And if you.
Speaker 1 (25:44):
Really ask yourself why seven times and seven iterations of it,
you're gonna get to that point where your heart just
breaks open and you all of a sudden have like
a real meaning behind why you're doing what you're doing.
Speaker 2 (26:01):
And I remember, I don't know, one.
Speaker 1 (26:04):
Of the weight loss shows that was popular a few
years back. I remember a woman saying, I'm here because
I want to go on a family bike ride, like
my children and my husband go on these bike rides together,
and I am not in the physical condition to be
able to do it, and that was a powerful, powerful
(26:25):
motivator for her, and I love that idea. I think
we carry the idea of having purpose in a.
Speaker 2 (26:33):
Lot of areas of our life.
Speaker 1 (26:35):
But you're the first person that I've heard say like
it can also be a powerful motivator for ongoing exercise,
and so expand a little bit more on other techniques
that you use to help your patients stay committed, because
you know, everybody likes to make promises in the gym,
(26:55):
but there is nothing people like procrastinating on more than
weight loss and exercise.
Speaker 2 (27:01):
So how do you inspire people to stay committed?
Speaker 3 (27:04):
So the most important thing, I think is to find
real life, day to day situations that are challenging or
at the very least just more challenging than you'd like
it to be. And that's where we always start, because
of course they want to get stronger, they want better balance.
And usually when I'm asking someone what are your goals,
that's what they're saying is these generic goals. But then
(27:27):
I will ask them, well, what in your morning routine
is hard for you to do? What in your morning
routine do you want to be easier? And they'll say,
like getting dressed, I lose my balance every time, or
showering I have to sit because I lose my balance
if I stand, or you know, I can't walk the
dog more than two minutes because I fatigue. And so
we try to find very specific goals that they literally
(27:52):
have to do on a daily basis, and there's so
much more inspired to work towards that and they're able
to see the relationship more between the exercise and why
they're doing it versus I'm doing this to get my
hip stronger. So that would be the number one thing
educating on neuroplasticity for sure, because with MS and knowing
(28:13):
that the reason you're experiencing weakness is because of neural
pathways can often make you feel like it isn't possible
to improve your strength because your neural pathways aren't even working.
So understanding what neuroplasticity is and how to get it
to work can also be just very hopeful for a
(28:35):
lot of people. And if they don't have hope, they're
not going to stay consistent because they don't believe it's
actually possible.
Speaker 2 (28:42):
So I absolutely love all of that.
Speaker 1 (28:45):
That creating the connection between the exercise and the goals
so that it becomes easier just to keep going. So
talk to us about like the intensity of these exercises.
Are are you pushing to fatigue? Are you saying let's
meet somewhere in the middle, Like is this a go
(29:06):
full out for ten seconds? Like where are we kind
of on the spectrum between like you know, restorative yoga
and CrossFit?
Speaker 3 (29:16):
Yeah, that's a great question. So there's a lot of
MS research that shows that low to moderate intensity is
enough that it doesn't need to be high intensity. And
I really I loved when that research came out because
at the time, I think a lot of people were
under the impression that in order to make any change,
regardless of your goals, you had to exercise for an
(29:37):
hour or forty five minutes and it had to be intense,
and this just proved that, no, it doesn't need to
be intense. So it really is going to depend on
the physical abilities that you have, but some simple seated
exercises at home is enough to make a difference. There's
also research showing that exercising throughout the day is just
(29:59):
as effective as exercising all at once when you have MS.
So if fatigue is a big symptom that you have,
you could do some moderate exercise or light exercise for
five minutes in the morning and then maybe five minutes
before lunch, maybe ten minutes after lunch if you're feeling
more energized, and that's just as effective as doing twenty
(30:20):
minutes all at the same time. So the intensity is
up to you. High intensity interval training is also something
that's been found to be effective in MS, but that
also varies in intensity for each individual person because low
intensity and high intensity will feel different for everyone. So
it's all about choosing what feels low intensity to you,
(30:44):
what feels high intensity. For some people, high intensity might
be jogging in place. For other people it might be
seated marching but as fast as they can go. And
so for the average person, I would say effective MS
exercises are low to moderate. You might not even break
a sweat.
Speaker 1 (31:04):
I mean, I love the idea of just meeting yourself
where you are. And we have heard over and over
and over again on the show about what you just
said about exercise, Like, we have this concept in our
mind that if it's not like forty five minutes of
just like banging it out at the gym, that it
doesn't count. But we know from diabetes research that as
(31:27):
little as two minutes of walking after a meal can
blunt your blood sugar spikes after you eat, and so
breaking up the exercise into those intervals is so so important,
and it's just it makes it easier for people to
just say, Okay, I'm going to take a break and
(31:48):
just do five minutes here, one minute here, whatever, whatever
I can, and so talk to us about Let's talk
more about maybe even so specific exercises that even people
who don't have MS could use on a daily basis.
And we've talked about a few chair exercises, but just
(32:11):
give us some things that people who are listening to
this and going like, you know, maybe I don't have MS,
but I could use some better balance, I could use
some better get up and go. How would you encourage
somebody who maybe doesn't have a fitness routine to get
started with some basics in their own home.
