Tony Fowler: And we're rolling.
Taylor Kruse: Welcome back to the Cruise Elite Podcast. What's up, Tony?
Tony Fowler: Good morning, Taylor
Taylor Kruse: Are you having dreary weather?
Tony Fowler: I am.
Taylor Kruse: Yeah, same here
Tony Fowler: I am. And I notice it before I even wake up. I don't know if if you're the same way, but... Even if the blinds are closed and I can't tell. what's going on outside. If I'm really dragging in the morning and then I tend to look outside and it's gray.
Taylor Kruse: Yep.
Tony Fowler: And drizzly or rainy. I'm like, what's going on there? why Why does it feel like every time? It correlates.
Taylor Kruse: Yeah. Yeah, we so our weather just... Really officially snapped cold you know for for the fall and now it's been raining like crazy and it's very damp and cold and i'm i'm immediately missing This summer because our routine in the morning
Tony Fowler: Mm-hmm
Taylor Kruse: Was so nice we we We get a lot of sun. where we live, which is great. And we would just go outside in the front and get. the sunlight and sit there and... Drink a cup of coffee and... That is all gone now.
Tony Fowler: Yeah.
Taylor Kruse: Yeah.
Tony Fowler: Yeah. You know, there's a lot made about. ah sunlight and vitamin D production. And all that. have you Have you looked into that ever? Is that something that's on your radar?
Taylor Kruse: Um... Yeah, I mean, I know it's important. i I looked at that on my own. I got some tests done for my... myself somewhat recently that had vitamin D.
Tony Fowler: Mm hmm.
Taylor Kruse: Levels. It's so funny I laughed, though, because... I got so many issues I'm working through right now. So I'm looking at my. I'm looking at my test and it's like non-optimal, non-optimal. Non-optimal. Vitamin D. Optimal.
Tony Fowler: Huh.
Taylor Kruse: And. And I'm just like, yeah, that figures like, isn't that how health is?
Tony Fowler: Mm hmm.
Taylor Kruse: It's so holistic. that my My scores are, I mean, how many people would like to have optimal vitamin D? I mean... Most.
Tony Fowler: Yeah.
Taylor Kruse: And so many people don't. And then here I am with like all these. All these things that need to improve. And then, oh yeah, by the way, you're... Vitamin D is amazing. Next. Non-optimal. You know?
Tony Fowler: It's like a D D.
Taylor Kruse: um Yeah.
Tony Fowler: D.
Taylor Kruse: Yeah, yeah.
Tony Fowler: A plus in theoretical physics.
Taylor Kruse: Exactly.
Tony Fowler: D.
Taylor Kruse: Exactly. Exactly. Yeah, so it's on my radar. You know, I know it's important stuff, but that was. funny for me to see.
Tony Fowler: Yeah. Yeah. I would be curious if you take one. one of those same tests sometime. in the late winter or something if if
Taylor Kruse: I know.
Tony Fowler: There is a difference because.
Taylor Kruse: Yeah.
Tony Fowler: It's talked about a lot. I've never done the tests. So I have no idea. But.
Taylor Kruse: Yeah, well, I got to say I did focus on getting as much sun as I could. as i could this summer More so than than normal
Tony Fowler: Mm hmm.
Taylor Kruse: you know I was saying, like, I got... I got like the first tan of my adult life this summer. Basically.
Tony Fowler: Yeah.
Taylor Kruse: you know something that wasn't Something that wasn't a...
Tony Fowler: Yeah.
Taylor Kruse: ah fisherman's tan, you know, usually it's just my forearms and my face.
Tony Fowler: Right. Awesome, man. Awesome. well Amen. What's cozier for a rainy, dreary day? than talking about applied neurology.
Taylor Kruse: Yeah.
Tony Fowler: We've got an interesting episode teed up. uh I... had mentioned to this I mentioned this to you a while back. And... You know, one of the things that that I keep seeing. And... the questions that we get from listeners, but also just in the conversations. and the examples that we bring up is how often Pain. or tightness. or even injury history. tends to be one-sided.
Taylor Kruse: Right.
Tony Fowler: tends to be something that's... Mostly happening on the right side of the body or the left side of the body. um One of your. Uh, examples. that you bring up for yourself. is That. Historically. you were having injuries on the right side.
Taylor Kruse: Yeah, exactly.
Tony Fowler: um And it would be the knee one time, and then it would be the the wrists and the elbow the other time, but it was always kind of on that one side.
Taylor Kruse: Right.
Tony Fowler: and you started talking about patterns and Not to get too ahead of myself, but it seems like there's a there. there. In terms of.
Taylor Kruse: Mm hmm.
Tony Fowler: Asymmetries. And... the nervous system, and the human body. between left and right.
Taylor Kruse: Mm hmm.
Tony Fowler: And so I thought it'd be really cool to just. Have an entire episode talking about that.
Taylor Kruse: Yeah, that's great.
Tony Fowler: Um... So to kick us off, I think... You know, it might make sense to... Talk about these asymmetries generally and then as we move forward get more and more specific about you know, one sided issues or or how to deal with. issues that cross the body and that type of thing.
Taylor Kruse: Mm hmm.
Tony Fowler: Um, So... First of all... Why left and right? Like why? Why do we have the, not not why do we have these structures, but what what is it about the the way that the nervous system is made? That. leads to this. Uh... you know dichotomy between left and right.
Taylor Kruse: Yeah, it's... ah it's It's interesting. When you when you look at... The brain and the nervous system, it's like... Well, a human is basically... two halves Slap together.
Tony Fowler: Hmm.
Taylor Kruse: When you look at the brain, right? There's a right side of the cortex. There's a left side of the cortex. When you look at an image, it maybe be all looks like one. but There's a right and there's a left side. As you go into subcortical structures. this idea continues right so we get into like the brain stem we have a right side of the brain stem We have a left side of the brainstem. We look at the cerebellum. that little brain that lives underneath the big cortex that we say is kind of the home of are movement ABCs, accuracy, balance, and coordination. Well, we have a right cerebellum. and a left cerebellum. So when you look at images... you know, things look like one big structure, one big physical structure. But. In fact, we have... Halves to that. And... It's like they've just been. Slapped together and and you know why by design ah Well, I mean... Did two things come to mind? uh for for me it's one it It's a good... survival strategy i think to have a right and a left side. and And what... what's really interesting about The brain. What's really amazing about the brain is... its ability to compensate. So even though we have a right and a left side, There's... an incredible level. of compensation that our brain is able to do. In other words, lots of... systems in areas that can pick up the slack. for another underperforming area. maybe even a ah neighboring. underperforming. area. And I think as far as a survival strategy goes, this is a great design because... If there's an injury to one area, of the brain. Let's say... on the right side. Hopefully, and what usually happens is that Areas nearby are able to pick up the slack for that now injured area, and even on the other side of the cortex. you know there's There's the ability for the other. hemisphere, the other side. to also compensate. So there's like all these systems and structures all over. the brain that are able to help one another out. And I think that that is primarily a survival strategy. right it's it because if we put all our eggs in one basket And. this This area of the brain is for only this. one thing. And it happens to be, let's say, in the right cortex, but not the left. If that area gets injured, well, guess what? You are now without. the ability to use your body in a certain way. Or... to remember things or... you know to whatever the case might be, whatever so whatever skill is lost. due to that injured area. So it's not built like that. All right, it's not built like that. and And it's a great it's a great survival strategy. the The other thing that comes to mind as we take those two halves and... put them together. is human locomotion. Just, you know, like how important. It is for... Humans. to be able to move and get from One point to another. It's very, I mean, when when you really... boil it down. It's humans are either going to move towards something. Because they want to there's a goal And they're going to... try to accomplish that goal. Or sometimes the goal is the opposite. Move away from that thing because... It's either non-interesting or... dangerous. So we're always moving The question is, what direction and why? And when we take those two halves and put them together. and you kind of look into the circuitry of how Movement is created. You start to see how the design starts to look very... Advantage is for walking.
Tony Fowler: Mm hmm.
Taylor Kruse: You know, that kind of reciprocation of. opposite hand, opposite leg. And... Those are the two things that... that really come to mind. It's survival. And it's locomotion. You know, when we look at those those different... halves and put them together.
Tony Fowler: Yeah, that's fascinating. ah ah ah An example that comes to mind that would illustrate your your first point is. Having two eyes. You know, if if one eye gets poked and...
