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Episode 08 - Concussion & TBI Recovery in Professional Athletes with Ben Velazquez

Episode 08 - Concussion & TBI Recovery in Professional Athletes with Ben Velazquez

In this conversation, Dr. Pastore is joined by long time friend and colleague Ben Velasquez to discuss concussions & traumatic brain injury recovery in professional athletes. Conversation points include proactive treatments, recovery time, mechanical vs. biomechanical rehabilitation, the importance of posture and its affects on the autonomic nervous system, the parasympathetic nervous system, nutrition, and the repercussions of an inadequate program for concussion recovery.

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Dr. Pastore: Welcome to another episode of the Modus Nutrition podcast. I'm Dr. Pastore and today I'm actually honored. One of my dear friends for many years ... I think we go back about two decades, is my guest today. This is the great Ben Velasquez. Ben is an award-winning, nationally recognized, sought after strength and conditioning coach and performance rehabilitative specialist to professional athletes and corporate executives.

This I can really vouch for. Ben has this weird six sense ability. Sorry that I'm calling it weird, Ben.

Ben: That's okay.

Dr. Pastore: I actually think he could smell an injury on an athlete and how to fix it. But in all seriousness, he has this intuitive sense to evaluate individual ability of an athlete and where they're hurting and how they're hurting and then determine a suitable corrective action for overall improvement. He's delivered well over 200 seminars to over 1000 sports professionals. In his professional career, he's the founding partner and director of Human Performance for Sport Lab NYC, LLC that was here in beautiful New York City. Right now, Ben is the president of Gray Matters Sports Group and there's exciting topics to talk about there because for the last two years, Ben has been spending time researching the use of corrective exercise in mitigating the risk factors of concussions in athletes.

Along with his team at Gray Matters Sports Group, Ben also successfully worked with athletes from five different sports that were recovering from multiple concussions, and we definitely will be talking about that today.

Ben and his team have pioneered a five tier method of rehabilitating an athlete that has suffered from concussive trauma. And Ben's background, he's in addition to his Bachelor's Science degree in Aeronautical Science, Ben holds several certifications, which include an NCSA certified strength and conditioning specialist credential, licensed performance Soma trainer, ACSM exercise specialist, ISSA sports performance nutritionist... I could go on too long with letters of the alphabet, so I'm gonna stop there.

And then Ben's client roster includes multiple NHL, MLB, Division I NCAA soccer, NFL, even the Women's Track Team at University of Texas, to world championship boxers, Olympic athletes... he had like, five of them back when the Sydney Olympics in 2000. Ben's got an extensive career in pro-sports. With that intro, Ben, thank you so much. Welcome and thank you for joining me today.

Ben: Thank you, Robert. That was quite the intro. I'm gonna have to put that on my smart phone so that I can hear that. That was awesome, buddy. I appreciate it and thank you, and to your listeners for having me on the show.

Dr. Pastore: It's an absolute pleasure. And you should cut some of that as your lead in to leaving you a voice mail. That would be a good segue.

Ben, you know, something we've never talked about, all the years we've known each other, the basics. Could you talk a little bit about your background and what led you on your current career path.

Ben: Yeah, sure. So, as you mentioned in the intro, my undergraduate degree was in aeronautical engineering. Aeronautical science is a double major. And essentially, I wanted to work in that field, in the aviation field. When I graduated, I did for about 18 months, I worked for an airline. And I didn't like it.

So I went back to school and I studied physiology and I got a degree in physiology. And then I started in corporate fitness, working here in New York, at a place called Park Avenue Squash and Fitness Club, back when guys were playing squash and working on Cybex machines.

So I did that for a few years, and I gained it... being an athlete, a former athlete, I played some baseball at high level, I wanted to work with athletes. So I was fortunate enough to get my start in professional hockey and for a couple of years I went back and forth to western Canada to work with the WHL, in particular with the Saskatoon Blades in Saskatchewan. And I used to write all of their programs for this WHL team.

