Ep. 73: MS Research Updates: Spasticity, Vibration/Perturbation Training, and More with Dr. Gretchen

Join us in this week’s episode by welcoming back Dr. Gretchen Hawley, PT, creator of the MSing Link. With her broad knowledge and specialization in MS, we will dive deeper into her research, recent findings, and more.

This week we focus on:

• – How vibration and perturbation training increases proprioception and reduces the risk of falls.
• – More research updates on treating spasticity.
• – Aerobic exercise and its benefits on supporting neuroplasticity.
• – The impact of treating comorbidities to improve overall health and how that can also help with MS symptoms.

Tune in now and learn more about MS and stay up-to-date on the latest research!

You can find Dr. Gretchen’s work and website at www.doctorgretchawley.com

Read the transcript:

Garrett Salpeter(00:05.571)
Actually, we’re going to go right into the real recording. It normally asks us to do test recording. So we will skip over the first few seconds here. And we’ll get started. So you ready? You need any, I’ll take a sip of water here.

Gretchen Hawley (00:18.71)
Yeah, I’ll do a sip of water too.

Garrett Salpeter(00:21.763)
Thanks for watching!

Gretchen Hawley (00:22.962)
I had COVID like a month ago, but I’m still like, my voice is still crackling every now and then. So I like, I always have to have water nearby. So ready.

Garrett Salpeter(00:28.98)
Mm.

Garrett Salpeter(00:32.812)
Okay, and babies made it through okay, I’m sure they were checking, right?

Gretchen Hawley (00:36.702)
They were, yeah, so far so good. No issues there. Yeah.

Garrett Salpeter(00:42.768)
Alright, good. I’ll clap as our little audio thing here. So, alright. Let’s see, you sound good, you look good. So, can you hear me? You can hear me alright, I assume. Alright, good. Well.

Gretchen Hawley (00:51.864)
Yep, I can hear you good.

Garrett Salpeter(00:57.771)
Ladies and gentlemen, welcome back to the New Fit Undercurrent podcast. We are joined today for the second time by Dr. Gretchen Hawley, who you may know as the host of the Missing Link podcast and the writer and curator of the Missing Link website and program. And she is a wealth of knowledge on the topic of MS and helping patients navigate the MS disease and work to restore function. And…

It’s been fun to connect the dots on several of the patients that we’ve shared that have been working with her and also using the newbie. She’s very graciously had me on her podcast a couple of times. She was on, if you haven’t heard it yet, I would encourage you to go back and listen to episode 40 on our podcast when she was on. We talked more generally about the differences in treating orthopedic and neurological patients, about neuroplasticity, and about some of her very valuable frameworks for how to treat and help.

MS patients. So a very good episode. We’ll sort of pick up where we left off there. So if you would like to go back and listen, I encourage you to do so. And today she’s joining us to share some research updates. So it’s been almost exactly two years since she was last on the podcast. So she’s joining us to share some updates in her work and on research in the field and help us all get up to date on things that clinicians can use in working with patients.

And also that if any individual patients are listening, that perhaps they might be able to use on their own or complementing the newbie or different things here. So I’m excited to dive in and Gretchen, welcome.

Gretchen Hawley (02:34.862)
Thanks so much for having me. I’m always excited to share updates because I feel like the way that I treat is very evidence-based. And so anytime there’s updates, I love for everyone to know them because it is usually something that you can implement on your own as well. So thanks for having me. I’m excited to dive in.

Garrett Salpeter(02:53.603)
Awesome, yes, I’m always excited to learn more. I was at a conference last weekend and someone said something really good. He said, I don’t wanna be the smartest person in the room, I wanna be in a room where everybody’s getting smarter. That was a good quote. So hopefully the collective room that we’re sitting in and all doing this, having this conversation together, we’re all gonna be getting smarter here. So update wise, I know we talked a little bit, I haven’t heard all of.

Gretchen Hawley (03:08.115)
I like that.

Garrett Salpeter(03:20.395)
these details. So I’m even excited to follow along and listen to, but I know one that you intend to share is related to vibration. So can you dive in and start there?

Gretchen Hawley (03:36.802)
Sorry, you cut out for a second, but now I think you’re back.

Garrett Salpeter(03:41.187)
So my audio will probably be fine when it’s all caught up, but I’ll make a note here for the time.

So asking about, you mentioned vibration being kind of the first topic. So can you start there please and let us know some of the new updates related to vibration technology.

Gretchen Hawley (04:07.058)
Absolutely. Yeah, one thing that a lot of my clients are working towards, and I think your clients might be as well, or at least those interested in Newbie and Newfit, is reducing tripping and reducing falls. And that can be extremely powerful because it will not only mean that you’re likely improving strength and balance, but it also improves your confidence and it affects you psychologically as well.

And so at this conference, a big topic was reducing falls and improving that through vibration training and therapy. And it was really interesting because the very first few trainings were all about the effect that falls and vibration training actually have psychologically. And so they were showing tons of research on how improving your balance and reducing falls.

through vibration and perturbation training affects us psychologically. And I just thought that was really cool because so often we assume that training our muscles will improve us physically, but we forget.

