In this episode of the Flex Diet Podcast, I’m joined by Dr. Eila Wolf, who specializes in functional neurology and Chinese medicine. We dig into how these fields come together to help people dealing with concussions, migraines, and chronic pain — and why traditional approaches often fall short. Dr. Wolf walks us through the science behind her methods, including how acupuncture, vestibular work, and eye movement assessments can reveal what’s really going on in the brain after an injury. We also talk about her new book, The Concussion Breakthrough, and how it’s helping patients who’ve been struggling with long-term symptoms finally find a path forward. If you want a deeper understanding of how the brain heals — and how functional neurology can help you or someone you know recover faster and more completely — you’ll get a ton out of this conversation.
In this episode of the Flex Diet Podcast, I’m joined by Dr. Eila Wolf, who specializes in functional neurology and Chinese medicine. We dig into how these fields come together to help people dealing with concussions, migraines, and chronic pain — and why traditional approaches often fall short.
Dr. Wolf walks us through the science behind her methods, including how acupuncture, vestibular work, and eye movement assessments can reveal what’s really going on in the brain after an injury. We also talk about her new book, The Concussion Breakthrough, and how it’s helping patients who’ve been struggling with long-term symptoms finally find a path forward.
If you want a deeper understanding of how the brain heals — and how functional neurology can help you or someone you know recover faster and more completely — you’ll get a ton out of this conversation.
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[00:00:00] Welcome back to the Flex Diet Podcast. I'm your host, Dr. Mike T. Nelson. On this podcast, we talk about all things to increase muscle performance and improve body composition. Do all of it in a flexible framework without destroying your health. Today on the podcast, we've got Dr. Eila Wolf, and we're talking all about the integration of functional neurology or clinical neurology.
And the role it may play in concussions, migraines, and, uh, other things kind of along the pain spectrum. Uh, we also talk about her background in the history of Chinese medicine and acupuncture and some of the different mechanisms there. Uh, what are some of the techniques used in functional or clinical neurology?
How I try to explain it to people is. Imagine you've got something in a safe and you're just [00:01:00] trying to find the right code to open the safe. And that code could be a, a basically combination of different types of eye movements, uh, head movements for vestibular work, and then obviously proprioception or just general body movements.
And we also talk a lot about the mechanisms kind of behind this. Uh, some simple things you can do on your own. How concussion is related to eye movements. So a lot of times if we know the patient had a concussion and we know what different parts of the brain are doing, these different eye movements, if you can find and measure where those eye movements are not working the way that they should, uh, that gives the practitioner an idea of what part of the brain is having issues.
You can also then look to see what other things that part of the brain does. Maybe we can train up that part of the brain via neuroplasticity, uh, to regain, uh, that function. This could [00:02:00] be in the case of migraines. This could be in the case of concussion and many other areas. So I think you'll really enjoy this podcast.
Uh, make sure to check out her brand new book that she has out in which we talk a lot about that. Also, and if you enjoyed this, please check out my newsletter. I got a lot of great stuff on the Daily Insider newsletter. Go to mike t nelson.com and you can hop on to the newsletter directly there. So thank you so much for listening to this podcast and enjoy this conversation with Dr.
Aya Wolf. I.
Dr Mike T Nelson: welcome to the podcast. How are you today?
Dr Ayla Wolf: I'm awesome. How are you
Dr Mike T Nelson: doing? Good. Thank you so much for being here. And we were talking I guess off air and you just got back from doing a cool lecture at Northwestern, correct?
Dr Ayla Wolf: Yeah. I graduated this is gonna date me, but I graduated from that [00:03:00] school in 2006 and Oh, okay.
Since then I've done some continuing education courses there, but they reached out to me and they were like, Hey, do you wanna come do a little lunch and learn and talk about your book? And it was funny 'cause I just got back from Toronto on Sunday night and actually was doing some cadaver lab stuff up in Toronto that was really cool.
Oh, cool. Yeah. But then I got an email from the school and they were like, oh, are you gonna have a PowerPoint? And all of a sudden I was like, oh, well I guess I do have to talk for an hour, so maybe I should show up with some slides. So, these days life is coming at me so fast I have to just like on the fly, be like, alright, we can throw this together.
No problem. Make it happen.
Dr Mike T Nelson: Yeah. Do you have any tips for putting together PowerPoint presentations?
Dr Ayla Wolf: I think at this point I've been doing it for so long that I have so many slides and I can always just pull from my existing deck and kind of put something together. So I was able to pretty quickly do that and I think it went well.[00:04:00]
Dr Mike T Nelson: Oh, that's good. I was just talking to Buddy lost then about this. 'cause I did a talk for the F1 racing teams today. And it was on, it was awesome. And it was on a new topic and on one hand I'm like excited to do new topics because it forced you to look at all the research, especially the stuff you used, but can you support it?
Is there new stuff? So on one hand it was really cool and super exciting. On the other hand I'm like, oh crap. It did overlap a little bit with kind of what I've already pulled together for slides. So that made it a little bit easier. And the other thing I realized is when I've got, probably 10 years ago, I was doing like a different talk, like three or four different talks every year.
And I realized, I'm like. This is stupid. They're all the different audiences. Like none of these people at the talk number two saw me at talk number one, why am I making my life so hard by reinventing the wheel? So then I realized, I'm like, oh, I could give almost the same talk, like four different times the different audiences that made my life so much easier.
Dr Ayla Wolf: Yeah. People don't realize, like when [00:05:00] you're, putting together a new class and new slides, like one single slide could potentially represent like one to three hours of research and work and information. So I think a lot of people, if they've never taught before, don't quite recognize how much time can actually go into like creating a brand new, class talk.
Dr Mike T Nelson: Yeah. And I always feel like I may do this at one point there be like no value added to any student. It's just more of an ego thing of. I feel like putting a list of all the references I read and never used, because there's like, as there's so much that goes into, you're like, oh this looks amazing.
And you're like trying to shoehorn it in. You realize at the end it doesn't fit and you just cut it out. And like the amount of stuff that you go through that doesn't make the cut due to time or topic or there's a poor study or what have you. I feel like there should be some, I don't know, just from my own ego gratification list of like, here's all the shit I looked at that I didn't use.
Dr Ayla Wolf: Yeah. Proof that I worked really hard on this.
Dr Mike T Nelson: Yeah. Yeah. Because I think now with [00:06:00] AI and a lot of the tools, I don't know what your opinion is, but I'm, before it was like, okay, if people read the abstract, I'd be okay. That's not the best, but maybe I give you a pass. If you're not, you don't know how to read research.
It's not like your main gig. I don't think anyone's even gonna read the abstract. They're just gonna type crap into ai. It's gonna spit back. They're gonna ask for references, it's gonna spit back, whatever, and they're gonna be like, woo-hoo, look, I got 20 references away. I go. And I, I don't know. That's just my pessimistic view,
Dr Ayla Wolf: yeah. It's gonna be an interesting world once more and more people are relying on AI to do their thinking for them. I do feel, AI still gets things wrong though, so like you gotta be really Yeah, exactly. You gotta be really careful when you're pulling stuff out of there. 'cause it's not always right.
Dr Mike T Nelson: Yeah. I. I still use it, but at the same point, I don't trust anything it tells me. If that makes sense. Yeah. Like I'll sometimes like try it to see where it's at and try to get a consensus, and then at the end of the day, you're still back to, okay, [00:07:00] maybe I've narrowed it down a little bit, but I had to go back and read all the studies and go through it by hand and kind of look at it.
Because even yesterday when I was doing stuff, I found like the DOIs were wrong. Like some of the studies were wrong. The conclusion it had was not necessarily how I would interpret it. So yeah, I would agree with that.
Dr Ayla Wolf: Yeah. Yeah, definitely have to be a little careful with that.
Dr Mike T Nelson: Yeah. And tell me about the cadaver lab in Toronto.
Who was that? Was that through a different company or for your own ed education or?
Dr Ayla Wolf: Well, I flew up there. I taught a two day kind of private course or for like, invite only. So I taught for two days and then I took a class for two days. From pony Chang, he's an acupuncturist and he has been doing a ton of research on doing a lot of cadaver lab research and looking at the ancient textbooks on anatomical locations for acupuncture points and basically finding that, like for example, right here on the wrist, there's four points that are very close [00:08:00] together.
And so in his mind he was like, why would you have four different points with technically four different like indications for why you would use them? But they're all close together. And sure enough, what he discovered was like every single point is at a point where the nerve brand has a nerve branch.
