But that's the idea.
All right, appreciate you, The Voice Guy.
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Today we're asking hard questions.
Why are physical therapists,
the supposed experts in human movement,
still describing biomechanics like it's...
It's a great year,
but it's still a long time ago.
Here,
while AI is quantifying everything...
While trainers are capturing slow motion
video, while patients are expecting data,
most PTs are still writing knee valgus
noted at sixty degrees.
Our guests today believe that if we want
to defend our space in musculoskeletal
care,
we need to measure what we claim to
master.
Today,
they're representing one of the most
interesting tools in movement assessment
right now.
Let's bring our guests today,
Maka and Dan.
Welcome to the show.
Thank you.
Good to see you, Jimmy.
How was the intro?
Did I sort of capture like the goal
of what we want to talk about today?
Like,
was I close or I'm just a podcast
host.
What do you think, Maka?
Nailed it.
All right.
So let's start with this.
What changed about the way movement is
valued in our profession?
Let me rephrase this.
How it's valued just not in our
profession,
but even outside our profession and with
our patients and with the people that we
interact with,
other professionals or sometimes the dirty
word, payers.
What's changed about the way movement is
valued?
Well, I'll start off.
I don't know that anything has changed so
much,
but I think there's a very deep interest
in understanding biomechanics,
and a lot of people
attest to understanding biomechanics and
talk about it a lot,
but can't really quantify it.
And I think sort of like made up
terms for describing some of the things
that they see.
And of course, it's like,
it's very challenging.
I've been a PT for three years.
And it's still,
it's still very challenging to notice
biomechanical faults or defects or
asymmetries with the naked eye.
And then how to describe them, right?
Like how would you do,
like describing them from one clinician to
another is probably vastly different.
Macca, how would you answer that question?
How have things sort of changed?
I think the competition has changed,
honestly.
So from PT to PT.
So parents sending their kids in,
you're trying to figure out which clinic
you'd like to go to.
So I think who's going to assess the
mechanics correctly,
who's going to assess it differently.
So I think that's the biggest thing that's
changed.
I think we know that valgus is bad.
Too much valgus is bad.
But I think we need to understand, like,
how do you know if it's too much
valgus?
So I think it's changed.
I just know I was just feeling right
in a profession where it's not the
profession where we'd never,
that would never be okay somewhere else.
So let's call this out.
Are,
are physical therapists too comfortable
just sort of eyeballing biomechanics?
I think some are comfortable.
I think some are really busy too.
I'll add to that, that, um,
some are very comfortable with it.
Um,
I've been a PT for thirty years.
And by the way,
I don't know that I'm always accurate.
Right.
But I am comfortable with it.
I think I know what I'm talking about
when I see a patient with excessive valgus
or whatever it may be.
But I also think that less experienced PTs
are not very comfortable with it and kind
of feel like they're guessing a lot.
Right.
And so what do we do?
The question is, like,
what do we do about it?
So when we add quantifiable data
to movement, what changes?
What changes clinically?
What changes?
I'll stop there.
What changes when you can actually
quantify it?
I think your rapport with the patient
changes, definitely.
So being able to explain to them,
this is too much valgus,
show them too much valgus,
speed of valgus.
I think your direction of how you're
rehabbing someone changes too in what
phase.
So is it too much valgus during the
loading?
Is it too much valgus during the landing?
That's definitely going to change the way
that I'm doing some rehab.
I'm an athletic trainer.
I'm not a physical therapist.
I've worked with various ranges of
population,
but I think that's what changes a lot.
Um, Jimmy, what was your question again?
Sorry.
Yeah.
So, so sort of like what,
what changes clinically when we can
actually add quantifiable data,
like when we can actually say,
this is the number and I can do
it and I can get to that number
reliably and confidently.
Totally.
Well, I agree with what Maka said.
In addition, first of all,
educating patients is huge.
I mean, when you can show patients,
this is what's normal and this is what
you're doing.
Now we have goals and objectives for them
to, you know,
targets for them to get to,
but also documentation for standardization
of documentation, right?