Garrett Salpeter(05:19.491)
So just to, I’m sorry to interrupt. I want us to keep that train of thought, but if people are wondering here, when you’re talking about vibration, are we talking about like a vibration platform or when you say perturbations, like one of these treadmills that I’ve seen in motor control labs that oscillate side to side. Just so everyone can kind of visualize what you’re talking about as we go here, can you just share a little bit about what exactly that means?

Gretchen Hawley (05:22.904)
That’s okay.

Gretchen Hawley (05:43.686)
Yeah, so vibration therapy or vibration training can be done at home or in a clinic. And typically it’s done with you having your feet sitting or standing on a vibration plate. And there’s a few different options. They have ones that go back and forth or side to side or up and down, but you have your feet on a plate that vibrates. And again, you can be sitting or standing.

Whereas, perturbation training can either be, as you just mentioned, you’re on a treadmill or one of these motor machines that will make you fall off balance that require you to have a stepping strategy. So it purposely puts you in these safe positions to lose your balance and make sure you’re training your body to recover when you lose your balance in real life situations. But that also can be done

in person, as long as you can do this safely, you could have someone just tapping you from one side to the other. But the whole point of perturbation training is putting you in a position that makes you have a stepping response. So you’d have to step to help recover.

Garrett Salpeter(06:59.191)
Awesome. Thank you. Thank you for that. So now we’re on the same page. So then, then you were, you were saying, you’re talking about some of the, you know, the psychological effects of falling and things like that. So we can get, get back, get back on that, on that train there.

Gretchen Hawley (07:11.262)
Yeah, yeah. So the research was showing that about 70% of people with MS will have falls. And one thing I also should clarify is falls are not always heavy falls to the ground that end in injury. Sometimes that’s what we think of when we think of a fall, but a fall is any time you ended up on the ground unintentionally, even if it was controlled. And so many people don’t consider that a fall.

And if we don’t consider that a fall, then we’re missing out on a whole area of training that could really improve safety and balance when moving. So the first several studies that were shared in the research were all about the cognitive effects of vibration and perturbation training, because the better that we get physically, the better oftentimes we feel emotionally as well and the safer we feel.

And that feeling of confidence is vital in improving our walking and reducing our falls for the long haul. Because even if we do improve our balance through vibration or perturbation training, if we are still fearful of falling or not confident that we can walk without falling, it won’t have as big of an impact. So there was just a big focus on

focusing on the psychological and the physical components and how they relate.

Garrett Salpeter(08:44.835)
Awesome. I think that’s great information. And are there any of your… You have this Missing Link program. I mentioned that in the intro. I didn’t say it’s MS-ing. So it’s a wonderful, clever bit of wordplay, which I very much appreciate. Puns are my favorite form of humor. So just as if people haven’t seen the website or something, it’s missing msinglink.com, right, is the website.

So, you now through that website, you’re working with people even more remotely than in person. I know obviously you are a physical therapist, have worked with people in person, but working remotely. So, are you recommending certain vibration products to people or can you talk a little bit about what specific recommendations there might be in that category?

Gretchen Hawley (09:35.594)
Yeah, absolutely. So we mentioned both vibration and perturbation training. However, because I mostly work with clients virtually now, I do every now and then work with some clients in person. So if I’m working in person, that might be a little bit different because we could do perturbation training safely, but I would never recommend that someone at home that I’m not able to witness and make sure they’re staying safe.

that they have their spouse just pushing them in one direction or another to force them to take a step. That’s probably not gonna be the safest. So in the missing link and with all of my virtual clients, what we tend to focus on is more of the vibration training. And one thing that was shared that I thought was really interesting was that the best version, they didn’t give any specific brands of what product would be best, but what you really wanna be looking for

is a vibration plate that goes up and down versus side to side or rotation or forward backwards. They mentioned that those can be helpful, but the ones in research that specifically showed a benefit that was statistically significant in reducing falls were the vibration plates that went up and down. And the reason for that was because they were going up and down against gravity, whereas

positions and vibrations didn’t affect gravity. They were all on the same plane. So typically now in the missing link, when someone asks, you know, what brand should I get? I don’t give a specific brand, but I do say look for the ones that go up and down. And some vibration plates offer lots of different types of vibration. It’s not just one or the other, but you’d want to for sure be working with one on the setting where it goes up and down.

instead of side to side or rotation.

