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Hello and welcome back to the podcast. Today's episode is a little bit different. This is actually a recording from one of our monthly Q and A calls that we have inside the Missing Link where I'm answering actual questions about walking and balance and strength training, spasticity modifications, et cetera, that were asked directly from my Missing Link members. And these conversations and this guidance that you are about to hear are all about helping you better understand what's going on in your body with ms, especially when you run into roadblocks, when exercising, or when symptoms appear, or when your symptoms worsen, and what you can do next. So if you find this helpful, just know that this is one piece of the support and guidance and education that we offer inside the Missing Link program along with our Dr. Gretchen AI, which is our 247 guidance and support system that we have in place for between calls. So with that said, let's dive in. The big question is, how does someone with Ms. Actually improve their mobility, strength, energy independence? The list goes on. My name is Dr. Gretchen Holley, physical therapist and multiple sclerosis specialist. Welcome to the Missing Link podcast. Tune in as I share the top strategies and exercises to help you gain control over your life with Ms. Using research driven insights and advice from top in industry experts. Whether you're newly diagnosed or have had Ms. For over 30 years, whether you have relapsing Ms. Or progressive MS, this podcast is for you. You're sure to feel empowered and inspired after each episode. Ready? Let's dive in. All right, welcome everyone to our Q and A call for this month. As always, this is my favorite thing to do every month. I just love being able to answer your guys's questions. And just as a reminder, these questions can be for me as well as any other Missing Link member too. Sometimes we have questions about product reviews from people with Ms. Who have used them. We have one question today where I am going to ask for your feedback because I know several people have experience with one of the questions, but of course I'm always here for you as well. And just a reminder that we do have Dr. Gretchen AI available to you inside the Missing Link as of October this year. So if you didn't want to wait a full month to ask your question to me, where we can hop on this zoom call for me to answer, then you can absolutely just check chat with Dr. Gretchen AI. I have infused it with all of my knowledge, education, experience that I could possibly think of and so it should be responding as close to me as possible. But with that said, let Me pull up the questions. When I do see a question already in the chat, I'm going to answer the ones that were submitted first and then I'll come. But I do have an answer for that question. There it is. Okay. Our first question is, I notice improvement in my walking. Yay. However, what keeps happening is that my left leg, which is my weaker leg, it literally stays behind me. When taking a step with my right leg, there seems to be a delay before it comes forward to the next step. Also, it feels heavy to move the left leg forward. This makes it hard to walk evenly and also makes walking more difficult. What exercises can help? So this is a pretty typical gait pattern. It even has a name which is a step to gate versus a step through gate. So I'm going to demonstrate. Let me step back here. And this applies to stair climbing. It applies to stepping up on a curb. Just general walking. Pretty much anytime we're taking steps, there's two options for, for this step. So option number one is a step through gait. This is something that you likely have if you don't have anything going on in your legs, no spasticity, no weakness. And what that means is you take a step forward with one leg, let's just say your stronger leg, and then your other leg fully steps through, passes that leg, and comes forward. And then when you take a step with the other leg, again, it comes forward, comes past that leg, and lands in front. So every time your foot lands forward, it's beyond what the other leg was able to go. So you're just continuingly walking forward continuously. Whereas a step two gait pattern is you take a step with your stronger leg and then your weaker leg or more spastic leg or whatever is happening with that side, it doesn't come through. It either comes to meaning in the same alignment as the other leg. So you would take a step forward with your stronger leg. Then this back leg just comes to the same point. So this makes walking slower. It can make it more tedious. It can. It can lead to a bunch of other symptoms and reasons for this happening. But step two can also mean that it stays behind. So you might sometimes experience where you step forward with your stronger leg and your weaker leg doesn't even come to the same position or distance as your other leg. It stays a little bit behind. Maybe your toes are in alignment with your heel. So it does kind of have this leg drag presentation. Even if you're not literally dragging your leg, it can have that presentation because it stays behind you. So when you have that, which is what this question is referring to. When you have that, it can be caused from a few different things. So to say exactly what to do, it's going to be different for each person in your specific symptoms and Ms. And everything that you're dealing with. However, some of these options might be appropriate for you. So option number one of why that might be happening is weakness in your hip flexors. If which are the muscles on the front of your hip. If you don't have enough strength, not that you need full strength, but if you don't have enough strength in