And so he started to then look at like every single point and he recognized every single point is right where some nerve branches off. And so he's basically been able to put together a very specific. Body of work to say that these acupuncture points are very much anatomically based on nerves. And so all of this talk of like energetic channels or meridians and, this whole kind of esoteric conversation of like, how, where did these acupuncture points come from?
He's basically like, there is an anatomical reason and it's all based on nerve, the nervous system. So obviously for me specializing in neurology [00:09:00] and really appreciating that perspective, it's, it was a super cool class.
Dr Mike T Nelson: Very cool. What are your thoughts about, I, so for a while I was looking at acupuncture stuff and I'm like, how did they come up with this?
Like I, my thought was, I don't know if you agree with this or not, is that the. Eastern style medicine was derived from a lot of, I don't wanna say trial and error in a negative way, but the fact that they just, they didn't do like the west and just hack up bodies and look at 'em and see what was going on.
So it seems like it was more of a outside in approach of, Hey, let's try this thing and see what happens. And they're just, over time you find patterns that seem to emerge of, hey, if we hit the H seven point, we find this effect, or we do this, we see this. Versus the western thing is like, I don't know, let's just cut everything up and look at it from the inside out.
I don't know what your thoughts are on that.
Dr Ayla Wolf: Well, my, my understanding of Chinese medicine history is that they actually did do a lot of [00:10:00] dissection.
Dr Mike T Nelson: They did. Okay. That's what I've always wondered about because like, how the heck did they come up with these points from just not doing any dissection?
I don't know. That always seemed to me very mystifying.
Dr Ayla Wolf: No, my understanding is that they did do a lot of dissections. Ah, and this gets a little gruesome, but my understanding is that they actually dissected live bodies prisoner. Oh, that prisoners? Yeah.
Speaker 4: Oh yeah.
Dr Ayla Wolf: Yeah. So they learned a lot about anatomy.
They actually did a lot of dissection to understand anatomy pretty deeply.
Dr Mike T Nelson: Interesting. Was that sort of accepted by the culture or is that kind of a separate thing or, I don't know. I'd always, I'm just curious how that ended up.
Dr Ayla Wolf: Yeah I know that the people who initially wrote the kind of ancient classic, the Huang d Jing or the Yellow Emperors Cannon of Internal Medicine, what I was taught, and I, at this point, it's like I always have to second guess everything I'm taught these days.
Yeah. But [00:11:00] what I was taught was that the reason that the, those authors were anonymous at the time was because they were saying that. Disease comes from your own cho lifestyle choices. Basically like what you eat and what you think and what you're doing to your body is actually what causes disease.
It's not demons and external forces that we have no control over. And that went against the accepted like maybe religion at the time or the accepted belief at the time. So for them to come in and say, actually demons and spirits are not what's making you sick, was such a radical thought process that they had to remain anonymous because of the fact that they were going against what was accepted.
So, ah, yeah. Interesting.
Dr Mike T Nelson: Ah, very cool. What would you say to people who don't really necessarily, I, for lack of a better word, believe in acupuncture and I would say for a while I was in that camp because I'm like, ah, how can this affect [00:12:00] this? And then. I did some stuff and then I have the dolphin micro point or microcurrent stimulators.
And the craziest thing is like you drag it over certain points and you'll hear the pitch change at acupuncture sites. So if you're a numb nuts like me who's not trained in acupuncture at all, you can look at a diagram and go, oh, H seven point and you could actually find the point. And the craziest thing to me is like when you do the training for it sure as crap, like almost all of the points actually map out to the tone change.
And even if I don't know what I'm looking for, you can still find it, which to me is like, it was mind blowing. I'm like, even if I was to fabricate a device to figure out how to trick everyone in the world, like I have no idea how you would do it. So it's somehow picking up on some change that appears to be reproducible in most people, and it maps to the points that are [00:13:00] considered acupuncture sites, which is crazy.
Dr Ayla Wolf: Yeah. Well, so I think your question was like, how do you talk to someone who says like, ah, that doesn't work.
Dr Mike T Nelson: Right? 'cause some of these people would quote and there is some literature, and I would not say it's all the literature of the toothpick study, right? Where you look at the M mri you do some acupuncture, we looked at imaging, and then you poke another site that's not an acupuncture site, so it's a sham controlled study.
Some of those studies did show effects, some of 'em didn't show effects. It's, back and forth, the people who would say, oh, it's all bunk. We'll, cherry pick a few of the studies that did not show an effect, for example which again, could be due to a myriad of different things, obviously.
Dr Ayla Wolf: Yeah. So part of the problem is that with. With trying to create research on acupuncture and make that research design look exactly like a double-blind placebo controlled trial. So that research model was meant for pharmaceuticals, right? Right. And so to take a pharmaceutical research model and try to plop it down on an [00:14:00] accu on acupuncture, it a, it doesn't really work because that's just not how the body works.
BI think it's taken a very long time to really even figure out how can we do meaningful acupuncture studies. So there's a lot of studies that were just very poorly designed because
It was the process of learning how to do the research. And so I, and I felt like I learned that firsthand because in my doctorate program I did a study using transcranial doppler ultrasound to try to show changes in cerebral blood flow with acupuncture.
And my whole study was confounded by the fact that I was working with UFC fighters, but we were trying to like tease out exercise versus. Actual head contact. And so the whole study was just confounded because you the length of time that you're exercising or the length of time that you're sparring, how many hits to the head you're getting while you're sparring.
Like, there was just too many confounding factors with my study. It was, in hindsight, it was a terrible [00:15:00] design. And so even for me trying to like conduct a research study, I realized, oh, like you've gotta think through so many different issues and confounding variables and how do you isolate all of that.
And then this idea of, doing a acupuncture on non acupuncture sites is also really difficult as a as a control group because. It. From my perspective, acupuncture is a neuromodulatory tool. It modulates the nervous system. That's one of its main effects. And so if you're inserting a needle at a non acupuncture point, we have free nerve endings everywhere.
Yeah. So you're still impacting the nervous system. And so that's why I think a lot of the sham acupuncture where you're just doing a non acupuncture point, you're still having some kind of neurological impact and you're still having some kind of systemic impact because when you insert a needle, you are mechanically deforming the tissues.
That's gonna [00:16:00] create a, some kind of immune response, and it's gonna still release a lot of chemicals. And so you just can't really do fake acupuncture and not have some kind of effect on the body.
Dr Mike T Nelson: Is there a better trial design or research design you would go to then in that case?
Dr Ayla Wolf: There are needles called stre berg needles, and so it's a blunt needle, and so you can pretend to like tap it in and then it doesn't actually penetrate the skin.
Oh, now, okay. That, works really well if you have somebody laying face down and they can't see what's going on or
Dr Mike T Nelson: they can't see what's going on. Yeah.
Dr Ayla Wolf: Yeah. But I did use those as a control group in my study and I didn't like using them. They were super awkward and I could see all kinds of reasons for why that would be a difficult thing to use.
So I think one of the. Best things is really looking at, having a control group or they're just not getting any treatment or they're getting what's [00:17:00] called the standard of care, whatever that may be. For whatever condition you're studying. And then you have your acupuncture group and you're, comparing outcomes.
So some people are using these stre berg needles as like a sham needle. I think they're still figuring out what's the best way to really study this. There was a really cool study that actually was doing FMRI imaging of the brain, and they were comparing two different acupuncture points that were only like an inch and a half away from each other, and.
There were completely different effects in the brain based on whether you were needling pericardium seven versus pericardium six.
Speaker 4: And
Dr Ayla Wolf: pericardium six all of a sudden lit up this whole connectivity between the midline cerebellum, the flock ulus, and the insular cortex and parts of the brainstem, like the nucleus tractus soli terrace.
And so this point is used for nausea. And so how interesting that you're actually seeing it light up the insular cortex, which is where we have a map of our internal [00:18:00] GI tract, right? And our stomach. And like if you're nauseous, like that insular cortex is lit up and and that connection between midline cerebellum and things like, motion sickness and nausea and the vestibular system, like, it just, it makes a lot of sense when you read that research and yet when you do a point that's an inch and a half away, that has nothing to do with nausea, none of those areas of the brain light out.
So really interesting.