Garrett Salpeter(11:32.747)
Okay. So that’s good that you mentioned up and down too, because also before we move on from this topic, I wanted to spend a moment talking about the mechanism here. This is something that I’ve looked at a little bit off and on during the years. I’m not using vibration on a regular basis. I certainly wouldn’t call myself an expert, but you know, I think we can at least talk about it for a little bit here. So, so if someone’s standing on a platform, the surface is actually moving up and down. So it’s sort of like they’re doing mini jumps.

and landings, it’s like they’re landing from a half an inch, half an inch, half an inch, and they could do it 10, 40, or something times a second, depending on the frequency of vibration. And so I’ve heard that described a few ways. One being that it creates these vibrations that help pump lymph, because you get the mechanical pumping. I’ve heard it described as, creating, since you’re getting these miniature, essentially landings, as if you were falling off a half inch surface or whatever the amplitude is, each…

those all those times per second, you’re getting a little bit of vertical axial loading. So I’ve heard of people talk about bone density benefits. We’ve got lymph bone density, but ultimately, especially given your area of interest in mind being the nervous system, we want to talk about how it causes the reflexive neurological activation. So like you talk about perturbations and the stepping response is the mechanism of action and is the benefit essentially that it’s causing the nervous system to have to react all those

all those times per second to the change in force and get that reflexive firing happening faster.

Gretchen Hawley (13:11.818)
Yeah, and not only that, but it makes your muscles activate too. So it might not feel like it in the moment when you’re using it, but just the fact that it’s going up and down, it’s making your neural pathways activate and it’s making specific muscles activate and those specific ones that are responsible for reducing that risk of fall. So things like the muscles on the front of your ankle, the tibialis anterior,

the muscles on the back of your ankle, which would be the calf muscles, the outside, which are the peroneal. So it activates a lot of different muscles with the goal of strengthening them to reduce falls. And of course your neural pathways have to be activated first. So vibration training is a way to get both done. And it was also mentioned that the method that you would use for vibration training specifically,

was that you would use it for, I believe it was three times a week for six weeks and you would do about five rounds where each round is one minute, or sorry, you do five repetitions for one bout of training, which was basically as long as you could handle, followed by one minute rest. So initially the first bout was about one minute.

and then the next week or maybe three or four weeks later, it was still about one minute. And then once you were closer towards the end of the six weeks, you might increase it to about a minute and a half. So it’s really slow increments. It’s not like the first time you do it, you’ll use it for 20 minutes. It would be one minute for several weeks and then maybe a minute and a half.

for several more weeks and then maybe two minutes. And so you slowly work your way up. And after each bout, you have at least one full minute of rest before going at it again.

Garrett Salpeter(15:13.923)
Okay. So that, that all makes sense. Uh, one also, one thing that’s worth mentioning is, you know, of course, in our, all these different mechanoreceptors that we have these sensory afferent pathways, there are pathway, you know, there’s force, you know, you mentioned the muscles are working and there’s also pathways for vibration and, uh, getting more sensory feedback, you know, as we’ve seen by using the newbie and many other conversations we’ve had on here, you know, can be helpful. And I do know a few.

clinics around the country that have combined have had the new beyond while people are standing on a vibrating vibration platform, uh, or being on the vibration platform and doing squats or lunges or different movements or pushups with their hands on the platform, different things like that too. So I think there’s, you know, a way where things can, can combine, um, the, um, let’s see audio issue here.

1610 so you are

Garrett Salpeter(17:03.587)
Let’s see, can you hear me? Hello, hello.

Gretchen Hawley (18:13.947)
There we are.

Garrett Salpeter(18:15.427)
Let’s see, can you hear me? Yeah, that was strange. I don’t know what happened. I wrote down the time when it happened so we can chop it out. I was talking about vibration, receptor, path, mechanoreceptor pathways, and how some people use it in combination with the newbie at different places. Oh, looks like you froze again. Can you hear me?

Gretchen Hawley (18:17.091)
Yes, can you hear me?

Gretchen Hawley (18:21.847)
Yeah, that’s bizarre.

Gretchen Hawley (18:26.2)
Okay.

Gretchen Hawley (18:41.145)
Mm-hmm.

Gretchen Hawley (18:44.812)
I can still hear you, yep.

Garrett Salpeter(18:46.203)
Okay, good. All right. So, I think we’ll just pick up. I think it will have gotten me saying that thought. So I’ll kind of finish that thought and then just apologize, let everyone know we had a little moment where it froze. So sorry if there’s a slight delay, but we’ll continue on here and then we’ll pick up.

Gretchen Hawley (19:03.647)
Okay. I could also mention, um, if you wanted to go just a step further, there was research to just saying that like the way that you would implement it was about one minute bouts at a time followed by one minute rest. So for anyone who does has a vibe. Oh, you got that. Oh, okay. You were frozen that whole time for me, but I just kept talking.

Garrett Salpeter(19:09.772)
Mm-hmm.

Garrett Salpeter(19:19.031)
Oh, we got that. Yeah.

Garrett Salpeter(19:25.979)
Oh yeah, I heard that audio and the video should be saved locally. So that should all come through. Was that, were people just standing on that or were they like holding certain positions? I understood they were standing, they just standing on it.

Gretchen Hawley (19:30.135)
Okay, perfect.

Gretchen Hawley (19:37.915)
Um, they were just standing. Yeah. I, they didn’t mention any specific position that they were in.