your hip flexors to bring your leg forward, it's just going to stop wherever you have strength. The more strength you have, the more forward it will come. However, that often does require that you have more knee bend and a little bit ideally of ankle dorsiflexion where you can lift your toes. So one thing that you could be working on is strength training to improve your marching, that hip flexion strength as well as bending your knee. That can also help you get a bigger, more full step forward and ankle dorsiflexion. So in the missing link, we've got, of course, exercises for all of these and there's lots of options. You can do them standing, you can do them sitting, you can do them seated and reclined, you can do them lying on your side that so many different positions. So pick the position that feels best for you. But if you're sitting down, the marching looks like this. If you're upright or if you're reclined, it's going to look like this and you're just lifting your knee up towards the ceiling and then back down. We have the full description and demonstration in the missing link, so definitely watch that video if you're more curious on hip flexion and marching. We also just had a full Ms. Specific exercise class this month. I believe it was about 30, 35 minutes just on hip flexion strengthening. So if you're really into hips strengthening specifically for hip flexors, definitely check that out. But that's going to be one area that you can focus on to improve that stride. With bending your knee, it's our leg kick exercise or a hamstring curl where you're going to focus on pulling your leg back. So getting your heel to come closer to the chair if you're sitting or closer to your butt if you're standing, really trying to strengthen the muscles on the back of your thigh. So again, we have the full demo for that one and full explanation inside the missing link for that, so standing marching would be this. And the leg kick or hamstring curl would look something like this. But again, you can also do it lying on your side in bed, on a couch, lying on your back, lying on your belly. There's other positions too. So that's the first component is strength. If you don't have enough strength in these muscles, that can make moving your leg forward more challenging. Another thing is, is tightness in your muscles. Now, specifically with moving our leg forward, we need strength in the front, but we also need flexibility on the back side of our body. If we don't have that, and the backside, meaning our glutes, our hamstrings, hips, low, back, everything, if that is tight, that will not let you move your leg forward because it just works when the backside muscles tighten and contract, it locks you in a backward position, so moving forward is even harder. It could be related to spasticity, could be muscle spasms, could be general muscle tightness. But we want to make sure that we're stretching out our backsides. So this would be the stretch that we have inside the missing link, like the figure four stretch. Just to demonstrate quickly, you sit. Usually I like to do this seated. There's other positions you can do, but you grab one leg, pull it up over your lower leg so that your ankle is resting on your lower thigh. Sit up tall and hinge forward, keeping a flat back. If that's too hard, you can always modify by crossing your ankle at the bottom, just both feet on the floor and hinging forward. Either way, you should feel that stretch in your outer hip, maybe even your outer thigh, depending on where you feel tightest. A hamstring stretch could be a really effective one because that's another muscle on the back side of our body. So, still sitting, one leg out straight and hinge forward, you should feel that on the back part of your thigh and holding here. Of course, you'd want to do it on both sides, even if one side is feeling tighter than the other. But any stretches that we can think of for our backside, those are the two most common ones that when locked up, can make moving your leg forward hard. The third and final thing I want to mention for this specific symptom and mobility challenge is that if you've been doing this for a while, unintentionally, subconsciously, then it could just be that your brain thinks that that's how you should be moving. Even though it feels wrong to you and you want to change it, your brain might be feeling like, well, this is normal for Me, this is how I walk now. And so it can be really great to practice a full stride if possible. So practice standing with or without a mobility aid, holding on to something if you need. Because we're not doing this for balance, we're doing this for stride. So all of your weight, or most of it is on that front leg. And you're going to practice just moving this leg all the way forward, through, past that other leg. So that step through you don't actually have to lift the leg for this. Right now we're not aiming for perfection. All we're trying to do is literally just can you move it through even if your toes stay on the ground the whole time? And then pull it back and then pull it through? Can you get it to even go that far? Now that can be really tricky. Right now I'm on carpet and I'm wearing socks. There's friction there. That's it actually is somewhat challenging. Can you get a magazine? Trying to look around my room to see if I have anything that would be slippery. But you can find something slippery to put under your foot, maybe even put a shoe on and put, put something like a, a magazine underneath it. And again, just slide through as least friction as possible. And what this is doing is it's retraining your brain that you want your body to have a step through pattern. Now the stronger you get at this, then you would want to implement. What we have in