So I got a lot of experience kind of in the trenches with young athletes. That helped me to get in the NHL and work with individual athletes in the off-season. And I did that for quite a number of years, primarily in NHL, some football, worked with a lot of track and field. And then I realized that I didn't have enough time in the off-season to get these guys right. Because most of them were hurt. So I thought about going back to school to study PT, but the PT model here in North America was very... how can I say? It was very secular and limited, and it was not what it is in Europe. It was not what it was in other parts of the world.
Ben: So I decided to take a non-accredited course in physiotherapy from France. It's an osteopathic course. And was given by a gentleman who's one of my mentors, Dr. Guy Voyer, who is a Ph.D. and an M.D. as well as an osteopath. He's a really interesting guy. Probably a savant when it comes to the human body.

So I studied with him starting in 2004, and started doing more rehab, and had a lot of success. That's when we would share a lot of our athletes with you, Robert. We worked with a lot of baseball in 2012. It was a combination of rehabilitation, performance, and for me, it's one big gray area now, which we'll talk about.

And then about three and a half years ago, when the concussion thing really started to hit the media hard, I started within the evaluation asking the athletes how many have had concussions in their history, and the number was pretty astounding. It was probably close to 80%, which meant that every athlete that we sat on the table at Sports Lab, 80% of them had had at least one event, at least one concussion.

So I said, wow, there's something to this. And that's when my engineering background helped, because there was nothing that was offered from an exercise component for these athletes. In other words, there was no rehab for them because it was a "brain injury". And so I started kind of looking at, what are the mechanical components of a TBI? How did they affect the body's posture? How do they affect the body's ability to accept energy and communicate energy or accept kinetic energy, ground force, however you want to call it, and communicate it? And that's kind of what's been happening for the last two and a half years, is how do I apply the engineering concepts to helping an athlete to rehab, and/or to mitigate the risk factor for contact sports?

Dr. Pastore: Wow. So that leads to a question I was going to ask you, what got your... because I know you're interested in concussions. So it really was Sports Lab and these athletes and you seeing that 80% risk, which is just off the charts, of every one that you were seeing for your daily work had that risk. And I mean, I was in that pool at the same exact time, and I was in shock at how poor the treatment options were. A lot of medical doctors at the time that I was exposed to was just prescribing various types of steroids, to try to reduce some inflammation. There is just... It really was a medication, go in a dark room...

Nobody really doing anything to work with these athletes physically. I've never heard of it, I've never seen a play book coming out of medical schools, back at that time, that was being done, to address these athletes. So that's a huge thing. So I'm so glad to know that that was your introduction. Can I ask, other than you seeing the lack of the physical treatment aspect, was there anything else that you felt that was just lacking in the world of concussions?

Ben: Yeah, and now I think there's more than one study. But there's definitely one study to link the increase in the likelihood of an orthopedic injury post-concussion. So I believe it's you're 40% more likely to suffer an ACL injury if you've had one or more concussions. And finding that.

So I guess the point of saying that was that the athletes that have had multiple orthopedic injuries were putting themselves at a higher risk factor for being more susceptible to a TBI, because those mechanical injuries were either not rehabbed properly, or the neurological aspect of them wasn't addressed, and so there was a direct... For me, there was a light-bulb effect. It was like, oh, wait a minute. These guys that are in non-contact sports are suffering real TBI's with no contact, but they have the history of mechanical injuries. So what's the link there? You know what I'm saying?

Dr. Pastore: Yes.

Ben: Yeah. So that's kind of the way we're looking at it now, where we're not looking at it as a concussion, we're just looking at it as another injury. And how do you look at it globally and assess what comes first, the chicken or the egg. Was it the ankle sprain you got two years ago, or the TBI you got two years ago, and where are you today?

Dr. Pastore: I definitely want to talk about rehabilitation. I don't want to leave this amazing... I think we're going to have to... I was going to say, the amazing dialogue about concussions. I think we're going to have that peppered in the whole dialogue. But always, for me, Ben, that really triggers something in my own brain. Because the way I've always focused my work, my thoughts on concussion, is just knowing that the neuro metabolic cascade post TBI... There's just some very well known pathways that transpire. There's this non-specific depolarization and initiation of some action potentials within the brain. There is the dumping of excitatory neurotransmitters, which of course, can throw off your gait. Which then leads to injuries, especially if that's your career, your job. There's a massive efflux of potassium, increased activity of membrane-ionic pumps that are just desperately trying to restore homeostasis, because obviously you're throwing off the sodium-potassium pump, if you're seriously losing and depleting potassium from that area.