Garrett Salpeter(19:46.655)
All right, so let’s just for easy, let’s start when, do you see the timer on your screen or no? Oh, it gets to 20, I’ll pick up again, 20 minutes even. So that’ll be easy.

Gretchen Hawley (19:56.474)
Okay.

Garrett Salpeter(20:02.055)
Sorry, we had a slight issue with the connection freezing there. So we’re just chatting about the vibration and ways that people have combined this, at least a few clinics have combined vibration with the new B. I don’t have a lot of personal experience with it, but it sounds promising. So I’m glad that we were able to talk about that. Thank you Gretchen for sharing that. Then in terms of these research updates, I believe the next one you want to talk about was-

So a few findings related to spasticity, is that right?

Gretchen Hawley (20:33.475)
Yes. Spasticity, which is basically an intense form of muscle tightness that doesn’t often release with just stretching alone, is a big symptom in multiple sclerosis, as well as some other neurological conditions. And it can be super frustrating because the higher the level of spasticity, the harder it is to move. So if you’ve ever been walking and you feel like

not because it’s weak, but because it feels restricted, that’s likely spasticity. Or sometimes it feels like heaviness. So if you’ve ever felt or said, when I walk it feels like I have a 50 pound weight attached to my right leg or my left leg, that heaviness that can also be spasticity. And for a while, what researchers were showing were best practices to reduce spasticity and other forms of muscle tightness as well.

was stretching or other forms of muscle release. So that might mean stretching as you and I know it where it’s 20 to 30 seconds or more prolonged stretching where it’s maybe three to five minutes or it could be muscle rolling with a foam roller or a tennis ball, massage, different muscle release techniques like those. But the focus at this conference and the research updates that I got

was that stretching is still important. And they did actually recommend that stretching should be done at least two to three times per day. And I always like to go on the conservative side. So what I’ve been recommending is the three times per day for sure, and 20 to 60 second holds. So again, I’ve been recommending more of the 45 to 60 seconds, but research was showing the 20 to 60 seconds, which is interesting because a few years ago, they were showing that

prolonged stretching like the three to five minutes might be better. So this is kind of a little switch in what type of stretching is best for spasticity. But not only that, there was a heavy focus on talking about strength training to reduce spasticity and aerobic training to reduce spasticity. So with the strength training, we wouldn’t want to strengthen the muscles that are spastic.

Gretchen Hawley (22:59.567)
we’d want to strengthen the opposing muscles. So if you had spasticity and tightness in your hamstrings, which for those that need a reminder, are the muscles on the back of your thigh, we would want to strengthen the quad muscles, which are the muscles on the front of your thigh. Or if you had spasticity in your calf, we’d want to strengthen the muscles on the front of the lower leg, or vice versa. And so determining exactly where the spasticity is and still focusing on stretching that area

but strengthening the opposite side can be mutually beneficial. And I think the newbie is great for that. I have a decent amount of clients that I work with who are using the newbie and they’re using it in that way, whether they realize it or not. As I’m talking to them, we realize where their spasticity is. And then they tell me what exercises they’re doing with the newbie and we realize, oh, that’s perfect because your spasticity is in the opposing muscle. So…

when we’re looking for strength training, that’s really what we’re trying to pinpoint on. And then aerobic exercise has also been shown to improve spasticity, which I love that this research came out because so often when people have spasticity, it feels like you can’t do aerobic exercise, like you can’t move fast enough to get your heart rate going, but there’s so many different ways that you can do aerobic exercise.

which we’ll also get into, but the point of reducing spasticity was doing movements with full range of motion, with whatever that range of motion is. So if you had spasticity in your leg, it might mean squatting up and down fully, fully standing up, fully going down, versus just these mid-level squats. So getting your heart rate up with full range of motion.

Garrett Salpeter(24:51.767)
So a couple of things I want to talk about. I’m going back to applications of the newbie in a moment, but for aerobic there, you’re talking more about like calisthenic type movements, what I would describe it. So talking like doing bodyweight squats, we’re not talking like, you know, stationary bike or something like that, but more like more calisthenic type movements through the full range of motion.

Gretchen Hawley (25:12.387)
Right, yeah. The research that they presented were more of the calisthenic type movements. I do imagine you could do something like a bike as long as the focus was the full range of motion in the knee and ankle. So, because sometimes when people ride a bike, we have a little bit of a knee bend that whole time, but this would really be the focus of fully extending and then fully bending and just that full arc of motion, which…

can be hard to do on a bike because the bike pedal is at a, or the bike seat rather, is at a specific height that will allow you to maybe extend more, but that might not allow you to bend more, which I think is why they focused more on the calisthenic type movements.

Garrett Salpeter(25:54.611)
So just to kind of clarify here, and I mean, not to split hairs, but when we’re talking about aerobic, I was envisioning more, you know, steady state here. When we’re talking about this, I would imagine many of the MS patients that you and our team have worked with, you know, would likely fatigue, shoot, anyone would fatigue after enough bodyweight squats. So is this more

Is this more of an anaerobic interval type training than at least a little different than what I would think of when I hear the term aerobics thinking more like longer steady state? Is it more that type of, you know, you do different intervals or how is it kind of organized?