Speaker 3 (32:30):
So one of the most important things is making sure
that your exercises are functional. And this kind of goes
back to what we were talking about earlier, where if
you're doing exercises lying down, you could go to stand up,
and especially if you're looking to climb stairs better or
get up and go faster and with better balance, it
might just not carry over. So making sure your exercises
(32:52):
are functional. And the best way that I can explain
this is to pick a goal that you have for
this situation. Let's just go with the example of walking
and practicing walking is a great exercise, but what you
really want to do is break walking down into as
many individual movements as possible. So if we really think
(33:13):
about it, taking a single step forward just with one
leg requires that you shift your body weight forward, that
you bend your knee, you lift your ankle up, you
straighten your knee, you lift your knee up towards the ceiling,
you put your heel down, and all while that was happening,
you were on one leg. So that's seven individual movements
(33:36):
that can now be seven specific exercises that you do
that are directly correlated to your walking. You could do
the same thing for standing up off of low surfaces
like a squishy couch or even a toilet can be
hard to stand up from. What are the steps that
you need to stand up from that low surface. One
(33:57):
might be sitting up tall, especially if we're thinking of
a cat, you might be slouching and relaxed, so sit
up tall. Another is scooting forward. Then you have to
be able to open your feet nice and wide to
be balanced. Then you have to be able to bend
your knees, then bring your body forward, and then stand up.
So that's six different movements that could each individually be exercises.
(34:20):
So one exercise could be scooting, one could be hinging forward,
so each one you would do repetitions as if it
were its own exercise.
Speaker 1 (34:30):
I love the idea of just breaking it down and
making it so simple and doing things absolutely with intention
every single step along the way. And it's truly fascinating
to think that so much muscle and brain coordination goes
into things that we just kind of take for granted.
(34:50):
You know, it's a moment to have some gratitude. I remember.
I remember one time my friend told me that she
went to a meditation and the guy that was the
meditation said, does do anybody's teeth.
Speaker 2 (35:02):
Hurt right now?
Speaker 1 (35:03):
And everybody was like, your teeth, no, And he's like,
that's the whole meditation is just gratitude that your teeth
don't hurt. And just having that gratitude that you can
scoot across the couch, get your feet apart, stand up,
activate your spine to sit up straight is really really
powerful to think about what a difference that could make
in our lives of just giving that like, wow, I
(35:26):
can still do these things whereas other people cannot, and
what a powerful message that is. Tell us about your
five day MS strength challenge.
Speaker 3 (35:39):
Yeah, so if you have miss and if you've never
been to a physical therapist, especially one that knows about
multiple sclerosis, all of this information that we're talking about
can be extremely overwhelming, and while it hopefully will make
you feel hopeful and inspired, it can also put a
(36:00):
pause in whatever you're doing, like, oh my gosh, Okay,
I've got hope, but I don't even know where to start.
So that's where the five day MS Strength Challenge comes in,
and I break down some of the most important concepts,
like some that we're talking about today, neuroplasticity, functional exercise,
how to stay consistent, what parameters you should be doing.
(36:21):
But it's in small videos. So each video is about
five minutes or less, just one video per day. So
the idea is to give small chunks of attainable information
and then by the end you have a plan of
what exactly you specifically are going to do, because for
each day there's a homework assignment, and for example, one
(36:42):
of them is to create your why. One of them
is to create your list of what things throughout the
day are really hard for you to do. One of
them is to break down that list into the exercise
is So by the end you should have a plan
of exactly what you're going to do. Instead of just
hearing this information, breaking it in the five days helps
you actually implement it. Mm hmm.
Speaker 1 (37:03):
I love that being able to implement it and then
getting going and having and building that consistency along the way.
What else do you want to add for you know,
I asked this a lot, and especially with a condition
like MS, which can be so debilitating. What gives you
(37:27):
hope that we're moving in the right direction with MS?
Because we started this whole conversation by saying, like, we
really don't know what causes it, we really don't know
how to like prevent it from from progressing.
Speaker 2 (37:40):
Where do you see the Where do you see hope?
Speaker 1 (37:43):
And where do you see progress for people that maybe
have just gotten this diagnosis or know someone.
Speaker 2 (37:49):
Who is maybe feeling defeated at the moment.
Speaker 3 (37:52):
Yeah, So I've realized that it's way easier for me
to feel hopeful than it is for the person with MS.
And the reason is because I get to treat so
many people with MS, so I get to see on
a daily basis people improving. But if you're the one
with MS, or if you have a loved one with MS,
(38:14):
you might only be seeing that one person with MS.
You don't have proof of how many other people are
actually improving through this type of exercise, and so it's
easier for me to see it. And so I really
tried to infuse that hope in everything that I do,
and even on social media, I try to share clips
of me working with people one on one and showing
(38:36):
the improvements, because for so many people, as I mentioned earlier,
they think it's not possible for them. And maybe it's
because they've tried physical therapy before and it didn't work
for them because it was orthopedic PT, or they have
primary progressive MS, so they just feel like it's going
to progress anyways, there's nothing I can do. Whatever the reason,
(38:58):
there's someone in your see similar shoes that has seen improvements.
I have seen improvements in people with all forms of MS,
at all ages, whatever age you've been diagnosed, at all
mobility levels. I've even seen people who have gone from
being in a wheelchair to then be worked towards using
a role leader and then trekking polls and now she
(39:20):
is even sometimes not using any mobility aid. And so
there's people out there who, while MS is different for everyone,
are in a very similar position, and they are seeing
improvements even though they didn't think they could because this
is a different form. So I hope that knowing that
it exists is at least enough hope to get people
(39:41):
started and motivated.
Speaker 1 (39:43):
I love that, So everybody, if you know someone who
has multiple sclerosis, be sure that they are getting that
functional exercise from somebody who really understands this condition on
a deeper level. It has been such an honor to
get to talk to you today. Thank you so much
for coming in and being a guest on the Lindsay
(40:05):
Elmore Show.
