As a DPT and Certified MS Specialist, Dr. Gretchen Hawley has devoted her career to treating and supporting patients with Multiple Sclerosis and other neurological diseases and conditions. In this episode, we talk about the differences in treating orthopedic vs. neurological patients, how to approach (and utilize) the concept of neuroplasticity, establishing the right mindset and frameworks for effective long-term progress, and more!
To see Dr. Gretchen’s online programs and podcast, check out www.doctorgretchenhawley.com or search your favorite podcast platform for The MSing Link.
Garrett Salpeter 00:32
I’m Garrett Salpeter and I believe that the most powerful and transformative way to help people recover from pain and injury, heal from trauma and reach their highest levels of fitness and performance is to focus on the nervous system.
In this podcast, we’ll share knowledge from the frontiers of neuroscience and inspirational stories of how applying that knowledge has empowered people from all walks of life to heal, adapt, and grow.
Welcome to the Neufit Undercurrent Podcast. I’m joined today by Dr. Gretchen Hawley, who is a Physical Therapist and MS specialist. And we’re going to learn about what that means when we dive in and get to speak with her here. She is also the host of a podcast called The MSing Link where missing is spelled M-S-I-N-G to emphasize MS and the wonderful work that she does to support MS patients, both in New York and through her online platform, across the country and around the world. She’s super smart and passionate about how physical therapy interventions can help patients with MS restore function and improve quality of life. And she also takes a more holistic approach looking at the psychological and emotional aspects of living with MS. In addition to the physical and neurological. I’m really excited to dive in and speak with her doctor Gretchen, welcome to the show.
Dr. Gretchen Hawley 01:51
Thank you so much for having me.
Garrett Salpeter 01:53
This is going to be a good one. We’ve had a few episodes in the realm of MS here. And I think with your experience, we’re going to get some new insights here today and talk about even some different elements of what can be– What’s a very big topic, very challenging topic, and very relevant, important topic for many people.
One thing I’d like to ask you as we started off here, and I think would be a good kind of segue into the conversation is for MS patients or patients with other neurodegenerative conditions that tried physical therapy and “Failed” or didn’t make progress. Why would you say it failed them? Or why would you say they didn’t make progress?
Dr. Gretchen Hawley 02:39
Yes, this is a great question to start with. Because I have had so many experiences where a client comes to me in the clinical office, and they’ll come to me with zero goals, I’ll ask them like, hey, what goals are you working towards? And they’ll say, I don’t have any goals. I’ve been to PT before, it didn’t work for me, I’m only here because my neurologist told me to come. So it’s something I hear a lot. And I think it’s really important to talk about, because there are specific ways to exercise and to do physical therapy, when you have multiple sclerosis, or really any other neurological condition. And a lot of people don’t know that. And so when you go to a traditional physical therapist, they will treat you and give you exercises for orthopedic conditions, which I can see why they might do that, you know, that’s how they’re trained. And when you have MS, you might be working on your walking because your hip isn’t moving well, or your knee or your ankle or balance. And those are also orthopedic conditions. So they’re treated in more of an orthopedic way. However, when you have these conditions, it is important to keep neuroplasticity in mind, and make sure that the exercises are very functional, and that you’re doing the appropriate amount of repetitions and sets without pushing into fatigue. So there’s a lot of specific exercises that are a great, but also the parameters for those exercises that really make a world of a difference.
Garrett Salpeter 04:14
That’s great. I really liked that distinction between orthopedic and neurological patients and conditions and treatment strategies. Can you speak a little more to that? So if you’re working with something with a patient who has a neurological condition like MS. What specifically, will you do differently with them that you would not do with an orthopedic patient? How would you describe that distinction?
Dr. Gretchen Hawley 04:41
So I always start all of my sessions based on their goals because of course I have my own goals for each of my clients, but what’s most important, is what they are working towards. So if I’m working with an orthopedic client, basically meaning if they’re coming to me with low back pain or maybe a back injury, hip replacement, some type of orthopedic condition, I will ask them what their goals are. But we mostly focus on strengthening orthopedically, meaning, if they’re here for low back pain, I’m probably going to work on core strengthening, and back strengthening and glute strengthening, and maybe a little bit of stretching, a little bit of massage. So, it’s focused on that one area. And then once they’ve accomplished that, usually they’re good to go, they’re out of my office, because they’re no longer in pain, or they’re healed from whatever injury they had.
Whereas if it’s someone with multiple sclerosis, we start with the goals. And I base all of my exercises off of their goals. Because when it comes to MS, usually not all the time, but usually, they’re coming for a general thing, general weakness, generally, their walking isn’t as good as it used to be, or their balance isn’t as good as it used to be.