Gretchen Hawley (26:31.299)
Yeah, definitely more intervals. I think when most people hear, I’m glad you asked that question because when most people hear aerobic, they think running on a treadmill or going for a run outside or even walking on a treadmill. But when we’re talking about aerobic exercise for spasticity and even just aerobic exercise in general, it’s more intermittent training. So it’s more about getting your heart rate up, whatever that means for you. There’s no guidelines yet as to

how high your heart rate should be, like a specific number or percentage. And there’s no guidelines yet for how many minutes you should be maintaining that for before resting. So usually what I suggest is to do any type of movement in full range of motion that gets your heart rate up once you can feel it. And once you feel like if we were talking, your breath might be getting a little bit more shallow and you might be struggling to have a conversation, which might be 30 seconds, a minute, a minute and a half, et cetera.

then you can stop and rest and then get back into it. So it’s kind of more like high intensity interval training aerobic rather than just sustained aerobic.

Garrett Salpeter(27:40.879)
So for people listening who are in a clinic where they have the new B and there might be working with MS patients, I think we’ve got two things that are research-supported that make a lot of sense that you might already be doing or may choose to start doing with the new B but stimulating the antagonist musculature and then having patients do these more full range of motions and if we do them with new beyond I mean being able to move through a full range of motion is wonderful I think that’s

a big part for all of us, whether we have a neurodegenerative condition or not. Moving our joints through their full range of motion, using our muscles at shorter and longer lengths is a vital part of maintaining and improving our neuromuscular system and all that. So that, I mean, I think is congruent with a lot of what you and I both talk about and share with people. So that’s good. And then I think the newbie in that case would essentially be an amplifier.

If you’re going to get some amount of input from doing 30 seconds worth of body weight squats, if you have the new beyond during that time, you’re going to be getting, especially in the areas where those pads are going to be getting that amount plus, plus more, more input, which can help accelerate that neuroplastic adaptation and help it happen either more significantly or faster or both. So I think that’s good. And then, you know, in terms of stimulating antagonist muscles, I’m glad to hear that you mentioned some of, some of our mutual clients are

actually have that in their programs already. I think that’s, you know, probably by design. Shout out to Mandy, who is our MS specialist and writes some programs for people, but also people are using it, you know, at various clinics around the country there. In terms of spasticity, I do want to want to ask a little bit about effect size and, you know, the rate at which people can make progress and some of that there, in part because

Back just a few episodes prior to this, in episode 65, we had a physical therapist named Courtney Ellerbush on and she was the lead investigator in the study that was just published. It was a case series of seven patients using the newbie and was looking at essentially these different markers of functional recovery. And many of them were able to make improvements. And one of the measures was spasticity, looking at the Ashworth scale.

Gretchen Hawley (30:03.139)
Yep, modified Ashworth scale.

Garrett Salpeter(30:05.943)
That’s right. Thank you. So looking at that and saw some improvements, a majority of patients improved in a majority of muscles, but not all. What have you seen is sort of the effect size. If things are going well, obviously there’s ranges. Some people respond faster, some respond a lot slower. What’s sort of the average range that you see in terms of how quickly people expect to improve with spasticity?

How much do they improve within one session and then maintain or lose that between sessions or over days? What does that pattern sort of look like? Because plasticity is just sort of its own animal in this whole realm of recovery.

Gretchen Hawley (30:48.331)
It really is. Yeah, and I know of Courtney and that research. I haven’t read through the article yet, so I’m curious to catch myself up to speed on that. And I don’t know what she found, but what I have found is that spasticity, for sure, is it’s its own beast. Spasticity is something that sometimes is reliant on other parts of the equation, like strength and balance, and other times it’s just not reliant on any of that. And it’s really intense, regardless of what you do.

What I have found when it comes to using these techniques that we talked about and the level of improvement and who sees improvement is that first and foremost, it starts with what level of spasticity you have. So on the modified Ashworth scale, there’s a grade one through four, and there’s a one plus, there’s a two plus. So within the one through four, there’s probably realistically about six grades, I believe. So four,

is the worst spasticity you can imagine. It’s called rigid. And that level of spasticity basically implies that even the Hulk could come and try to move your limb, like bend your knee or straighten your knee or your arm. And even the Hulk wouldn’t be able to get it to move because it’s just that rigid. So if you’re that rigid, which would be a four, or even if you’re about a three, the likelihood that you would see

improvements right away or even within a few months is very unlikely, I would say, it might take you a year of staying consistent with these exercises and this the combo, the stretching, the strengthening, the aerobic. But if you’re on the lower to middle end, so if you’re a grade one, one plus two, two plus, for all of my clients that I’ve worked with who are in those ranges,

they do tend to see improvements, I would say, within two to three months or so. And when I say two to three months, that’s more of the lasting improvements. They will see improvements earlier on where after the first few sessions, they’re saying, wow, I don’t feel as tight. I don’t feel as spastic, but by the next time I see them, they’re back to feeling tight and spastic. So usually it’s been around the three month mark or so where

Gretchen Hawley (33:11.127)
it’s lasting longer. And of course, they’re implementing these exercises at home as well, it’s not just at physical therapy. But if you’re in that lower to mid range, you’re way more likely to see improvements with this type of training. And for me personally, it’s been about three months of consistent training, again, about the three times per day to start noticing those changes over the long haul versus just intermittently.