Speaker 3 (40:06):
Absolutely, thank you so much for having me.
Speaker 1 (40:11):
Kids Calm is officially here, and it is time to stop.
Speaker 2 (40:15):
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Speaker 1 (40:19):
Relaxation and wind down routines. Kids Calm is a melatonin free,
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Instead of melotonin, it contains masonol, which helps you to
make your own melatonin, as well as five HTP, which
(40:41):
helps you to make your own serotonin. It also has
B vitamins like B twelve and B six, as well
as D vitamins.
Speaker 2 (40:50):
That help with peace and relaxation.
Speaker 1 (40:54):
It has all the talking points that you want it
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Speaker 2 (41:14):
And RESTful sleep.
Speaker 1 (41:16):
It can be given after homework, before bedtime, and it's
not only going to help you to make your own
melotonin and serotonin, but it also helps to level out GABBA,
which is our primary relaxatory neuro transmitter out there. You
can get a two pack of Kids Calm or you
(41:40):
can check out the laid Back Kids Pack which contains
Kids Calm as well. Head to Lindsayilmore dot com slash
amare to save ten dollars on your first order. That's
Lindsay Olmore dot com slash amare to get Kids Calm Today.
Speaker 2 (42:00):
The Lindsaylmore Show is written and produced by me. Lindsay Olmore.
Speaker 1 (42:04):
Show segments are produced by Soueproco and Derek Lugo.
Speaker 2 (42:08):
Sound design and editing is by Jive Media.
Speaker 1 (42:11):
Support the Lindsay Elmore Show by heading to Lindsaylmore dot
com slash podcast. Your contribution, no matter how big or
how small, helps us to bring the best guests to
the interview chair. Thank you so much for listening, Subscribe,
rate and review the show on Apple Podcasts, Share this
(42:31):
and all of your favorite episodes with a friend, and
on social media, be sure to tag at Lindsay Elmore
Show and help us bring the pod to more people.
Multiple sclerosis is a chronic, immune mediated disease of the
central nervous system that affects the brain, spinal cord, and
optic tracts. It is characterized in the majority of people
by relapses also known as exacerbations and remission of neurological symptoms,
(00:22):
as well as a variable progression of disability over time.
In addition to the relapsing forms of MS, a small
subset of people have a disease course that is progressive
from onset, with few or no clinical relapses over time.
Rehabilitation is an essential component of the comprehensive care for
(00:45):
persons with multiple sclerosis. Multiple Sclerosis is unpredictable, it fluctuates,
and it progresses over time. Therefore, the rehabilitation team must
be knowledgeable about the range of symptoms that can occur
and be responsive to their variability between one person and another.
(01:08):
Unlike most neurological disorders, including spinal cord injury, traumatic brain injury,
and stroke, there is no fixed deficit in MS. The
symptom profile, disease activity, and MRI burden are all variable.
Therapists must be prepared to treat each patient individually with
(01:30):
flexibility throughout the disease course. Today, we're going to be
talking about how physical therapy in patients with MS is
fundamentally different from traditional physical therapies. We're going to be
talking about how functional physical therapy can help our bodies
to improve our neuroplasticity, improving not only muscle tone, but
(01:57):
improving the connections between the muscles and the neurons and
the brain. My guest today is doctor Gretchen Hawley. She
is a doctor of physical therapy and a multiple sclerosis
certified specialist, and we are going to dive in and
talk about how patients with multiple sclerosis can reduce fatigue,
(02:20):
get stronger, improve their balance, and walk better, all leading
them towards the greater goals in their life. That makes
it easier to stick to an exercise routine over time.
Speaker 2 (02:35):
This is The Lindsay Elmore Show.
Speaker 1 (02:37):
Welcome to The Lindsay Elmore Show, a podcast for people
who deserve to be healthy. With honest, open and enlightening
conversations with doctors, thought leaders, creatives and spiritual gurus. You'll
walk away with simple and tangible tips and tricks that
allow you to live your healthiest life so you can
(02:59):
pursue your dreams. Overcome obstacles and leave your market. Doctor
Gretchen Holly is a doctor of Physical therapy and a
Multiple sclerosis certified specialist. Doctor Holly utilizes the concept of
neuroplasticity in her online MS wellness program, The Missing Link
(03:22):
to help clients reduce fatigue, get stronger, improve their balance,
and walk better. Her clients feel more energized, empowered, and
in control of their own lives with MS. Doctor Holly
has been a keynote speaker at several MS conferences and
lectures frequently for MS support groups, and continues to keep
(03:45):
herself up to date on the newest and best MS
practices by attending the MS Consortium each year.
Speaker 2 (03:53):
Doctor Holly uses.
Speaker 1 (03:55):
Social media to create more awareness around neuroplasticity exercises that
can help improve the quality of life for individuals living
with MS worldwide. Doctor Gretchen Holly, Welcome to the Lindsay
Elmore Show.
Speaker 3 (04:14):
Of course, thank you so much for having me.
Speaker 2 (04:16):
I am so excited.
Speaker 1 (04:17):
We have never talked about multiple sclerosis on the show,
and it really really makes a big, big impact on
so many people's lives. Start us out. What inspired you
to start working with patients who have multiple sclerosis and
(04:39):
how does it differ from other neuroconditions.