So we start with a general goal, and we break it down. For example, walking actually requires seven different movements to occur. And if any of those seven movements are challenging than walking is going to be challenging. So if someone tells me they have a goal of walking better, I will look at their strength in each of those seven different movements, and then give exercises based on that. So some of the exercises are more generalized, but we break it down to work on specific muscle groups. So for walking, you need to be able to bend your knee, you need to be able to lift your knee up towards the ceiling, you need to be able to lift your ankle up so that you don’t have foot drop. So each of those specific muscle groups will be an exercise that I give. And then from there, it’s all about the parameters, making sure you’re not pushing into fatigue, making sure there’s lots and lots of rest breaks perfect quality, because your brains remembering what you’re doing. So if it’s bad quality, we stop immediately. So there’s a lot of those parameters that you can introduce to any exercise that you do.
Garrett Salpeter 07:07
I love that emphasis on quality. They’re one of the last things you said because that speaks to the specific adaptation, the said principle and how important, how specific our adaptations are neurologically good or bad. One thing that we’ve talked about on this podcast and in other talks over the years that you know, that I’ve given for our mutual friend, Dr. Walls, for example, is this notion– I want to present this to you and hear your feedback on it, you can agree you can poke holes in it, but I’ll be curious to hear your perspective.
So one of the things that I like to describe if we’re speaking to an MS patient or other patient, other neurodegenerative condition, is to say, look, the amount of work that it takes to actually induce neuroplastic changes, is about the same as the level of commitment and work that it takes to train to become a gold medal athlete or an elite professional athlete, it’s normally hours a day. And not just for a few days here and there. But day after day, week after week, month after month for months or years to really drive those sorts of neuroplastic changes. So although with a tool like the Nuby [phonetic 08:24] you know, we can create more of that quality input like you said the quality and specificity is important. But we can help people achieve that faster. But it still is a long process to drive these changes. And I’m curious to hear your thoughts. Do you think that’s a fair way to position this proposition? If we’re trying to talk to a neurological patient, to help them manage their expectations around how long it’s going to take and the type what is going to take the level of commitment? Do you think that’s a fair description?
Dr. Gretchen Hawley 08:50
Oh, that’s really great. I have mixed feelings on that. So part of me agrees 100%. You know, there’s no research. Well, let me back up. There’s lots of research right now showing that neuroplasticity does happen that we are able to recreate those pathways in our brain. But there is not research yet at least indicating a protocol for it. I get asked all the time, like okay to get neuroplasticity work, how many days a week do I need to exercise and for what intensity and there is no protocol and it’s different for everyone. And it can absolutely take years and years and years to form those new pathways or strengthen the pathways that are already there. But on one side of me, I wholeheartedly agree but on another side I do feel like by starting with any exercise programs specific to your limitations. You don’t know how long it will take. I have some people who have gained strength from these neuroplasticity based exercises within a few months. And sometimes it’s really interesting. I love sharing this.
Garrett Salpeter 09:59
That’s a great answer. I like that, it’s very consistent with our experience where we’ll have some some patients in their first session, improve gait or, or get new sensation or get the ability to lift their foot for the first time in years, I mean, literally in one session. And that’s a great way to describe it, what you said is, it’s not a neuro plastic change, you’re just tapping into that, you already had that there, you were just blocking it, you are inhibiting it, you know, like a governor on a car preventing it from going at full speed. But then those longer term changes. So I think those some good context there. Thank you for that. And now, I want to turn a little bit into your experience here and talk about this distinction you have as an MS specialist. So after you became a DPT, you completed physical therapy. And then you got interested in MS and achieved this additional certification specialization. Can you tell us about what inspired you to do it and what the designation means?
Dr. Gretchen Hawley 09:59
Let’s use foot drop as an example where you know, people have their ankle weakness or their foot drops as they’re walking, I will give an exercise specific to that muscle group. And for some people, they’ll tell me ‘Oh, my gosh, I’ve been exercising for a while, but I’ve never done that exercise. And within 3 days, I’ve already noticed an improvement.’ So what that tells me not to confuse the listeners, that is not neuroplasticity, your brain has not worked that fast. But what that tells me is, you had a neural connection from your brain all the way down to your ankle, you just weren’t using it, you were overcompensating with different muscle groups. And I think that’s important to know, because sometimes the strength is not fully lost, you just subconsciously and unknowingly weren’t using that pathway. So by doing specific exercises for those muscle groups, you can strengthen the pathways that are already there. But when it comes to the neuroplasticity side of things with rerouting and finding new neural pathways, that does take longer for sure.