Taylor Kruse: Yeah. Exactly.
Tony Fowler: You can't see. If you only had one eye. you know. that you would be in for a much harder ah compensation. than if you have a second eye that you can you know keep open and and keep
Taylor Kruse: Yeah. That's right.
Tony Fowler: Keep seeing, right?
Taylor Kruse: You know, that's ah that's an interesting example actually is the visual system because... when When you look at... how visual Input is processed. Like when you look at... A diagram. of of how... visual input. enters the eyes and then You look at where it goes. in the brain for further processing. it's really interesting because the the visual input that's coming in, let's say through the right eye. We'll enter the right eye but it's not an ipsilateral type of. Um, processing or... it's not It doesn't have just ipsilateral. Um, effects. On. one side of the body, it actually splits. So visual input coming in through the right eye will actually eventually split and has an influence on both the right and the left cortex. another possibility to kind of build the case for survival strategy because if If you are right, I... what If all the processing for your right eye happened, let's say, in the right... cortex and you get an injury. Let's say to the right eye. Well. you're kind of out of luck You might not be able to have some level of compensation to at least... Use that right eye to some degree. So looking at the left eye, it also splits, of course, goes to the right in the left cortex. It's an interesting one. compared to... When we look at just basic voluntary movement. and although there is always some level of bilateral activation happening. when you look at basic voluntary movement. If I move the right side of my body. Most of that. activation is going to be coming from the right side of, let's say, the cerebellum. And. uh also the opposite cortex so the the left cortex basically right it's it's more complicated than that but we can at least reduce it to understand it and know that Those are the primary. pathways that that are involved, yeah.
Tony Fowler: Yeah. No, I mean, it makes sense when we talk about vision and how... important it is to coordination and movement.
Taylor Kruse: Right.
Tony Fowler: Um, How it would inform the other side of the brain that's... navigating you know that's controlling the other half of the body.
Taylor Kruse: Right.
Tony Fowler: Right. Back to your locomotion.
Taylor Kruse: And it's the most important. first Yeah.
Tony Fowler: Example.
Taylor Kruse: It's the most important. for locomotion and survival. is your eyes.
Tony Fowler: okay
Taylor Kruse: It's hard to do either one of those things if you can't see well. That's why it's at the top of that hierarchy right when we talk about the the neural hierarchy.
Tony Fowler: Yeah. So when we talk about that those two halves... kind of kind of splice together, right?
Taylor Kruse: Right.
Tony Fowler: Um, You know the image that I get is one of a mirror image you have two halves of the brain they look the same from the outside, right? ah your Your face is mostly symmetrical.
Taylor Kruse: Yeah.
Tony Fowler: You just have two eyes on each side, two nostrils. Your mouth is right in the middle. You got two ears, right? There's two arms on each side. There's two legs. um So it's very easy to... just assume the whole thing the whole way through. is symmetrical.
Taylor Kruse: Right.
Tony Fowler: ah But we've we've stumbled upon upon a couple examples where that isn't the case. Um, So I just wanted to... to talk about some of those structures that All right. inherently asymmetrical. And. Also ask you if there are any structures in the brain. that may be like that as well. um So the ones that come to mind are... for me are the internal organs to start.
Taylor Kruse: Right. Yes, that's the big one.
Tony Fowler: Um, Lungs seem symmetrical, but your heart? It's kind of offset. And... the lymph system is kind of offset. Maybe because of the heart. I don't know. um and the livers on one side.
Taylor Kruse: Right.
Tony Fowler: you know when we talk about boxing we talk about getting a liver shot um And so I'm curious how this might play into. applied neurology, if at all.
Taylor Kruse: I think it does ah it does play into it, I think. I mean, those actual... physiologic differences. matter. um There's... You know, there's theories out there especially based around how organs in their asymmetry affect our breathing?
Tony Fowler: Hmm.
Taylor Kruse: for example you And it's a thing, I think, you know for sure. it it definitely can play into the patterns that we see. Um, What you... generally see is that Even with something like... Breathing. If you... assess it on a person and you... For example, we have an assessment called an arrhythmic excursion where you... have your hands on somebody's lower ribs and then you have them breathing and you're evaluating what's moving, what's not. Is it somewhat symmetric? Is there... movement on one side. not the other, or maybe movement on one side and then... some latent movement on the other And you see a lot of differences. You see a lot of differences in... the way a person's breathing. I think we see these same differences in the way A person is walking. And it's hard for me at this point to go. Those differences are present because of... these this physical asymmetry that we know exists because of our Organ placement. right It's hard for me. To go all in on that Especially when I... when I See... patterns That. Typically... look more neurologic in nature. Like when we talk about. cerebellar patterns in the body or PMRF patterns. in the body. Really what this all comes down to... is differences in muscle tone. Side to side.
Tony Fowler: here
Taylor Kruse: And you can have those differences for so many different reasons. It's hard for me. to go all into the camp of oh it's it's because your liver is over here and it's asymmetric or, you know, one side of your... one side of your ribcage does not expand. you know, Due to... how the the lungs are positioned and More mobile on one side, less on the other. Like there's a lot of different theories, right? And they're all valid. Like they all. They all get worked into this in some way. But... We can't just reduce it to that because. When you start. Testing. different things with. people and their neurology. You see... How? much of an influence all these different sensory systems have on muscle tone. in movement. you know the eyes We talk about a lot. the vestibular system. the proprioceptive system. There's so much there and it all has an influence on muscle tone and side to side difference. Okay, these pathways we're talking about.
Tony Fowler: Mm hmm.
Taylor Kruse: movement pathways, sensory pathways. It all matters. right It all matters, and and that's what makes it. difficult, I think. to to do this kind of work and to try to figure out. What, in fact, do we need to do with a person? to try to maybe... call it restoring some level of symmetry, even though I don't actually. believe that that's the goal. Because... with Function and you know with humans it seems like by design things are asymmetrical to some degree. And symmetry doesn't really seem like it should be the goal. But... The way that I view it. Just based on. experience and you know, meeting people and learning about their different uh compensations and things that they're complaining about pain issues whatever they're even their performance you basically see that... Everybody has some level of asymmetry. Both. In there. structure and in their function And so it's not really, okay, we're supposed to be perfectly symmetric. I think that idea. doesn't match. But... when our Compensations Get. Two. Large, let's say. There could be. consequences to that. Right. And for me, I'm always looking for. the type of comp compensation that we see in function. Right? where There is some... Let's call it an imbalance. with the brain. Okay, everyone's kind of familiar with like a muscle imbalance. Maybe your right side is stronger than your left side. very very comment and find stuff like that. We're going now. many level levels higher. And we're saying that those imbalances actually begin somewhere else, not just in the muscle. Because... higher order systems are responsible for controlling. those muscles right, so That's why. I find it so valuable to have. Neurotesting because you can get an idea for some basic patterns. Like. whether or not somebody needs more Activation. directed towards the right side of their cortex versus the left. This is something that we're always interested in and always trying to figure out because if our testing can suggest one or the other. And then we start doing that. through testing we can see, oh yeah, okay, what if I design training for this client? that is a little bit more... targeted towards maybe the right brain. Because... These tests suggest that that would be good for them. And then we test and function improves. If I can now create some level of asymmetry in their training. based on those deficits that I think I'm seeing. Usually I feel like we can close the gap. between what these imbalances might be and although we're never going to find perfect symmetry When we close that gap. We see an improvement in function. And if we hit it right, usually everything gets better. Pain goes down, performance goes up. All these goals can can be accomplished. when we figure out the right. pattern to go after it's it's pretty cool
Tony Fowler: Yeah, one of the Hmm. one of the things you said just stuck out to me is that like uh symmetry isn't the goal
Taylor Kruse: Yeah.
Tony Fowler: um That were inherently. asymmetrical. And so I guess part of part of why I'm going down this path is because... It seems like inherently we're mostly symmetrical. And so just identifying where. structures might not be. might be clues as to to why the body is is the way it is. what one of
Taylor Kruse: Well, that's a good. Sorry, go ahead.
Tony Fowler: um the Well, no, no, please.
