You're listening to the PT Pinecast,
where smart people in healthcare come to
make noise.
Here's your host, Jimmy McKay.
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Now, most of healthcare runs on numbers.
Think about it.
Blood work, numbers, imaging,
measurements, cardiology,
data down to the millisecond.
But when it comes to movement,
the thing we claim is our domain,
we still say things like, looks better,
improving, tolerance increased.
Today's guest believes it's not good
enough.
He runs a referral-based clinical
biomechanics lab in Vegas that turns
walking, balance,
and strength into objective numbers,
the kind that make clinical skill
invisible outside the treatment room.
He says PTs aren't movement experts,
not yet.
He's building what he calls the quest
diagnostics of human movement.
Our guest today, Chana Wong.
Chana, welcome to the show.
We've talked about you before,
but now you're here.
Well, thank you for the great intro.
I really appreciate it.
I'm
Happy to be here talking to the one
and only Jimmy McKay,
the voice of physical therapy.
Well, it sure shouldn't be the face,
but let's dig in.
I love bold statements.
And you are a physical therapist.
I want to make sure the audience
understands.
Yes, I am.
I am a physical therapist.
This is why you can take shots because
when you are one of us,
you can say things, which is good.
So I love bold statements,
and I'm going to give you a chance
to sort of explain what that means.
You say PTs aren't movement experts yet.
I love bold statements.
What do you mean by that?
Well, to be honest with you,
we are trained in movements.
But to be an expert,
I think the bare minimum requirement is to
be able to objectively measure, validate,
and demonstrate movement.
Oftentimes in clinics,
physical therapists depend on
observational data, inferred data,
or non-standardized data.
And what I want to push for
or advocate for is that instead of relying
on those data,
we should actually standardize how
movement is tested so that we use
standardized data.
So it sounds like that's a bold statement,
but what you are and aren't saying,
you're not saying the problem isn't lack
of skill, it's lack of objective proof,
sort of what I said in the intro.
Infrastructure in physical therapy that,
you know, clinics are busy.
Standardizing data is hard.
That's why it's important to create a
structure where we can measure movement
reliably and consistently all the time.
Okay,
so we'll get into the model in a
second, but I like to spoil it.
Let's get to the end first.
What actually changes in a clinic when
movement becomes measured objectively,
when that becomes easier and simpler and
more repeatably?
Yeah, so one of the,
when I first started Muvik Health,
I guess that's best way to describe it.
I spoke with a lot of physical therapists,
spoke with a lot of medical doctors,
spoke with a lot of patients and also
the payers too.
And the feedback was very unanimous.
In healthcare,
credibility and authority is actually
linked to standard.
Right now,
physical therapists are doctorate degree
professionals that practice without having
standardized diagnostic infrastructure.
So when I spoke with physical therapists,
a lot of them were telling me that
they were acting like a salesperson.
In some ways, it's good.
Some ways,
it's not what we went to school for.
We went to school to be the doctors
of physical therapy.
So they have to sell to the patients
that they have to come back for the
next visit,
why they need to be in physical therapy
and how physical therapy helps.
Professions that use standardized data,
whether it be outside of health care like
pilots,
pilots, forensic scientists, engineers,
you never question them.
You get that automatic buy-in that you
trust them, right?
So when you flew out to Anaheim past
weekend,
you probably never questioned the pilot.
you just know that they're going to do
the right thing.
Same thing with the doctors,
medical doctors, podiatrists,
optometrists, dentists,
they all use standardized data and you
sort of
patients or the consumers get automatic
buy-in that they trust what they're doing.
In physical therapy,
it's a little bit different.
Right now,
there's about seventy percent of patients
self-discharge because there's that big
clarity gap that we don't really address.
in physical therapy.
So patients can't see the move,
can't see the problem or progress
objectively.
So they default to,
I feel better as a finish line.
So that results in physical therapists
getting pushed into earning the buy-in
from the patients.
So when we start using standardized data,
it creates a familiar process for the
patients and it creates,
it fundamentally changes physical therapy
from solution led profession to the
diagnostic first profession.
And when you do that,
we have three things that change.
Patients see their deficits,
black and white, in detail, using numbers.
Physical therapists can
stop pitching and start meeting with
clinical authority and payers actually
will see objective data that they need to
reward rather than just counting visits.