I've also been fascinated with the hyper glycolysis, kinda to generate more cellular energy in the brain, adenosine-triphosphate. But then also the lactate accumulation has always been something on my mind. The calcium influx... people don't realize how, yeah, calcium's such an important thing, I get it's working in our bones and skeletal system and so many other facets, and voltage-gated calcium channels, we obviously need calcium to store and launch and release neurotransmitters. But you have calcium pouring into a cell, it actually causes damage to a neuron. It's why we have calcium-binding proteins outside cells that prevent that type of damage. So they can cause some problems. And calcium influx usually transpires with sequestration... it's like, sequestered within the mitochondria, leading to impaired oxidative damage.

And then the last two things that I think of is the decrease in adenosine triphosphate and an up-regulation of these calcium-binding proteins that are just not working so well, which initiates apoptosis or cell death.

So, just the things I listed would lead you to have gait issues and injury issues and all the problems that we see within concussion. And I'm starting to feel dumb that I never made the connection between, there's a frequent set of injuries. Here's a concussed athlete. I'm thinking of all the neurochemistry, chicken or the egg. That's really fascinating.

And then I go back to the body-blow syndrome. So with your boxers, we think of the great one, Mohammed Ali, right. Wasn't there a saying, I've never seen a study on it. I think there's some papers on body-blows. But wasn't there studies on boxers that are really great at protecting their head do not risk a reduction or benefit from a reduction in concussions. Taking all those body blows and how the brain is moving in the skull.

Ben: Yeah, that's another rabbit hole, Robert, for sure. To the first part of your point, I think that's what we're seeing now. Your expertise is obviously the biochemistry. And what we're seeing now is that we have to get the biochemistry in order first, in order for the brain to have more ATP to be able to increase that neurological threshold which allows the athlete to rehab from the injury. So, how can I have more fuel in tank to allow the rehab to occur and the brain to heal itself, which it will do, and that is basically, what's my current biochemistry?

What was the environment prior to the event, so did you have a bad diet or did you have all of these elevated inflammatory markers for whatever reason? And that event for you turns out to be an eight out of ten. For another athlete, it's a two out of ten, because they had a much better environment. So, we're on the same page with that.

And the as far as the injuries are concerned, for me, any injury that's not rehabbed properly, for me is going to affect the central nervous system. And if the central nervous system is in any way leaning towards a sympathetic state, so the fight or flight mechanism for your listeners, that has a whole biochemical cascade. But more importantly, that is not allowing, that is making the athlete more susceptible to a TBI at a much lower intensity. So the same contact that may have had no effect on Robert has a huge effect on Ben because I didn't rehab my knee properly.

And so, the homeostasis of the body has been altered in a way where, you're just more susceptible. And to your point, the body blows, it's not necessarily brain contact any more. They're looking at impulse injuries, which you can get from a body blow. You can get from shock wave if you're a soldier in Iraq. And it could be misconstrued as PTSD when in fact, you've had multiple sub-concussive trauma.

And so, it's all this new world of information that we're trying to piece and put together, but it's very exciting, because it offers possibility where there wasn't possibility before. There's countless players in non-contact sports that have had to retire because they couldn't rehab properly.

Dr. Pastore: Wow. Can you talk about that, Ben? So, as someone who specializes in these professional sports rehabilitation space, walk us through the process of assessing and recommending a course of action for an injured athlete.

Ben: Yeah. So I started a group called Grey Matter Sports Group, which started off as being a practice of professionals like yourself that were dealing with athletes and different spectrums of their performance and well-being, and we wanted to be able to refer back and forth athletes that we got that we wanted to rehab from concussions. But it's kind of grown into a think tank, because all the information is coming at us so fast, both anecdotally and research based. And so, we essentially share information on a monthly or a quarterly basis, as to what anecdotal results that we're getting in our practice. And in my particular practice, I work with an osteopath, I work with a chiro, I work with a functional medical doctor that does all the bloodwort and does all the nutrition. And then I handle the mechanical aspect.

So an athlete will come in and, like I've said, they'll probably been to a lot of places before and they haven't gotten the results or they haven't been happy. So they come here and we do a complete neurological and mechanical evaluation on them in my office. And they get their bloodwort done. And they also do something, what's called a VOR test, which is a Vestibulo-Ocular test, to look at essentially the GPS of the body. So they're looking at the eye function, the inner ear function, what information is the brain getting as to where that athlete is in space. What's the bloodwort saying as so where that athlete, how that athlete is monitoring their biochemistry? And then mechanically, what does that look like to me? What's the guys resting heart rate when he sits in the office? What's their HRV after a couple of days? How do they manage their gravity line? If they exercise for ten minutes on the bike, do they get symptoms coming back?