the missing link is called the single step exercise. That's where you're taking a single step just like you are as with what we just described, but you're actually trying to have good form with it. So you're going to be bending your knee a little more than what is normal for you. Lifting your leg, marching a little more, lifting those toes, really exaggerating a single step so that you start to build strength with lifting it, not just keeping it down low, dragging the floor and moving it through. So lots of different components there. Again, what's going to work for you? It might be all three. It might be just one or two. It's going to be dependent on why that's happening for you. And we do have another question similar to that, but I do think it's a little bit different. So let me find that we're going to skip to that one first. The second question is, lately when I walk with a cane on my left side, my right side tends to sag slightly and collapse very gently. Does this mean it needs to be strengthened and how? So a little bit of a Different issue or symptom. But sagging or dropping is a form of hip weakness. So in this case, need to visualize this. The cane is on the left side. If you're using your cane correctly and it's on the left side, you want to use it on the opposite side of your weaker leg. So that to me means your right leg is probably your weaker leg. And then the question says, my right side tends to sag. Okay, so that could mean the weaker leg. It also could be the left side. So let's talk about this. If you've ever heard the Trendelenburg gait, that's essentially what this is. And it's when you're on one leg, usually when you're walking and taking a step forward or multiple steps, you have one hip that drops or sags. So to demonstrate, I'm going to take a step forward on my left leg. If my right hip is dropping down, usually that is an indication of weakness on the left hip. So this is easier, I think, seen visually than just heard verbally. But when the one hip, when the right hip falls, you'll see that my left hip pokes out. Typically, this is what happens, and it's due to weakness on that left side, usually the gluteus medias. We've got three different glute muscles. One of them is more responsible than the others for keeping that hip in when we have all of our weight on that side. So a lot of people assume that if the right hip is falling, the issue's on the right hip, but more times than not, it's actually that left side. So the seated clamshell exercise that we have in the Missing Link would be a really great one to try again. It's sitting, feet are together, knees open. It's a glute strengthening exercise. We've also done some exercises in different classes for where we do a side step or side kick to strengthen our glute muscles. That can also be a really helpful one, but one that a lot of people don't think about for glute strengthening is practicing standing on one leg with or without a mobility aid. So it's basically just what we in physical therapy, we call it a single leg stance. But stand on one leg and don't let that hip fall out. Easier said than done if you have this symptom. But if that's too challenging, if standing on one leg, if it just falls right out and you can't keep it in, then you want to think about our weight shifting exercise. And again, that's in the missing link, how much weight can you put on that left leg without it falling out to the side? And there's no right or wrong answer here. Is it 50% of your body weight? Is it 60, 70, 90? Whatever it is, hold it the longer you hold it. Now this is a strength and endurance exercise for those glutes and you will feel it, especially if you weakness there. And then as soon as you feel like, okay, I'm done this start, maybe it's starting to pop out a bit or I'm just tired. Then you back off and put weight on your other leg and then you'd shift your weight forward again. And the goal again is just can you keep even hips, nothing's dropping, sagging. With more and more weight through that leg, it might take you a few weeks or even months to get to the point where you're standing on one leg and that other leg is somehow some way, whatever works for you off the ground. Okay, the next question, and this is one that I'm going to ask you guys for your experience because this conversation actually comes up quite frequently inside our Missing Link Facebook community. So the question is, have you used vibration plate therapy with any of your Ms. Patients? I'm looking into purchasing a vibration plate to use at home as it appears this could help with issues I have with my balance, numbness in my feet, et cetera. I'm interested in any experience or perspective you might have on this. Thank you. So my question to you is, have you tried a vibration plate or vibration therapy of any kind? And if so, how did it help you? Also, I would encourage this person to go into our Facebook community and search vibration and you're going to see all of the comments that have come up there. I'll share first anecdotally and then I'll look to see in the chat if anyone else is sharing anything. So we have. I have never personally used vibration therapy in person with a patient just because we didn't have it in the physical therapy clinics. They're a little bit bulky to bring around and I haven't done an in person in home session with someone who has had one. However, I can share just anecdotally from experiences of our missing link members and other people that I know with Ms. Who have used it that they do notice an improvement in exactly the things that this question is referring to in balance, in numbness or tingling or just overall sensation in the feet or legs in spite of spasticity, in overall movement or fluidity of movement. And just based on