Dizziness with Dr. Matthew Fothergill
Show Notes:
In today’s episode of Post Concussion Inc, we speak with Matthew Fothergill, a physical therapist who specializes in long-term lifestyle planning for patients who have experienced single or multiple sub-concussive hits. He also works as a personal health consultant and advocates for head injury awareness. Our conversation revolves around his adolescent experiences with football, hockey, and the undiagnosed concussions that he experienced due to the culture around head injuries at the time. We focus on dizziness and the variety of ways to explain the feeling. The importance of the use of words for both patients and medical professionals. We speak about his career and how his work in multiple environments brought him to this point in his working life, including how his times as a skilled nurse led him to specialize in transitioning and work with older athletes suffering from dementia. Later, we discuss the difficulty of distrusting the medical establishment, especially for older athletes, and how you can empower yourself as a patient, so join us today for a highly informative discussion!
Key Points From This Episode:
● Learn a bit about Matthew and the type of work he specializes in.
● How his adolescent experiences with sport and undiagnosed concussions influenced his career as a physical therapist.
● How his many injuries exposed him to multiple therapies.
● Matthew’s experiences working with concussions during internships and clinical rotations.
● Pivoting to becoming a skilled nurse and his experience treating severe brain injuries.
● How his work as a skilled nurse led him to specialize in transitioning.
● The transition challenges that older athletes face.
● When athletes still receive inadequate treatment, despite the considerably advanced knowledge on head injuries.
● The pervasive cultural conditioning of invincibility: how it harms athletes and serves to keep concussions invisible.
● The different types of dizziness, like vertigo or lightheadedness, and how to identify them.
● Contributing to the healing process as a patient by specifically describing your symptoms.
● The significance of words from Matthew’s experience of being both doctor and patient.
● Why every patient needs to be treated for their unique symptoms while also keeping their history and context in mind.
Connect with Our Guest:
Follow Matthew on Instagram @thehealthcollaborator
Connect with Matthew www.thehealthcollaborator.com
Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I’m your host, Bella Paige, and welcome to the Post Concussion Podcast, all about life after experiencing a concussion. Help us make the invisible injury become visible.
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[INTERVIEW]
[00:01:03] BP: Welcome to today's episode of the Post Concussion Podcast with myself, Bella Paige, and today's guest, Dr. Matthew Fothergill. Matthew is a personal health consultant, advocate, and physical therapist who specializes in long-term lifestyle planning for those who have experienced multiple sub-concussive and or sub-concussive head hits. He focuses on helping clients access the right resources quickly, as well as personalizing plans to account for each individual's unique strengths and barriers to achieving their goals or implementing potentially helpful interventions. Welcome to the show, Dr. Matthew.
[00:01:40] MF: Thank you. Thanks for having me.
[00:01:42] BP: Do you want to tell everyone a bit about your injuries that you did have and what happened?
[00:01:47] MF: Sure, yeah. That's why I got into it. I grew up playing hockey since I could walk. As soon as I could walk, they put skates on me. I grew up in Boston, so hockey's real big where I’m from, and then I started playing football in high school. That was in like the early mid-‘90s and then early 2000s, so concussion awareness was still minimal. When I was in youth hockey, I would be playing like four teams at a time, getting hit a bunch of times in the head, banged up against the boards a couple times a day, starting at 4:00 AM after a not full night of sleep. That started there. I don't remember much of it. My memories of that part of my life are slim. What I do remember is the football concussions or what I can now diagnose as concussions but were not diagnosed at the time.
When I was playing high school football, I was a receiver and defensive back, so a lot of very high-impact hits, full speed people coming at each other from a long distance away, getting hit. It wasn't as frequent for me but it was big. It's different than the lineman. I got hit a couple times, a bunch of times in practice [inaudible 00:02:59] practice. There was one time, two instances in particular, that stick out in my head. One time was in practice and there was a big guy. I’m about five foot ten and fast. He's about six foot five and strong. So we're doing a drill, and he hit me pretty hard in the head, and that's the only time I ever remember getting hit in the head where I lost consciousness. I blacked out like two seconds. It was not a massive event, and nobody really noticed it because I didn't follow to the ground or anything. We just collided, I saw black, came back too, and was pretty much okay.