Ben: So we look at that. It's very, very subjective.

Dr. Pastore: Now can that... I can imagine that one big challenge is the athlete that, they have to go through surgery. They blew out a knee, it requires surgical repair, maybe another part of the body. How much of a wrench in the machinery is that for what you're trying to do with your colleagues? If at all.

Ben: So generally, I mean most orthopedic surgeons at that level, that are dealing with athletes, are very good. So the work that they do, for the most part, is very, very good. What happens immediately after that surgery, and a lot of cases, pre-surgery, too... I mean, you yourself know, Robert, that we got a lot better results when we were able to get an athlete that came in and you were able to change their nutrition and their supplementation prior to surgery.

Dr. Pastore: One hundred percent.

Ben: And I was able to do pre-hab stuff to them ready for surgery. I can't quantify it, but the results were a lot better. So now you take that same athlete that comes post-surgery, and the surgeon does a great job, but he has to fly back to... I don't know, and I'm not picking on Boise, Idaho... but I'm just picking a city, right? They don't get the quality of the rehab that they're supposed to get, for an athlete. Let's make sure to be specific about that.

Rehab for an athlete is different than rehab for my 93 year old mom. There comes a point where they have to get "field ready", or what I call "game ready". And there's a big, gray area to be filled between the time that the PT lets you go after doing six weeks post-surgery ACL, and you're ready to step on the field. And if that's not done properly, then that will set you up in a patter where you're more susceptible for other injuries, mechanically, and in my humble opinion, you're susceptible to TBI because you just don't manage your gravity line like you would normally. So it's impossible for you to accept ground force and dissipate it, take a blow from Robert and dissipate it in a safer manner, because of the previous injury. Does that make sense?

Dr. Pastore: It makes perfect sense. I was lecturing for the NHL back in June, and what was so fascinating was watching hours of tapes and footage of just poor posture, poor gravity line of an athlete running. But their list of what their complaints were. This knee is bad. This hip is bad. But if you really map that out, and you just draw planes of where their shoulders should be in that movement, where their hips should be, if they're out of whack, not only are they prone to injure another part of the body, bad footing, bad shoulder, bad footing, bad hip. You could blow out an elbow having a bad hip, right? We all know that from Tommy John's surgery. Just look at a pitcher's hips. That plays a big role.

Dr. Pastore: But what fascinates me is this whole talk of TBI. Don't rehab right, have really horrendous gravity, really horrendous understanding of your position on the field. Injured. And I understand you want to account for disruptions in the field. We know some great baseball players that love their stories, and I love listening to the stories, of them growing up in areas of the Dominican Republic, playing on a field that's not perfectly level, having balls bounce all over the place. And they could catch them and field anything. And of course, they turned out to be some of the best baseball player in the world.

This is a different story. If you're body mechanics are off from the beginning, and you're out there trying to play a contact sport like hockey or football... Wow. Now I can completely see, and it's bringing back cases in my mind, Ben, of people that may have... because you know, when we worked on the same athletes, not everyone was a choir person, right? A choir boy or girl. They would either do everything you're saying, 100%, drop off what I'm saying. Or vice versa. And it has to go hand in hand. You have to have that aspect, where the work that you're doing is so critical and profound to that athlete being game ready. There's no short cuts.

Ben: Absolutely. And the key component, you hit on it, is team. You have to collaborate with the group of like-minded progressive individuals, that are experts in their field, because I would rather stay in my own lane, and be an expert on the mechanical portion of it, and concede to people who are a lot smarter in the other areas. But you need to have a global understanding because... Listen, if you look... It's just like the injury. If you look at an athlete's bloodwort, and you never met an athlete before, you can look at certain variables in their bloodwort and go, it's not if this is going to happen; it's when this is going to happen. Based on the data that I see here, and I've never met the athlete.

So it's the same for me. If I see a guy that's had an ankle or a knee or whatever it is, pick the injury, and they haven't rehabbed it properly, they're in a contact sport, there's no question that that athlete is more susceptible, because that athlete doesn't have the ability to dissipate force the same way because of the prior injury. So, rather than make a better helmet, how do we create protocols that prepare the athlete better to accept force, to accept contact.