this science of vibration and what it does to our cells and our muscles. It does actually work our muscles. And if you've never tried it, so often when people first try it, they'll message me and they'll say, I was so sore, like I was standing on it. Or you can even use it just sitting on a chair and your feet are on it and you'll feel it. Your muscles do have to work. It's really good for balance. And what's also cool about the vibration plate, and this has been missing link members experiences too, is that you don't have to use it for that long. It's not like you need to use it for 30 minutes even, or 20. I know lots of people use it for one minute or up to five minutes. Yeah, I'm seeing Rhonda say 10, 10 minutes. It's a, a shorter duration than what you might anticipate, which is nice. It's lovely if you just don't have the energy or don't have the time or just don't want to spend more than just a few minutes on it. And those that use it for that amount of time typically are also the ones sharing that they are seeing improvement. So it's not one of those things where the longer you use it, the better results you'll see. So I hope that answers the question. Kind of shares my perspective. Based on what I know from research, it is a valid form of therapy. I think when it comes to all the different things on the market these days, it's just really important to understand how it's supposed to help. And if how that's supposed to help is valid and backed by research, then it will likely help in that way. The reason that I reference this is because I recently had a podcast episode on the pulse vibration therapy device. And without getting too much into it, it's a device that you can put on your leg and it looks like electrical stimulation. And before I ever looked into it, I assumed this is electrical stimulation. But if you think it's electrical stimulation, you're going to be very disappointed because it doesn't work like that. It's not going to yield the same results as electrical stimulation. It's not going to feel the same. But if you understand it's not that it's a vibration therapy, therefore I can expect vibration therapy type results, then you're going to feel like, oh, okay, yes, this is actually feels the way that it's supposed to feel, or I am getting the appropriate results that I might expect versus if I thought it was electrical. Stimulation. Okay. Just going to look in the chat to see if anyone is participating in the vibration plate therapy. Thoughts? Karen says wonder if it would help relax calves. With relaxing for foot drop and calf tightness, I don't see why not. Yeah see Rhonda shaking that she agrees that it does help in that way. Amy says I got to try vibration plate therapy at a clinic this summer. It felt like sensory overload and triggered my left side paresthesia. So my OT or occupational therapist suggested starting smaller. She had a vibration ball. I try and I ended up buying a vibration peanut shaped ball to use. I'm experimenting with it to see if it helps reduce my paresthesia. Over time I might be able to work up to standing on a vibration plate. And that's another really great point too. Amy of most vibration plates have different levels of vibration and it really ranges. I know some of them start at level one and goes to like 50 or 30 like it. It is quite a big range. So if you do feel sensory overload which absolutely can be a thing, it does happen then you can start very very minimal. As I mentioned too, you don't have to just stand on it. I know we have some missing link numbers who sit on it. So their feet are on the floor but their butt is on the vibration plate or they're sitting in a chair but their feet are on the vibration plate. So there might be ways that you can reduce it or as Amy found using a different type of vibration. It doesn't have to be a plate. Maria says, I just bought the Life Pro Rumblex after you suggested it. Just started using it. Made me nauseous at first but now it's great. I do sit to stands on it. Increasing the time I stand seems to be beneficial. That's a good point too. Two good points here. If you've never been on one, it can be nauseating. Slow and steady. You're not. Don't. I would never recommend just going go big or go home. So you know, start incrementally but also you can do exercises on it if you're able to. And you can have mobility aids around or a countertop and hold on while you're on it. But you can exercise on it. You can use it however your body is able to. Helene says, I use a vibration plate. It helps with tightness in my legs and back from Ms. I have tried sitting on it last night. Awesome. Thank you for sharing. Stan says I used foot vibrating and heat machine can feel it working up to my knees. Very cool. Camille says I've Been using a plate for three years. I found it helped with balance. I practice weight shifting on it. Very cool. Let's see. It does loosen up my spasms and decreases pain in legs. I use it for 15 minutes. Very cool. Thank you for sharing. And then Pam says, my foot massager has a vibration feature, which is very nice. Ooh, that is nice. Awesome. All right, well, thank you everyone for sharing your experience with that. The next question is. I have found your Neuroplasticity 101 course to be amazing. So informative and inspiring. I've had Ms. For 37 years and the concept of neuroplasticity always gives me hope. I just need to be patient with the little baby steps. Can you talk about Neuroplasticity Quarterly or continue to speak about the hope this gives for people like me? I think positive self talk works. I sometimes just visualize new pathways forming in my body. I am so, so happy to hear this statement. I know it's not technically a question, but I truly believe that if you understand what neuroplasticity