So it sounds like some things I don't
want to infer,
but completion rates and patient buy-in,
those two things are pretty tight,
well tied together.
That might increase.
Yeah.
Referrals.
could also you could infer that it would
increase documentation.
Clarity is something that could increase.
And then you mentioned reduced
defensiveness with payers because you're
able to.
Of course, you know,
I'm glad you mentioned that because our
co-founder Akash Patel is also a physical
therapist.
He's a he's like a brother to me.
He's the type of person.
regardless of any field he went into,
he would have succeeded.
Like he could have been,
if he went into medical field,
he would have been the best doctor in
the United States.
If he went into engineering,
he would have been the best engineer in
the United States.
Uh,
but I'm glad I'm so happy he chose
physical therapy, but, um,
he actually worked with, uh,
he actually partnered with the clinic
where he reviewed.
He partnered with the clinic,
only made one change to the clinic.
He reviewed the movement reports with the
patients the same way the physicians
review their lab report.
No new exercises,
just objective data and clear
interpretation.
Within one year,
the plan of care completion rate for that
clinic rose from fifty one percent to
sixty eight percent.
So, yeah.
I mean, we know this, right?
I got a Peloton downstairs.
And when I can track my progress and
I can see how things are improving,
I can look how often I'm doing that.
When they give me those stupid little
badges,
I fall for it every time because we
want to earn the digital cred.
But it's a feedback loop, right?
And now we're able to see that.
So we've dug into this conversation before
because we spoke without recording.
Now that we've gotten the attention of the
person listening,
now I want you to walk them through
the business model of what Movique is
doing now.
In the intro I said,
you started calling yourself
like the quest diagnostics of human
movement.
So if pretend for a second that I
don't know the model,
I want you to walk people through,
not theoretically,
because you are doing this right now.
This is not theoretical.
This is practical.
So walk people through this,
walk PTs through what Movique is doing,
and then we'll talk future state of what
you're hoping to do.
OK, yes.
So we're a clinical biomechanics lab.
We're not a physical therapy clinic.
We partner with physical therapy clinics.
We also partner with medical clinics as
well in orthopedics, neurology,
and podiatry.
So when you identify somebody with
movement deficits,
you can refer your patient out to our
clinic.
It's as easy as filling out a form
on our online dashboard.
And just like Quest Diagnostics,
we coordinate scheduling and we coordinate
testing with the patient.
They come in,
they get tested using a motion capture,
force plate, and balance plate.
Once we get all the data,
we input it into our dashboard.
And on your end,
on the physical therapist's end,
you can open up that report.
And you can see different metrics based on
their gait, running, jumping,
functional skills on fourth plate,
and balance plates,
such as limits of stability,
weight distribution, et cetera.
And you can use that report.
You can speak with the clients.
Here's the report.
Each report contains the results.
the clinical interpretation,
what that metric means, and the reference,
and whether it's within reference or out
of reference.
So that's like the blood test.
Yeah.
Right.
So you're set up in Vegas and your
model is,
and I'm going to say it and you
correct me where I'm wrong.
I'll give it a good first draft.
You're set up in Vegas and your goal
is to be that blood testing lab.
Listen,
if you're a PT clinic for sports or
outpatient orthopedics,
it's going to cost you a lot of
money to do these things and training in
time.
So why not?
It takes space too.
Sorry.
Good point.
Yeah.
And which is a premium too in a
larger metro.
So why not utilize us because we've got
equipment, space, and staff.
Mm-hmm.
You send us a patient pre-eval, post-eval?
Mostly post-eval.
I would love to get to pre-eval someday
so that it's more like, yeah.
And you send them to,
they send them to MoVic and then you
run them through whatever battery of tests
that you have that the PT feels
appropriate.
And then the report goes to the PT.
Now they're able to,
the next time they see that patient in
their clinic, because you're not a clinic,
you said that.
We're not a clinic.
As soon as when they see them in
their clinic,
they are now able to have that blood
panel results in front of them to help
guide them.
Yes.
What did I miss?
Anything?
You haven't missed anything.
That's exactly it.
Well, you've told me this before,
so I'm cheating, which is good.
Okay.
I don't think that's cheating.
And then do your homework.
That's not cheating.
Okay.