Dr. Pastore: That's an interesting statement. And it makes me think of what you guys are doing now. Is there anything you can share with me, as president of Grey Matter Sports Group, anything about the five tier method of rehabbing an athlete post-TBI (traumatic brain injury, for those who may not know). Could you share any of that with our listeners, Ben.

Ben: Initially, it was five tiers. And I would say you can still divide it into five tiers. But every athlete that comes in, we look at three major components. We look at neurological, which we initially broke down into two tiers, one vestibular and one more central nervous system oriented. The second one is biochemical, which we spoke about, which that's your field of excellence. The third is more mechanical, which we look at both what's the condition of the soft tissue and how can manual treatment help that? So is there a fixation that C012? Do they have internal rotation on this shoulder? Do they have a lack of scapular function here that a therapist can help them with? Do they have a tight psoas? Whatever.

And then I come and go, okay, how is that athlete managing their gravity line? So in other words, what's their posture. And when the layman thinks of posture, they think what our mothers told us, right? Sit up straight, put your shoulders back. Which is valid. But when we look at posture, we're looking at where does the brain perceive that it is in space? At all times? And what information is the musculoskeletal system giving the brain as to where it is in space, and vice versa? What's afferent, what's ascending? And what's efferent, what's descending? And what, for a lack of a better term, what's screwed up? Is the eye giving the body bad information because of that first TBI, or is the ankle giving the eye, the inner ear, the cervical spine, the brain bad information because that ankle injury was rehabbed improperly. And how do we get that athlete back to a good gravity line, a good posture, so that they're in a better position to accept force, to dissipate force. We're not going to get rid of concussions, but how do we provide a better insurance policy?

Dr. Pastore: We're not going to make that go away.

Ben: Right. To this same thing. You tell your athlete, listen, you know what? I know you're a football player. But dude, if you eat this way, you're going to have a better environment for that daily contact and for that one event. You're going to be better prepared.

Manual therapy. We need to be more proactive in our model. We're going to plug in your treatments rather than wait until you feel pain or that you're not performing better, because in most cases, that's late. It's too late. It's being reactive.

So, hey, Robert, I'm not sleeping, is late. Versus, hey, Robert, I wanna look at my bloodwork to optimize everything so I sleep better.

Dr. Pastore: Yeah. Athletes need to reactive. Athletes need to be proactive, pardon, is what I'm saying. Athletes need to proactive, not reactive. Because what they do, Ben, this is what I say a lot on the podcast, and please feel free to disagree with if you disagree. But when I talk about a professional athlete, just amazing, you think of the hockey goalie, a phenomenal goalie, all those saves. Those movements are not natural.

Then I think of the pitcher that's coming out there, six foot and change, gonna throw anywhere between a change up to a fast ball, maybe have between 77 to 90-something miles per hour. That's gonna last for maybe seven innings. One arm. Not natural.

You got the great golfers, you got Tiger Woods, all that explosiveness, the positioning you need to be in, just to be able to be perfect posturally, for playing a game of golf. Not natural.

So you're making the body move in an unnatural way, and the job I had when I was working that field, and I believe you still have it to this day is, how can we do everything that we can to mitigate injury risk as best as we possibly can in an unnatural movement realm?

And obviously, football, guys running into each other that are very large. You want to dissipate as much force as possible, but these are all unnatural things. So it requires so much more work. And also, what I noticed... You know what, that's why I love when you said, "I work with a group of people, we'll get on the phone, we'll meeting, we'll have meetings and talk about these n-of-one cases." That is how you really build a practice. You learn amazing stuff on a university level. Nothing is then going to educate you the way it is when you're out in the field actually applying your craft. And how many things change.

And one of the neat things that happened is Raul went to tell us some really key components of his life when he was working with me. And no one says it better than Raul, not to put words in his mouth, but on this podcast he said, after winning the World Series as a young man, his ankles killed him in the morning, and he could not run 40 yards. After I did one thing... I did a lot with Raul, but I did one thing. I identified his immunological relationship to what he was consuming to nourish himself, I.e. his diet. Was something he consuming just reacting immunologically in a way that would promote more of the inflammatory cascade he obviously was experiencing. He said after seven days after me identifying, and him doing all the work, and avoiding those foods, he could then run 100 yards without pain. Right?