is and you're able to explain it to someone, like, that's how deeply you know what the possibilities are. It can be so motivating and give you so much hope, especially, especially during those seasons of life, weeks, months, whatever it might be, where movement is harder than usual, or you're having a symptom flare or a progression or whatever it might be. So just to quickly touch on neuroplasticity, in case anyone does need that reminder, Neuroplasticity is the ability of our brain to do two things. Number one, to strengthen the connection, the neural pathways, which are the connection from our brain to our muscles. So if. If I were to tell you right now, you're sitting down, lift your leg, either leg, doesn't matter which one. Lift it up. If you are able to lift it in any capacity, even if it's barely, Even if it's way less than the other side or what you used to be able to do. That tells me that the connection between your brain and that muscle, AKA the neural pathways that are making that happen, are there and they are working. They're just weakened. And one way that neuroplasticity works, through a bunch of every exercise that we have in the Missing Link, as well as other strategies that we talk about, is by strengthening those neural pathways that are already there. They are just weakened. However, the beautiful thing about neuroplasticity is that it also works in another way. If I were to tell you the same thing, Lift your leg and it doesn't lift at all, then what that means is that your brain is going to try neuroplasticity in a different way. Neuroplasticity is also the ability to find a brand new pathway from your brain down to that muscle. So if you try to lift and there's no movement, that tells me, okay, those neural pathways that once worked pre Ms. Are not working anymore. They're too demyelinated. But let's find a different way. It's like if you're going to the grocery store, but maybe there is a snowstorm like we all recently just had on the east coast, or there's construction, there's something stopping you from going your normal way. You're not just going to go back home and never get groceries again. You're going to find a different way to get there. You're going to go on back roads, maybe you even call Instacart. There's other ways to get your groceries and to get to the grocery store. That's when neuroplasticity is specifically finding the way yourself instead of calling for help. So neuroplasticity is the ability to find a different way. Which the reason I think that's extra important to understand is because if you don't understand that and you assume that if you go to lift your leg it doesn't move, you might assume that it's not going to move, that this is not an effective exercise for me, because look, nothing is happening when in reality, the best thing that you can do, and I know that it's easier said than done, but the best thing that you can do is do that movement. And success is not how much movement do you see? Success is how much effort am I putting in. The, the more effort you're putting in, the more repetitions that you're putting in that effort, the more focused you are during each movement, the more likely your brain is to find a new way to strengthen or a completely new reroute for that neural pathway. So it really is a beautiful thing. I think, hopefully I'm explaining it in a way where you can visualize it, because neuroplasticity isn't something that you can see, it's not really something that you can feel. It happens behind the scenes and it happens slowly over time. But every repetition truly, truly matters. The one reason why I say you can't really feel it is because, and this person in the question kind of alluded to it, they said, I sometimes just visualize new pathways forming in my body. I have Had a good handful of patients I've worked with in the past who have Ms. That visualize neuroplasticity. They close their eyes. Usually it's at night or when they're meditating and they'll close their eyes. And one person in particular, his name was Rick. He would tell me he would visualize fireworks going off in his brain, but then they would travel down to his hip flexors or to his calf muscles or whatever body part he needed assistance with and needed neuroplasticity to work for. And he said he could literally feel like a tingling and a sensation. So you can absolutely visualize it. Neuroplasticity works for muscles, which is how I mostly talk about it. It works for mindset. If you're a chronic negative self talk person or just chronic overwhelm, chronic anxiety, you can use neuroplasticity in so many ways. I know people who have used the strategies to talk better to recover their. They're speaking so lots of different ways. It's very fascinating, but I'll stop there. I could talk for probably five more hours on it. Okay, the last question today is how can you tell the difference between neurological pain in the leg and muscle atrophy and a muscle that shortens and causes pain when you stretch your leg or when you walk? So this is actually three different things. They all can lead to pain, but it is technically three different things. So we're going to. Let's break this down. The first part of the question is how can you tell the difference between neurological pain. Sometimes this is called neuropathic pain. Neuropathic pain or neurological pain is pain that is caused from misfiring of neural pathways. So basically, your brain is getting the wrong message for the reason of having MS, Ms. is causing this to happen. So you know how if you were to touch something hot, of course we would feel pain right there and we'd have that reflex of taking it off. You might have misfiring in your brain where all you did was touch a pen, but your hand misfired a signal that