Taylor Kruse: Well, what I was going to say is that's interesting. you So you keep saying. Things look symmetric and and it didn't really occur to me Until this moment. That. To the average person. The human looks symmetric. Right unless you have a trained eye Like you said. Well, we have two eyeballs. We have two ears. right we have two sides of the face but the face looks symmetric well when you when you start Looking. At people. and the way they're moving and really zooming in. Why? you can see that it's not actually symmetric. There is actually... I would say most people. have some level of facial asymmetry. But you don't really see that unless it's the average person that doesn't. isn't looking at people in this way. They may not recognize that unless it was very significant. like let's say somebody who's had a stroke and they've had You know a lot of atrophy and loss of control of those muscles maybe on one side of their face So they have that that sort of droopy look to the corner of their mouth and maybe their eye. and you know that that's more of the extreme example Right? But. with the general population. healthy people can have these asymmetries. And. Most do. Most do, if you look. If you look pretty closely and this is what we're. Teaching a lot in our courses, especially with like cranial nerve evaluation. where we look at the face and the cranium and We also look at gate, right? we We talk about gate and we look for all these little subtleties in gate where. We see these little postural. Compensations where... Maybe we're finding a loss of muscle tone somewhere. versus on one side of the body. versus another. And that stuff's hard to see. if you're not looking for it. But it's there with most people. Which is why when I look at... Somebody I... I don't see symmetry
Tony Fowler: yeah
Taylor Kruse: But I can see how... Somebody might, if they're not. looking really closely or they don't have that training.
Tony Fowler: yeah I think one example that most people are familiar with and take for granted is. um Uh... Hand dominance.
Taylor Kruse: Sure.
Tony Fowler: Ciao. A lot of people are right-handed.
Taylor Kruse: Yes.
Tony Fowler: a smaller group of people are left-handed. Some people are ambidextrous. Um...
Taylor Kruse: Right.
Tony Fowler: And that's the outlier, not the not the norm. So I'm curious how how how that fits into this puzzle.
Taylor Kruse: Yeah. Yeah, that's an interesting one. i I get questions on that quite a bit, especially in our courses when we start talking about cerebellar testing.
Tony Fowler: Mm-hmm.
Taylor Kruse: Because testing the cerebellum is one of the first things we teach people how to do because it gives you so much valuable information right away. Which... Basically, you're learning about which side of the body is more coordinated than the other. And most people have a deficit. As you mentioned, we have more people that are right-hand dominant. so The question is, well, does that play into like the testing? That's what people ask. And it it does, right? It is more likely. that a right-hand dominant person is probably going to have uh, less. Right hand. cerebellar deficits or right cerebellar deficits. I say that because it's an ipsilateral relationship. Okay. And maybe those. coordination issues would exist on their left side. And that is the most common pattern that we see. No question. and We should circle back to that in a minute because I'll... I'll explain. what the possible outcome of that could be.
Tony Fowler: okay
Taylor Kruse: Right. because we see it a ton. So. but But it's interesting. After testing... Lots of people. Even. right Let's say right-hand dominant people. Sometimes we'll have... still a right cerebellar deficit. And the deficit can show itself in different ways. Sometimes it's body area specific. So. For example, I'm right-hand dominant. And when I do my cerebellar testing. it's very clear that the right side of my body mostly is more coordinated. then the left. Okay, that's the common we see that very commonly, but... I do show. On occasion... A deficit when my... testing is directed towards my right. Ankle. So... To give our listeners an idea, if you don't yet know... what cerebellar testing looks like. They are rapid. kind of rhythmic movements that we would do. so ah tapping your hand, tapping your foot on the ground. um any Any kind of movement that... requires some speed. some accuracy. some rhythm. And then we do that for, let's say, six seconds or so, and you compare side to side. did you know are you seeing or is the person feeling a ah different side to side in their coordination. So for me, I'm mostly... um going to be a left. cerebellar deficit. but that right ankle when i do a simple assessment called foot tapping Sometimes. That shows a deficit. which does not go. with my right hand. dominance. Kind of thing right pattern
Tony Fowler: Yeah. So it's not the whole story.
Taylor Kruse: It's not the whole story and and and it's Here's where it gets really interesting. That deficit for me only exists when... I'm not feeling my best. So let's say my immune system's compromised in some way. Or... I got really lousy sleep for a few nights in a row. Okay. Maybe... i don't know i'm traveling i didn't I didn't get to eat as well as... I would if I was at home or something. and And that's typically when that pattern. shows itself. Now as you dig deeper, I have injury history. on that right ankle So then you got to... wonder, hmm. Is that involved in this? right Because I've sprained the ligaments in my right ankle. more times than I can remember when I think about skateboarding growing up. and also a couple of really nasty ankle sprains. in college wrestling on that right ankle. So there's a lot of history there. So then it's like, okay, well. It seems like the pattern only comes out when my... My system as a whole is compromised to some degree. And then it's almost like then the local. function, let's call it. starts to... surface as not as working not as good. as other things. So then I'm the righty with actually a ah right side cerebellar deficit.
Tony Fowler: mm-hmm
Taylor Kruse: that's only there once in a while. So history matters, injury history.
Tony Fowler: Sure.
Taylor Kruse: All these other things can play into it when it comes to function. Which is... interesting and Oh, you see that a lot too. right we see that a lot too So. Something to consider.
Tony Fowler: Yeah, I guess. One of the things that strikes me about... hand dominance in particular. Is that it seems like. Most people, I think it's like something like 9 out of 10. are right-handed. one out of ten are left-handed and then some smaller percentage. is ambidextrous just uh from from the the numbers that I've seen.
Taylor Kruse: Mm hmm.
Tony Fowler: To me, that implies that there is a structural bias. Maybe in the maybe in the cerebellum, maybe somewhere else in the brain.
Taylor Kruse: Yeah.
Tony Fowler: I don't know. that That. favors a side.
Taylor Kruse: Yeah.
Tony Fowler: And I'm curious about that because that seems significant.
Taylor Kruse: It seems significant. I don't know.
Tony Fowler: Hmm.
Taylor Kruse: ah This is something that is... ah This is something that... people It doesn't seem like people are agreeing on this anywhere you look. So it's really, and this is why there's different philosophies and ways of. thinking and methods that are designed around. you know one idea and it's It's hard, again, for me to... to consider it being Coming down to one thing. Um, So I don't know. um i i i'm it's it It actually seems like. as we move forward in our understanding of the brain and nervous system less and less people are agreeing on some of these side to side. differences in in structure
Tony Fowler: Hmm.
Taylor Kruse: And it's becoming... It's... It's becoming hard to... uh, To pinpoint any. any one thing. Yeah.
Tony Fowler: and So... I guess ah to phrase it another way. That rule of thumb. maybe way more simplified than... Uh... you know, what people are actually finding in in the studies and in the field.
Taylor Kruse: Yeah, I think so. And the thing is for me is I... For me, it's like I... I sense that. And... you know Someone might have this curiosity. to go further. to understand that. And I don't. I just, ah there's there's this. Trait about me. as A learner. And I don't know if it's good or not good, but it keeps me... It keeps me in. in the lane that I want to be in, which is more. It's always more based on... Having things I can apply.
Tony Fowler: Mm hmm.
Taylor Kruse: Having things I can apply Because you could take this. into so many different galaxies with... what people are learning. and and with new emerging research about the brain and nervous system that It's so easy to follow those things out of curiosity. And the the more you go into... The depths. with the brain and nervous system. the less applicable. any of it becomes. So for me... I actually feel like I've always been good at drawing a line for myself almost like predicting enough that, yeah, if I go if i go into that that, that's probably not going to help me.
Tony Fowler: who
Taylor Kruse: with what I'm actually doing. which is... really incredibly basic. When you. Consider. What? some other researchers and people are doing. in the field of neuroscience. It's incredibly basic. In fact, it's so basic. that if you were to approach somebody whose life was devoted to research, on the brain and the nervous system They would. They would look at. what we're doing. as None of it is true. Because... They may understand the brain and nervous system. at such a more complex level. that to reduce it to basic rules and things. and sides of the body. would seem like it's not possible.
Tony Fowler: Mm hmm.
Taylor Kruse: And that's kind of... It's interesting. It's kind of exciting. It's kind of cool to know that it keeps going and it's going going and going. And maybe I'll save some of that study for... yeah other chapters of life.
Tony Fowler: Sure.
Taylor Kruse: Right? But right now, it's like... How do I stay on target? and and and keep it applicable. So... i I start to go down some of those roads and I'm like, eh. We gotta... let's keep it let's Let's keep it where we can to. you know, So that we have assessments we can run and then we can look at function. You know, because the goal for us is movement, right?