Speaker 3 (04:43):
Yeah, multiple sclerosis kind of came into my world pretty randomly. Fortunately,
at the time when I started working with people who
had MS, I didn't know anyone who had MS, whether
I grew up with them or went to school or anything,
which is that very rare because the town that I
live in is one of the top three areas in
(05:05):
the entire United States with highest population of MS. But
after physical therapy school, I was working in an outpatient
orthopedic clinic and I happened to have two patients around
the same time who both were diagnosed with MS, and
they were around the same age. They had the same
type of MS, yet their symptoms were vastly different, and
(05:29):
I loved that because my favorite part of being a
physical therapist is brainstorming and getting creative with each individual client,
and this was definitely a disease where you had to
do that because each individual person would have varying symptoms
each time I saw them, and even hour to hour,
(05:50):
their symptoms could change, so there's just a lot of diversity,
and I immediately fell in love with that, but also
realized that I didn't feel common fit in treating someone
with this type of disease because it is very different
than orthopedic. So that's when I took extra steps to
become an MS specialist.
Speaker 1 (06:09):
So talk to us about the natural course, what is
the history, what's the path of physiology of MS, what
are kind of the earliest symptoms, and then how does
ultimately once accumb to MS.
Speaker 3 (06:22):
So typically there is one symptom that someone will experience,
and oftentimes it's years before a diagnosis because so many
of the symptoms can be chalked up to other things.
And anytime I educate on this, people without MS are like,
oh my gosh, I need to go get tested because
there's so many things that just people without MS also experience.
(06:46):
And that could be random weakness in one leg or
pins and needles, or numbness in one side of your body.
It could be one leg, one foot, one hand, one arm.
Vision is another big one. Vision is actually reported to
be the number one first symptom of MS, but there's
(07:06):
also some debate around that, with the idea that when
our vision changes we take more serious action. But if
we have numbness and a leg, we might think it's
sciatica or back pain or something, so there's a little
bit of a debate there, but those are some of
the most common first symptoms, and for some people they
might have that symptom and then nothing for years and
(07:28):
years and years. For other people that might be the
start of other symptoms happening more frequently or maybe not
for a few months, but then another one comes back on,
and that really depends on the type of MS that
you have. So one type being you have a symptom
in the beginning, but then you pretty much recover even
(07:50):
fully or partially, and then you'll get another symptom, but
then you'll recover, and so this is called relapsing remitting,
where you're kind of off and on. But then there's
another type called secondary progressive, where it starts off with
the off and on with the relapsing remitting, but then
at some point, usually fifteen twenty years or so later,
it changes to just a progressive state, so slowly over
(08:13):
time it continues worsening. And then the third type is
primary progressive, meaning you have a flare in the beginning,
but it never really goes away. It's just progresses slowly
from the very start. And to make matters even more complicated,
everyone is so different. So for some people they might
(08:35):
go through these stages very fast, for others it might
take fifty years, and so it's different for each person.
Speaker 1 (08:42):
Okay, so we have three different types that all present uniquely,
and so I love what you said about vision changes,
that we take things more seriously when it's our vision.
And I just want to reiterate, like, don't ignore pins
and needles, and don't ignore neuropathy, and don't ignore all
the other symptoms until they get worse. And so you
(09:05):
mentioned testing, talk to us about how this gets diagnosed.
Speaker 3 (09:10):
So unfortunately, there's no one test that diagnoses MS, so
oftentimes it does start with a visit to your primary
care physician, who then will hopefully send you to a neurologist,
and from there it's a medical exam, medical history, going
through all of your information. There's no big link between
(09:31):
genetics and MS. I believe the most recent number I
heard was up to four percent, so not a lot,
but that's where they would start. And then the next
most common test done is an MRI because when you
have MS, and if you're having active symptoms, you will
usually see scars or allsions in the brain or spinal
(09:53):
cord on an MRI, so that would be next and
sometimes most of the time that's really all it requires.
But if they're trying to rule out other diagnoses, which
is also common, then they might do other types of
blood tests evoked potential looking at your nerves. So those
are some of the most common ones. It's usually a combination,
(10:14):
not just one or the other.
Speaker 1 (10:15):
So talk to us about the lesions and the scars.
How are they similar and different to other brain lesions
such as the amyloid plaques that people are familiar with
from Alzheimer's disease. How do they resemble or differ and
do they occur only in one area of the brain
or do they occur in multiple areas.
Speaker 3 (10:35):
Yeah, that's a great question. So they differ from amyloid
plaques in the sense that the reason that they are
occurring is due to demyelination. So for those that don't
know what that means is we have a mielin sheath
that covers our nerves and it protects our nerves so
that our body can function normally, so that if you say,
(10:57):
pick up your leg, you pick up your leg. When
the myelin withers away. You might have the thought of
pick up your leg, but that connection isn't working as
well or maybe not at all, and so you think
to yourself, pick up your leg, and it just doesn't
lift either at all or not as much as you
would hoped. So when that myelin withers away and it's demiolinated,
(11:21):
that's what results in the scars and plaques. Where it
occurs is often a different place, and in fact, to
be diagnosed with MS, you have to have at proof
of at least two lesions that occurred at different times,
and they are in different places within the brain and
or the spinal cord. And it also can affect the
(11:43):
optic nerves as well, which is why vision could be affected.
Speaker 1 (11:47):
So when I think of myelin, I think of kind
of it wraps around the nerves and it allows the
nerve signals to move faster, you know, because it causes
them to jump from place to place instead of having
to go down the entire length of the neuron. Which
makes sense with what you're saying about how you say,
lift your leg and it just kind of doesn't. It
(12:10):
just kind of is slow. So talk to us about
some of the root causes of MS. What do we
know about what causes it?
Speaker 3 (12:18):
Yeah, so this is another one where unfortunately there's not
any major causes. It's usually a combination of things, and
that could range from obesity or growing up around industrial toxins.