Dr Mike T Nelson: Yeah I like from mechanistic standpoint, I like those designs a little bit better for that application because I, yes, I understand randomized placebo controlled trials. Like I, I get it, but I think sometimes there's too much of an emphasis placed on that without a lot of thought put into, okay, well can we come up with a unique design and ask better questions instead of just always defaulting to, well, this has to be the gold standard for everything that [00:19:00] we ever do.
I think we run into problems for that and some things like, supplements or things like that. Yeah, that makes sense. That's a good design. You can have a crossover period, you can have a washout period, all that kind of stuff. But just because it's not that design doesn't mean we have to throw it out and say, oh, this is all horrible data.
It just depends on what question you're asking. What are you trying to figure out? And again, like you said, I'm. A huge fan of just simple outcome-based studies, which I know are boring and journals don't like to publish 'em, but it's like, Hey, how about this people who report having nausea? Let's do the standard conventional treatment and then let's do an acupuncture treatment and let's just compare results, right?
Which yeah, was did, move the needle, right. Did anything really actually happen between the two groups? And if you have a fair amount of data showing that, Hey, it looks like this acupuncture thing is getting a result that we can actually quantify in a study, then yes, like by all means, do more mechanistic work and, try to figure out what's going on.
But it just seems like a lot of the me [00:20:00] mechanistic stuff is good and ultra sexy when. A lot of times we don't even know. Does the thing even work?
Dr Ayla Wolf: Yeah. I think the most valuable research studies on acupuncture would really be things that are looking at, what is happening in the brain as far as like SPECT scans.
Sure. And also understanding like quantitative EEG too. And how is acupuncture actually changing the conversation in the brain as far as electrical activity? And is it shifting people into a more alpha state or, there's, I think that, I think we're, we've been looking at it all wrong, and that if we just start bringing in more of these brain scans in terms of electrical activity and also blood flow, then we would really get a much better idea of what is it doing in the brain and how, why is it helpful?
And I think we just haven't really done enough of those. 'cause those are expensive studies to do. So, if I had all the money in the world, like I would be looking at, acupuncture's impact [00:21:00] on regional blood flow to the brain, and then quantitative EEG studies, and then also looking at how it can potentially impact ocular motor function with, o iconography.
So those are the things that I would wanna see, but again expensive to do.
Dr Mike T Nelson: Yeah. And even if you have like VNG or things to look at, like fancy eye movements for people who are listening, again, you can do a pre and post, be like, Hey, let's test this treatment versus acupuncture. And you can have a very quantified outcome, from, doing that too.
I also think of,
Speaker 4: yeah,
Dr Mike T Nelson: like research on psychedelics. It's yes, randomized placebo controlled trial, but. One of the researchers is on record quoting, going, well, even if people have never had psychedelics before, like nobody is gonna confuse high dose niacin with like high dose psilocybin. Like you're just, you.
You're just probably not gonna confuse those two. And you're definitely probably gonna know which one is the treatment arm, and [00:22:00] there is, and they've tried to get around it, like I think. One of the studies, I don't know if it was done in the US if it would pass IRB, but they even gave him verse set like after they did the treatment to literally try to wipe out their memory of the study.
Which is wild.
Speaker 4: Yeah. Wow. I'm
Dr Mike T Nelson: like that one was never repeated again. Probably for good reasons and probably ethical reasons, but yeah, so then you're like, okay, well what is a better, trial design? And they've done, some FM MRIs like David Nutt's group was the first group to do, and I think it was IV infusions of LSD in 2014 and stuck people in an FM RI to see what was going on.
And so now we have a lot more data showing, oh wow. There is a lot more hyper conductivity in the brain. There's changes in the default mode network. So we're getting a lot more data now, but a lot of it I think is still limited in terms of the FDA approval because this is a standard model and it doesn't really quite fit the [00:23:00] standard model.
Dr Ayla Wolf: Yeah. I'm gonna quick turn up my blind. Oh, yeah. All good. So my, my son is right in my eyes here. Yeah.
Speaker 4: Sorry to complain
Dr Mike T Nelson: about sunny days in Minnesota.
Dr Ayla Wolf: All right. Now I'm not being blinded by the sun. Yeah.
Dr Mike T Nelson: All good. Why did you get into acupuncture To start?
Dr Ayla Wolf: I was always originally, oh, I lost my video. Okay. I was originally very interested in herbs, so when I was six years old, I would go out into the woods and I would like mix stems and flowers and branches and roots.
And I was fascinated with this idea of taking things from nature, mixing them all together, and then somehow they create this healing potion.
Dr Mike T Nelson: So I bet your parents love that. Did you give 'em like a heart attack? Like you bring all this crap in from the woods, Hey, let's try this.
Dr Ayla Wolf: Well, I didn't make anybody drink it or eat it.
Oh, okay. But yeah. Yeah. But I was like fascinated with this whole concept, like from a very early age. And so [00:24:00] I, I think that. That's what started it. And obviously my mom was very interested in herbs and natural remedies. And so I grew up with the idea or the concept that if something is wrong, why would you immediately go to like a super invasive thing or a pharmaceutical with a bunch of side effects first?
Why wouldn't you try something that's natural before doing something that comes with more risks? And so that was how I was raised. That's how my brain always worked. So from a very young age, I knew that I wanted to study herbs. And then when I was 13, I met a naturopathic doctor and that was, they were from Australia.
And that was the first time that I had ever met somebody where that was their career. And I didn't, like, I didn't know that was a career. I knew I wanted to do it, I just didn't know it was a career. So when I met somebody. And that's like what their career was. I was like, oh, well I need to be a naturopathic doctor then.
And so I went to Australia and I went to that school. [00:25:00] Like I, I talked that information in my head when I was 13. Then when I was 19 and I was basically doing pre-med at the University of Minnesota, I found the school that, that naturopath went to that I had met seven years earlier. And I walked into the study abroad office and I said, Hey, I need to go to this school.
I need to study naturopathic medicine. And they were like, well, you could do that, but none of those credits would transfer back. Like, we don't have a program. Herbal medicine is not part of the pre-med curriculum.
Speaker 4: Yeah.
Dr Ayla Wolf: So I was like, okay. So then I found a little department at the U of M that allows you to design your own major.
And so I basically then designed my own major, had to write a whole pitch of like why I wanted to do it, what it was all about. They approved it and off to Australia. I went to study herbs and so I did that, came back and I had one year left and I took an introductory course to Chinese medicine and my teacher was Chris Hafner, [00:26:00] who's been practicing in the Twin Cities for a really long time.
And he just, he was a phenomenal teacher and he was the one that had created this mindset shift for me where he said there, there's a, those type of like western medicine where you're still looking at the body from a very, like, western pathological framework. And then in Chinese medicine you have this entire different model with which to look at health and disease.
That's very different. At the time that really spoke to me, and that was what cemented my decision to go study Chinese medicine after I graduated. And in hindsight, I would've loved to have gotten the dual degree in both like naturopathy and Chinese medicine, which is offered at a school in Portland, but at the time didn't know that existed.
So o off I went, studied Chinese medicine. Since then, have always been fascinated with functional medicine and functional neurology and how acupuncture can be used as a neuromodulatory tool [00:27:00] in the context of these other kind of mind, approaches and knowledge. So.
Dr Mike T Nelson: Oh, that's very cool. Is there any, what would be like your top three favorite herbs?
I know it's like a really generic question. It can be for any, anything in particular, but I usually find like people have like their. Go-tos that they tend to rely on a little bit more than other things. Again, obviously depends on what you're trying to do, of course, but
Dr Ayla Wolf: Yeah. Yeah. It's a hard question because in Chinese medicine we, instead of using large quantities of one herb, we often combine lots of herbs.
And so it's hard to say that there's maybe one herb that I love. But some of the formulas that I take often to support my brain health are formulas that kind of address more of like the neuroinflammation in the brain and the microglia. So alaria is one that you can get as a single herb.
But it's in a lot [00:28:00] of Chinese medicine formulas. So that's one that I love. And then ginseng is another one that is very powerful in all the different things that it does in the body in terms of energetics and in terms of improving kind of mitochondrial health and someone's energy levels, but also improving organ function from like kidney and heart perspective and spleen and lymphatics.
And so I feel like ginseng also has tons and tons of beneficial effects on the body. So that's probably one of my other favorites.
Dr Mike T Nelson: Yeah, and it seems like there's been a lot more research on ginseng now in terms of the different components and sub components and different types and different uses.
It seems like there's been a lot more research in the last 10 years in that area.