Garrett Salpeter(33:40.067)
Okay, that’s good information, so thank you for that. And I think that, you know, for, you know, of course using technology like the Nubi, the goal is to accelerate that. If you can take what might often take three months and make it two and a half or two months, or, you know, that’s sort of the goal there. And people listening who have experience with the device, of course, likely are already thinking about the use of different frequencies, where, for example, you can use one

set of frequencies to support the relaxation of muscles. You can actually put that on the muscles that are spastic. Try that. Sometimes it causes a temporary worsening. Sometimes it helps right away, but generally it helps at least over the span of multiple sessions. Then on the antagonists, like you talked about where we want strength, we can use a different set of frequencies to preferentially contract those muscles. That’s the set of frequencies that were used in…

For example, the study that we actually haven’t talked about yet on this podcast, but study that came out showing the newbie being able to promote muscle hypertrophy where you’re getting more contraction there. So for people who have a device, that’s sort of the line of thinking that we want to apply is help lengthen or inhibit or relax the spastic musculature and then contract more, activate more the antagonist musculature. So just piggybacking off of what you said earlier.

Gretchen there. And then that pattern I think is worth discussing a little bit where, you know, it’s interesting where people, you know, we see this, I’m sure everyone listening who’s a clinician likely has seen this or patients who have experienced it, but you know, you get, you start your session at some level, at the end of the session, you get, you know, some benefit and you’re like, wow, I feel better right now. And then, you know, that might last a couple hours and by the time you wake up the next morning, you’ve regressed back.

So the goal is you’d want to be better when you woke up that next morning than you were when you woke up the previous mornings. You’re, you’re, when you’re comparing same, you know, the same circumstance to circumstance, you’re seeing improvement. But when you’re in that peak state of having just completed a session, gotten a lot of input, a lot of the proper training, it’s sort of like warming up for, uh, for a weightlifting event or a sprinting race, like you don’t necessarily. I mean, the, ideally you, you want to, you don’t want to have a

Garrett Salpeter(36:07.147)
ton of warmup time. You want to be able to transition in, you know, have that sort of robust system, but you don’t necessarily go run your fastest right away or lift your heaviest weight right away. You do that after a few sets of and kind of work into it and same sort of thing here. And we’re always adapting and getting better to what it is that we’re doing or becoming more like the state that we’re in most frequently. So the more frequently you can be in that state at the end of the session, when you’re in that peak state of peak function of improved function,

The more frequently you can do that, the more you’re going to start adapting in that direction. So we want to encourage people not to think that it’s not worthwhile or that anything is wrong if they don’t maintain that and start over at the previous session exactly where they were. The goal is to check the same time points, check where you were in the morning, waking up and then going into your session when you’re cold before you’ve done any warmup. Kind of compare those milestones to just one other thing that I think is relevant.

Gretchen Hawley (37:03.699)
Yeah, and I think too, when we’re talking specifically about spasticity, it’s really important to have the same discussion of we would not want to go, go big or go home, especially not in the beginning, because with spasticity, when it lessens, sometimes what happens is whatever strength you have or don’t have is then truly revealed. And for some people with MS,

when you lessen spasticity, it sounds like a great thing. Like, yes, I’m finally more flexible. I’m not as tight and spastic. But what some people say is they feel like they have jelly legs. Like, they got rid of the spasticity, but there’s just no strength there to stand for very long or to walk well. And the reason for that is because the spasticity was so tight that it was limiting your use of muscles. And so if we just get rid of all of that spasticity super fast,

you’re way more likely to feel off balance and unsteady because you haven’t walked or moved that way in a very long time. So we actually want it to be more slow and gradual so that we can also work on strengthening at the same time. That way over the long haul, you’ll have reduced spasticity while also having improved strength and balance, not magically reduced spasticity, but you’re feeling wobbly and all over the place.

Garrett Salpeter(38:28.299)
Sounds like good, excellent insight too. That’s good, that’s good. So anything else in terms of research updates or anything else for our two year catch up here?

Gretchen Hawley (38:40.755)
Yeah, the only thing that I wanted to also mention was a few updates on the aerobic exercise component, which we did talk about just now in relation to spasticity. But even not in relation to spasticity, over the last few years, there has been a lot of research showing that doing aerobic exercise first before neuroplasticity type exercises and training will actually prime your brain for neuroplasticity.