Then, later on, I transferred schools to play at a higher level. I started having more higher impact hits because everybody in my league ended up playing division one college football. It was a lot of really hard hitters. There was one weekend I remember as the Sadie Hawkins dance. I remember it clearly. I was at boarding school, so I was in my dorm room after an away game. We had driven like three hours. I get back on Saturday supposed to go to this dance, and I couldn't turn the lights on. So I locked myself in my room, turned the lights off, and stayed there for the rest of the weekend. That was kind of my first big eye-opening moment to the impact of head hits and concussions. Looking back on it, I can think of a handful of times that I probably had a concussion based on what I know the symptoms are now.
[00:04:28] BP: Yeah, that's really common because we didn't – Well, let alone when I started about 10 years ago doing all this. Then like when I even had my concussions before that, most of those were never – Nobody ever mentioned the word concussion. Then even imagining even time before that, there's lots of people that have come on the podcast as well who go, “Well, there's been a lot. I just –” Nobody ever said anything when they were growing up about it, which is really common. That's what led you to do the physical therapy and all that? Did you have long-term symptoms as you got older?
[00:05:05] MF: I think that the path that I ended up on kind of like accidentally treated them for me. I had a bunch of orthopedic injuries too, so I dislocated my shoulder a bunch of times. Like I said, like I’m small. I’m pretty small for a football player, so like high-impact stuff hit me real hard, so dislocated shoulder, broke my nose, tore my quad in half. That was playing baseball. I wasn't even in contact. I had surgery on both my feet for bunions, which is a genetic bone growth disorder. Then I had a million sprained ankles because I’m hyper mobile. I can dislocate all my joints if I try.
[00:05:44] BP: Okay, yeah. I’m not.
[00:05:46] MF: No. That kind of like all of that together. Then when I was – I think it was two or three. I don’t remember this fortunately, but my brother stabbed me in the ear with a candy cane. It was a plastic candy cane, so it was a little bit thinner and sharper. He just stuck it in my ear and then popped my eardrum, so my eardrum now is made of rubber and skin from my arm. They rebuilt that.
[00:06:06] BP: Crazy story.
[00:06:08] MF: Yeah, pretty wild. Yeah. But it kind of just like exposed me to a ton of different therapies. I had speech therapy. I had physical therapy as a child. Some of my earliest memories are sitting in a dark room with like a podcast set up, like a microphone and headphones on, and they would be like, “Matthew, put the green block into the yellow hole.”
[00:06:30] BP: I’ve done that actually. Yeah.
[00:06:33] MF: That was my first memory when I was like four years old.
[00:06:37] BP: That's funny.
[00:06:38] MF: I did that stuff and then just kind of like based on where I was in my life and my coach, my first football coach. His best friend was a performance coach and a very progressive kind of guy, so we did a lot of yoga, a lot of meditation, a lot of breathing exercises. I always recovered quickly from things as soon as I started doing that when I was like 15.
[00:07:01] BP: Which is great.
[00:07:02] MF: Yeah. Looking back on it, that seems to have been impactful, and then all of those experiences led me to studying physical therapy, which I learned even more about my body and how it all works. It just opened up the ability for me to take my lifestyle and my culture experiences and apply a medical lens to it. Now, it just inspired me because now I know where research is. I know how to digest it, and I know who to talk to, and bringing those two worlds together was helpful for me for the first couple years. Playing football on a couple years into college, I did have some PCS symptoms but very mild. I would have a lot of dizziness. But, again, like I got stabbed in the ear, so I have vestibular issues to begin with. I have blood pressure issues that run in my family, and all of these things can contribute to symptoms.
[00:08:01] BP: You've done a lot of work with concussions, so do you want to tell everyone about that?
[00:08:05] MF: Sure. I was very fortunate to have good experiences with my school internships and clinical rotations. I bounced around. I was in Florida, New York, and Hawaii, and Boston. When I was in New York, I worked at an orthopedic hospital with all the professional athletes, and I was there in the winter through the summer. So we had in-season and postseason football players, basketball and hockey as well. So the winter sports came through in season and then getting their surgeries. I got to see a lot of the orthopedic stuff there, but all of them had head injuries too at some point. I got to see their program that they work on there for that and communicate with some people.
Then when I got out of school, I was actually kind of sick of sports, so I went into skilled nursing, kind of a complete 180. It led me actually to working with folks living with dementias. In that setting, I worked in a lot of memory cares, post stroke, post TBI, like severe physical –
[00:09:17] BP: Brain injury?