Dr Ayla Wolf: Yeah. And I do think it's hard to source really high quality ginseng, so a lot of the stuff on the market is not to be trusted. Yeah. Which makes it difficult. 'cause then you have lots of people ordering things that [00:29:00] maybe say they have ginseng in them and they really have like a poor quality ginseng, or not the right species of ginseng.
And then they take it and they're like, that didn't do anything. So that's also tough as well.
Dr Mike T Nelson: Yeah. Oh, very interesting. And then how did you get into functional neurology? Or maybe you should explain what is your definition, of functional or clinical neurology? I guess I'll start there for people who might be alike.
I don't even know what he is talking about now.
Dr Ayla Wolf: Yeah. I always say that functional neurology is a mindset with which you approach any patient or any human right. Whether it's sports optimization or somebody that has some kind of disease. The problem I think, with kind of classical neurology is.
This idea of, oh, your brain scan's normal, so therefore you must be normal. Right? And it's like, well, no, like brain scan's gonna show gross abnormalities in the anato anatomy of the brain, right? But there's so much more happening from a software perspective, [00:30:00] and if you don't test the software, you're gonna miss all kinds of things.
And so I think that, with my specialty in post-concussion syndrome, that's what I deal with all day long, is troubleshooting the software and saying, okay, what's not working for this individual? And how do we then craft a very customized program to, to fix it? And so for me, functional neurology is saying, whoever is standing in front of me in this moment, we're gonna test them in this moment to see what's happening in this moment from all kinds of different angles.
And then we're gonna try to optimize them. And again, whether the goal is to improve sports performance or if the goal is to simply be able to stand up and not be dizzy it's like the, we need to approach them with that mindset rather than just saying, oh, can you follow my finger?
Okay. Your pursuits are good. Yeah, that's fine. Right. So I think that classical neurology, a lot of things, like as long as they're good enough, they just get [00:31:00] glossed over. And with functional neurology, we're really saying it's not that you have to fall on this line, this side of the line, or that side of the line.
We're not drawing a line in the sand and saying, this is normal, and then everything over here is abnormal. Everything over there is we don't have to worry about it. We're not really drawing that line in the sand. We're saying, let's test this person and optimize this person.
Dr Mike T Nelson: Yeah. I, I don't know how we ended up with the.
I think we've gone awry by looking at static pictures of things in the body and over concluding from them from, if you even look at like muscle, like for years they had something called the Athlete's Paradox, where they would take and look at muscle and they would see these little droplets of intramuscular triglycerides next to it.
And these are from people who didn't exercise from people who were overweight would have insulin resistance. And I'm like, oh my gosh, look at this. Like they're really insulin resistant when we see more of these little fat droplets. And then someone got the idea to test athletes, and I think it was a high-end endurance runners that they tested [00:32:00] and they took the snapshot picture and they're like, uhoh, they have all these intramuscular triglycerides next to the muscle again.
But when we do this other test, they're actually very insulin sensitive. So for a while it's called like the Athlete's paradox. Like, well, well what the heck? We've got this same static picture and we've got two completely different results. And over time the theory now is that, oh. Because we're taking a static picture.
We don't see the flux, we don't see dynamically, we don't see an output or function of what's actually going on. And it turns out that the athletes intramuscular, triglycerides might be the same size, but the flux through them is a lot higher. So they are storing more fat there, but they're actually burning more fat around on the other side.
And so they're turning over those triglycerides at a very rapid rate where someone who's not an athlete isn't really turning them over. And I think we do the same thing in the brain. We take a picture and we go, oh, looks normal. You must be good. Right? Instead of testing eye function, vestibular function, or some other function even a muscle.
Yeah, [00:33:00] same thing, right? If I just took a static picture of your bicep, like, yeah, we can look at volume and get some idea, but we all know that depending on how your nervous system interacts with it, like your strength levels and how you perform. Even for the same air quote size muscle might be different when you reassemble it back into an actual human.
Dr Ayla Wolf: Yeah. Do you know Dr. Kemp, David Kemp?
Dr Mike T Nelson: I do not.
Dr Ayla Wolf: Okay. So he presented a, well, he wrote up a case report for one of the ISCN conferences, and it got publish through Frontiers in neurology. But he had a patient with multiple personality disorders. She had four different personalities. Oof. And when she would come in, based on which personality was currently there, her neurological exam would be completely different from personality.
Oh,
Dr Mike T Nelson: that's crazy.
Dr Ayla Wolf: Personality to personality. Her entire neurological physiology changed. I'm like, how do you explain that with a brain scan? Right. You can't.
Dr Mike T Nelson: Yeah. One of the, I think I might have told this story in the podcast, one of the craziest videos I saw of Dr. Carig. [00:34:00] God, years ago, like it was on VHS tape, they had converted over to video and he's doing the exam.
And this lady comes in and she is like, she's, she had been diagnosed with Tourette's, like had very much, Tourette's like syndrome. And she said her all the time, her left side of her arm and left side of her body or upper body just felt like it was on fire and incredibly painful. So he is doing all this stuff and he does a technique where he puts warm air into the ear, which will stimulate these vestibular canals.
It's a way of checking to see, some vestibular response to see if it makes any difference. And as soon as he does it, the, her voice changed. All her ticks went away and she's like, oh, all my pain went away. And she spoke like in a very normal voice, a different tone. And then once that sort of neurologic sensation wears off, she reverted back to the same symptoms she had before.
And it was the craziest thing to see it like actually on. Video to see the same [00:35:00] person present radically different within a matter of like seconds. And that always stuck with me of like, holy crap, that's insane. Like the difference you can see. And in this case, and again, it's not always this simple, but it, in this case it was this one particular input was the main thing.
Like if you've got all the logs that are stuck going down the river and you take the one kingpin out, like everything starts flowing again. Like sometimes you get lucky and you find just that one thing that's holding everything up. That was just crazy to see.
Dr Ayla Wolf: Either you get lucky or you're just as smart as Dr.
Carrick and you can just zero. Yeah. You're just like, you can zero right in on it. Yeah. And even in
Dr Mike T Nelson: his case, it took him about 20 minutes to figure it out. So it made me feel just a little bit better. But,
Dr Ayla Wolf: The warm air in the ear thing is interesting because I have such a crazy, like, tickle reflux with that.
Oh, interesting. I can't handle it. You can't handle it. I'm like I'm pulling away, I'm laughing hysterically, like it causes some kind of crazy rate response with me. But [00:36:00] one of the things that, one kind of sensory trick that works all the time in my practice is when people come in with an active migraine.
If I use auricular insufflation and I do a puff of air in the ear once every three seconds for a minute and a half. I almost don't wanna say it out loud, but like, I'm batting a thousand every single time I do that. The headache. A, it moves locations first and then B, the intensity drops.
And C sometimes it completely goes away, huh? Yeah. In 90 seconds.
Dr Mike T Nelson: Is that something people can do on their own? Because I'm sure I'll have an email box full of like, can I try this on my own?
Dr Ayla Wolf: Yeah. Well, so originally there was a device that came out for, the sinuses. It was a puff of air in the nose. And I think it was used to treat sinuses or something, but ev it, like it went on the market and then all of a sudden all these people with migraines were like, it made my migraine go away.
And so there's some research to say that like [00:37:00] putting, like air up the nose or puffs of air in the ear, it just is some kind of sensory stimulus that completely shifts the migraine. But yeah, I literally just have one of those insufflation bulbs and I'm just putting it like what
Dr Mike T Nelson: you'd see on the end of a blood pressure thing for people are listening if they're not familiar with what it looks like.
Dr Ayla Wolf: Yeah. I might have one right here if you want, if you want a demo.
Dr Mike T Nelson: Yeah, if you got one there. She's looking for one right now.
Dr Ayla Wolf: All right, here we go. Let's, yeah. Looks like the end
Dr Mike T Nelson: of a, yeah. Blood pressure thing on a little bit of a hose.
Dr Ayla Wolf: Exactly. And I just go 1, 2, 3, 2, 2, 3, and I count up to 30 and I just have that in the ear.
So it doesn't matter which
Dr Mike T Nelson: ear.
Dr Ayla Wolf: Yeah sometimes I like to start on the side where they don't have the headache and then I go to the side where they do have the headache. Yeah.
Dr Mike T Nelson: Huh. Interesting though. That's a good tip. I'll have to keep that in my back pocket too. [00:38:00]
Dr Ayla Wolf: Yeah, and there's ways of like doing a little bit more scientifically, like hooking this up to a Welch Allen Otoscope and doing it through that.