Smoking is definitely not going to help anything, especially if
that's genetically already there, or if you also are around
(12:38):
industrial toxins. One newer piece of research that came out
within the last year and a half or so was
that having the epstein bar virus, which is also mono,
was a huge predictor of multiple sclerosis. And so there's
lots of people who get the epstein bar virus and
don't get MS in this test or in this study. Rather,
(13:03):
everyone who had MS also had antibodies for the epstein
bar virus. So that's kind of newest on the radar.
It's been thought about for the last twenty plus years,
but now there's actual research showing that that might be
one of the causes. And then low vitamin D level,
so living further away from the equator is also a
(13:24):
big one.
Speaker 1 (13:26):
I mean, it's interesting. Epstein bar is a great example
of what is now being taken more seriously, this idea
of latent infections that can cause all kinds of broad
reaching problems throughout the body.
Speaker 2 (13:43):
I mean, epstein bar.
Speaker 1 (13:45):
It used to just be okay, so you have mono
or you get the you get the hairy tongue or whatever.
But now we're seeing epstein bar just kind of correlated.
But you know, it's it's that classic debate of you know,
is it cause a or is it just correlation?
Speaker 2 (14:02):
And so but it is interesting.
Speaker 1 (14:04):
The concordance there that you have one hundred percent of
people who have an MS have the antibodies to epstein bar,
and there's got to be something there. And you know,
it's also that fascinating discussion of like, well, so many
other people had epstein bar but did not have MS,
(14:24):
and so it's interesting what that trigger might be that
kind of turns it on because like you said, it's
not necessarily genetics. And what easy tests that people can
do to like get your vitamin D checked.
Speaker 2 (14:40):
I mean, that is such an easy, easy, easy thing
to do.
Speaker 1 (14:43):
So let's talk about how you approach exercise, because you
are a physical therapist and your approach to exercise is
helping to reduce fatigue and help people to get stronger,
improve their balance, walk better, and it also uses this
concept of neuroplasticity.
Speaker 2 (15:06):
So talk to us.
Speaker 1 (15:07):
We've talked about neuroplasticity a little bit on the show,
but tell us your understanding of it and how it
specifically applies to MS, and then how does it inform
the way that you teach your patients to exercise.
Speaker 3 (15:20):
Yeah, neuroplasticity is so important to understand because it's the
reason that someone with MS can still have the ability
to improve their strength, walking, balance, everything that you just
listed even though they have this demilinating progressive disease. So
neuroplasticity is the ability of our brain to either do
(15:42):
one of two things. One strengthen those neural pathways, so
those neural pathways that have the demyelination, they can actually
be strengthened. Or Neuroplasticity is also the ability to rewire itself.
So if there's just no chance, if that demyelination is
so intense, there's very little likelihood that it will actually
(16:03):
get stronger, your brain can rewire itself, which is great
because in MS, that rewiring is what can actually find
a new neural pathway to improve your muscle strength. So
the biggest difference between orthopedic exercise, which is what most
people do. If you're looking to go to a gym
(16:25):
lose weight like back pain, should or whatever it is,
it's probably orthopedic exercises which are focused on the muscle.
It's focused on muscle toning, muscle strength. But when you
have ms, your muscles are affected. So it might think
you might think that focusing on your muscles is the
way to go, but that's not where the issue is
(16:46):
starting from the issues and the nerves. And so when
you're exercising, you have to do strengthening and balance and
stretching exercises in a way that promotes neuroplasticity, not just
promoting muscle strength. Because if we can strengthen those neural
pathways or rewire a neural pathway through neuroplasticity, that's what
(17:09):
will actually result in change in function and daily living.
Speaker 1 (17:14):
So it's that in functional medicine, it's the concept of
going further upstream. You know, where people are not working
at the end result of weakened muscles, but.
Speaker 2 (17:25):
You're actually working.
Speaker 1 (17:27):
You know, you're not mopping up the water that's on
the floor, you're turning off the faucet in a way,
So teach us how these nervous system conditioning exercises. I
mean they sound like they have to be fundamentally different
from muscle based exercises.
Speaker 3 (17:46):
So sometimes yes and sometimes no. Sometimes it's very similar exercises,
but you are just implementing alertness and urgency and some
of these strategies that are shown to promote neuroplasticity. So,
for example, attention focused attention is a big one, and
so the more focused you are on what you're doing
(18:08):
and what your intention is, the more likely you'll strengthen
or find those new neural pathways. Same with urgency, So
if you can somehow create urgency into your exercise routine, again,
you're more likely to find or strengthen those neural pathways.
Urgency could mean a challenge, maybe you're standing on something
(18:28):
that's a little squishy and you don't want to fall off,
Or it could be timing yourself. Maybe you're trying to
do a certain number of repetitions before the song ends.
So something that feels a little bit urgent can significantly
help improve neuroplasticity. Alertness, salience, having it means something. All
those things matter, But another big, big difference is the
(18:50):
position that you're in. Because when you have MS, you
don't have the same carryover as someone without MS. So
if you were to go to regular traditional orthopedic physical
therapy and you're looking to improve your hip strength, a
lot of the exercises that they would probably have you
(19:10):
do initially are lying on the plinth table and maybe
it's a straight leg raise or a clamshell sideline leg raise.
Those are all great orthopedic exercises. But if you have
a MASS, what's likely to happen is your hip will
get stronger. But then you go to stand up and
that hip strength is nowhere to be found because your
(19:31):
brain didn't carry over that that hip strength lying down
should also be used when you're standing. So it's really
important that when you have a MASS, you're exercising as
best as possible in the specific situation and the specific
position that you're looking for improvements in.