And then this is done on an annual
retainer basis right now.
Yes.
So we partner with the clinics on an
annual contract.
Got it.
Understood.
Yeah.
Well,
the clinics can travel us out through the
pilot program, too.
So it's, there's a low cost effect,
low cost way to trial moving cows.
Yeah.
To see where the right fit.
Good.
Okay.
So why has physical therapy sort of
tolerated subjective measurement,
for lack of a better term,
when we ask people how it feels, right?
Why have we,
why has our profession tolerated
subjective measurement for so long?
Why is this, how is,
how are we still,
how is this still okay?
Well, to be honest with you,
it's just my speculation,
but standardizing data in clinic is very,
very difficult.
I think the biggest example that most of
us use in outpatient clinic is five times
set to stand.
The proper way to do five times set
to stand is to ensure that the chair
height is between sixteen and seventeen
inches.
The chair cannot be anchored to the floor
or the wall.
And that's where sort of there's the
variation of it.
And when I was working as a clinician,
I actually met with a retired internal
medicine physician.
I was taking a blood pressure,
and I actually did it the way everyone
does it, just arm hanging down,
legs slightly off the floor,
feet slightly off the floor.
And she was pointing out to me, Chana,
the way you're doing it is invalid.
I won't take your results for it.
And that's when I sort of learned that
standardizing how we measure is very,
very important, not just for patients,
but also our referral partners who are
mostly physicians.
Understood.
All right.
Quick break.
Thanks to U.S.
Physical Therapy.
You didn't start your clinic to sell it
off.
You built it to last.
At U.S.
Physical Therapy,
they help clinic owners stay local,
stay in control, and grow with confidence.
They're not a private equity firm.
They're physical therapists helping
physical therapists grow.
Visit them online at usph.com.
That's usphpartnerships.com.
And I do also wanna say thanks.
This episode brought to you by one of
our nonprofit partners, Team Gleason,
supporting people living with ALS with
access to care, mobility,
and independence.
If you wanna support a cause,
that aligns directly with function and
dignity, you check out teamgleason.org.
All right, let me ask this.
Why is standardized diagnostic
infrastructure in physical therapy?
Why is it needed?
Is it needed?
Where is it needed?
Like answer those.
Yeah, yeah, of course.
I think that's actually the most common
question that I get.
Among physical therapists,
the biggest pushback is everyone moves
differently.
And I agree, everyone moves differently.
And that isn't actually an argument
against standardization.
It is actually the strongest reason for
standardization.
We don't say every heart rhythm is
different, so ECGs are useless.
We say it the other way.
Because every heart is different,
we need a consistent way to measure it
using ECGs.
The goal of standardized diagnostic
infrastructure isn't to standardize the
output or to make everyone move the same,
it's to standardize the input the way
testing is done because standardization
controls for variability amongst humans
and it creates a shared baseline that all
physical therapists can use.
So right now in physical therapy,
hypothetically speaking,
it's not a possibility,
but it's hypothetical, two people,
same age, same demographics,
same left knee pain,
can go into two different physical therapy
clinics and walk out with different tests
being done to them,
different baselines established,
and there's a possibility of different
treatment plan or plan of care.
For physical therapists like us,
we like to call that individualized care.
But at a higher level,
at like a payer's level,
they call that variability.
If two people with the same diagnosis walk
into physical therapy clinics,
ideally they should be tested the same
way.
But it's not.
And that creates the noise in whether the
patient made true improvement or not.
And the second reason for the importance
of standardizing diagnostic infrastructure
is that standardized data is the universal
language of
high stake decision making in any
professions.
So as I mentioned,
professions that we trust with our lives,
pilots, engineers, forensic scientists,
they rely on objective standardized data
because the stakes are too high for human
error.
Healthcare workers also work the same way.
The professions that make critical and
important decisions like, as I mentioned,
physicians, dentists, eye doctors,
they rely on standardized data because the
cost of being wrong is too high.
So for me, it's just my opinion.
When we argue that physical therapy
doesn't need standardized diagnostic
infrastructure,
we're making a dangerous claim that
the consequences of being wrong are so low
that it's okay to eyeball movements.
And you and I know that's not true.
And I know people don't mean it that
way,
but it's the way I infer it as
well.
Movement is a vital sign.