Absolutely. So what inspired me was the fact that any type of neurological condition with physical therapy is different, especially with something like multiple sclerosis, is different for every person on everyday that I see them. And so it really requires brainstorming and being creative and modifications. And I just love that side of physical therapy, which is very different from– You know, as I mentioned earlier, an orthopedic client, if you have a hip replacement, there’s a protocol that you this is what you do at week#1, week#2, so I just loved having variety and not doing the same thing every day with each patient then slowly progressing. So it was that that really intrigued me. And not only that, but when I became– When I offered to run my first MS based physical therapy program, I of course started treating people with MS. And I noticed how quickly how different each person was, I had three patients on my caseload, and each of my patients were so vastly different. And each day they came in, they had different levels of energy, different levels of strength. And so that’s when I decided that I didn’t want to be an orthopedic PT, treating someone with MS. But I really needed to become an MS specialist to best help them. I didn’t want to be another story of I’ve gone to PT and it didn’t work for me.
So that’s when I decided to research what was out there. And the Consortium of Multiple Sclerosis Centers the CMSC, they offer an MS specializations called the “Certified MS Specialist.” So I started studying for that exam. It also requires observation hours following an another MS Certified PT around. So I studied for that. Loved it because it touches on all things MS. This is the same MS exam that a neurologist would take if they wanted to become a certified MS specialist. Nurses have their own exam, but this would be for PTs, OTs, neurologists. So you really need to know everything about various symptoms, various treatments, the types of MS, types of therapies, and so it allowed me to gain a new sense of appreciation of how much there is out there and how to specialize it for people with MS.
Garrett Salpeter 15:14
Awesome, I appreciate you just want to acknowledge your commitment in going through that program and really diving in to help this community because a lot of times, like you said, there, you know, MS patients go into physical therapy, they’re treated like orthopedic patients, and just don’t get the care that they need, or deserve, or really benefits them. So for you to really commit to this. Just want to acknowledge that. That’s awesome.
Dr. Gretchen Hawley 15:41
Awesome, thank you.
Garrett Salpeter 15:43
So in your practice, now, a little bit of an open ended question here, what, what stands out to you as some of your most inspirational or kind of best success stories, and you already mentioned one in three days, you had someone, you know, who just doing specific exercises was able to improve their drop foot, but what stands out to you, as some of you know, really the most kind of inspiring examples of what these interventions can do for MS patients?
Dr. Gretchen Hawley 16:13
I’ve so many in very different ends of the spectrum, but one that always comes to my mind first, is one of my clients who had a goal of walking her daughter down the aisle at her wedding. But not only that, it was a beach wedding. And so very uneven surface. And this is someone who was using a mobility aid, and she didn’t want to use that for the wedding. And so we worked hard, and she was actually one of my MSing Link members on online program. But with the specific exercises, I’m trying to remember how many months she was doing it for, I think it was about anywhere between 6 and 8 months before the wedding. And by the time the wedding came, she was able to walk her daughter down the aisle without a mobility aid, she did hold on to someone. So it wasn’t completely unassisted. But she was just so happy that she was able to show up physically, in that way on that day. So that one is one of my favorites, I think it shows the power of consistency and doing specific exercises for a specific goal.
Dr. Gretchen Hawley 17:18
So that’s top on my list, but I also have others that to the outside world might not seem as big of a deal. But these are clients who were able to achieve goals just within their home. And you know, I’ve so many patients that I work with, who for the most part are pretty sedentary at first. And they’ve been able to reach goals where they are able to walk throughout their home more of the day. And because of that they can stand while they’re brushing their teeth, stand while cooking, so they’re more functional. And I love when I hear feedback like that, because that truly changes your quality of life. If you’re mostly sitting, and now you’re functional, even just within your home, you can do more day to day activities. It just changes the game, it changes your mindset, it changes you physically, you have better balance, better strength. So those are equally as important.
Garrett Salpeter 18:12
Yes, that can have a huge impact on quality of life. Yeah, very good. Thank you for sharing those. Those are wonderful stories. And I think it’s just important to share those because it gives people hope, and it shows people what’s possible. And, you know, when you’re going through a program where you don’t feel necessarily tangible progress every single day, it can be difficult to stay focused on the long term vision. But to hear and hear stories I got I think helps us realize what is possible long term if we stick with it for long enough and do the right things and accumulate those small victories along the way. We’ll shift the other side of the coin, what are some of the biggest challenges working with MS patients or that are– You know, I mean, that in a very open ended way and that you mentioned some fatigue, you mentioned that they– You know, physical therapy, exercises that are not necessarily geared for them. What are some of the biggest challenges either in treating or in receiving treatment? So, very, very open ended question that… We curious to see where you take it.