So just simply by doing aerobic and cardio exercise first, your brain is more likely to find and strengthen those neural pathways, which is what we’re shooting for with functional exercises like I do and with the newbie as well. So initially, we didn’t know much. We just knew aerobic exercise first, and that’s good. But now we actually do have some guidelines. We don’t yet know.

how many minutes to be shooting for or anything like that. But we do know that we want to be shooting for about 60 to 80% of your heart rate. So initially we didn’t know how high to go, but now we kind of have that guideline. We also know that the two most important factors that will play a role in aerobic exercise to promote neuroplasticity is the intensity and the speed.

So this could mean for intensity, maybe you’re holding more weights or you’re using a resistance band. You’re doing something to make the exercise more intense. And then speed is pretty self-explanatory. The faster you’re moving, the more likely you’ll be able to promote that aerobic exercise in a way that would promote neuroplasticity. For those who might be thinking right now, especially if you do have MS or any other.

neurological or autoimmune disease, you might be thinking, well, if I do that, my legs are going to be so tired, I won’t be able to then do my exercises afterwards. So you could always do seated exercises with your upper body. It doesn’t have to be your lower body if you know that that’s going to fatigue you, but you’d use the same guidelines. So one really easy example is I like to do seated.

Gretchen Hawley (41:02.103)
upper body jumping jacks. So you’re sitting and you’re just bringing your arms up and down, up and down. And we’d want to go as fast as we can. And we’d want to make it a little bit more intense potentially by adding weights or resistance band. So it doesn’t always have to be with the legs. I just wanted to throw that out there too, but I’m really excited that we now have, excuse me, I’m excited that we now have those guidelines because for about two or three years, there were no guidelines. We just knew that it was helpful. So I thought that was exciting.

Garrett Salpeter(41:31.467)
That’s great. And I can’t help but make the connection there between some of these concepts. Um, I actually was just on a, um, live event, you know, a couple of months before we’re recording this here with, with our mutual friend, Dr. Walls, and gave a talk on some of the benefits of exercising the body on the brain and a lot of inspiration for this talk came from the book called spark by Dr. John.

I don’t know if it’s R-A-T-E-Y, I don’t know if it’s Ratty or Ray T, how he pronounces his name even. I’ve just seen it on the book. He talks a lot about how exercise creates BDNF, brain-derived neurotrophic factor. It creates these compounds that actually act like miracle-grow fertilizer for the brain and nervous system and help grow new, whether you can grow new neurons in certain areas or at least new connections between them. And also…

different growth factors for growing the scaffolding like glial cells around new neurons. And also I think it’s VEGF, Vascular Endothelial Growth Factor, helps grow new blood vessels, microvasculature, so you can bring blood and energy to these. So all of these growth factors are created and secreted by the body in response to exercise. And so that sets the stage. It’s like literally like putting fertilizer on nerves so they can grow faster. And he told a really cool story.

Um, you know, of course in that talk, we’re talking about how it’s relevant for MS just, just like you’re sharing here. But he also told a story that I was reminded of it when you were talking about doing this before, uh, you know, a rehabilitation session or before, you know, functional training session. He talked about how there was a, um, uh, group of students that they were studied, studied going from eighth grade into ninth grade, so they’re entering, entering high school and these students were behind in reading.

And they all were having a special literacy class, the first school period of the day. And some, you know, maybe half the kids, I don’t know what the exact percentage was. A group of the kids went for what they call the zero period. And they did basically gym class and they were running and doing aerobic activity beforehand, and then half the group didn’t. And they saw the group that, the group that went and exercised before this literacy class, they were just like a grade level or two beyond.

Garrett Salpeter(43:53.055)
The group that didn’t do that, it made such a huge statistically significant difference. It was just, it was amazing. And so it definitely speaks to this connection between brain and body. You know, we often, or some people think of the body just as being this, you know, machine to carry around the brain, but it’s a, you know, the body affects the brain, the brain affects the body. It’s a two-way street. And I just couldn’t help, but think of that example also.

Gretchen Hawley (44:16.471)
Absolutely. And, you know, I always talk about neuroplasticity and how it affects our physical body, like our strength, our balance, our walking, but neuroplasticity affects everything. It affects the way that we think. It affects our habits that we have. It’s way more than just our muscles. So yeah, that’s a beautiful example of other ways that priming your brain in that way can help your neural pathways, even just for learning. That’s awesome.

Garrett Salpeter(44:42.475)
Yes, absolutely. So before listening to this podcast, hopefully everyone was doing some exercise, they were able to take in the information. So let’s see. So we’ve talked about vibration and perturbation training, spasticity, and then now aerobic training and using that as essentially a warmup to help open the neuroplasticity window, any other topics or anything else that

Gretchen Hawley (44:49.312)
Yeah.

Garrett Salpeter(45:11.671)
that you’d like to share while we’re doing our updates.