It dictates independence, fall risk,
chronic disease trajectory,
return to work or activity.
activities of the living,
it reflects quality of life as well.
So for me,
if physical therapy wants to be seen as
a high value profession,
we need to anchor to the same thing
that the rest of the rest of healthcare
is anchored to,
which is objective standardized data.
If someone said,
what's the difference between AI video
analysis and what you're doing,
like a clinical biomechanics lab,
how would you explain that?
Yeah.
So for me, AI video analysis,
like the movement analysis that we use
through our smartphone, iPad,
or even laptop, it's a powerful tool.
I love it too.
I personally use it for myself as well.
But the core limitation is that it
produces inferred data.
So what that means is that the AI
model doesn't actually directly measure
movement.
It estimates movement from the camera
angle, lens distortion, phone placement.
So in other words,
it's not directly measuring it.
It's measuring based on its previously
trained models.
Um, but you know,
what's what AI video analysis or movement
analysis is great for is it's great for
engagement and coaching.
Um,
it's great for providing immediate visual
feedback and it helps patients see the
movement,
but the greatest risk shows up in
healthcare.
When we use inferred data from movement,
AI movement analysis,
like a medical grade standard because
inferred data can change with protocols or
setups rather than the patient's
physiology or their biomechanics.
So it can create a false baseline and
it can lead to misleading progress.
So that's why AI video analysis positioned
themselves as a wellness, fitness,
or visualization tool.
Um, yeah, go for it.
Yeah.
Movie tells clinical biomechanics.
It's it's different.
It's a completely different tool for
that's used for different purposes.
So where, so we produce standardized data,
you know, uh,
the sort of testing is completed in a
controlled condition using the same
equipment, same instruction,
same tool on their same scoring system.
So we remove the noise so that the
baseline and the follow-up is a true
apple-to-apple measurement.
And that difference is really everything.
And that's what separates AI video
analysis and movie health or clinical
biomechanics lab.
Both can coexist.
I don't think it's one or the other
issue.
Right, right.
It can't be.
Yeah,
the best clinics in Las Vegas actually use
both.
So they use us to establish true baseline
and true progress.
And they use video analysis for
in-the-moment coaching.
So does the profession need...
comprehensive testing like this?
I mean, you're in Vegas now.
I imagine the goal is to spread in
other major cities and then see how this
goes.
But someone asked on our live stream,
does the profession need comprehensive
testing like this?
Where do we need our quest diagnostics of
movement?
Well, I'm going to say yes.
I think it is very important.
The reason being is that in every other
healthcare,
every other branch of healthcare,
comprehensive diagnostic testing is sort
of like the non-negotiable bare minimum
standard of care.
It explains the mechanism,
quantifies severity,
and create a true baseline,
objective standardized baseline that
they can track over time.
In physical therapy clinics,
most of what we use for evaluation is
fast, low-cost,
minimal equipment tests that produce
binary results or it's graded on a
subjective scale.
So the output is mostly observational
data, inferred data,
or non-standardized data.
So,
and another thing for me is if a
patient can perform your test at home with
the chair and a stopwatch, it's a screen,
not a diagnostic.
It lacks clinical authority and was never
meant to carry the weight of clinical
prescription.
It was designed to triage more than to
explain why and why is everything behind
behind your plan of care.
For me,
physical therapy needs standardized
diagnostic infrastructure or comprehensive
testing,
not to replace clinical judgments,
but to strengthen it.
We need something that we can anchor that
we own in physical therapy so that people
appreciate physical therapists for what
they do.
Understood.
All right.
So to the clinic owners listening right
now,
because that's what you want to talk to,
right?
That's the audiences that you're serving
now and want to continue to serve.
If you're a clinic owner listening right
now, what's their first practical step?
Like what, what would you have people,
you know, what's, what's the goal?
Would you want them to do or no?
Can you rephrase the question again one
more time?
I guess if a clinic owner is out
there and they're in the Vegas area,
you want them to test drive, right?
You want them to come in there and
take a look.
But if someone isn't in the Las Vegas
area, what's their first practical step?
I think they should try to use
standardized data.
practice using standardized data as much
as they can.
I think most clinics,
I would love for all clinics to invest
in technology.
I think physical therapy should move on
from visual or manual to more towards
technology-driven healthcare.