What's neat about athletes is the challenges, they're doing things that are unnatural. We have to work harder to keep them as safe as they can, because their sport puts them in a higher state of injury than a CEO. That would be one hell of a dangerous position, if I'm wrong there, if that's for that CEO. I don't think a risk there is having the risk of your hockey players or line backers on a game to game basis for him. No, not at his quarterly board meetings, no. They seem to be doing well.

But I also think they respond... Here's what I'd like to know. I think they respond quicker than the average person to a course of action, a treatment modality, that is on target. Do you feel that, with an athlete versus the lay public?
Ben: Yeah. I definitely see that, when the athlete complies with what we give them, they respond much quicker. I think that they have, obviously to be at the level that they're participating and playing their sport and getting paid for their sport, they have highly developed nervous systems, and I think that that's one of the areas in the field of sports science that's young and that's being looked at by some of the smarter guys in the field, is really understanding how to be able to get the athlete in a parasympathetic state. Every one of the athletes that you and I have worked with, that operate at a high level, talk about the game slowing down when they perform at their best, and being in what's referred to as a "flow state" or however you want to call it.
Ben: And in my humble opinion, I feel like, again those three components play a huge part. So what is your biochemical environment that allows you to get into a parasympathetic state quicker, or do you have responses that don't allow you to? What is your environment mechanically that contributes to you getting into a parasympathetic state quicker, or do you have components of that that interfere with it? And what's your program-wise recovery, including soft tissue and everything else, that allows you to get into a parasympathetic state? Or do you have nagging aches and injuries and stuff that you don't deal with by getting the proper treatment that prohibits you from getting in that sympathetic state?

Ben: I think ultimately, the more we know about that, the higher our athletes will perform, and the better our results will be.

Dr. Pastore: Yeah, I agree. There's so much. And we have so many colleagues that are working in different areas, and I believe teamwork is the only answer to help mitigate as much risk as we possibly can in sports, these contact sports, and in sports where there may not be contact, like your work in track in field, and your work with the Women's team. That's very rewarding. And I'm assuming that area is less risk for concussion, but so much greater risk for mechanical injury.

Ben: Absolutely.

Dr. Pastore: And that... Would you approach, Ben, a very similar case to those types of athletes that are injured in the complete, total absence of a concussion, are you still looking at the biochemistry components and the whole spectrum as you're doing with TBI? Or is it a little modified?

Ben: No, I absolutely do. For me, in a perfect world, every athlete that came to see me would go see my colleagues, because the results would be exponentially better. And I learned really early on in my career, when I worked with that track and field team, we had a 110 meter hurdler, and she doesn't mind me sharing her name, Michelle Freeman, she was an absolute beast. And she had a multiple tibia fracture during a race which she actually finished. It is horrific to watch, but she, on the last hurdle, she snapped her tibia. And the doctors couldn't figure out what was going on, because it was a non-contact injury and she was extremely strong. She wasn't on any PED's, she was natural, she was just gifted. When we sent her information to Dr. Sorano, he asked for some blood work, and it came back that she wasn't absorbing boron, along with several other minerals.

And so that, early on in my career, showed me, wait a minute! You need to know the details when you're dealing with high level athlete, because an athlete like that, you need to know that right away, and you need to mitigate that right away, because she potentially hurt her ability to win a medal in her entire career because of that one injury. It was something guys will look, therapists were looking at her like, what is going on here mechanically? And it wasn't, it was a biochemical issue with her.

So, that happens in the concussion space, and it happens outside of the concussion space. And to me, it's one big gray area.

Dr. Pastore: Absolutely. And it's something I did a webinar on endurance athletes a while ago with some experts in the field. And I brought up my work with some track and field stars, and without even knowing it then, they were, especially the women, they were victims of the female athlete triad, where they were just crushing calories and not putting enough back, under-consuming macronutrients, and it ended up having early track of osteopenia, the precursor to osteoporosis, and then of course had a great risk for fracture.

One of the routine things that I would do all time, I didnt' care how fit the athlete was. They would come in to see me, part of my work included just looking at a fracture risk. We needed to have baseline data there, because too many great athletes, I would see some just tremendous injury. And yes, you can never stop every single break, but if you see warning signs, decarboxylated ostocalcium is elevated, a DEXA scan seems a little, what? Especially with a female athlete, how can that be possible? I saw that in track in field. I saw baseball players where I said, I think a fracture is gonna happen. One guy said, no. Third week of the season, snap.