sent to your brain saying, oh my gosh, this pen is so piping hot and your hand is feeling like it's burning right now just from touching a pen. It was the wrong message. That's not actually what's happening, but that's what your brain is perceiving. It was told that wrong message, it believes it, and it makes you feel that sensation oftentimes. And also further on that neurological pain or neuropathic pain can feel like burning. With that example it can feel like just this stabbing pain. It can feel like a dull ache. It can feel like any type of pain. And oftentimes, the majority of the time, it's not associated with movement. It's. So if you straighten your leg or bend your leg, it's not that it would worsen with one or other of those movements. It just kind of happens. And it can happen with some steps, but not all steps. It's very unpredictable. Whereas the second part was, how is that different from muscle atrophy? So muscle atrophy is just a fancy name for weakness, but specific weakness where your muscles have shrunk. So you know, if you lift a lot and you're eating lots of protein and your muscles get big, if you stop working out and you're not eating protein, you're not focusing on muscle bulk, your muscles can shrink and they won't be as big. That's what muscle atrophy is. And with ms, oftentimes what I see specifically in areas of like the calf muscles is you'll have one calf that looks physically smaller than the other one. That's atrophy. The third part to this question is, so what are the differences between those two things and a muscle that shortens and causes pain when you stretch your leg or when you walk? So that muscle shortening that causes pain, or another way that I like to think of it, is muscle shortening that restricts movement is a form of spasticity. So spasticity is when your muscle contracts involuntarily. You didn't mean for it to, but thanks to Ms. And misfiring, it contracts, it shortens. And then if you try to straighten it, either it won't. It physically won't be able to, or you might be able to, but it's going to feel like a big stretch, or you can't fully straighten it, or it's painful. So that is more of spasticity. So the management for these, if we're going there, is for neurological pain, usually it's a medication of some kind that your neurologist would prescribe you. If it's muscle atrophy, usually it's strength training. If it's the spasticity, usually it's a combination, depending on what level. There's lots of different levels of spasticity. It might be just purely a stretching regimen with the stretches for the specific body part that you are having. Spasticity in specific time frames. All that jazz with or without a combination of medication there. If it's very severe spasticity they do have more severe methods like a Baclofen pump that you can have surgically put in. They have Botox. There's lots of different options, but each are managed a bit differently. So it is important to understand what each one is. Okay, so that wraps up the questions. Let me come into the chat and see what else was shared. The very first question that came in was thoughts on the zine? Crazy expensive, though. Yes. I'm curious if you guys have heard of or tried the zine. So the zine, it's kind of hard to explain. Let me actually pull it up via video. Zine is. Oh, mobility aid. There it is. Zingo. And I actually was able to try it out in real life at the annual Ms. Conference that I was at last year. So it's a really interesting device. I don't know anything else out there like it right now. And as you can see from this picture, so this person is standing, holding onto what looks like a wheelchair that's behind her, and there's these handrails up front that she can hold onto for stability. There's a seatbelt that you wear and if you fall. So if this person's knees were to buckle or she trips or something happens and she falls, this seat belt keeps her up and the seat stays as is. It sounds crazy and like it wouldn't work, but I purposely tripped and it. It catches you and it does prevent a fall. So it's, to my understanding, mostly designed for people who want to be able to walk when they need to, but can also sit down when they need to. So it's just a click of a button and you're able to stand up with it. I do have Missing Link members who use it. This person's golfing, they've used it to do their standing exercises more safely, and then they'll sit back down. The chair does raise up if you want to have conversations with people, but at more of an eye level. So there's. There's lots of benefits to it. It is bulkier than some of the other mobility aids. So it really just depends on you're looking for and what you need it to do for you. I'm into it. It's a cool device if it's right for what you're looking for. Anne says, I found it easier to step through when I lead with my weaker leg. Yep, it's almost like the staggered stance exercise. Yes. Amy says I'm a Trendelen burger. Sometimes both hips, but most often on my stronger leg. Yeah, that's the interesting thing about Trendelenburg is it is often on your stronger side. Our thoracic spine plaques. The reason for trunk issues with sitting upright and standing, can new pathways be made after a few years of this? So in terms of what symptoms are related to specific locations of plaques or scars or the sclerosis, there's not clear data yet that's super specific. Like, you know, in our thoracic spine, if it's at T4, then you're going to have this symptom on this side of your body. They are getting closer to knowing more specifics like that. But we don't know 100% right now in terms of with trunk issues, with sitting upright, it could be a thoracic spine, spine plaque, it could be an issue of strength versus endurance, maybe related to