[00:09:19] MF: Yeah. I got to see a lot of the acute stuff in that phase and do the work there just as a staff physical therapist and really kind of learn the ropes and how it all goes in the medical setting and then figure out what happens after that. In that setting, I don't know how it is around the world. But where I was, I was the only young male who had played sports who worked in the building. At any given time, I was the only one who could communicate to athletes. You have athletes coming in with dementia.
[00:09:54] BP: Even if you're older, you're still an athlete. Yeah.
[00:09:57] MF: Exactly. That’s – You got to treat everybody as the person that they are, the unique person. So I ended up being the guy for all of the old-time football players from the ‘70s and ‘80s who ended up in there with dementia. It just led me to research all that stuff, and I’ve been going to the conferences, and I had an opportunity that stems from that to work as a consultant with families of folks who are living through this process. I really started to focus all my energy into the transitional phases of life, so transitioning from concussion to not playing, and not playing to returning to sport, and playing to retiring, and then retiring to getting a job and being diagnosed and going through all that stuff, and then transitioning into older adulthood.
[00:10:50] BP: Yeah. Well, it's all really important. Mentally, they're really huge steps, let alone physically as well, right?
[00:10:56] MF: Yeah, absolutely.
[00:10:58] BP: Do you find athletes have a lot of challenges even when they're older doing transitions?
[00:11:03] MF: Absolutely, yeah. Everybody, but like I can speak to the athletes because that's what I do. The unique challenges for specifically contact sport male athletes, this may very well change in the next generation because in the ‘50s, ‘60s, ‘70s, ‘80s, the guys that we're seeing in nursing homes and memory cares now in 2021, they had a very different culture around sport than we do now, so like it might change. But their challenges come with the early football players resent the sport or they don't know that it hurt them.
Then, like the middle range football players and hockey players, when they started to diagnose concussions, were being treated with smelling salts and things that now we know don't work. The disadvantage of this rapid progress and research and information is that these guys who are just now starting to experience the symptoms of CTE look back and they're like, “They treated me poorly.” So they have ingrained resentment or distrust of medical care because of how they were treated as commodities. I mean, as athletes, as professional athletes in particular in college, you're a money maker. That's a big challenge is to be able to create an environment that doesn't feel medical for those guys. I think it could apply to a lot of other people, but that's one that really sticks out to me for the athletes.
[00:12:33] BP: For sure, yeah. Well, I found – Well, I was really angry at the medical system mostly just because I wasn't getting better, and like I’m a big science. I really believe in all of it, and having it not work was like made me – But I also understand a lot of those athletes got not treated correctly, and now they're suffering, but we didn't realize all the extent of what head injuries could do now. But when we see athletes today that are still getting treated like that, that's what drives me like kind of crazy because we know now. We know that there's a lot more risks to a head injury than we ever realized, especially like smaller impacts, so there's a lot of that out there as well.
[00:13:12] MF: The problem now has kind of evolved into this. It’s the underlying cultural issue. It's the invincibility complex. It's the “I could never get hurt.” The conditioning in football camp is you learn how to not feel because if you feel, it means you miss a rep and it means you're not going to get the scholarship and it means your family is going to stay poor. Or it means that you're not going to go to college or it means that you let your brotherhood, you let your family down. If you speak up about it, you're letting everybody down.
[00:13:46] BP: Yeah. That's really hard.
[00:13:47] MF: That conditioning is hard to break.
[00:13:50] BP: For sure, yeah. It's hard just mentally as an athlete to just accept that to not be super competitive and just kind of ignore all the signs because that's what I did. I just pushed through with struggling and ignored it, which was the worst decision I ever made. But that's what I did because I was an athlete and that's all that mattered to me, so that's really hard as well.
[00:14:14] MF: It’s so complicated with the head injuries because it isn't necessarily a functional disability. If you tear your ACL, you can't run. You have to stop. You don't have a choice because your leg will fall off. With a head injury, you get dizzy. You can tough it out. You have a headache. You tough it out because that's what's supposed to happen. It’s contact sport. You're supposed to tough up and really any sport.
[00:14:40] BP: A broken like a leg or just anything, like you said. It makes a huge difference compared to your head injury because it's way easier to push through because, well, also nobody can see it, so nobody can be like, “Whoa, you shouldn't be doing this too.” Because like when you have a broken arm, someone's like, “You should probably take a break.”