Dr. Gretchen Hawley 19:23
So I can think of one for each thing. So one for treating then one for receiving the PT and exercise. In terms of treating so when I’m treating someone with MS. I would say the biggest challenge is mindset. Because a lot of people don’t understand what neuroplasticity is, and at least in my eyes, neuroplasticity is the reason that someone with MS actually can improve their strength, improve their walking, improve their balance. So if you don’t understand what neuroplasticity is, or if you don’t believe it, if you don’t believe the research that’s out there. It’s going to be really hard to stay on track and even commit to any type of exercise program.
So a lot of what I do for the first several sessions with my clients is education, to try to break down that barrier of that mindset. Because if they feel like it’s not going to work for them, they’re not going to do what it takes in order to actually see the improvements. And then they’re going to think that it didn’t work for them, but really, it was that they didn’t commit to it. So mindset, I think is the hardest thing from the treating perspective. But from my clients perspective, I think consistency, because they feel that– Well, first of all, it’s hard to stay consistent for anyone, MS, other neurological disease or otherwise, consistency is hard. But also, for those that are committed, they want to push themselves, they want to exercise 5 days a week for an hour if they can. And it’s important to remember not to push into fatigue. And that’s a different mindset, you have to have to embrace this concept of, hey, rest rates [phonetic 21:05] are a good thing. And if you exercise 5 days a week, but it puts you over the edge, and you have negative side effects from it, four days a week is okay, or three days a week is okay. And so educating on those things, so they don’t overdo it. But then helping them stay accountable and consistent. Because if you don’t stay consistent for long enough, you won’t see those neuroplastic changes, as you guys know too. So those are the two biggest challenges I would say.
Garrett Salpeter 21:34
That’s good answer. In terms of fatigue management, that’s such an interesting one, that’s probably one of the biggest challenges that we come across is just figuring out because you want to induce some fatigue, but not too much, because it can take an MS patient much longer to recover than a traditional orthopedic patient or an athlete or something like that. So that’s yes. And the mindset around that. That’s very good that you brought that up.
Dr. Gretchen Hawley 22:03
Yes, and I think another thing, too, is, you know, a lot of the exercises that I give are, as I mentioned earlier, they’re very functional. And so if you have a goal of standing up with more strength or sitting down with more control, we’re going to practice things like standing up and sitting down and a lot of seated based exercises.
However, I think a lot of us, if not all of us grow up with this mindset that exercise means running and jumping jacks and lunges, and all these high level things. And so when I teach my clients seated exercises, their initial mindset is, well, this is an exercise, like, how is this going to help me? So again, it’s a lot of education and demonstration on my behalf of hey, this is how Steven Marching is actually going to help with your walking. Because if you can’t make that connection, you’re less likely to stay consistent, because it doesn’t feel like your normal exercise that you may have done 15, 20 years ago.
Garrett Salpeter 23:01
Yes, that’s an important one to reframe there, a great insight. So shifting gears a little bit here, let’s talk about your podcast, The MSing Link. You’ve done 30 ish episodes now and what stands out to you across a wide range of topics related to MS, like I mentioned on the front end of this show, some psycho emotional work, some movement based on neuroplasticity, what stands out to you as some of the biggest insights or the most meaningful glimpses of progress in the field across the episodes there in terms of what comes out in your podcast?
Dr. Gretchen Hawley 23:43
Oh, that’s such a great question. The first one that comes to my mind, I interviewed a neuro immunologist. And he talked to us all about newest research in the world of Multiple Sclerosis. And he taught us about re-myelination, re-myelination of course, is the goal because then you can repair those De-myelinated areas. So he was giving us updates on re-myelination as well as a new disease modifying therapy that has not been released yet. It’s still in clinical trials. But he was talking to us about that. So that was one of my favorite episodes so far, because it gives you that education, backed by research of what’s to come. And therefore it can give you some type of hope. I find that when working with Multiple Sclerosis, whether you’re the PT or the client, it can be so easy to feel hopeless.
So I think that having that knowledge and that education is something that can really help you stay consistent knowing like okay, this is coming. It’s out there. We don’t know when it’s coming, but they’re making leaps in progress. So that was one of my favorite episodes. And then I also like — I have had a few MS. Neurologists on. And I think it’s really powerful to hear in more of a relaxed setting compared to an appointment, what things you should be talking to your neurologist about and how to mention those things. And not only that, but what treatments are out there. Because I know that I have a lot of clients who do not work with MS. Specialized neurologists. And they don’t even mention their spasticity, or their bladder issues or their depression, because they think it’s unrelated, or they just feel like, there’s nothing I can do anyways.