Speaker 1 (19:49):
Okay, So that is absolutely fascinating that we're what we're
looking at is an inability of the musculature to kind
of communicate back to the brain that this strength needs
to be in place no matter where I am.
Speaker 2 (20:05):
That is very very cool.
Speaker 1 (20:06):
So I want to know more about this alertness focus
and the salience that goes into it. So we'll be
right back after a word from our sponsors.
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That's Lindsayilmore dot com slash amre to save ten dollars
And now let's get back to the show. Teach us
how you teach your patients to I think urgency everybody
kind of understands. But when you say focus, when you
(22:02):
say alertness, and when you say salience, when you were
talking about the intention behind it, where are you putting
the focus and how are you training people to stay
in that in that brain thought pattern.
Speaker 3 (22:16):
So there's two ways that you can do it. One
is to implement those strategies during your exercise, and then
the second is to implement those strategies during your rest break,
so between your exercises. So if you wanted to implement
alertness during alertness and attention during an exercise, you would
want to make sure that you're fully focused on For example,
(22:40):
marching is a great exercise where you're practicing lifting your leg,
lifting your knee up towards the ceiling, So you could
be hyper focused on how high is your leg getting,
how many inches do you think is between the floor
and your foot, Where are you feeling the muscles, are
you feeling it in your hip or are you feeling
some compensation, maybe you're actually feeling it in your back.
(23:02):
So being hyper alert and focused of exactly what is happening.
But if you wanted to implement this between an exercise,
so during a rest break. One thing that I like
to do. Do you know the game the bop It? Yeah, yep,
so classic kids game. I actually never played it until
a few months ago, but I purchased a bop It
(23:24):
because it is the perfect thing to have you pay
attention and get that urgency and focus and alertness all
in one. And it's a game that tells you for
those that don't know, it tells you pull it, spin it,
bop it, twist it, and so you have to do
it and if you miss it, you lose the game.
(23:44):
And there's music playing and the music speeds up the
more you do, and so it really requires all of
that alertness, attention, urgency. So you could do something like
that between your exercises. As for salience, that is a
little bit different. So salience means it needs to mean
something to you. If you are exercising just because someone
(24:06):
told you to, you're less likely to get those neural
pathways working, and so it's really important that you're asking
yourself why is this important to me? And get really deep.
One exercise that I like to do with my clients
is I'll ask them what their goal is, And usually
they'll say something like I want to get stronger or
(24:26):
I want to walk better, and then I'll say, okay, why,
and I just keep asking why until we get to
a deeper meaning. And so often I'll give you an example
of someone recently. So I had a patient who said
that she wanted to walk better, and I said why,
and she said, because then she could do more things
(24:46):
with her son. I said, well, why does that matter, which,
of course that matters, but we're trying to get really deep.
So why do you want to do more things with
your son? And she said because she wants to be
able to go outside more than just stay in the house.
And we keep going deeper and deeper, and eventually we
end at she wants to go trick or treating with
her son. She wants her son to have that experience
(25:07):
because she was a single mom and no one else
would take him. And so her vision went from exercising
to walk better to exercising so that she can take
her son trick or treating. And how much more emotion
is that going to bring you when you're exercising, when
you're doing the silly exercise of marching, you're thinking about
(25:28):
trick or treating, and your brain wants that, it wants
to know the why, and so it's more likely to
promote neuroplasticity.
Speaker 1 (25:35):
It reminds me of the seven levels deep exercise, when
you're really trying to get at why am I doing
what I'm doing?
Speaker 2 (25:43):
And if you.
Speaker 1 (25:44):
Really ask yourself why seven times and seven iterations of it,
you're gonna get to that point where your heart just
breaks open and you all of a sudden have like
a real meaning behind why you're doing what you're doing.
Speaker 2 (26:01):
And I remember, I don't know, one.
Speaker 1 (26:04):
Of the weight loss shows that was popular a few
years back. I remember a woman saying, I'm here because
I want to go on a family bike ride, like
my children and my husband go on these bike rides together,
and I am not in the physical condition to be
able to do it, and that was a powerful, powerful
(26:25):
motivator for her, and I love that idea. I think
we carry the idea of having purpose in a.
Speaker 2 (26:33):
Lot of areas of our life.
Speaker 1 (26:35):
But you're the first person that I've heard say like
it can also be a powerful motivator for ongoing exercise,
and so expand a little bit more on other techniques
that you use to help your patients stay committed, because
you know, everybody likes to make promises in the gym,
(26:55):
but there is nothing people like procrastinating on more than
weight loss and exercise.
Speaker 2 (27:01):
So how do you inspire people to stay committed?
Speaker 3 (27:04):
So the most important thing, I think is to find
real life, day to day situations that are challenging or
at the very least just more challenging than you'd like
it to be. And that's where we always start, because
of course they want to get stronger, they want better balance.
And usually when I'm asking someone what are your goals,
that's what they're saying is these generic goals. But then
(27:27):
I will ask them, well, what in your morning routine
is hard for you to do? What in your morning
routine do you want to be easier? And they'll say,
like getting dressed, I lose my balance every time, or
showering I have to sit because I lose my balance
if I stand, or you know, I can't walk the
dog more than two minutes because I fatigue. And so
we try to find very specific goals that they literally
(27:52):
have to do on a daily basis, and there's so
much more inspired to work towards that and they're able
to see the relationship more between the exercise and why
they're doing it versus I'm doing this to get my
hip stronger. So that would be the number one thing
educating on neuroplasticity for sure, because with MS and knowing
(28:13):
that the reason you're experiencing weakness is because of neural
pathways can often make you feel like it isn't possible
to improve your strength because your neural pathways aren't even working.