[00:14:58] MF: Yeah. It's one of the big efforts.
[00:15:00] BP: Yeah. You can follow Dr. Matthew on Instagram @thehealthcollaborator, which you can also find in our show notes and as well as other contact info. But with that, we're going to take a break. Be sure to stay tuned to listen in on our conversation on word choice.
[BREAK]
[00:15:21] BP: Want to create awareness for concussions? Want to support our podcast and website? Buy awareness clothing today on postconcussioninc.com and get 10% off using listen in. That's L-I-S-T-E-N-I-N and be sure to tag Post Concussion Inc in your photos. We'd love to see them.
[INTERVIEW CONTINUED]
[00:15:47] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige, and today's guest, Dr. Matthew Fothergill. Something we had talked about before in our conversation was dizziness, and as you kind of mentioned that you've had dizziness problems. But there's different ways of being dizzy, so how can explaining this properly help someone get better care?
[00:16:10] MF: Yes. I love this question. The reason that I actually started to learn about this is where I went to school in Northeastern University in Boston, and the way they do their PT program is they have concentrations. So you could do sports, you could do pediatrics and geriatrics, or you can do vestibular. I chose the vestibular route, so I’m technically a vestibular specialist PT. Vestibular deals with inner ear dizziness, all that stuff. That just kind of – I geek out about this stuff. It's exciting to me because it's such an important piece of this whole thing. Dizziness, and this is a little geek fact, so like the Latin root actually just means like off, off-kilter, like weird. It’s just like not right.
[00:16:56] BP: I didn't know that.
[00:16:58] MF: That’s not the exact translation but that gives you the baseline. It's like dizziness is like you're just not quite right. There are terms underneath that umbrella that mean very specific and different things, and vertigo is one of the ones that gets confused a lot. So vertigo is something that a lot of people hear and use in description of their symptoms, but the vertigo root word actually literally translates from spinning or like false sense of motion. In the past, in ancient Rome, they described drunk people as dizzy because they were wiggly on their feet and wobbly. Vertigo is if you felt like the world was spinning around.
You have that and then you have lightheadedness, which is another very specific type of symptom where you feel kind of like you do if you're taking off on a plane. It's like a rapid change in the pressure, and you feel something just get lighter, and it like floats away. Sometimes, it happens like if you're in a dark room in the summertime, and you go out, and it's real bright. You kind of just feel things like lighten up. There's other things within that umbrella, but the important point with it all that I get excited about and excited to talk about is that if you find the one that specifically describes what you're feeling, it can help you to find the right specialist.
[00:18:25] BP: Yeah. My logic behind it is if you keep just saying the word dizzy, you're not explaining enough of what's happening.
[00:18:33] MF: Exactly. Because dizzy is like a – It’s kind of a bucket diagnosis. That's what we call it in medicine, bucket. Throw it in the bucket. It's just – Fibromyalgia is a similar one. It's like if they don't know what to call it, we'll call it that. It's a description of a symptom versus a diagnosis of a pathology, so like it's akin to pain for a knee injury. You would say dizziness for injury x, y, z, and it's like what kind of pain? Is it stabbing, shooting, aching, burning? Those things underneath the pain umbrella describe symptoms that can tell you where it's coming from. Underneath dizziness, if you're talking vertigo, if you have false sense of motion and spinning, then it directs us to say, “Well, that could be vestibular.”
Where do vestibular symptoms come from? Inner ear. It can be a cervicogenic dizziness, which is in the neck. These are the things that you see in the impact head injuries and concussions a lot because you have the whiplash injury along with the head injury.
[00:19:41] BP: I had a few of those.
[00:19:43] MF: Yeah, right. Mostly, it’s like that. A lot of the race car drivers are the only ones that did anything about it, and they literally just like –
[00:19:51] BP: They were all against it until they realized that it could save their lives.
[00:19:54] MF: Yeah, exactly, exactly. Because you realize like even if you don't hit your head and if it's whipping around, you could impact nerves and vessels traveling from your heart up to your head. So the neck can be the source. The inner ear can be the source. A lot of people talk about the crystals in your inner ear moving around and all that. Describing what the dizziness is or what the symptom is or what you're feeling can guide the diagnosis of it.