But I honestly find that like this by itself works really well too, so.
Dr Mike T Nelson: Huh. Any thoughts on what the mechanism might be?
Dr Ayla Wolf: Well, I mean there's a huge connection between information from, the cranial nerve eight going into the brainstem. And so we do know, like both auditory information and vestibular information travel along cranial nerve eight.
And some of the auditory information still also ends up in the vestibular nuclei. And really close to that vestibular nuclei is the trigeminal cervical complex, which is where all head pain is going to in the brainstem. So who knows if by doing, some kind of puff of air on the ear drum, if it's changing some kind of sensory information through cranial nerve eight and then going right into the brainstem, right where we have that vestibular nuclei in the trigeminal cervical [00:39:00] complex and somehow it just overrides whatever pain sensation is getting, transferred to that same spot.
I don't know. That's my
Dr Mike T Nelson: interesting. If you have someone who reports of migraines and they get very either sensitive to auditory or light sensitive, obviously some people are both, does that give you any ideas of what you would look at in terms of eye stuff or vestibular stuff, or do you find that it's just not really related?
Dr Ayla Wolf: I don't think that the light, well, anytime someone has light sensitivity, I'm wanting to zero in on the mesencephalon. And that's, and explain what that
Dr Mike T Nelson: does for people who are listening.
Dr Ayla Wolf: Yeah. So in the me the mesencephalon, you can just call it the midbrain for simplicity's sake, part of our brain stem.
And so that's where we have the edinger westfall nucleus, which is what controls pupil constriction. And so I would pay close [00:40:00] attention to the Pupilary light reflex. And I want to know if somebody is light sensitive, are they walking around with larger pupil sizes than is appropriate for the lighting conditions in the room?
So that's one question you wanna ask. Another question is if you flash a light in their eye, how quickly is that pupil actually constricting in response to that light? If people have a latency where a light flashes, but there's a lag time between that light stimulus and their pupil responding, well that could also create some light sensitivity.
So, so I'm thinking about what is happening in that midbrain and with the pupilary light reflex app that I have. I don't know if you have the same one. The Reflex app where it's taking 30 pictures a second. Yes.
Dr Mike T Nelson: Yeah. I had it and I, to be honest, I didn't pay for it right now, but I did use it quite a bit and it was actually really amazing if you could get it to, I had the early version, which had a few bugs in it, but the later version was.
[00:41:00] Pretty darn good. I had a few people download it and try to test it out on themselves just to get an idea if something's really funky. And in a couple cases it was. So I'm like, yeah, you definitely go need to, you definitely go need to see someone to get this figured out because they were ah, doctors told me I'm fine.
I'm like, I think you should see someone. I don't really want to. I'm like, well, download this app, do a couple of these tests and then you can get some of the data from it. And it was definitely wonky. So I'm like, yeah, your data's screwy, something's going on. Like, go see an expert.
Dr Ayla Wolf: Yeah.
Yeah. So I pay a lot of attention to that when people have light sensitivity. And then I think also understanding the degree to which the light sensitivity is present all the time versus like when you're just having a migraine. So with a lot of my concussion patients their light sensitivity is there all the time.
And it's just a constant thing. Whereas a lot of people that maybe get only one or two migraines a month. Maybe they say I'm actively having increased light sensitivity when my migraine is [00:42:00] there. In between you could have some people that have more constant light sensitivity and other people that don't.
It just depends on how sensitive their system is, because migraines really are a sensory processing disorder. And so there is research to say that a lot of these people that suffer from migraines, they are light and sound sensitive and they have sensory processing issues that persist even when they're not actively having a migraine, if they're really having, like, if, if they're severe.
So you have to just figure out some of those pieces of it. And then I think the thalamus plays a big role too, in, in its ability to just gate unnecessary information, some people find that. They're just overwhelm. They just get overstimulated easily. Whether it's a combination of light and sound and motion.
And so you've gotta like tease all of that apart and say, okay, what's actually happening for this individual? Like where, what situation is it that's causing this?
Dr Mike T Nelson: And I assume [00:43:00] you'd be looking at different responses potentially between left side and right side then in terms of left eye, right eye
Dr Ayla Wolf: In terms of the pupil pupillary life reflex.
Yeah. Yeah, exactly. I had a patient who just came in and it was like all signs were pointing to left eye, left midbrain. And initially he came in and both of his pupils were large and like a, and I would say it was like 5.8 millimeters in a brightly lit room, which is pretty large. Kids generally have larger pupils, but this guy was almost 30, so not super young.
And as I started to work with him, the right eye really started to respond and improve. And the left eye had like a lag time. So it was like the right pupil got smaller first. The left pupil like was more sluggish to actually respond. And so a lot of and his main symptom was like left eye pain.
So there was very clearly like some kind of either trigeminal irritation happening [00:44:00] only on the left side or issues with movement of the left eye. The right eye had no pain, it was just the left eye.
Dr Mike T Nelson: Very cool. And then related to concussion, tell us a little bit about the use of eye movements too.
Basically give us information about concussion because I think people have seen like, maybe it's just on TV or like, oh, this person got concussed and you see 'em do like the, hey look up, down, hey, you're good or bad, or, whatever they're I know they have more, fancier concussion protocols and stuff like that.
But I think people in general are down with the idea that eye movements are related to concussion. But I think most people underappreciate all the different things the eyes are doing and also diagnostically because they're literally an out part of the brain can give us a lot of pretty cool information from what's going on in the brain without having to do an FMRI or other scans that may not even show anything different.[00:45:00]
Dr Ayla Wolf: Yeah. And there's different classes of eye movements and if we wanted to get as simple as possible, we could say that our eyes perform two functions. One to look at something and two to look at something else, right? So it's like we have to be able to stabilize our gaze when we're looking at something.
And even that gaze stability involves the neck. There are cervical ocular reflexes that help to stabilize gaze. So a great example of that, I had a patient come in and his main complaint was shoulder pain. And he had it for two years teenager, high schooler going off to college to play football.
And he had been to a bunch of PTs. He had even had like EMG studies done to see if there was some kind, something wrong with his nerves. He said, I did a bunch of pt, I did everything they asked me to. And it's just, it's not getting any better. And it's very disruptive. I'm sitting in a classroom, I'm in pain all day, it's dis, it's distracting.
And so I said, [00:46:00] well. You play football, so have you had any concussions? And he said, well, yeah, I did have one. And, it was okay. Like I, I got, I wa I walked it off or I was fine after a few days. And I said, well, when was that? And he said, oh, it was about two years ago. I was like, when did this thing start?
Oh, about two years ago, right? I'm like, yep, okay.
Speaker 4: So
Dr Ayla Wolf: the very first test I did was I just said, stare at my thumb. And what happened was, as his eyes were looking at my thumb, his eyes were perfectly stable, but his head was bouncing all over the place.
Speaker 4: Yep. And
Dr Ayla Wolf: so right away I just said, okay, that cervical ocular reflex is not working.
This is what we need to work on. This is creating this dystonia. And if we fix the cervical oc, the cervical ocular reflex, we can probably start to smooth away this dystonia. And sure enough, that's exactly what happened. And so it was such a great case where if I didn't know anything about neurology or eye movements, I would've probably treated that as a purely orthopedic problem.
Which it was not, which is why it wouldn't have responded to just [00:47:00] massage therapy or stretching, or strengthening or, standard kind of PT approaches. So, so, so gaze stability is one, right? Like, can we hold our eyes on a target and do that well? And not just with staring straight ahead, but all these different angles, right?
So when I look at people's gaze stability, I might see, well, they can look off to the left just fine, but as soon as they look off to the right. All of a sudden they develop p posis or their eye wants to drift back to the center, or they start twitching and you can just see the neurological breakdown in their system if they're looking off to the right.
So all of a sudden you or you see
Dr Mike T Nelson: the eye go out and then come back and then go back out again and do weird shit.
Dr Ayla Wolf: Yeah. Yeah. So being able to understand gaze stabilization, not just from looking straight ahead, but on at all these different angles is important. And then, like you mentioned, the pursuits are the thing that people are the most familiar with because that's what the cops do.
If they [00:48:00] think you're drunk, that's what they do. If you get a concussion in the middle of a game can you follow my finger? Right. Functionally we wanna know, can you follow my finger right and left, but also up and down and at diagonals, and then what happens if your neck is an extension or flexion or looking to the right or the left.