a plaque, maybe not. Maybe related to something else, maybe spasticity. In terms of can new pathways be made after a few new pathways? If we're talking about neuroplasticity, I think that's when this question came in. Can be created at any time. Our brains, Mississippi or not, is always in a state where it can make neural pathways stronger. It's just that when you have ms, it makes it harder. As we get older, it makes it harder. Not that it doesn't happen. It's still possible. The longer you've had a disability, it makes it harder. Still possible, but it might just take longer. So, yes. Can new pathways be made after a few years of any symptom or, or any demyelination? Yes, it might just take longer. So there's a lot of hope for neuroplasticity. The last thing I'll share about neuroplasticity, unless another question comes back to it, is a lot. The majority of research that's done on neuroplasticity and has formed what we now know neuroplasticity to be, was in people with brain lesions, not necessarily spine lesions. However, and I'm curious if anyone wants to share every 100% of Ms. Neurologists that I talk to and ask this question to or Ms. Researchers, anyone in that space that I ask, what are your thoughts on neuroplasticity for spinal lesions? 100% of the time it's the data might not show it, but we have no reason to believe that it doesn't also work for spinal lesions. So the idea out there amongst this population of neurologists and researchers is do the same things you would normally do is if you had brain lesions, assuming it's going to work, still follow those Same principles, worst case scenario. If at some point in the future there's research saying, sorry, nope, it doesn't work for spinal lesions. It's not that it's going to do you any harm. You're not going to be any worse off. The only possibility is maintain, stay the same compared to if you weren't doing the neuroplasticity strategies or see possible improvements. And I know, and this is where you can chime in if you want, we've had, we have lots of missing link members with spinal lesions, spinal plaques, whatever we want to call them, and lots of people with progressive forms of ms, not just relapsing forms, that have seen improvements through neuroplasticity. So that's like, that's one question I get all the time is, but will it work for me because I have progressive Ms. Where I have spinal lesions? We don't know 100%, but there's no reason to believe that it wouldn't work. I saw the real Dr. Gretchen made on neuroplasticity, demonstrating her leg lifting while doing marching, whether a lot or barely any. Still good and keep trying. Yes. It was so encouraging. Yeah. And if the p. If anyone didn't see that post, it was a post where I'm demonstrating lots of different ways to do the marching exercise. And it was the same, I shouldn't say lots of ways. It was the same way. It was just seated marching, but I demonstrated lifting really high, lifting just a little, barely lifting, not lifting at all. And in the video, I was just saying each one is equally as successful. I really encourage you to get out of the mindset of success equals lifting high, because for neuroplasticity, that's not true. If you can lift high, amazing, that's great and a great sign. But if you can't lift high, that doesn't mean neuroplasticity is not working or won't work. So don't think of success as the amount of movement you see. Think of it as the amount of effort you put in. The more effort you put in, the more likely your brain is to strengthen or find a new neural pathway. If you think about, again, we're in the middle of a storm just constantly here in the winter. If you are putting all your effort into shoveling forward, you're going to hit a roadblock. You're not eventually going to be able to push all that snow out of the way in one swoop, but every time, if you put as much effort in as possible, you're going to get to the end of your driveway much faster than if you're just putting a little bit of effort in each time. Much, much faster. It's the same with our exercises. I'm finding that after emotional distress, my symptoms get worse and pain becomes horrible. I always try to do chair class with tay at night before bed. Sometimes I am in too much pain to do the class. Should I pick some stretching exercises from Missing Link? So first and foremost, you are not alone. Stress distress of any kind can worsen any and all symptoms. This is easier said than done. But if you do know or notice, it tends to happen more at nighttime because maybe you just have a stressful life and your days are stressful for whatever reason, then if possible, and this isn't always possible, but if possible, try to be proactive about it. If the symptoms that are worse is pain and tightness and therefore you're looking for stretches and you're. Emotional distress tends to happen at nighttime or around specific events that you can know when they're coming before that happens. Maybe at 4pm that's when you'd want to do your stretches. That's when you'd want to meditate. That's when you'd want to just take time for yourself to regulate de stress. Another great class that you could take. Tays are great. We also have the Brain gym exercise classes. We have the yoga classes. Those all would be really beneficial even if you just do five minutes of them. The brain gym ones are just so interesting. I'm a huge fan of those. It's all about activating different parts of your brain and it can reduce stress as well. So if possible, be proactive. If not, because we're not always able to be proactive, that's okay too. But have a. I like to do a written list of things that have helped you in the past. So if it stretches, what stretches what body parts are tight so that if you get to that time and you're