It's a hard thing to talk about too in a public-facing way in medical settings, in medical review rooms, on boards, in research laboratories. It's an open forum to like talk and find these words and describe them, and then you put out a piece of literature and whatever. But you're not ever talking to patients in those situations, so like the communication about it becomes challenging because they'll put out a super specific word. The person who's diagnosing it will have this information about the word, and then they expect everyone that comes to them to know what they know. We take for granted this education that we have. It becomes a responsibility both of the clinician and the patient.
That's why I say it's kind of hard because it's like you're suffering. It's an emotional time. You're having symptoms. You shouldn't have to necessarily be like in full charge of getting your own help. But if you're motivated, here's a clue to how you can do it more efficiently because a lot of people go straight to researching dizziness. Or you'll Google dizziness or you'll Google concussion.
[00:21:32] BP: That's like googling headache. The amount of things that are going to pop up, it's actually insane.
[00:21:37] MF: Exactly.
[00:21:38] BP: It's kind of scary. Don't do it.
[00:21:40] MF: No. When you're dealing with a head injury and potential issues with sensory processing disorders, if you're staring at a screen, you're not going to go through three, four, or five pages of Google results. You're going to take the first one. So whatever pops up, you're going to go.
[00:21:54] BP: WebMD.
[00:21:56] MF: Yeah, exactly.
[00:21:57] BP: It’s usually what’s first.
[00:21:57] MF: It’s just like well-funded and not really accurate.
[00:22:01] BP: Yeah, exactly.
[00:22:02] MF: Sometimes, it is. That would be my clue for that, like the big hint and the big clinical pearl.
[00:22:08] BP: No, it's great. I think it's so important that like listeners and patients understand that you have to try to explain. If someone's not getting it, try to explain it in a different way because maybe you're just not communicating it properly so that your doctor can actually help you, right?
[00:22:27] MF: Yeah. The hardest thing to do is be in that state of having symptoms or like seeking help. You've made yourself so vulnerable already to go and ask for help. It's hard to say or to have that mindset of like, “I can also contribute to this process.”
[00:22:44] BP: Yeah, for sure.
[00:22:44] MF: Because like you want it to be done to you. It’s a very human thing to want to have things done to us, not with us.
[00:22:51] BP: Go there, be treated, go back better. Yeah, I could see that's the thing. Yeah, for sure.
[00:22:57] MF: If you're searching for it, search for all of those different kind of terms and symptoms first, and then it'll tell you. Do I need to see an ENT, ear, nose, and throat doctor? Do I need to see a physical therapist who specializes in vestibular or neck? Or do I need to see a chiropractor? Or do I need to see a neuro-ophthalmologist if it's a visual impairment? Or do I need to see a general neurologist if it's a central nervous system issue? It could save you a lot of time and trouble and insurance and money out of pocket.
[00:23:28] BP: And frustrations.
[00:23:28] MF: Frustrations.
[00:23:29] BP: In the States, yeah.
[00:23:31] MF: Time is of the essence with this stuff . Not only for solving the problem and not letting it get worse. But like we talked about, like you don't want to start to develop and foster this resentment of a system that's trying to help you. If you run into things that aren't going to help you, it can build up, and you start to be like [inaudible 00:23:49].
[00:23:50] BP: There's a lot of that in the concussion world where people are very against traditional medicine almost because they get bad experiences. Then I know I’m trying to encourage people to like try again because that's not how it works. I’ve had great doctors and I’ve had terrible ones too, but that's with everything in life. That's how it works.
[00:24:10] MF: Oh, my god. You know what? The thing is those terrible doctors are really good at something else.
[00:24:15] BP: Yeah. They just couldn't help you.
[00:24:17] MF: That's exactly the thing.
[00:24:19] BP: Yeah. That happens too, especially when you're going into an ER because ER doctors have to focus on – Their specialty is so wide, so like that's not where you should expect the most help. You need to find outsourced help from there.
[00:24:36] MF: Their trauma triage. That’s –
[00:24:37] BP: Yeah, exactly.
[00:24:38] MF: Education pieces is like people with dizziness go to the ER. They don't know. They're not trained in an Epley maneuver.
[00:24:46] BP: No, they're not. They don't have time to – They can't know everything. It just doesn't work that way.
[00:24:50] MF: They make sure you're not dead.
[00:24:52] BP: That's their job. Something – One of my favorite things we talked about when we talked previously was that words matter. So do you want to explain that to everyone here?
[00:25:01] MF: Yeah. We kind of started on it with this.