Gretchen Hawley (45:15.127)
I think those are the ones that are probably the most relevant. There, there were other big topics, including sleep. And that was a really interesting one because a lot of the clients that I work with have sleep symptoms. I’ll call it that. And sometimes it’s related to MS, but other times it’s not. And what was pointed out during the trainings was that so often when you have MS or another condition, any symptom that you have is blamed on that.

when in reality it might have nothing to do with that. And so you might have sleep symptoms because your bladder maybe isn’t working as it should and so you have to get up frequently throughout the night to pee. And so that would be more of approaching, improving your sleep by going to a urologist or a pelvic floor physical therapist. But they were pointing out how common it is for sleep disturbances.

in MS and other conditions to actually be from sleep apnea or insomnia or restless leg syndrome, which are actual diagnoses that are treated in other ways, dissimilar to how MS is treated. So I just thought that was a really unique approach in really just reminding us like any symptom that you have might be related to the condition that you have, but it also might not be. And so it’s really important to work with someone

knows that and is open to seeing all sides, because in order to get treated in the best way, you have to understand the cause of it. So they approached that with sleep, as well as a few other conditions, but I just thought that was a refreshing take on all these things that can be symptoms of MS.

Garrett Salpeter(47:04.607)
Yeah, that’s a great insight for patients who do have MS. I mean, sleep is so important to stop the progression of the disease and then to help if you wanna have any sort of chance to restore function, that adaptation happens during sleep. So it’s vitally important. And to know that reduced sleep quality is not just because of MS, but could be from these other co-morbidities or other things. I think that’s…

really useful information and a great perspective for people to take from this. So thank you.

Gretchen Hawley (47:37.951)
Yeah. And you know, we could even apply that to the other things we talked about here. You know, when it comes to spasticity, when is your spasticity worse? Is it related to poor sleep? In which case, if we improve your sleep, we also might be improving your spasticity. Or is it related to fatigue or heat or cold intolerance? So if you do know of a trigger that makes one of your symptoms worse or even falls, and we were talking about vibration training.

have you noticed any triggers of when your falls or tripping might be worse? Is it related to sleep or fatigue or heat intolerance or sensation changes or anything? Because ultimately we want to be focused on the cause and these specific types of trainings that we talked about today, but if there’s anything associated with it we also need to be focused on that.

Garrett Salpeter(48:29.287)
Amen. I also reminded of just two episodes ago, we had Amy Myers on who’s a very well known functional medicine physician. And she was talking about functional medicine being, you know, trying to get to the root cause of course, that’s what we’re doing and trying to do in the realms of physical therapy, rehabilitation. Um, so I, I love that you said that it’s a good reminder of that’s, that’s got to be our kind of our North star really trying to figure out the root cause and work at that level, because if you can get that first domino, then

Other things are, you know, get better, become irrelevant, you know, whatever it might be. But that’s a great way to look at it. So an excellent, excellent note on which to, uh, to wind down here. Gretchen, can you, uh, remind everybody, please, the best, best places to follow you. We already mentioned the missing link website, but talk about your social channels and other, other platforms as well, please.

Gretchen Hawley (49:21.047)
Yeah, so on my website is where you can find all my services and also where to find me in other places. But I’m on Instagram as Dr. Doc Gretchen. I also have a YouTube channel for anyone who likes to watch longer form videos for exercises or symptom management, walking, you name it. And my handle over there is my full name. It’s Dr. Gretchen Hawley. I do have my podcast called The Missing Link. And as of recent, this past July, a book.

called the missing link as well. So searching for the missing link with that spelling of M-S-I-N-G link, you’ll find me in some way, shape or form.

Garrett Salpeter(49:56.991)
That’s right. I know we did a shout out on social for your book when it came out. I got, I was very fortunate. Thank you for got to read advanced copy and I really enjoyed it. I think it’s wonderful. So best place to get that is your website or Amazon or what are the best places to point people to for that.

Gretchen Hawley (50:12.823)
Yeah, on my website right now, I basically just direct people to Amazon. It’s available in as many countries as Amazon would allow me to have it available in, which I think is 13 countries. So as whatever country you’re in, you can go to Amazon and search for the missing link, or you can just search for my name and it should pop right up for you. And it will be an audio book coming in mid January or so. So I’ll keep you posted with the link for that once it’s available.

Garrett Salpeter(50:40.728)
That’s a cool experience. You were in the in the studio recording all that, right?

Gretchen Hawley (50:44.885)
I was, yes.

Garrett Salpeter(50:46.703)
We just released ours too. And so on Instagram, it’s all spelled out. It’s not dr.Gretchen. It’s D-O-C-T-O-R, dr.Gretchen also, just to make sure you’re following the right one. So on that note, thank you so much for coming back on the show. And even more importantly, for the wonderful work that you’re doing, the great information you’re putting out there, the way that you’re helping people that you’re working with directly, and the others that you perhaps never directly interact with, but benefit from your great information.

Gretchen Hawley (50:55.536)
Yes.

Hehehe.

Garrett Salpeter(51:15.023)
And it’s an honor to be able to collaborate with you. And I appreciate you. Thank you, Gretchen.

Gretchen Hawley (51:19.255)
Of course, thank you for having me.

Garrett Salpeter(51:21.499)
And thank you everybody for listening to this episode of the New Fit Undercurrent podcast.