Tony Fowler: Yeah, so So in your practice. you know, ah hand dominance. And... everything that goes into that. whether it be the cerebellum or other things. It's all kind of the firmament and then you're You're just... you know You're just working from that level.
Taylor Kruse: Yes, and and every time...
Tony Fowler: in the soil. You're not. Yeah.
Taylor Kruse: Yeah. And every time I think I know something, I meet somebody who. violates it. So... you know Here comes the person. you know with ah you know Here comes the right-hand dominant person, and we test all their body areas, and their coordination is worse on their right side.
Tony Fowler: Yeah.
Taylor Kruse: Everywhere. I mean, it's like, okay. How did this happen? what What is this? um It's... it's It's so complicated the way that a human is able to compensate. We are we are compensating systems, you know? it's It's really amazing. So... When you see stuff like that. It's... ah It forces you to go. Yeah, there's a there's a lot here and I don't want to get lost in the weeds. So You stick to your assessments and you stick to your functional outcomes, which is always the most important. Yeah.
Tony Fowler: Yeah. So... One more, one more. sort of structural point that I think you do use regularly. in applying this stuff is Uh, where. Pathways Dekusate. And I learned that word from you.
Taylor Kruse: Oh yeah.
Tony Fowler: um And so it seems like there's... several specific places. You mentioned one earlier. Between. you know the eyes and the cortex where
Taylor Kruse: Yeah.
Tony Fowler: those pathways cross from one side to another. And so I thought it might be cool to kind of outline those.
Taylor Kruse: Yep.
Tony Fowler: at least the ones that you care about from an applied perspective. Um, and and And just mention them so that when we start talking about problems. on one side or asymmetries or other things that we can we can refer to those points as perhaps ah places to focus our attention, right?
Taylor Kruse: Yeah, that's that's an interesting one. So we were talking about this the other day in the NeuroDojo when I was teaching sensory testing. kind of like our more advanced sensory testing lecture. where the students learn how to... Test sensation on the skin. So... too We use tools like... a vibration tool. So testing, can you feel this? on you know one side of the body. can Do you feel it the same? on the other side of the body So we're testing. technically lots of different levels of a person's neurology, but... Very basically, your first testing. local receptors, And. Just like we can have. imbalances In. Right and left. sides of the body with movement. You can also have Sensory imbalance. where Perhaps. a person Feels vibration. Quite accurately on their right side. Let's say the back of their right hand But then when you test that. Same sensation on the back of their left hand. They go, oh, actually that. I didn't feel that as much. the' right The right seemed... more intense. So. Those sensory... Deficits are very common. And we're looking for... It's not that we're looking for like super subtle ones. Typically, we're going to be more concerned. uh with ones that are Larger? But. It's amazing in a healthy population. you'll find those. And and some of and there's lots of different reasons why. you can find those but This is a very big part of our philosophy. is is testing. a person's ability to feel these different sensations. And we have a whole toolbox of sensations that we actually test. And those sensations belong to their respective categories in terms of... the sensory pathway or or spinal tract. that they travel. And... The other day we were looking and you know We were looking at this a little bit closer, and so we have sensations that belong to what is called the dorsal column. so Something like vibration. It's more of a dorsal column sensation. And then we have sensations that belong more to this spinothalamic. system such as... sharp. sensation or something that's becoming a little bit uncomfortable but also temperature like warm.
Tony Fowler: mm-hmm
Taylor Kruse: and cool So we have this toolbox with these different sensations that we test to learn about any... local receptor deficits that a person might have. at The skin level. And when what this tells us when we find these deficits is. maybe we have receptors that need training. Okay, maybe we have a peripheral nerve that needs training. We look at the different levels as we follow. The pathway... and try to understand. where the problem might be. along these levels And the sensory information always... ends or terminates in the opposite cortex for processing. So, in other words, as we follow the pathway Eventually, it always ends up... In the cortex, which is critical for us when we're trying to understand side to side differences. in the body, which we always are. That's what we're always looking for. So for example, If I don't feel vibration... the same amount on my Left. hand let's say there's a loss of of sensation there technically you could say that is a right brain problem. because all sensory input. goes to the contralateral, so that means opposite. Cortex. except smell. So... this This is the basic rule we use. there you know This rule can be violated, but more... but It's pretty pretty solid. right to look at it this way So that tells us a lot. Side to side. um which is very important Back to what you were saying about where things cross. It's interesting because... the two pathways, let's say, that we spend the most time talking about, the dorsal column and the spinothalamic. tract or system. they cross the midline in different places, different areas. So the the one that's... Really interesting to us. is this dorsal column because it it the the deck you say um word that fancy word It's fun to say.
Tony Fowler: It's a good word.
Taylor Kruse: Yeah, it is It. actually crosses in the brainstem. at the at the level of the medulla. which is kind of the lowest. portion there of the brainstem.
Tony Fowler: It's way back.
Taylor Kruse: And.
Tony Fowler: Way back in the early... part of your brain.
Taylor Kruse: Yeah. Yeah, subcortical. And so many things, like if you look at the. brainstem. This is why it's such an important um structure. to to know how to test and and work with because there's so much. Crossing. And there's nuclei that live there. and descending pathways, and it's ah it is a... when When I teach our students this, I show them a graphic. of some of these pathways that cross at the level of the brainstem but then also where descending pathways begin.
Tony Fowler: Mm hmm.
Taylor Kruse: And it looks like. what you see on a yeah On a map. um um in a subway subway station. We call it the subway station. Because you know, you're looking at the graphic, you're you're taking the commuter rail, the subway or something, and everything's color-coded.
Tony Fowler: Mm hmm.
Taylor Kruse: and you see okay this this starts here and then you know you follow it and it ends here
Tony Fowler: Just take the green line, you know, to...
Taylor Kruse: and Exactly. You got green lines and blue lines and orange lines and everything seems to be crossing somewhere. That's what it looks like. That's what it looks like So that dorsal column. crosses in the medulla. eventually goes to the opposite cortex. We like to say the parietal lobe for. sensory processing and it's very important. to know that because What that suggests... I've seen this. A lot. is this. this i this kind of theory using this theory to help so let's say back to the Loss of sensation on the left side. of the body we said the left hand We might. We might think okay Maybe there's... receptor issues happening locally. okay, perhaps I've had an injury there. Maybe I have a scar. So that might be the case. But I also have to look at. peripheral nerves that supply that skin area. maybe Maybe we have a peripheral nerve issue. Following the pathway more, maybe we have a spinal cord issue. following the pathway. even more i arrived there at that medulla And. At that point... One of the neat things that we've we teach our students about this is that we could potentially use brainstem activation to increase Sensation. on that left side of the body And I've seen it work many, many times, which is really cool, where when Something like humming.
Tony Fowler: Mm hmm.
Taylor Kruse: Or gargling? or activation of the muscles in the in the throat or even the tongue. Because... these this area. is... um Related. to the medulla when you start looking at cranial nerves. That originate there and supply muscles to like the pharynx and. The tongue and... There's a lot there. but You get the idea. I can maybe activate those muscles. to potentially stimulate the medulla And. In neurology... We like to look at... Pretty much everything is a two-way street.
Tony Fowler: Right.
Taylor Kruse: And when I first learned this idea of activating... Something. to help something else. right It was taught to me as, remember this. A rising tide lifts all ships. And some people say things that... Act on or things that fired wire together, fire together.
Tony Fowler: Mm hmm.
Taylor Kruse: Right. There's a lot of different sayings. that Describe this idea It's amazing because when we know the basic neurology, we can then activate one area to help out maybe an underperforming area. So that loss of sensation on the back of the left hand might be improved. While a person is gargling. Let's say warm liquid. And all of a sudden they're like, oh, that's crazy. Peace. vibration feels the same On my right versus my left. That's crazy. And, and so that's an example of how you would use one system to help out another one. And that would go into the training process.
Tony Fowler: Mm hmm.
Taylor Kruse: And it doesn't have to be even the medulla because you don't necessarily know what's going to help yet. You're testing different. possibilities. Maybe that doesn't help. And so you continue your thinking. into the opposite cortex, because we say that... this sensory input eventually is processed in the opposite parietal lobe. So then perhaps... more parietal lobe activation. could help restore sensation more equally on that left side. So then we reach into our toolbox and we go, well, how can I activate the parietal lobe? and there's lots of different ways, but one of those would be ipsilateral smooth pursuits.