So we're testing it based on is there a cervical component that is interrupting. The smooth movement of the eyes, or is there a vestibular component? Or maybe the eyes are being tugged one direction, you're trying to make them go another direction. So, so we're looking at pursuits. We're looking at ods, how, how fast are your eye movements and how reactive are they?
So we give you a target over here. As soon as you, we present the target, how fast can your eyes. Go look at that target. And so all these different aspects of eye movements all involve different parts of the brain. So if we know that our pursuit mechanisms involve the parietal lobe signaling down to the lower brainstem, but our [00:49:00] socos involve the frontal eye fields in the frontal lobe, well already we know we.
We've got two different eye movements involving two different parts of the brain. And so that gives us a whole load of information on the difference between how is the parietal lobe functioning, how is the frontal lobe functioning? And then we can look at, optic kinetics. We can look at optic, kinetic after nystagmus.
So if somebody's got a lot of disequilibrium, I like to pop the goggles on them, spin 'em around, stop them, and then count and see how long does it take for that nystagmus to stop? Because some people, you spin them to the right, maybe seven seconds go by after you've stopped spinning them. Eyes settle down, you spin 'em to the left.
You stop them and all of a sudden you've got 30 seconds of nystagmus kicking in. Well, all of a sudden you get the eye
Dr Mike T Nelson: going.
Dr Ayla Wolf: Yeah. Yep. And so all of a sudden you realize, okay, there's an imbalance in the way the brain is perseverating on movement to the left compared to movement to the right.
Every time this [00:50:00] person moves to the left or turns their head to the left, their brain thinks that they're moving after they've stopped moving. Like, and so these things are things that often don't get tested in a basic eye exam.
Dr Mike T Nelson: Yeah. I think people think eye exam, which is useful. I just had mine done the other day.
But you're looking at maybe eye health and AB best acuity. How well can you see things near and far? Like I haven't been to a normal optometrist yet. Yes, there's some behavioral optometrists and specialists that do this stuff, but there's a lot of other eye movements that can go on. Especially, I've noticed, like you mentioned with the with the tight trap or if people have just issues that are persisting and they've seen 1, 2, 3, 4, 5 specialists, my question I always ask 'em is, okay, if you're complaining of a right shoulder issue, you've seen, this just happened a couple months ago.
You've seen six specialists for your right shoulder, [00:51:00] you've got imaging, you've got everything. Like it's clean. There's barely anything going on there. I ask 'em like, has anyone ever looked at anything other than your right shoulder? They're like, no. I'm like, you've seen six people already that are specialists.
Like, do you really think the right shoulder is the root cause of the issue? I'm not saying there's no issue there, but do you really think that we should look at the shoulder just more in depth? Again, they're like, well, maybe not. And so usually like those patterns are like the hallmark of, okay, something else is going on.
So the question I always think of, like you were saying, is. Why is the right trap tight all the time? Or why is the neck lit up all the time? And the first thing I think of when I see like the neck, especially if it's bilateral, is real tight. Okay. Why is that tight? Is it trying to basically hold your worldview tight?
Because something in your brain is thinking that everything is moving. Your brain doesn't like to be confused. And so if it thinks the world's kind of moving, it's gonna go whoop and tighten everything up because it wants everything to be nice and stable because it works much [00:52:00] better when it's stable, but there's a cost to that stability if it's trying to make up for some other function that's not doing what it's supposed to be doing.
Dr Ayla Wolf: Yeah. I like to tell my patients the victim is what's screaming the loudest. So Yes. We don't wanna just keep hammering on the victim. We need to find the perpetrator.
Dr Mike T Nelson: Yeah. Yeah. So tell us how this relates to, you've got a new book that's out.
Dr Ayla Wolf: Yeah, well the book is really things that I kept telling my patients over and over again for years.
And I think that I'm in a unique position where when somebody gets a concussion and they have persistent symptoms, usually the last person on their list of people to go see would be an acupuncturist. And so by the time patients would get to me, they would've already seen lots of other people. And so when I started to study with the Kerik Institute and get trained on functional neurology and start implementing all these functional exams and functional neuro rehab [00:53:00] strategies I really got thrown into the deep end of the pool immediately because of the fact that the people that were coming to me were coming to me years later.
And they were the people that were not responding to anything any other doctor was doing. And so for 10 years, I basically have had to troubleshoot. And for 10 years of troubleshooting, I've had to constantly learn. So for 10 years there's just been constant learning, learning learning.
This patient came in, what do I need to know for them? What do I need to know for that person? What do I need to know for that person? And all my cases were tough. Like I wasn't getting easy cases. And so I, but to
Dr Mike T Nelson: me that's the, not to interrupt you, but that's the hallmark of people who are getting better and actually providing a better service and helping more people.
The end result of that is you get more and more difficult cases that force you to figure more shit out.
Speaker 4: Yeah. Yeah. Which feels
Dr Mike T Nelson: like you're not learning anything, right? It feels like, oh my God, even now [00:54:00] with like some of the functional neurology, I feel like I'm the dumbest person in all these classes I take.
But then you realize, oh, maybe I do know a couple things because you're further down the road than you think you are because. All the people you're getting are all the people. No one else could figure their shit out.
Dr Ayla Wolf: Exactly. No, exactly. And so functional neurology is hard to learn because you have to be willing to fail.
You have to be willing to Oh yeah. To try something and go, that didn't work. Now what? And so it's very humbling. You, I don't have a big ego because I know how much I've failed over the last 10 years. Right. But I've also gotten some really important wins. And I did feel like, I love to teach. I love to educate.
And so when I was working with these people, one of the things that I think my patients found most valuable when they would work with me is that they will, by the time they get to me, they feel hopeless. They feel gaslit. They are, haven't been given an [00:55:00] explanation for why they're having the symptoms they're having.
So when they come to me and I can run them through all of my functional exams, and then I can say. Here's exactly why you're feeling like your head is floating off your body, or here's exactly why you can't walk in a straight line. All of a sudden it's like all that anxiety just melts away because now they have a, some proof that there is something wrong with them.
B, they feel heard, and c, they, they feel validated and they know that, oh, well if she understands why I am having this symptom, well then she hopefully understands how to fix it too, right? And so I think that the reason I wrote the book was because I a, wanted to help more people than just who I can see in my office.
I spend a lot of time with my patients, so I can't, I don't have a high volume practice. I spend so much time with each person that comes in, and so I can't see very many people in a week. And so I wanted to write the book to reach more people because people were [00:56:00] suffering. And I found that I was giving my patients really valuable information, and I just wanted to get that out to a larger audience as well.
Dr Mike T Nelson: Yeah, it is. As someone who's gone through a lot of the neurology stuff myself, even just as a patient, like for years, I didn't know I had any eye issues. And then in my mid twenties I figured out I did, and then that made everything make sense up to that point, but I still couldn't fix it, and so I went through various different professions, different people, different professions, and they're basically telling me you're crazy, or, oh yeah, you do have this issue, but here's a surgery consult. I'm like, oh, okay, cool. Like what are the odds of surgery? They're like, 20%. I'm like. That would be nice to know before you gave me the surgery consult and sent me out to a surgeon to reattach eye muscle stuff.
Luckily I asked like, what is, what do you think the outcome is? And he is like, yeah, 15, 20%. Like that sounds a horrible [00:57:00]
Speaker 4: Yeah.
Dr Mike T Nelson: But you feel like such a weirdo when you know that there's something wrong. But every professional is like, yeah, but nah, there isn't anything you can do about it.
It's not fixable. Or they're like, it is not related to anything else. Like, we can't fix it, but it's not related to anything else. I even got kicked outta one optometrist's office because I figured out. Okay. I probably have to figure out some of this stuff myself to find other people that can help me.
And so I started playing with some of the, I have a midline scar from open heart surgery and on a bro string test, which is an old school 3D test. If I would move the scar right about like middle thoracic to the left, my right eye would turn on the rock string for like 10 seconds and I could see different objects and I could repeat it at any point.
And so I remember telling the one optometrist this at the end, and he looks at me and he goes, yeah, we're done. Now. I'm like, I guess I'm not coming back to his office.
Dr Ayla Wolf: Yeah. Wow. Zero [00:58:00] curiosity on his part.
Dr Mike T Nelson: Yeah, because in my head I'm thinking, this would be good information though. I'm telling you something, even though it's batshit weird.