So to hear these neurologists talk about all the different options, not just disease modifying therapies, again, can be inspiring and give you actual tips that you can bring to your next appointment. So I think those are the ones that stick out to me. But there are a bunch of other exciting ones too, that teach you how to declutter your home because if you can declutter, you can be less stressed. So again, tackling more of that mindset versus just clinical and practical.
Garrett Salpeter 26:06
That’s great. It’s definitely recommend it for anyone who’s interested in learning more about MS, both clinicians and patients listening to this. Dr. Gretchen’s Podcast, the MSing Link, and can you tell us a little bit more about your community and your offerings? You mentioned the MSing Link online community there. Can you tell everyone, as I say a little more about how you actually interact and types of services that you offer?
Dr. Gretchen Hawley 26:32
Yes, absolutely. So I started my online program, the MSing Link, because I was working at a physical therapy clinic, I had this MS program there. And I was just seeing for years and years that my clients with MS had the highest rate of no-show and cancellation. And it was always because of something valid, maybe here in Western New York and Boston, Massachusetts, the weather is so unpredictable, maybe it wasn’t safe for them to go outside, especially if they’re using a mobility aid, where they didn’t have transportation or their fatigue was just so high, they couldn’t leave their house that day. So they’re all very valid reasons to cancel or no show. But that was resulting in lack of consistency and therefore not getting results. And so I decided to start an online program, which essentially is the same exercises that I give my clients in person, but they’re recorded and put online, which is really great. Because anyone can access it anywhere in the world.
So I started it for that reason. And then it’s grown over the last three years into this educational resource with what exercises to do. And you know, we’ve guest experts with MS Neurologists, you can ask them your questions, we talk to occupational therapists, we have yoga and meditation. So it’s more of this wellness program versus just physical therapy. But over the last year and a half to two years, we’ve put more of an emphasis on community for support as well as accountability.
So, I interact with them every single week, I do a Facebook Live, we have monthly check-ins where they can ask me questions talk to each other. So this is really great community. And I feel like being able to do it in your own home is so valuable, you no longer need to get dressed to go out somewhere. And of course I have some people are doing in person PT as well as online to help them stay consistent. So that is the main thing that I offer. I do also offer one on one guidance, I call it the mentor membership. And this is a program where I can really fine tune a program based on what your goals are. And then we also have zoom exercise classes. So this is something I do weekly for anyone looking to do MS specific exercises from the comfort of their own home.
Garrett Salpeter 29:05
Awesome. That’s a very good suite of offerings and how can people find you? The website for this and then can you let us know where on social or what’s the best place to interact with you or learn more about your work?
Dr. Gretchen Hawley 29:19
Yes, so my website is MSinglink.com. I’m on YouTube, which is Dr. Gretchen Hawley is my handle. I’m on Instagram as Dr. Gretchen and I’m also on Facebook ads. Dr. Gretchen Hawley.
Garrett Salpeter 29:32
Awesome and MSing Link is M-S-I-N-G. So we’ll put the put the note in there. So we can get to make sure everyone gets the spelling M-S-I-N-G Link. And this was wonderful. Anything that you feel we didn’t cover that you wish to share with the listeners here? Any last pearl of wisdom. It can be a new clinical Pearl or it can be something that is really important to you that you just feel like it would be incomplete without?
Dr. Gretchen Hawley 30:08
Oh, that’s a great question. Well, one thing we did touch on this, but I think it’s so important to know that you actually can get stronger. You know, there are things that you can do. Even if you’ve had an experience in the past that didn’t work for you. There are things that you can do to actually improve your balance and your walking and to be more ambulatory, outdoors and participate in life more with your family and friends, you know, go out for walks go out to dinner. I know that for some people that seems like forever down the road, or maybe not possible, but there are exercises, there are things that you can do to help improve that. So seeking out those professionals to help you with that. And then groups and accountability to help you actually stay consistent, can be a make or break between reaching your goals versus not. So I hope you guys feel inspired to take action or keep taking action towards your goals because it is possible.
Garrett Salpeter 31:03
Awesome. That is a fabulous note on which to end. I couldn’t have said it any better myself there so I won’t even try. Thank you so much, Dr. Gretchen for joining us and thanks everybody for tuning into this episode of the Under Current Podcast.
Dr. Gretchen Hawley 31:17
Thanks for having me.