Tony Fowler: Yeah.
Taylor Kruse: which is an eye tracking exercise. So if I follow my target to my right And I do repetitive smooth pursuit exercises. I'm stimulating the right parietal lobe. You get the idea? Perhaps that helps. restore sensation on the left so you don't necessarily know What's going to help? Is it a local issue? Perhaps. Maybe all you need to do is... Phil. the missing sensation. by providing vibration there on the hand.
Tony Fowler: Manual. manual stimulation, yeah.
Taylor Kruse: Yeah. Yes, yeah exactly. Maybe there is a peripheral nerve issue. right maybe Maybe we have to look at... you know let's say the radial nerve and you happen to have an injury history that goes with that or for some reason you're having a more mechanical issue. you know And that peripheral nerve is... impacted or you have a spinal cord. problem or a history of injury there and that nerve is impacted in some way. so that Information is. Not as clear. right into when it's traveling.
Tony Fowler: Right.
Taylor Kruse: So this is the idea of... looking at a one-sided issue. Understanding. Originally, what we were talking about is where things cross. When you know that, you can think about those different levels and include it in your testing and your training. and not everything crosses in the same place. Well, why? Well, I would guess it's a survival strategy.
Tony Fowler: Sure. If there was only one crossover point and it got borked.
Taylor Kruse: Yes. then we're not going to were yeah We're not going to go very far. as a civilization if it only takes an injury to one spot to take us out.
Tony Fowler: So. You just outlined essentially in this last passage, the eight levels. Model. of
Taylor Kruse: Right.
Tony Fowler: of ah Problem solving, I would almost call it, right?
Taylor Kruse: Exactly.
Tony Fowler: um going from the local level, following the nerve. up and then into the spine where you have these big pathways the dorsal column and the
Taylor Kruse: Mm hmm.
Tony Fowler: a spinothalamic and then up into the brainstem and then it crosses over at one point.
Taylor Kruse: Yeah.
Tony Fowler: um But then. you know You can keep going up but to the cerebellum and and trigeminal and then you know then all the different brain areas until finally you reach. the cortex in this case on the opposite side.
Taylor Kruse: Exactly.
Tony Fowler: Um, And. you know. Good news, we have an entire episode. about that process and following that process through the eight levels. um
Taylor Kruse: That's right.
Tony Fowler: To me, that's... That was one of the most important. uh episodes that we've done together i think um
Taylor Kruse: yeah that was good maybe we can stash that in the show notes
Tony Fowler: Yeah, let me put a link
Taylor Kruse: Yeah.
Tony Fowler: um So where might else? Besides the medulla. or the brainstem to simplify, where where else are we seeing crossover points?
Taylor Kruse: so on the kind of staying for a moment with that sensory discussion, that other... That other system, we would look at the spinothalamic system is interesting because it it does not. DECUSATE. in the medulla.
Tony Fowler: Mm hmm.
Taylor Kruse: it It decusates at the... level of the spinal cord. So. For example, We might not be looking for to like brainstem activation. at that point to help. um that sensory system necessarily but we might then look again at the parietal lobe because
Tony Fowler: Mm hmm.
Taylor Kruse: All sensory goes to the contralateral. um you know, cortex. So just to kind of finish that off now. When we start looking at movement pathways, It gets interesting, especially when you look at some of like the cerebellar pathways. and you know There's a lot there, but... but... What it comes down to is that... Some of these... pathways. Will cross at the level of the ponds some at the medulla. It's very useful to know that. because... Again. especially with cranial nerves. they become a very... important stacking tool. for us when we're when we're... trying to help people improve. basic movement. So... for example We typically look at... Some of the pathways that have more of an influence on the pawns as being more accuracy based. And then some of the ones that have more of an influence on the medulla, we look at being more rhythm. based
Tony Fowler: Interesting. yeah
Taylor Kruse: And it's really interesting to see that because that means if we have ways to activate those different. Let's say divisions of the. brainstem, we might be able to accomplish certain goals when we're looking at what we think is dysfunctional movement. For example, is somebody having an accuracy issue? Maybe more pontine activation could help that. versus is somebody having a rhythm issue. and they look different and we teach people how to identify those differences in testing. And accuracy issues the... easiest one to describe and think about, it's literally what you... would assume. the person can't hit the target. Effectively... you know, and repetitively. And so there's... there's accuracy problems, so... For example, one of our classical cerebellar tests where you You touch your nose and then you reach out and you touch. A coach's finger.
Tony Fowler: Hmm.
Taylor Kruse: And you go nose, finger, nose, finger, and they're moving the target on you.
Tony Fowler: Mm hmm.
Taylor Kruse: and Sometimes we even do this. where You're using like peripheral vision. to sense where the target is and you're reaching out, you're trying to touch it and you might miss. Right. and And that starts to look like if if it's. repetitive it starts to look like an accuracy issue So... you would then approach it, the thinking the same way. where you're using the eight levels and thinking about that subway station. Right? to go, okay, what what am I really seeing here in what levels? might matter. in helping this very specific issue that looks more accuracy based than it does rhythm. Rhythm problems might look different. It might look more ratchety. As the person's moving, they might be taking a strange movement path. So. They're doing the say the finger nose type of assessment and the path they're taking with their arm. Looks like it's happening. In a strange way where maybe the speed of the movement. And the tempo is changing. when it really shouldn't. All right, that would be look. we would look at that as potentially more of a rhythm issue. Maybe that's what you're seeing, but they're not missing. Or maybe they have... misses, so it's accuracy issues and rhythm issues. So that this is why it's important to kind of be able to tease out what you think you're actually looking at. Because then you can think about. the the neurology that's... Call it. further upstream.
Tony Fowler: Mm hmm.
Taylor Kruse: Because those things might be impacting. function. And. I love that. I love that because before I learned all this, everything was just a movement problem. You look at a squat, you see someone's left knee wobble. Oh, must be stability. No. there's a lot more that goes into that wobbly knee. It can't just be a glute medius problem. Right? Because that's that's what it was for me at that point. Okay, left knee wobbled.
Tony Fowler: Right.
Taylor Kruse: They're having a hip stability problem. Okay, no problem. What's the solution? Let's go train the glute medius.
Tony Fowler: Strengthen the one side, yeah.
Taylor Kruse: Yeah. Yeah, so so it's... ah It allows you to go, and everyone knows that doesn't sound right. Okay? You don't have to know. You don't have to know neurology. You get to a point where you when you're. You spend enough time around movement. You watch enough people move. Even if you don't yet. study neurology. You get to a point. in your career as a coach where you go, yeah, there's got to be more to that. I'm not sure what it is yet. But, and and that's. You know, that's why I love neurology is because then you could go, okay. So the left knee wobbled on the squat. Yes, it does look like a stability issue. Where does stability come from? It comes from the brain. It doesn't come from the gloop medias. Right? So then we can follow the pathway. and go, well, why is the glute medius not? doing its job well. Let's look at some of these higher order systems that are telling it what to do. Right. And I love that. i love that so then if I If I know how to test things, if I know... you know how to use the tools in my toolbox, i can I can start to get a little bit bigger picture. on a person's function and some of these higher order systems which is uh it's so it's so useful to Teasing out. specific types of issues.
Tony Fowler: Yeah. Um... I'm assuming like that you said the eyes. tend to correspond with the same side of the brain, even though they cross over to both. But like when you were simulating. one cortex, you were doing ipsilateral pursuits to that side. Um, I'm assuming ears also.
Taylor Kruse: Yeah.
Tony Fowler: tend to correspond. With. the side of the brain that they're on like if you wanted to stimulate the left side of the brain
Taylor Kruse: Yeah.
Tony Fowler: through those pathways for whatever reason, you would use the left ear.
Taylor Kruse: Yeah.
Tony Fowler: Um,
Taylor Kruse: Yes, so the higher... When you get into the higher order senses... It. It gets... It gets more challenging and more of these. more of these More of these things violate the basic rules So, it which is fine.
Tony Fowler: Cool.