So understanding what neuroplasticity is and how to get it
to work can also be just very hopeful for a
(28:35):
lot of people. And if they don't have hope, they're
not going to stay consistent because they don't believe it's
actually possible.
Speaker 2 (28:42):
So I absolutely love all of that.
Speaker 1 (28:45):
That creating the connection between the exercise and the goals
so that it becomes easier just to keep going. So
talk to us about like the intensity of these exercises.
Are are you pushing to fatigue? Are you saying let's
meet somewhere in the middle, Like is this a go
(29:06):
full out for ten seconds? Like where are we kind
of on the spectrum between like you know, restorative yoga
and CrossFit?
Speaker 3 (29:16):
Yeah, that's a great question. So there's a lot of
MS research that shows that low to moderate intensity is
enough that it doesn't need to be high intensity. And
I really I loved when that research came out because
at the time, I think a lot of people were
under the impression that in order to make any change,
regardless of your goals, you had to exercise for an
(29:37):
hour or forty five minutes and it had to be intense,
and this just proved that, no, it doesn't need to
be intense. So it really is going to depend on
the physical abilities that you have, but some simple seated
exercises at home is enough to make a difference. There's
also research showing that exercising throughout the day is just
(29:59):
as effective as exercising all at once when you have MS.
So if fatigue is a big symptom that you have,
you could do some moderate exercise or light exercise for
five minutes in the morning and then maybe five minutes
before lunch, maybe ten minutes after lunch if you're feeling
more energized, and that's just as effective as doing twenty
(30:20):
minutes all at the same time. So the intensity is
up to you. High intensity interval training is also something
that's been found to be effective in MS, but that
also varies in intensity for each individual person because low
intensity and high intensity will feel different for everyone. So
it's all about choosing what feels low intensity to you,
(30:44):
what feels high intensity. For some people, high intensity might
be jogging in place. For other people it might be
seated marching but as fast as they can go. And
so for the average person, I would say effective MS
exercises are low to moderate. You might not even break
a sweat.
Speaker 1 (31:04):
I mean, I love the idea of just meeting yourself
where you are. And we have heard over and over
and over again on the show about what you just
said about exercise, Like, we have this concept in our
mind that if it's not like forty five minutes of
just like banging it out at the gym, that it
doesn't count. But we know from diabetes research that as
(31:27):
little as two minutes of walking after a meal can
blunt your blood sugar spikes after you eat, and so
breaking up the exercise into those intervals is so so important,
and it's just it makes it easier for people to
just say, Okay, I'm going to take a break and
(31:48):
just do five minutes here, one minute here, whatever, whatever
I can, and so talk to us about Let's talk
more about maybe even so specific exercises that even people
who don't have MS could use on a daily basis.
And we've talked about a few chair exercises, but just
(32:11):
give us some things that people who are listening to
this and going like, you know, maybe I don't have MS,
but I could use some better balance, I could use
some better get up and go. How would you encourage
somebody who maybe doesn't have a fitness routine to get
started with some basics in their own home.
Speaker 3 (32:30):
So one of the most important things is making sure
that your exercises are functional. And this kind of goes
back to what we were talking about earlier, where if
you're doing exercises lying down, you could go to stand up,
and especially if you're looking to climb stairs better or
get up and go faster and with better balance, it
might just not carry over. So making sure your exercises
(32:52):
are functional. And the best way that I can explain
this is to pick a goal that you have for
this situation. Let's just go with the example of walking
and practicing walking is a great exercise, but what you
really want to do is break walking down into as
many individual movements as possible. So if we really think
(33:13):
about it, taking a single step forward just with one
leg requires that you shift your body weight forward, that
you bend your knee, you lift your ankle up, you
straighten your knee, you lift your knee up towards the ceiling,
you put your heel down, and all while that was happening,
you were on one leg. So that's seven individual movements
(33:36):
that can now be seven specific exercises that you do
that are directly correlated to your walking. You could do
the same thing for standing up off of low surfaces
like a squishy couch or even a toilet can be
hard to stand up from. What are the steps that
you need to stand up from that low surface. One
(33:57):
might be sitting up tall, especially if we're thinking of
a cat, you might be slouching and relaxed, so sit
up tall. Another is scooting forward. Then you have to
be able to open your feet nice and wide to
be balanced. Then you have to be able to bend
your knees, then bring your body forward, and then stand up.
So that's six different movements that could each individually be exercises.
(34:20):
So one exercise could be scooting, one could be hinging forward,
so each one you would do repetitions as if it
were its own exercise.
Speaker 1 (34:30):
I love the idea of just breaking it down and
making it so simple and doing things absolutely with intention
every single step along the way. And it's truly fascinating
to think that so much muscle and brain coordination goes
into things that we just kind of take for granted.
(34:50):
You know, it's a moment to have some gratitude. I remember.
I remember one time my friend told me that she
went to a meditation and the guy that was the
meditation said, does do anybody's teeth.
Speaker 2 (35:02):
Hurt right now?
Speaker 1 (35:03):
And everybody was like, your teeth, no, And he's like,
that's the whole meditation is just gratitude that your teeth
don't hurt. And just having that gratitude that you can
scoot across the couch, get your feet apart, stand up,
activate your spine to sit up straight is really really
powerful to think about what a difference that could make
in our lives of just giving that like, wow, I
(35:26):
can still do these things whereas other people cannot, and
what a powerful message that is. Tell us about your
five day MS strength challenge.