That changes the function. So whether you agree it's related or not. Like if somebody came in, I'd be like, oh, that's interesting. Like I may not know what to do with that information. It may not make any sense, but the fact that you can change it to me told me that, oh, this is malleable. It's not a permanent fixed condition.
Because if it was, then it wouldn't matter. Anything that I did would not change the outcome. And I can clearly show that doing something, even though it's weird, change the outcome. So I would think that, someone who is in that field would be like, oh, that's cool. But again, like you said, when you find the right person, shout out to Dr.
Jeremy Schmo and other people I've gone to through the Care Institute and other, functional neurologists. It's nice to know, oh, we can do measurements. Oh look, oh, in my case, a lot of it was vestibular function that was not working the way that should, which was causing eye issues. So yes, I had eye [00:59:00] issues, but some of the root cause is actually a vestibular issue, not necessarily the root cause being an eye issue.
And then when you're able to work on those things and actually see and feel a difference and a change, you're like, oh, cool. So I'm not crazy. Nice.
Dr Ayla Wolf: Yeah. They've done research where they found that like applying pressure to e the inside of the foot versus the outside of the foot changes people's ability with convergence and divergence.
Yeah. And so our bodies are so inter. Connected in ways that we don't even understand fully. And so I think that's, one of those things where you've gotta be curious, you have to be open-minded and you have to be willing to assess and test things. And that's what I love about Dr.
Schmo too, is like he can get so creative and his therapies based on the fact that people all have really strange little idiosyncratic things that are going on with them in their nervous system. And you've gotta be able to work with that.
Dr Mike T Nelson: Yeah. And that's what I found too with the [01:00:00] higher level, therapists, physicians, and doctors, is that they don't necessarily follow a strict protocol or algorithm.
They know what they are, but they're looking more at, okay, what is the root cause? Okay. You're missing this eye function here. Cool. Okay. What part of the brain does that go to? How is this related to something else? Oh, it's related to this other thing. Cool. So let's try this other thing and let's see if that transfers to make this thing better.
So we're gonna measure the thing. Oh, yep. The thing's definitely off. Let's go try this. Vestibular rehab or whatever the drill is. Oh, we measured the thing again and it didn't get better. Okay. Let's try this other thing because we know this other thing is related to it. Oh, look, it did get better. Oh, cool.
Right. So they understand like the principles of the system and a lot of the networks. And then they're like, okay, it could be this thing, or this thing. We're not really sure. So let's just start with this and see if it makes a difference. Let's start with this. See if it makes a difference.
Because the benefit of testing the nervous system is you get immediate feedback on it. Which is nice. You don't have to [01:01:00] wait for two weeks like you do a training or two months or two years to see if the thing you're doing was actually productive or not. You literally have feedback immediately to determine what direction to go.
Which is very useful when you're trying to troubleshoot very complex things.
Dr Ayla Wolf: Yeah, absolutely. And you can't really do functional neurology unless you have that super strong foundation of neuroanatomy and how all the things are connected. And we're still we're still learning how all this, which is always changing.
Connected. Yeah, exactly. And so you also have to be willing to recognize like, oh, what I learned five years ago is wrong, and now I have to change my thinking.
Dr Mike T Nelson: Yeah. And sometimes you learn things that work and the reason they work was complete bullshit.
Dr Ayla Wolf: Totally. Totally. It
Dr Mike T Nelson: doesn't mean that the thing doesn't work now.
It just means, oh wow. That theory, we thought about how that thing worked doesn't really work like that. Like at all. Like I've done. Oh boy. A whole bunch of stuff in the past, which [01:02:00] I don't know if it really worked or not. Some of it was like, Nope, that doesn't work at all. Some of it was like, yeah, that definitely works.
But the reason I was told, 10 years later now we know is just complete BS but it still works. So it is, it's still a useful thing to know.
Dr Ayla Wolf: Yep. Absolutely. Again, it keeps us humble 'cause we gotta be able to constantly update our models.
Dr Mike T Nelson: And so who is the book specifically for? Like who would you recommend?
Definitely check out the book.
Dr Ayla Wolf: I tried to straddle a line of definitely wanting the book to be a troubleshooting guide for anybody who has had a concussion or a caregiver taking care of somebody that's had a concussion, that has persistent symptoms. I feel like there's a lot of information out there of like, oh, if you get a concussion, here's what you should do.
Like immediately. Right, like emergency medicine. My book is not that, my book doesn't spend a whole lot of time saying, here's the definition of a concussion and here's what you need to do in the first 72 hours. [01:03:00] That my book is not about that at all. It's really meant for the person who has been suffering for months to years and is trying to figure out like, what do I do next?
And what tests haven't I done that do exist that maybe I didn't know about? What are the therapies that are out there that maybe no one told me about or I have never considered trying. So so that's the person that it's for, but it does have a, there's a lot of technical information in the book, especially in the ocular motor and the vestibular chapters, as well as the brain inflammation chapter.
A lot of biochemistry in that one. And so I just had a chiropractor the other day whose daughter had a concussion and he bought my book and we were talking on the phone and he was just like, this is amazing. Thank you so much for writing this. And so I think that people who are in, who are healthcare providers who maybe haven't done a ton of studying on the brain and on concussions, and want to understand like what is the scope of what I do need to learn?
Like this is a good eyeopener [01:04:00] to say, here's all the different things that you need to be aware of. It's not just can someone follow a pursuit or can someone stand with their feet together and close their eyes? There's like a lot more to it.
Dr Mike T Nelson: There's more than just a Romberg test Oh my gods.
Yeah. More than just a
Dr Ayla Wolf: Romberg test. So for people who, are clinicians and have a healthcare background but haven't specifically studied concussions, I think it's a great resource for them to,
Dr Mike T Nelson: would you say that. Mo, vast majority of people who have had a concussion, even if it's been years later, who still have symptoms that, I don't wanna say a hundred percent, but I would say in a very high percentage, can actually resolve a fair amount, if not all of their symptoms.
My, my vote would be yes, but I think the standard public view, because the traditional medical system has done a very poor job post-concussion, especially a couple years post-concussion, that I think [01:05:00] the typical message is, well, you had a concussion. These things happen. You're just stuck that way.
And the more we learn about the brain, we learn that the brain's probably the most plastic thing in the body. Meaning that it has the ability to change and change rather rapidly given the correct stimulus.
Dr Ayla Wolf: Yeah. Usually when people come to me, and it's been years down the road, I find a lot of things.
That are abnormal in my exam that boil down to either autonomic nervous system dysfunction and or some type of sensory integration error happening between the neck, the eyes, and the vestibular system. And I think that's the problem with having everything siloed, like going to the eye doctor and then maybe going to a PT that is really just observe, like just assessing for peripheral vestibular disorders, but not really looking at the integration between the eye movements with the vestibular system.
So I, I think that the most [01:06:00] common things that I see that have gone missed are that maybe these systems were assessed independently of each other, but they weren't assessed. In terms of how they integrate with each other. So that's one of the biggest things that I see that has gone missed and that drive symptoms for a long time after the injury.
Those pieces. And then because I do get a lot of complex cases, I do get the patient that has Lyme disease or mold toxicity or autoimmune disorders on top of their concussion or Ellers Dan, low syndrome, autoimmune stuff. And so I do get the people that do have a lot of inflammation and a lot of additional confounding disorders layered on top, those become more complex.
So I think I somehow seem to attract all of those types of complex cases, which is, it's a lot to unpack and maybe the progress is not quite as, as fast.
Dr Mike T Nelson: [01:07:00] Yeah. I've lost track of how many people I see for movement, hands-on, just performance type sessions who have been. Referrals from other physicians, physical therapists, even freaking Mayo Clinic, like all sorts of places.
And 80, 90% of those people, I would say, that are referred to me have some type of basic eye or vestibular issue. Obviously if they're really complex, I'm gonna send 'em to you or Jeremy Schmo or somebody like that if it's really like beyond what I'm doing. But it's amazing how often just some simple stuff can make like a huge difference.
And what I've noticed is if your eyes are off, your vestibular system is off. One of the hallmarks is if you're only doing like hands on work or treatment or physical therapy or something and it's just not working. Like they're just not seeing the result that they should by the time that they've invested.
In my experience, I don't know if you would agree that. There's probably a visual or vestibular issue. It's [01:08:00] literally your nervous system is not allowing air quotes that information in. There's some other issue that's like, Nope, nope, that proprioceptive, just get that outta here. We've got this eye issue.