Taylor Kruse: It's just part of it, right? So, and this is like, you get to a point studying this stuff where you... You get it. like We have people in our... course right now where They're doing unbelievable. in there. They're really learning a lot, and I can tell in the conversations and questions, they're just they're really on top of it. And then all of a sudden they get to a. as a point and everyone's the same way. They go. Wait a minute. How come this isn't matching now? so Why? Why does this visual scale? Activate. This side of the brain. or it's this side of the cerebellum. and this one doesn't like you want every you want everything to fit these basic rules and then when you get to the point where you discover that not everything does it's like oh
Tony Fowler: Interesting.
Taylor Kruse: It's like frustrating. But then you get over that. And you start learning. you know You start learning that. you know, a smooth pursuit to my right is going to be thought of as more of a right. cortical activation for the parietal lobe, but a saccade. to my... right is going to be more. left side. right And it just has to do with the skill. And the brain area is involved in the basic pathway. And and even that's not true. Really? Because if you were to outline... all of the structures involved in a very specific visual skill. it would be hard to find this clear organization of it.
Tony Fowler: Right. You can't actually isolate that much, right?
Taylor Kruse: Yes, yes. But but we can we can reduce it in a way that allows us to learn it. And again, most important. For us is. Apply it. Right. For a reason. So there's just going to be. bilateral activations happening And. um Back to like hearing. So hearing... or sound processing is an interesting one because it... it does go to both hemispheres. So like for example when I take in auditory input in my left ear. It will go to both. hemispheres um in the in that process but It. It still follows our basic rule. where we think more of the processing happens. contralateral. So. If I have sound coming in through my left ear. we could say that that is going to stimulate the right cortex.
Tony Fowler: Okay.
Taylor Kruse: More. Then.
Tony Fowler: Yeah.
Taylor Kruse: than the other side. Even though if you... Like Google up. the auditory processing pathway. You you know, it's a subway station you follow the line And it it crosses in the middle and... we We look at where it crosses in the at the level of the midbrain, which is the top of the brainstem now. so before we were talking about the medulla with the dorsal column now we're in the midbrain um There's different structures in the midbrain that... we might be interested in to... Maybe. maybe improve sound processing. Um, So same philosophy. Like maybe I can. yeah reach into my toolbox and select drills that help with. those areas And maybe get an improvement in. the opposite cortex or sound processing, right? Depends what your goal is. Everything is goal dependent. so We look at it as opposite side. which keeps it. Simple. Right.
Tony Fowler: Mm hmm.
Taylor Kruse: we can We can use that. And we do. That's why we test. ah very basic screening for side to side differences in sound processing and just hearing in general. Yeah.
Tony Fowler: Yeah, we simplify so that we can... Uh... choose our... our approach.
Taylor Kruse: Yes.
Tony Fowler: knowing that it's a lot more complicated. Then.
Taylor Kruse: Yeah.
Tony Fowler: the models might suggest.
Taylor Kruse: Hey. Absolutely. and And here's the thing, like anyone who has gone into. the Complicated part of neurology they Most of those people, don't they don't even know. than a more simplified version. exists with rules that you can actually follow and use. Most people... Do not know you can use applied neurology to help people with movement and pain. They don't know that. It doesn't matter what their level of education is. I meet i meet DPTs. All the time They did not know this was something you could apply.
Tony Fowler: Mm hmm.
Taylor Kruse: um because it's all, you know, in school you're learning. from a textbook and you learn about these structures. And you learn about, OK, if someone has a traumatic brain injury or a stroke and this might be impacted because of this. And you learn this basic idea of. right and left sides and you know motor control on the left side of the body coming from the right cortex, but it doesn't really go further than that. And people don't.
Tony Fowler: Mm hmm.
Taylor Kruse: They don't know. That you can. think through the different levels of neurology, and they don't know that you can build a toolbox of assessments and drills that can be directed at these different these different structures. so It's actually part of the reason why. It's going to take an extremely long time. I would guess for. Applied neurology. to be more accepted.
Tony Fowler: Yeah.
Taylor Kruse: I would guess. I mean it is happening. but it's it's going to be a while.
Tony Fowler: It's happening one podcast listener at a time, right?
Taylor Kruse: Um, Yeah, yeah. it's It's still the information that we're teaching people is not new. It's old, but the application is brand spanking new. when you look at it like that you know and Yeah, so it's... It's cool. It's exciting.
Tony Fowler: So we've talked about structure. Um... Quite a bit. But let's get down to application. let's Let's talk about... Common. issues that you see that present as one-sided. And... Uh... you know, some of the symptoms that you might. notice some of the assessments that you might use and some of the the drills and exercises.
Taylor Kruse: Cool. Hey, can we pause Tony real quick?
Tony Fowler: Yeah.
Taylor Kruse: i Just wanted I got a I got to do a pee break
Tony Fowler: Yeah, no problem.
Taylor Kruse: Very unusual, but...
Tony Fowler: ah And you had a little too much coffee, huh?
Taylor Kruse: I feel it. I feel like a five-year-old sitting here crossing my legs.
Tony Fowler: no no no i'm glad you said something you can always do that by the way
Taylor Kruse: Yeah, yeah. I never never have to, but perfect time to do it, I think. you you
Tony Fowler: You got it.
Taylor Kruse: Yeah cool.
Tony Fowler: Yeah.
Taylor Kruse: Alright, dude. Thank you.
Tony Fowler: cool cool cool yeah no problem
Taylor Kruse: and Don't remember what you asked there
Tony Fowler: Uh, so let's... Let's start talking about... uh application. And... You know, one one one thing that we've... uh mentioned earlier is that a lot of people have issues that present. on one side, whether it's pain, history of injury. Maybe tightness on one side.
Taylor Kruse: Mm hmm.
Tony Fowler: Um, And I think that that's a pretty common place to start, but I'm also curious what other common. one-sided issues are you seeing? And then maybe we can get into some. assessments. some history findings. and some some drills and exercises.
Taylor Kruse: Okay, sure so Very very common uh thing that we see with side to side difference. is stability. right, so really common to have. And and we we might say stability slash balance. I think. Most. people. Consider them the same thing. They're not really the same thing. But we also can kind of group them together for being really simple. um balance and stability problems. It's very common. for for one side of the body to express a more difficult. Time? with stabilizing.
Tony Fowler: Mm hmm. Mm hmm.
Taylor Kruse: And... And that is one of the most common. Things I'm targeting for everybody. Because most people have a side of the body that's not. doing its job. optimally in that regard. So that's a big one. And obviously we can have pain. Pain's the other big one.
Tony Fowler: mm-hmm
Taylor Kruse: Because... You hear... You hear more Often. That I have multiple pain issues on let's say the right side or the left side You don't hear as often like my right ankle. my right knee My left hip. my left shoulder That. Does exist. Where you're seeing, like... Some some part of the. you know, one side of the body and then it looks almost like the. The dysfunction whatever it may be kind of crosses you You will see that for sure. But I think personally, I see more one-sided issues than anything. Yeah. So stability is a big one, balance is a big one. Um, you know something Worth mentioning is actually blood pressure. Because it's, if you take... People's blood pressure on both sides. you'll often see a difference. It will not be symmetric. And I don't necessarily... know that it has to be perfectly symmetric. It doesn't seem like that would make sense when you consider... autonomic control. where it comes from. and there being two sides. to the brainstem, which is where a lot of our... Autonomic control. is coming from. So. I can't say for sure it's supposed to be perfectly symmetric, but I can say we don't want a big difference. You don't want a huge difference, and it may suggest... autonomic issues on one side of the brainstem. And. It's an interesting one because we we use this as a basic assessment. to understand like those pmrf patterns that we've discussed in in other episodes So, for example. Let's say you're doing gait testing on somebody. One of the patterns we look for is the PMRF pattern. which typically looks like. When someone's walking. Typically looks like if they have a right PMRF pattern. They might have an internally rotated shoulder. And. the the the shoulder is more depressed. Then excuse me the other side And. The arm typically is holding more flexion-based. tension so you might see a slight bend in the elbow pronation of the forearm. and even a little bit of claw hand.
Tony Fowler: Mm-hmm
Taylor Kruse: If you want to look at it that way, where the fingers are curled and that pronation. has turned the forearm in. and
Tony Fowler: So the palms facing back.
Taylor Kruse: So imagine You got it. Exactly.
Tony Fowler: Yeah.