And really test out the equipment that
we're using.
RunDNA, my favorite company.
Vault,
probably my second favorite company out
there.
Balance tracking system is great for
tracking balance.
And I think they should try all these
companies out,
reach out to the companies and find out
more about what they do.
Yeah.
All right.
Is there anything I didn't ask that you
wanted me to dig into or anything that
you think that, I mean,
because you're answering frequently asked
questions when you're doing outreach to
clinics, right?
Is there anything that you typically get
asked that I didn't give you a chance
to share?
They usually ask how difficult this is,
like in a sense that most physical
therapists are not trained in biomechanics
as extensively as we think we are.
Even when I went to school,
I had a great professor.
But for clinical biomechanics,
we're learning F equals MA and those
formulas.
So the biggest concern is that for clinic
owners that they won't know how to
interpret these results.
So it's all in the report.
That's the easiest way to say it.
It's pretty much...
reading through the report and going into
details with the clients or customers,
patients, sorry, one-on-one.
And you can go on our website and
download the sample report that you get.
And it gives you a pretty good
explanation.
And most physical therapists,
we're very smart.
And they really have no issues with it.
But that's their biggest concern.
Sure.
We'll share the website in the show notes,
but movichealth.com.
Are you ready for your parting shot?
Yes, I am.
Let's do the parting shot.
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
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All right, you're parting shot.
Shana, what do you got for me?
All right,
every innovation in a profession does one
of the two things.
It either raises the ceiling or it raises
the floor.
So raising the ceiling is about
expanding what's possible.
It's the new technology, new product.
It's exciting.
It's impressive.
Even I love new technology coming out in
physical therapy.
But raising the floor is different.
When you raise the floor,
you elevate the minimum standard of care.
It's about reducing variability and
ensuring that a patient gets high value
service regardless of which clinic they're
in.
Probably not as fun,
not as exciting for most people.
The space between the floor and the
ceiling is the variability.
It's how different we are from one or
the other.
Every physical therapy or every physical
therapist starts on the floor,
but only a elite few will ever reach
the ceiling and I can think of great
names, Jimmy McKay, Dave,
my co-founder Akash Patel.
They all reached the ceiling already,
but most of us are unfortunately down here
at the floor.
A profession isn't defined by its ceiling.
It's defined by its floor.
And right now,
when I see physical therapy,
we have a very, very high ceiling.
So some practice at the level of
physicians.
We also have very, very low floor.
So some people act as more as a
personal trainer.
Or glorified personal trainer,
with quotation, or coaches.
If we want to build a skyscraper,
you don't build a skyscraper only by
raising the ceiling.
You have to build the floors.
You have to create the infrastructure that
everyone stands on.
And in physical therapy,
we see leaders doing this quietly.
They're probably not as vocal as I am,
but one person I really want to highlight
is Brian Warner.
He was a founder of Physical Therapy and
Balance.
He's raising the floor in vestibular care,
creating a standardized benchmark so that
balance and dissonance treatment in
physical therapy isn't a guessing game.
Personally, I'm
more excited about raising the floor than
raising the ceiling.
Because raising the ceiling will only help
those who are elite few.
But when you raise the floor,
you help everyone.
You move the needle for the entire
profession within the healthcare system.
You shift industry towards a profession
that is valued, respected, defensible,
and indispensable.
And that is my parting shot.
Thank you, Jimmy.
website again,
I'll put it in the show notes,
but it's movichealth.com.
I'm curious to see where this thing goes.
I'm interested.
I like the fact that you're doing it
in Vegas too, but appreciate your time.
Thanks for doing this and walking us
through it.
You're welcome.
Thank you for inviting me onto your show.
Sometimes being in this new field,
it makes me feel like I'm talking,
I'm like a chihuahua talking to
barking at lions right now but i feel
like i roar today so thank you for
the platform and thank you for giving
small people like us
a platform to talk on.
Appreciate it, Sean.
Well, thanks for the time, man.
You're welcome.
That's it for this one.
We're just getting warmed up.
Smash follow, send it to a friend,
or crank up the next episode.
Want to go deeper?
Hit us at pgpinecast.com or find us on
YouTube and socials at pgpinecast.
And legally, none of this was advice.
It's for entertainment purposes only.
See, Keith?
We read the script.
Happy now?