We gotta worry about first, like, don't let any of this other info in. And then once you address the eye or the vestibular issue, a lot of times I'll even send 'em back to their physical therapist and be like, Hey, just go back and just tell 'em, you're gonna try to do therapy again. Physical therapist calls up and goes, I don't know what the hell you did, but all this stuff works now.
And I'm like, and a couple times you get the case of the physical therapist or the person calls back and it's like, yep, see they needed just those last three weeks. And you're like yeah, okay, whatever. They're better. I don't care. Like I don't, my ego doesn't need the credit or whatever. But so people are listening and they're just stuck and they're doing more, proprioceptive or physical therapy or even training or.
Things like that. And they're just doing everything. Air quotes correct, and they're just not seeing the result. Like the first thing I'll ask 'em is if you had a car accident, if you had a concussion, if you had other things going on. And if they're like, yeah, I've had three concussions. I'm [01:09:00] like, okay, I've, I could almost guarantee you've got some visual vestibular stuff that you need to sort out first and then you can still do those other things.
It doesn't mean that they're not effective or that they're not beneficial. It's just like you said, you have to figure out what the root cause is first and address that, and then you can progress from there. Okay.
Dr Ayla Wolf: I would absolutely agree. And to add to that, one of the things that I do see is people that have done a lot of vision therapy, and so they come in, they say, I have done a bunch of vision therapy, and when I look at all their eye movements with their head neutral, everything's beautiful.
Dr Mike T Nelson: Yep. As soon as they turn their head, it goes to shit.
Dr Ayla Wolf: Yep. As soon as they turn their head or go into extension or flexion, all of a sudden it all breaks down. So yeah, it's that again, cervical vestibular integration with the eyes that tends to get missed. And then they did all their eye exercises with their head looking straightforwards.
That's all beautiful. The [01:10:00] second they turn their head it falls apart. So Yeah.
Dr Mike T Nelson: Yeah. And sometimes I've seen in like direct trauma, like I had a guy years ago who was a goalie, got hit in the side of the head with a puck. Like sometimes you'll find. Very hyper-specific positions and eye movements that will I don't wanna say trigger the brain, but it's almost like as simple as how I explained to clients is if your body is organized in terms of survival, and let's say you were playing goalie and you got hit on the right side of the face in the temple, like odds are your eye movement looking at that thing you're looking away from it is gonna be off because your brain literally thinks, if we go back into this position, we move our eyes this direction.
Oh crap, some really bad shit happened last time, so let's just avoid that whole position. Let's subconsciously avoid it. And then they'll end up with these weird workarounds and, tissue that's tight and just [01:11:00] weird abnormalities and stuff like that too. I don't know if you've. I know that's a little bit over simplistic, but I've seen sometimes patterns like that just show up again and again.
And it's sometimes easy to miss because sometimes it's very hyper specific to, certain eye movements, head movements, that type of thing.
Dr Ayla Wolf: Yeah, no I definitely see that happening and I think that's where. A combination of, like osteopathic manipulation, craniosacral therapy, soft tissue distraction techniques, a lot of that stuff can help to unwind those holding patterns.
Sure. And then a lot of times I find too, before I start doing a bunch of eye exercises with people, if I just have them close their eyes and I walk them through a guided eye exercise warmup where I really have them with no visual input, feeling into that like, position of their eyeballs and having them like do circles and then [01:12:00] imagine that circle getting bigger each time and people can actually find improved range of motion of their eyeballs.
When you do these kind of somatic type visualizations with the eyes closed. And I feel like that can be a really therapeutic and important part of, diving into a neuro rehab program is like just getting them in touch with what does even feel like to just move my eyes one direction versus the other, and where am I feeling tension and where are the restrictions and can I work that out just by feeling into it and moving in different ways, and then visualizing different things.
So I often have people like, pretend like they're Superman, with like the lasers coming outta their eyes and so their eyes are closed. But I have them visualize the lasers, like doing different movements and it just helps to warm, warm up the system.
Dr Mike T Nelson: Yeah. I love that. So tell us the name of the book.
Where can they find it?
Dr Ayla Wolf: Yeah, it's called The Concussion Breakthrough. Discover the Missing Pieces to Recovery, and it's on Amazon.
Dr Mike T Nelson: Great. [01:13:00] And other bookstores or primarily just Amazon right now.
Dr Ayla Wolf: Right now. Just Amazon. Yeah.
Dr Mike T Nelson: Cool. Awesome. And tell us about your clinic, where you're located, how people can find you, all that good stuff.
Dr Ayla Wolf: Sure. Lake Elmo, Minnesota is where my clinic is and I am licensed in New York and Florida and Wisconsin as well. So, I treat patients out in Wisconsin once a month, and then I do fly to New York from time to time and work out of someone else's clinic there. We co-treat some complex concussion cases so licensed in four states, but primarily in Minnesota.
And then I also have my podcast, the Life After Impact podcast.
Dr Mike T Nelson: And yeah, there's another Crazy nerds have been on there, so Good stuff.
Dr Ayla Wolf: Yep. I, I that all came about after I wrote the book and realized, oh my gosh, my book is 600 pages long.
Speaker 4: People with
Dr Ayla Wolf: concussions don't want to read a 600 page book.
Typically, how can I get this information out there in a slightly different format? So that's how [01:14:00] the Con the Concussion podcast was birthed.
Dr Mike T Nelson: Awesome. And what's the name of the clinic? URL? Like how would they find you on the old interwebs?
Dr Ayla Wolf: Oh yeah, it's healing response neuro.com is the website.
Awesome. Yeah.
Dr Mike T Nelson: Very cool. Yeah. And last question on that, do you do any virtual sessions or is it all just in person, in those states?
Dr Ayla Wolf: It depends on what people are wanting help with. So obviously when it comes to concussions, I really need to be able to do my hands on neuro exams. I don't do a lot of telemedicine unless it's like preliminary.
So if somebody, I might gather a lot of intake information and get some information ahead of time via telemedicine before they actually show up in person. So there, there's like, other types of issues. If someone just needs some herbal therapies or something like that, I can do telemedicine, but I definitely prefer in person.
Dr Mike T Nelson: Yeah. Awesome. Well thank you so much for all that. I would highly encourage everyone to pick up the book. I'm actually gonna pick up a [01:15:00] copy myself too, because I'm sure there's a ton of stuff I'll learn in there. And it's also nice to know that if people have concussions, there's. There's definitely a lot of options available now.
There's ways you can, definitely get better. I just talked to a buddy three months ago and sent him to clinical neurologist in Denver. 'cause he lived out in that area and he had been struggling with some migraine stuff and then he told me what it was and I'm like, oh, this sounds like a vestibular thing.
So I said, just call this guy, just do a one hour session. He can do an eval. See if it is, maybe it isn't. I don't know. I have a pretty good feeling that it probably is. And yeah, he did this session. He is like, oh my god, this is so crazy. Like, he knew exactly what I had, he knew what was going on and what parts weren't working and this poor guy had, migraines on and off like most of his life, wow. So I think that it's good to get a lot of this information out there so people have resources, they know what to do, they can try some stuff and know that they can get help with it, which is a great,
Dr Ayla Wolf: yeah, that's what we're here for.
Dr Mike T Nelson: Awesome. Well [01:16:00] thank you so much. I really appreciate it.
This was great.
Dr Ayla Wolf: Thanks for having me on the show.
Dr Mike T Nelson: Awesome. Thank you.
Speaker 5: Thank you so much for listening to the podcast today. Huge thanks to Dr. Wolf for being on the podcast. Make sure to check out her, uh, brand new book. I think you will really enjoy it, and all the wonderful stuff that she's got out. I also did a podcast, uh, on her podcast. If you wanna check that out, we'll put a link to that down below here too.
And if you want more stuff from me, check out the newsletter. Go to mike t nelson.com. Go to the top on newsletter. We'll put a link down here below to that. Also, uh, check out Dr. Wolf's book. We'll put a link to that also, again, with no affiliate link. We don't make any money off the book, but I think you will really enjoy it.
If you enjoyed this podcast, please leave us a review or [01:17:00] how many stars you feel is appropriate. Send it to a friend. Download, like all the wonderful stuff that helps us out with all the old, uh, algorithms to get better distribution of the podcast. And thank you so much for listening. We really appreciate it, and we'll talk to all of you again next week.
Speaker 3: There's something wrong with his hearing aid. Yeah. What's wrong? I can't hear with it. Oh, no wonder. It's too far away.
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