It's unfortunate, but you would see the predictive data there. So I felt like we had to be so on our toes in our respective crafts, to find every single risk factor there was, and then try to mitigate it, and the hardest part was the mitigation was really the person sitting across from you that you're educating. Right?

Ninety percent of your athletes are going to listen to you, and then there're some that wouldn't.

Ben: That's a problem.

Dr. Pastore: It's a problem. But, Ben, one of the things I've also found very interesting with you, I want to go back to what you were talking about pasture and postural type exercises. Could you talk about your work in that realm, please, and how posture, how you define it, your work in that area, and how it impacts human health?

Ben: Wow, that's a great question. I recently, less than a month ago, I took part one of an international board certified kind of license to be a posturologist. And it's based on the work of Dr. Bricot, who's... I can't remember his first name, but he is a neuroscientist out of Marseilles, France. And I took a class with him years ago, and it talked about the postural system and its effects on health. And I kinda kept that information in my pocket, and now when I started working with concussions, I revisited it and I took the course, which is now very well organized. It's taught by a woman, which I'll get you her information, you need to have her on the podcast. She's very smart, PT out of Montreal.

Anyway, long story short, they look at posture from the standpoint of that, the eyes, meaning the muscles of the eyes, not the vision, and the bottom of the feet along with the jaw and the inner ear provide information to the brain as to where it is in space, 24 hours a day. It's much more complicated than that, but they have a really good system to assess the foot and they eyes' roll in the patient's posture. And so we utilize this system as part of our assessment, with the athletes, both to get a baseline, and B, to kind of go back to and say, hey, you know what, you've had your bell rung and we want to correct these issues and look what an impact they had on your posture based on the initial baseline tests.

So we're utilizing that work and the work with Dr. Bricot along with the work of Dr. Guy Voyer in terms of rehab. But from a general standpoint, to answer your question, it goes back to the effect of posture on the autonomic nervous system. So for the listeners, good posture can contribute to homeostasis within the autonomic nervous system, or bad posture will contribute to it being out of whack or non-homeostasis. And in most cases, it's going to be a sympathetic response. So if you have a patient that presents a poor posture, meaning they have an anterior tilt, their brain is getting information that is not accurate as to where they are in space. So their now in a constant struggle... they don't know that it's 2018; they think, oh, no, I must flee from this tiger.

So all these sympathetic responses go up, heart rate goes up, respiratory rate goes up, dopamine levels go up, and you have all of this, in your works, this biochemical cascade that occurs on a constant basis, that demands all of this ATP from the brain because it's getting all this conflicting information as to, am I falling forward? Am I not falling forward? My eyes are telling me this, but the bottom of my foot is telling me this.

So, it's never in that parasympathetic state that you and I strive to get the athletes to.

I don't know if that was a little too long-winded, a little too complicated.

Dr. Pastore: No, I think it's excellent. I also think, in that answer, you and I need to petition the American Medical Association to rename TBI "getting your bell rung". GYBR instead of TBI.

No, seriously. Please pardon my sense of humor. You know it's-

Ben: No, no. I love it. It's an old boxing term.

Dr. Pastore: I think that's a... No, I love that. I really... by the way, someone who over orders a steak, there's one server at a restaurant who said, "You can't un-ring the bell." So leave it to New York City restaurants.

Ben: Right.

Dr. Pastore: One of the things I wanted to bring up was talking about that, and having just the change in posture that's incorrect for your own physicality and how that affects the nervous system. I'd like to just discuss something that's extremely well known in science and medicine, that unfortunately not enough people know. Something as simple as... and pardon, I know this sounds funny, and I'm trying not to be flippant and really being serious here... If you just are holding in urine, and you're stuck behind your desk or back in the practicing days, you're working with a patient and you just don't go to the bathroom, just that process raises blood pressure. I just want to make it very clear that there is a biochemical cascade to just holding in number one. I'm sure there's a worse biochemical cascade with holding in number two. But when you've got... So, there's serious, serious, serious increase in blood pressure can transpire in someone... the tiniest change in blood pressure in someone who's already hypertensive is not a good thing.