[00:25:04] BP: Yes, we have.
[00:25:06] MF: Words. I love words. Words are cool. We have the privilege of having words, and we have the privilege of being able to understand each other and use words to clarify what we feel and what we mean. So often the words like we talked about is what starts your process. You don't know how to describe something. You're trying to find the words to describe it. If you can find those words, those words are going to direct you to the right resources.
The challenge with concussion is that in the grand scheme of things, it's a relatively new field of study in treatment. We've been through bloodletting and leeching for cancer and all that stuff and figured out that we're still kind of in early stages of concussion stuff. We have a ton of amazing awesome information and a lot of things that can help, and it's progressing super rapidly. But like we talked about in the research, like words in the research, the communication of that research to clinicians, finding out what each clinician specializes in.
[00:26:09] BP: And words. We talked how words can definitely affect you also. One of my things, the one thing that I think I had a doctor tell me, a neurologist, and she asked me if maybe it was in my head because I was like having so much pain all the time. Then I started going nuts about it possibly being all in my head, and it is technically in my head. But I remember like kind of going nuts, and like just those three words were repeating like, “Am I making this up? Am I struggling?” It's amazing how we can cling to certain words that people say to us.
[00:26:44] MF: Absolutely. The it's in your head is an age-old problem that still for some reason people –
[00:26:49] BP: Bad use of words.
[00:26:51] MF: Yeah. Ignorance is a word that has a negative connotation, but it literally just means you're ignoring. Ignorance in that sense is just that that person is not specialized in communicating to someone who has a brain injury. Think about words to a brain-injured person or a person living with brain injury, if we're going to be patient-centered [inaudible 00:27:15]. Like we talked about with pain and dizziness, that kind of parallel, words is parallel to physical insult. So, if you get hit by a pitch in baseball or you get punched in the chest boxing or like you fall and bang your hip or you twist your ankle, an insult to a healing injury would be physically putting pressure on it. So like you twist your ankle again while it's not healed or you bump into a wall on the arm that you just hurt already.
Those things have a much bigger impact when there's already an injury there. Words are that catalyst for someone who has brain injuries, so words do have a physical effect on people. They get into your brain. You have already a way of understanding it, which is now complicated by the fact that there's all sorts of physiological processes going on to heal it. Those words get – I mean, if it's not delicate, it can cause some things. The hard part about it is like if you get so, so, so specific on that, you end up having like the burden of fear of not saying anything at all. Don't be afraid of failing and falling on your face in the communication stuff but like just having that acknowledgement that the words are relevant as much as a physical impact to an orthopedic injury is. Having that awareness can help you get through it.
[00:28:50] BP: For sure.
[00:28:51] MF: For clinicians as well, like clinicians need to know that.
[00:28:53] BP: Yeah. It goes both ways. Yeah. It’s a two-sided conversation at all times.
[00:28:58] MF: I’ve learned so much having been on both sides of it. It helps me be – We've talked about this before. It's the reason that a lot of people who specialize in things are specialists is because they've been through it themselves and like the empathy and compassion and sympathy.
[00:29:14] BP: Yes. It’s very common. I haven't met anyone who has no relation to brain injuries or concussions specifically who works with them. Every single person, whether it was a family member, a child, themselves, they always have some sort of connection that led them to focus on it, which is really interesting but also kind of adds some passion which I think is important as well. But something else, we were talking about words to continue on it. Getting better from a brain injury can be a really slow process. When you're first starting, they kind of – When you do that, your visit, sometimes it seems like it could be two weeks, and it could be. I’ve met multiple people where it's pretty quick. But I’ve also met a lot of people where it's been years. So how do you explain to someone that it might take some time to get better?
[00:30:07] MF: The biggest thing that I’ve found in that piece is contextualizing. Contextualizing the process means something very different for everybody, so it's personalization, so for my high school and college football players who are trying to secure a scholarship or trying to secure a spot in the league or like get into a combine.
[00:30:36] BP: Yeah. Or anyone, right? Everybody.
[00:30:38] MF: Yeah. Well, like for – It’s context. That’s a very different conversation than a mother of three who is trying to gain custody of children after a domestic violence incident.
[00:30:53] BP: Yeah, for sure.
[00:30:53] MF: With an ensuing head injury.
[00:30:55] BP: And having a head injury as well while going through it. Yeah.