Speaker 3 (35:39):
Yeah, so if you have miss and if you've never
been to a physical therapist, especially one that knows about
multiple sclerosis, all of this information that we're talking about
can be extremely overwhelming, and while it hopefully will make
you feel hopeful and inspired, it can also put a
(36:00):
pause in whatever you're doing, like, oh my gosh, Okay,
I've got hope, but I don't even know where to start.
So that's where the five day MS Strength Challenge comes in,
and I break down some of the most important concepts,
like some that we're talking about today, neuroplasticity, functional exercise,
how to stay consistent, what parameters you should be doing.
(36:21):
But it's in small videos. So each video is about
five minutes or less, just one video per day. So
the idea is to give small chunks of attainable information
and then by the end you have a plan of
what exactly you specifically are going to do, because for
each day there's a homework assignment, and for example, one
(36:42):
of them is to create your why. One of them
is to create your list of what things throughout the
day are really hard for you to do. One of
them is to break down that list into the exercise
is So by the end you should have a plan
of exactly what you're going to do. Instead of just
hearing this information, breaking it in the five days helps
you actually implement it. Mm hmm.
Speaker 1 (37:03):
I love that being able to implement it and then
getting going and having and building that consistency along the way.
What else do you want to add for you know,
I asked this a lot, and especially with a condition
like MS, which can be so debilitating. What gives you
(37:27):
hope that we're moving in the right direction with MS?
Because we started this whole conversation by saying, like, we
really don't know what causes it, we really don't know
how to like prevent it from from progressing.
Speaker 2 (37:40):
Where do you see the Where do you see hope?
Speaker 1 (37:43):
And where do you see progress for people that maybe
have just gotten this diagnosis or know someone.
Speaker 2 (37:49):
Who is maybe feeling defeated at the moment.
Speaker 3 (37:52):
Yeah, So I've realized that it's way easier for me
to feel hopeful than it is for the person with MS.
And the reason is because I get to treat so
many people with MS, so I get to see on
a daily basis people improving. But if you're the one
with MS, or if you have a loved one with MS,
(38:14):
you might only be seeing that one person with MS.
You don't have proof of how many other people are
actually improving through this type of exercise, and so it's
easier for me to see it. And so I really
tried to infuse that hope in everything that I do,
and even on social media, I try to share clips
of me working with people one on one and showing
(38:36):
the improvements, because for so many people, as I mentioned earlier,
they think it's not possible for them. And maybe it's
because they've tried physical therapy before and it didn't work
for them because it was orthopedic PT, or they have
primary progressive MS, so they just feel like it's going
to progress anyways, there's nothing I can do. Whatever the reason,
(38:58):
there's someone in your see similar shoes that has seen improvements.
I have seen improvements in people with all forms of MS,
at all ages, whatever age you've been diagnosed, at all
mobility levels. I've even seen people who have gone from
being in a wheelchair to then be worked towards using
a role leader and then trekking polls and now she
(39:20):
is even sometimes not using any mobility aid. And so
there's people out there who, while MS is different for everyone,
are in a very similar position, and they are seeing
improvements even though they didn't think they could because this
is a different form. So I hope that knowing that
it exists is at least enough hope to get people
(39:41):
started and motivated.
Speaker 1 (39:43):
I love that, So everybody, if you know someone who
has multiple sclerosis, be sure that they are getting that
functional exercise from somebody who really understands this condition on
a deeper level. It has been such an honor to
get to talk to you today. Thank you so much
for coming in and being a guest on the Lindsay
(40:05):
Elmore Show.
Speaker 3 (40:06):
Absolutely, thank you so much for having me.
Speaker 1 (40:11):
Kids Calm is officially here, and it is time to stop.
Speaker 2 (40:15):
Fighting sleep and build better.
Speaker 1 (40:19):
Relaxation and wind down routines. Kids Calm is a melatonin free,
delicious fruit flavored gummy that both kids and adults will love.
Instead of melotonin, it contains masonol, which helps you to
make your own melatonin, as well as five HTP, which
(40:41):
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B vitamins like B twelve and B six, as well
as D vitamins.
Speaker 2 (40:50):
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Speaker 1 (40:54):
It has all the talking points that you want it
is sugar free, caffeine free, soy free, dairy free, non
g gluten free, doesn't have any preservatives, artificial colors, flavors,
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Speaker 2 (41:14):
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Speaker 1 (41:16):
It can be given after homework, before bedtime, and it's
not only going to help you to make your own
melotonin and serotonin, but it also helps to level out GABBA,
which is our primary relaxatory neuro transmitter out there. You
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(41:40):
can check out the laid Back Kids Pack which contains
Kids Calm as well. Head to Lindsayilmore dot com slash
amare to save ten dollars on your first order. That's
Lindsay Olmore dot com slash amare to get Kids Calm Today.
Speaker 2 (42:00):
The Lindsaylmore Show is written and produced by me. Lindsay Olmore.
Speaker 1 (42:04):
Show segments are produced by Soueproco and Derek Lugo.
Speaker 2 (42:08):
Sound design and editing is by Jive Media.
Speaker 1 (42:11):
Support the Lindsay Elmore Show by heading to Lindsaylmore dot
com slash podcast. Your contribution, no matter how big or
how small, helps us to bring the best guests to
the interview chair. Thank you so much for listening, Subscribe,
rate and review the show on Apple Podcasts, Share this
(42:31):
and all of your favorite episodes with a friend, and
on social media, be sure to tag at Lindsay Elmore
Show and help us bring the pod to more people.
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