feeling like, whoa, this came out of nowhere, but I'm in emotional distress right now, let me do stretches. You don't have to think, well, wait, what stretches should I do? How long should I hold? Have specific directions written out for you. Or if you know that focusing on your breath work, which sometimes we'll do in the yoga classes, if that helps you, then you know, okay, let me do that. I have that written down on my list. So when you are just randomly in those moments, pull out your list of things that have helped in the past that you've tried and do those. How would you stretch Your bicep region. Stretching your biceps is really hard. So our biceps is so if we're standing or sitting in the anatomical position. So facing forward, hands down by your side, elbows straight, palms facing forward as well. Your bicep is on the front right here. Right. So when we do bicep curl, we bend our elbow and straighten our elbow. The way to stretch the bicep would be to have a straight elbow. So for some people who have really tight biceps and maybe your elbow is always slightly bent just for having it fully straight, you might need someone to help you fully straighten it. That is enough of a stretch. But if you are able to fully straighten it and you don't feel anything, sometimes you can scoot to the side of your chair and push your put your palm of your hand on the chair and straighten your elbow that way. That way you're getting a little bit deeper of a stretch because the muscles are being stretched into your palm as well. You could also just have it in front of you, pull your hands down. Having it behind you though can sometimes be a more effective form of bicep stretch versus in front. But it would be something like that. Straighten, pull the arm down, have it behind you, maybe twist. It's a really tricky one if you have chronic or not even chronic, but if you have tightness and you feel like no stretch is really helping. Two things. One, just a reminder that you don't necessarily have to feel a stretch to be stretching the muscle. So you, you are stretching the muscle in those positions even if you don't feel it because that's not the normal position for the muscle. So it is being stretched. But also you could try different muscle relaxation technique like massage if you have the pulse Vibration therapy. Vibration can help with that as well. I think zine would be good to build endurance and be safer. Yes. I was at a clinic when the Zine reps were there trying it with people. The PTs and the patients who tried it thought it was pretty cool. Yeah. Comments Zumba dance class was very good. Fast paced and fun balanced addition to the Monday classes were appreciated. Awesome. I'm glad to hear that. Yeah. So if you've been a little bit out of the loop in the missing link, we just, I think it was last week we had our very first ever Zumba class which we've received really amazing feedback on. And then next week we have our first ever strength based class that uses equipment. I don't like using that word equipment, but it's like dumbbells. If you have 1 pound weights or 5 pound, whatever you want to use. It could be cans of tomato soup. Resistance bands like using some tools to help with strengthening. So super excited for that too. By far my most debilitating attack five years ago was a spinal lesion. I've. And I've definitely experienced neuroplasticity gains since then. Awesome. Thank you for sharing that, Amy. Amy, you're one person I think about every time that question pops up. Anytime someone says I have spinal lesions, will this actually work? I've heard you say that before, so you always pop into my mind. Most recent Brain Gym class. Oh, thank you for sharing. Clark shared the most recent Brain Gym class. Upon following your Bop it suggestion, I purchased the model with the Twist, pull and Bop It. I wanted to share what an excellent suggestion Bop it was for me. I am working my way up to the extreme after 100 score. That's crazy. Okay, so do you guys know what the Bop it is? Yes. Okay, yeses and knows the Bop It. I don't know how it's a kids game. I didn't find out about it until whenever I started talking about it maybe three years ago. Anyways, I've. I've now, since getting my first one, learned that there are other easier variations. But I have one where, where you can bop it in the middle, then there's like a twist, a spin, a pull, and something else. There's a fourth one. It tells you what to do and there's music in the background. And so it's a brain game essentially. And it's a really fantastic way to work on neuroplasticity. We've talked about this in the Missing Link, but it's been a while and at first a bunch of Missing Link members got the Bop It. And I remember you guys would share in the Facebook community, like what school scores you were getting. And if you've never done it before, it is really challenging, but it's so much fun. You try to beat your score. And one of the strategies that we can do for neuroplasticity is challenge and urgency. And so I love using the strategy of playing with the Bop It. Try to beat your score during your rest time. So your legs are resting. You just did an exercise. You don't have to use them, but let's challenge your brain in a different way. And then once you lose, because we all lose at some point, then do your next exercise, then come back and do the Bop It. So that's really cool though. Debbie, thank you for sharing that you've seen success with that and there are different levels. So once you do get to a hundred, it's. I think there's three different levels per device. The easier one that I don't have but should have started with is it's just the bop it is in the middle. And then is it just the pull and twist? Is that the one that you have, Debbie? No.