Taylor Kruse: It's the palm facing back is kind of the. the quick way to to see this where someone's walking away from you. And as they're walking, you see more palm on their right than you do on the left. that may suggest more PMRF pattern in the upper body. In the lower body, It's an outwardly rotated leg. coming primarily from the hip. And so with that. looks like is that one foot is turned out. There can be other mechanical kind of compensations that take. place with these patterns that sometimes make them a little bit harder to see and to be confident that that's exactly what you're looking at but generally speaking That's how you'll see it And you'll be able to. To say, yeah. that That matches. That looks like a PMRF pattern. So... in that individual, if they're having a right-sided... pmrf pattern that will suggest that um something's going on perhaps with the right side of their brain stem And when I say something's going on, like I don't mean something catastrophic. Like this is this is where people get like scared when they don't have to um Obviously. there are There are bad things that... um different. Signs can... are expressions of of movement and pain issues can Suggest. But in a healthy population, and I'm working with generally healthy people. And I'm teasing out. Such subtle things that if they went to a clinic They would be told to leave because they look amazing.
Tony Fowler: Hmm.
Taylor Kruse: and nothing's wrong with them. But this would be the same person that happens to have all... Right-sided pain. and, you know, different. different things that we would consider somewhat compromised, right? So it's like that person that is. too healthy to receive health. Or help from healthcare? care Right? That's the type of person we're working with. So I don't mean any kind of catastrophic. issue when I say maybe there's something going on with the brainstem. Because...
Tony Fowler: Mm hmm.
Taylor Kruse: what we're ultimately always looking for. or assessing is. the imbalance that might be there. And we know that there's going to be some imbalance because that's... what I would call normal, but... The question is, has the imbalance become too large? That now a person's movement is suffering in a way or their autonomic function is suffering in a way that is causing issues for them. so Back to the blood pressure thing, when someone has this right-sided PMRF pattern, and you can have it on either side of the body. It. usually comes along with a difference in blood pressure too. So. So let's say you you see that and you go, yeah, that might be a right-sided PMRF pattern. I'm not totally sure. Let me test their cerebellum. So you test their cerebellum. and you see more left side. coordination deficits. And then you go, oh okay, that actually makes sense. um if you think about basic pathways, because if somebody is less coordinated on their left, okay That's going to be decreased. activation to their right brain. And that means their right brain. cannot act on the right side of the brainstem. With. We're talking about like descending. cortical flow So we've got a underperforming kind of chain of systems. that now it's coming out as a postural concern during gait. And so I might check the box and go. Alright. left cerebellar deficits actually matches with what i'm seeing in gait I'm still not positive though. That that PMRF pattern seems pretty subtle. Here, let's do a blood pressure on both sides. right Comparing. the right to the left. And then maybe you find that their blood pressure on the right is a little bit higher. Then on the left. And you go, okay, I've i've seen enough here. to to tell me that i'm I'm probably, what I'm seeing in Gate is probably right. This probably is more of a right PMRF pattern. So. That's an interesting one to mention. just because I don't think people... Well, I know people for the most part do not know that you could take blood pressure on. both sides of the body, and it would... it would give you information on the right and left side of the brainstem.
Tony Fowler: Yeah, it's corroborating evidence, right?
Taylor Kruse: It is yeah It is. It's... And again, yeah, it's not... Sometimes I'll mention this on Instagram. and Lots of people freak out about it. If you have higher blood pressure on one side of the body, That means this isn't a medical emergency. And you have to you know get yourself to. Although I'm not necessarily talking about... Such a large difference. in blood pressure and one side that is so high that it's a medical emergency
Tony Fowler: Hmm.
Taylor Kruse: we could be talking about still... blood pressure that's in within normal range. but one side appears higher. and And I've done, I've taken blood pressure on both sides. of the body a lot. with clients in person. And I have found a lot. Differences side to side. Okay. um Somewhat large differences too. And guess how many of them were medical emergencies? None. None of them were a medical emergency. so it's It's also good to say that because people sort of jump to conclusions in their... in their mind. Um, because of the I don't know the fear around High blood pressure, I guess it is.
Tony Fowler: Mm hmm.
Taylor Kruse: Yeah.
Tony Fowler: Yeah, what other kind of history findings? might we be looking for for some of these one-sided Um... issues.
Taylor Kruse: All right, so... I had mentioned stability as being like a common. thing that you find. here's Here's what's neat about... kind of knowing the role that these brain areas involved in. with that same pattern I just described. The PMRF pattern. If in fact a person has that right-sided PMRF pattern, they're probably less stable on the right side of their body. So... That's... a good thing for people to know. because... here You can find a lot of that. stability maybe you think it's a balance issue and Maybe it's more so a stability-based issue. but um that's super common. You'll find that. and kind of match it to that pattern Um, talking continuing on with like the brainstem that one-sided pain issue that we talked about too, is often related to... the ipsilateral brainstem as well. It's... It's hard to say. It's like... I don't want people to misunderstand. I'm not saying there's a problem in the brainstem. I'm saying that somewhere there is underperforming that's going on. Right, so... somebody with a right-sided pain. History. they might be having right-sided. cortical issues right sided brainstem issues. and That can. manifest as feeling more pain on that side of the body, especially because the brainstem is involved in some level of pain inhibition. So... If the brainstem is not doing its job optimally. some of that like call it like nociceptive escape could be happening and there could be increased pain sensitivity on that side of the body.
Tony Fowler: Mm-hmm
Taylor Kruse: So just to kind of... point some arrows a little bit more specifically at the brainstem for some of those things that we discussed. Another one that comes to mind here. that's really interesting is, and it's on my mind because I just filmed some content. Yesterday with Alicia. on. testing for peripheral vision. testing the the different peripheral fields. So... Very very easy way You know, you can test it very easily and you will find differences in people's peripheral vision side to side. constantly. Really interesting. So in other words... I might. be able to pick up on movement. In my... on the right side of my
Tony Fowler: Mm-hmm
Taylor Kruse: Uh, periphery. Right? the outer kind of part of my visual field. without looking. right that's what using your peripheral vision is all about you're kind of dilating your gaze looking at something that's... Let's say out in front of you. but still having awareness. for the space around that area on either your right or your left.
Tony Fowler: Mm-hmm
Taylor Kruse: Okay. And. it's ah It's actually a great thing to test because let's say you... find that someone can sense movement. in the right side of their peripheral field. better. then the left. And... You're doing what we call our... our bunny test where... You stand behind somebody and you wiggle your... Your fingers like bunny ears? You know? And. You move it. into... different areas of their Periphery and they basically tell you when they see it If they have decreased peripheral awareness, let's say on the left side. this Goes into the weeds a little. We won't. talk about all of it, but... Very simply. Speaking. the outer portion of the visual. field. So how light information is coming in through the outside. part of the field that eventually goes to the contralateral cortex. So in terms of visual processing. So if I have decreased peripheral awareness on my left side, it suggests that I have decreased right brain activation. So it's a really fast. screen for somebody. I mean, imagine this, right? This is why neurology is so cool. Your client comes in, they have all right-sided pain. and you go okay what are some things i can test to get an idea for like patterns here So you test vibration on both hands. and they have less vibration sense on their left. So you write that down. And then you go, okay, client, can you tap both of your hands as fast as you can Let's look at your right hand tap it as fast as you can Let's look at your left hand tap it as fast as you can and they were less coordinated with their left hand. You go, okay. And write that down. um You look at their peripheral vision. And you test both the right side and the left side. And you find very quickly, and I mean like within 30 seconds.
Tony Fowler: Mm-hmm
Taylor Kruse: you find very quickly that they have decreased peripheral awareness. on their left side. And you write that down. Then you look at that and you go. Remember my basic rules. Remember my basic rules. Remember my basic rules. All sensory. input goes to the contralateral cortex except smell. And you go, okay, one more test because it's only going to take a second. And you bust out a little vial of. essential oil. and you have your client. plug one nostril. so you plug They plug the left nostril and you say, okay. Can you smell this? What is it? and they have their eyes closed can you smell this what is it And they go. I don't smell anything yet. And you're going. Okay. And then they go. Oh, that's lemon. And you're like, okay, interesting. Plug the... Plug the right nostril. Do you smell anything? Yep, that's peppermint. You go. Interesting. So you had decreased awareness of a smell. through your right nostril and you identified it as incorrect. you write that down. and you look at all your findings, which only took you... Five minutes. and you go Okay. Loss of vibration on the left. Less coordination on the left, decrease. peripheral vision. On the left. Loss of smell and identification on the right. coming in through the right nostril. All sensory goes contralateral except... smell, which is ipsilateral.