[00:30:57] MF: Yeah, communication. How do you explain it? Well, to the athletes, to a lot of athletes, it’s about what their goals are. For me, I’m trying to develop this system of communication in the work that I do that's like the only thing that matters to these kids, these young men and women, whoever it is, is that they continue to get better at their sport or they get to play and they get to stay in their social sphere. They get to maintain their –
[00:31:29] BP: It’s their world, right?
[00:31:31] MF: Yeah.
[00:31:31] BP: It’s a bubble but you're in it, and it becomes your world.
[00:31:34] MF: And you're trying to maintain it. The communication about the length of time it takes to recover from a head injury needs to become, “Well, look. Here's an opportunity for us to work on bettering your skills and performance as an athlete.” If in the process they decide to stop playing and stop getting hit in the head, that can also be a win. But you have to open the door first because they're never going to do the rehab if you don't believe that it's going to meet the goal that you have at that exact moment. So it's a very dynamic conversation.
But early on, it's concussion rehab. You don't even say that. You don't even talk about concussion rehab. I’m talking to these kids about the exercises that we're going to do are going to help you read a defense better, and you're going to thread a ball through two defenders because you're doing visual acuity exercises and balance, and you're building up your vestibular system so that your head turns and your visual ocular reflex is improving, and it translates to high performance.
[00:32:36] BP: I really love that for athletes because it just kind of gives you like a goal, right?
[00:32:40] MF: Rehab transforms from like, “Uh, I’m out. I’m losing time. I’m not making any progress. I’m going to lose my spot.” It takes it from that into, “I have an amazing opportunity to have an incredibly experienced and expert staff around me to make me a better player and human.” What's not appealing about that? You know what I mean?
[00:33:05] BP: No, exactly. It’s really important because the whole stop playing is like a terrible conversation to start with because it doesn't work that way.
[00:33:13] MF: The newest concussion like acute and sub-acute concussion research is talking about it's not complete rest. There's plenty of stuff that you can do that's important. It's graded exposure.
[00:33:25] BP: Just don't get hit in the head. That’s a big important part, right?
[00:33:29] MF: Don’t get hit again. Exactly, exactly.
[00:33:31] BP: Riders like equestrian, I always tell them like, “If you do get hit, in my experience, you should stop riding. Not stop doing everything. But the risk of being on a horse and falling off again, like that is not what you should be taking. I’m not saying don't exercise or don't continue on, but maybe take that risk out temporarily and then get back.”
[00:33:52] MF: Absolutely, yeah. It’s just your calculated risks, calculated risk. There's plenty of simulated environments where you can continue to improve. We have virtual reality now. We have –
[00:34:04] BP: Well, and you can also improve on the ground for any sport while not in it. There are so many techniques to build while you're safe.
[00:34:13] MF: Yeah. What's off-season training anyway?
[00:34:15] BP: Yeah, exactly.
[00:34:16] MF: You're doing this stuff anyway. You're just putting slightly different parameters on it to make sure that an acute injury doesn't become a chronic injury.
[00:34:25] BP: Is there anything else you would like to add before ending today's episode?
[00:34:30] MF: The big points that I hope people take away is that the whole process is about a fit. You want to have someone who understands you. You want to have a good team around you. If you're searching for a wedding dress, you're not going to take the first one they show you and you're not going to not get it tailored, same like the tux. You know what I mean? That's a big important part of your life. You're not going to not do the work to make sure it fits you. I would say that make that happen in healthcare.
There's this conception that healthcare is done to you, and it's a passive experience, and it's something that you just have to follow where it takes you, and you don't have any choice in it. You do. It’s your health. You absolutely have a choice and you have power and there are people out there. We talked about this is a sub-specialty for everybody who had a head injury, sub-specialty for all these different professions of clinicians trying to treat it. To find that can be difficult and discouraging at times, but they're out there. These people are out there, and they're willing to help. Hopefully, the things we talked about today can get you to them quicker.
[00:35:41] BP: For sure, yeah. I hope so too. It can be such a long road, so finding the right person is really important.
[00:35:47] MF: Absolutely.
[00:35:49] BP: Well, thank you so much for joining and sharing your story and helping others living their life post-concussion.
[END OF INTERVIEW]
[00:35:49] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the Post Concussion Podcast, and be sure to help us educate the world about the reality of concussions by giving us a share. To learn more, don't forget to subscribe.
[END]
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