We also know the same thing about our bodies being exposed to temperature change. Right? There's so many fascinating stories about cryogenic chambers and saunas were so big when I was coming up in the field, Ben. And infrared, near-infrared, all of that. But again, going back to temperature. You know, Harvard talked about in 2010, the most heart attacks transpire on a Monday, when it's freezing outside, and I'm gonna throw in you're holding in your pee to get to the office. So you have this perfect storm of all these various things that are happening to our bodies and our awareness of that is transpiring neurochemically, whether we like it or not.

So I found it fascinating, what you're doing with posture. I think that's amazing, I think it's extremely... The reason I think it's cutting edge is I think it's just not done. In all my years in working with pro athletes, consulting with different experts, that never came up. From some of my colleagues that are working in the realms neurologically, other colleagues that are working from a corrector of osteopathic, chiropractic perspective, and I think you know who I'm talking about. All great work. No one was looking at that aspect. And I think what you're onto there and what you're doing there is groundbreaking and I congratulate you on that, my friend. That's awesome.

Ben: Well, thank you. And I think to add to your example of the heart attacks on Monday in cold weather, that same person is shoveling snow, so they're forward-flexed position, elevating their heart rate with probably a lot of clothing on, so they're restricting what would be normal function of their diaphragm, their paracardium, because of the position that they're in as well. So there's a mechanical component to that.

And then, there are a lot of really good practitioners out there that are now being exposed to the importance of posture to health and wellness, not just performance. But the problem is, the research is lacking, because we're the only mammal, maybe with the exception of chimpanzees, that are bipodal. And so, looking at the posture of a rat versus the posture of a human is completely different. So it's one of those topics that, we never know if we're going to have a lot of the answers, because you can't really look at how improving posture is going to affect mitigating the risk factor of a TBI if you're studying rats. It's not gonna happen.

Dr. Pastore: It's not gonna happen.

Ben: So, the anecdotal stuff that we're getting from good practitioners is very important. Validated by all of the biomarkers and the different data points that we're now able to take. So you can say, hey, yeah, my treatment plan works, because look at HRV, look at resting heart rate, look at his blood work, and look at the VO2 max prior to it. That kind of stuff. That's kind of the direction it's going in.

Dr. Pastore: And then a spreadsheet of like, injury profile. Games benched, games played. There's so much data that comes out of that. And I can't say enough, when we were about the n-of-one. I can't say about the n-of-one. When I did my webinar on various types of endurance athletes and how we looked at specific modalities, all we kept sharing were n-of-one studies, because everybody's biochemically unique. Yeah, oh my god, c'mon man, I'm a Ph. D. Of course studies are so critical, peer-reviewed research is so critical. But when you're really working one-on-one, there only is this one athlete X. There's no publication on this individual sitting across from me at their time in life. And I've always loved the aspect of what biomedical informatics is. The mantra, it's the right drug for the right person at the right time. And you could substitute drug with so many different pieces of that puzzle of having individualized medicine. And that's really where we're headed. You could even look at a cartoon of a young man who never smoked a day in his life in a hospital bed with stage four lung cancer, and the uncle who's 70 going to visit him, who chain-smokes filter-less, and he's completely as healthy as could be.

Anyway... Thank you, Ben. I know how busy your life is. I just want you to know, this meant the world to me. My listeners are going to love this. I can't thank you enough. If you have two minutes, could you please tell our listeners how they can reach out and find more about you, maybe get on board with hiring your services, any information you have about how they can look you up, please. And Grey Matters.

Ben: Thank you, Robert. So, you can look up my name, which is... my website is just Ben Velazquez, and that's On social media, just look me up, Ben Velazquez on Instagram and on Facebook. And then, we have a podcast, myself and my colleague, Dr. Geanopulos, and it's called The Thrivalist And essentially, we just look at academics to athletes to successful people that we interview. And we try to get behind how they thrive. And there's always an element of human performance.

So, we interviewed the great Dr. Robert Pastore on there as well. So your listeners can listen to that interview which we kind of got really geeky about celiac disease and gluten. It's a great interview. That's where you can find me. And thank you so much, Robert. I'll do it whenever you want. This is fun.

Dr. Pastore: Right back at you, my friend. Thanks so much, Ben. Be well, my friend. I'll talk to you soon, okay?