Tony Fowler: Mm hmm.
Taylor Kruse: And then very quickly you go. My client needs right brain activation. So you start doing that in different ways. And that's a longer process. because now you're You're teaching them exercise.
Tony Fowler: Fair.
Taylor Kruse: and you're adding in these different inputs, and maybe you are using smell. through the right nostril and stacking that into different things. And maybe you are stimulating. the weaker part of their peripheral system on that left. And maybe you are putting vibration. On the back of their left hand, all with a goal. And when you understand the basic rules and the processing. and how when I provide those inputs and activate the right. hemisphere the right hemisphere will act on. subcortical structures, the right side of the brainstem. And generally what we see when we do that is. Very significant changes in muscle tone. Because muscle tone... Comes from a lot of different things, but the... cortex, the ipsilateral cortex, will work together. a lot with the ipsilateral brainstem to set Global muscle tone.
Tony Fowler: Mm hmm.
Taylor Kruse: and inhibit pain. So... Your drill stack might be your testing. to start. vibration on the back of the left hand. smelling through the right nostril. with peripheral awareness of some kind coming from the left side. And maybe we're doing a... mobility drill on the left side of the body too to activate the Ipsilateral cerebellum. That's a lot of right brain activation. happening all at once.
Tony Fowler: Yeah.
Taylor Kruse: And then. You stop the drill and you retest. And the client goes, that's weird. I'm rotating further i'm bending over touching my toes for the first time and a while Oh, and what do you know? my pain feels less. And that's very typical. So... That's kind of... highlights how this process might work and how you you select some assessments. At first. that are all Testing for... Well one you're running a test on function coming from One side.
Tony Fowler: Mm hmm.
Taylor Kruse: Right? And then when you start. getting clues that there might be some deficits or... Just... Under. performing systems that are involved with that stuff. Most of the time. It is as easy as providing activation. for those deficits. sometimes it's not that easy but most of the time you're going to get somewhere doing that Versus... what most of the time we're doing. If we're not following a process like that is. Just lots of bilateral activation. in it. may not be a strong enough stimulus it might not be specific enough And one input might kind of... cancel out another. So it's hard to... It's hard to get somewhere. It's like me when... I was working on my right-sided pain. from College athletics, right I was. generally working. On. those right sided areas that hurt. which when you look at the same pathways. means I was activating the wrong side of my brain.
Tony Fowler: Mm hmm.
Taylor Kruse: So I was furthering the deficit. Okay, and not getting results that Stuck. And then... Go figure. I had to do more movement on the left side of my body and work with some of these higher order inputs to direct more activation to the right side of my brain. which then started helping me improve muscle tone. My gait started improving. I had less pain So it's... We're always looking for one-sided issues.
Tony Fowler: Mm-hmm
Taylor Kruse: you know, which is it's It's interesting. you know and It wasn't until you brought up the idea of this podcast that I was like, this is kind of funny. everything we do. actually is based on... finding these one-sided imbalances and trying to close the gap.
Tony Fowler: Well, yeah, but because of the structure of the brain. in the nervous system and the fact that it is this these two halves what What it allows you to do is just be targeted.
Taylor Kruse: Yeah.
Tony Fowler: Um, you know, we didn't talk about. double-sided issues in this episode. though though those exist, right?
Taylor Kruse: They do yeah
Tony Fowler: um But. but Yeah, just I think inherent and in that that earlier piece of the discussion. it It's likely that. one half of your brainstem might be performing differently than the other half or the cortex or Maybe it's not the those brain areas, but related to one side of your body. that's related. What I love about the example that you just gave is you found a commonality. Not necessarily. a causal effect. Right.
Taylor Kruse: Right.
Tony Fowler: i you know, The higher order system. that might have been the issue in that example you gave could have been could have been a visual deficit. with the...
Taylor Kruse: Yes.
Tony Fowler: peripheral vision. It could have been. Uh... you know something something related to to smell. It could have been... a nerve issue on the peripheral nerve on the side of the body that lost vibration. But what's the commonality? All of those things connected to that one side of the. the cortex. And so by activating the cortex, you're sort of... hitting all of the the related systems and giving them giving them some love. Um, And I think that's a really. powerful example of of understanding just enough. To make changes, you know
Taylor Kruse: yeah thank you that's perfect i like how you said that uh that's That's what this is all about. especially in the work that I do because we're not... we're not diagnosing and treating
Tony Fowler: Hmm.
Taylor Kruse: Right? this is This is people, so people who don't know us. and the work that we're doing see us on social media and stuff And maybe a medical professional goes, that's not right. You're diagnosing and treating a pain. Whoa. No I'm not.
Tony Fowler: Hmm.
Taylor Kruse: I'm understanding the function. behind the systems And then I'm figuring out where the activation belongs. or where the inhibition belongs. And we're doing something. to improve the whole system. It just so happens that that might fix 10 things at once.
Tony Fowler: Hmm.
Taylor Kruse: And that's how it works. when it works. and And that's what's so fun about it. ah Most of the time when somebody tells me they have a right shoulder that's cranky and doesn't work the way that it wants to. They have mobility issues, pain from time to time. Most of the time, I'm not doing anything for the right shoulder to help them with the right shoulder. and And that's because of what you just described.
Tony Fowler: yeah
Taylor Kruse: Right. It's kind of that cumulative. effect of understanding the systems. in providing... enough of the right input. that Output. changes. And when output changes, we see those functional improvements in. mobility and stability and um you know, less discomfort. So that's what's so neat about. about this style of work.
Tony Fowler: Mm hmm. So I know earlier, this is an aside to you. I know earlier you were you were saying you wanted to... leave some guideposts for people. with one-sided issues and questions. So I guess this is our time to do that. um How are you feeling about that? are there any Is there anything that we need to... address that we haven't gotten to yet.
Taylor Kruse: No, i think I think we hit it. I think we did a good job. and i think for people that want to understand because when for our listeners they're They're probably trying to run themselves through the filter and kind of understand. Okay, you guys were talking about patterns, like which pattern am I? So I think at this point, we do have several resources. Dead. If you haven't heard these different episodes you want to make sure that you uh You check them out. We had mentioned the eight levels episode.
Tony Fowler: Mm hmm.
Taylor Kruse: That's a good one. There's also the gate analysis episode.
Tony Fowler: Yep.
Taylor Kruse: And. possibly the the one we did on like complex movement where we talked a lot about the cerebellum. These would be good episodes to to check out because we we did talk about...
Tony Fowler: Yep.
Taylor Kruse: these patterns. that are super important. like different cortical patterns, PMRF patterns, cerebellar patterns. and Those would be useful for... our our health and movement pros to learn more about so that they can start to think about. Maybe the patterns that... their clients are expressing.
Tony Fowler: Mm hmm.
Taylor Kruse: And then if you, you know. for for those that want to run themselves through the filter. It really helps to have an idea. of where you... are with that and what pattern you might be Because then you can start to... figure out your training approach. Simple stuff. Okay, I sound like the right PMRF pattern because my right shoulder droops and my right foot is turned out. So perhaps I need more of this complex nonlinear style movement. happening on the left side of my body. right and so When you know those basic things, it it starts to help you understand. what you can do to to move the needle.
Tony Fowler: Well, the left side of my brain. really enjoyed this podcast and the right side of my brain wasn't sure what the heck was going on
Taylor Kruse: ah I feel your pain. That's funny. There it is. I hope you guys enjoyed this episode. ah Make sure that if you are interested in in getting involved in our courses that you are on the waiting list. um There is rumor around the Cruise Elite household. Coming from the... the ceo that we might do we might do a small enrollment for people who are on the the waiting list. It's not. It's not totally in motion at the moment, but what that would entail is is if we would we did that, it would be... an opportunity to get involved in our neuro foundations course in a self-paced manner. And then. That means you can just go through it at your own speed. and that will prepare you for moving on to the neurodojo which at that point you'd be able to to catch the next. Live teaching. of the ah of the NeuroDojo. So there may be an opportunity to to get involved. So again, make sure you are on the waiting list, which you can do using the link in the show notes or going directly from our website. Once you're on that waiting list, you can then receive emails from us about when our future enrollments are happening. That's it. Thank you guys so much. for listening and we will be back soon.