We're all using the same tools to measure
things as opposed to our own
Different set of eyes and documentation
for insurance companies being able to
prove that a patient needs more therapy or
has achieved their goals,
whatever it may be.
Quantifying.
Yeah,
I was going to guess things like patient
buy-in, which was mentioned,
better documentation mentioned,
better communication with other healthcare
professionals,
with PTs to athletic trainers or to MDs
or to insurance companies.
And also,
I would imagine better outcomes tracking,
like changing over time.
I remember when I was in clinic,
measuring one thing on the same person,
twenty minutes later, felt different.
Yeah,
you open up your joint a little bit.
You activate some muscles a little bit.
It may change quite a bit.
I think the,
so you talk about the relationship or like
the communication from, you know,
the athletic trainer to the PT,
the PT to the surgeon,
that having substantial objective data is
so helpful with that communication because
it's not just like my eye looking at
this.
It's like factually,
this is where this person is in their
state of rehab.
I think sports medicine is
return to play.
So I will always communicate to the
strength and conditioning coach,
the athletic trainer, the PT, the surgeon,
and then the parent too.
So it holds that,
it holds the clinician accountable,
the athlete accountable,
and then gen pop patients accountable as
well.
Yeah,
I remember I was a swim coach for
kids when I was in PT school and
I was using like phone apps, right?
That would allow me to put like sort
of like a rudimentary goniometer on the
screen quickly, easily.
And when, you know, teaching a kid like,
I need you to bend your elbow.
I am.
And me to say like, okay,
look at your brother and let me show
you this angle and yours is this and
that number is larger than that one.
I need you to give me a bigger
number and I could show them side by
side.
That changed understanding,
which is simple but not easy.
And the competitive nature to you're like,
OK, yeah, elbow a little bit further,
a little bit more drive,
a little bit more awareness.
So a real specific use case that we
have is we call the AMI,
which was developed by physical therapist
Trent Nestler.
Michael,
you want to talk about it a little
bit?
Yeah, so our athletic movement index,
it uses four IMU sensors.
So there's two sensors that go on the
back and then two sensors that go on
the shin.
And it's a standardized test.
So Trent's dedicated most of his
profession to understanding why do ACLs
happen?
How do we rehab athletes back like
athletes?
And then how do we communicate them back
to the surgeons or whoever needs to know
this data?
And so our sensors are placed on the
body.
And it doesn't matter if I like you
as a kid or if I like you
as a patient, you're working hard.
the sensors are going to pick up the
actual data.
So we have them go through a series
of movements like planks,
double leg squats, single leg movements,
single leg hop.
And just the idea of it is to
standardize the approach and to take all
of that subjectivity out of it so we
can truly do objective data,
truly make our return to play decisions or
return to work or return to real life
decisions with actual data.
So it's been really helpful.
There's with our system,
there's sensors that are placed on the
body,
but you also have a video feedback as
well.
So that visual interpretation,
that's helpful for the patients.
And then you're gaining the rapport from
them too.
All right.
So Mac is already like your telegraph and
you're tipping off my next question,
which was going to be if a clinic
owner or a clinician is listening right
now thinking that sounds cool.
But man, I've been sold this before,
right?
Like, do I need another gadget?
What would you say?
Is it it's got to be simple.
It's got to be easy.
It's got to be quick.
If it's not those things.
It's hard to use.
So talk to me about what the actual
tech looks like and how it works.
Well, I can show you right here.
So here's the IMU sensors.
It's just you don't have the sticker on
them.
So it's an iPad.
So it's an app that goes on to
your iPad.
It's called vMove+.
We have two types of technology.
So if you're looking for that quick
assessment in the clinic,
I don't want to put anything on the
body, we have video AI.
So you basically open up the application,
start filming.
Our system will place an algorithm over
top of the body.
We always blur out the face as well
to keep it HIPAA compliant.
And you can have them do any type
of movement that you want.
You can have them do a box drop,
lateral bounds.
I just did a mass testing with baseball
pitchers.
And what our system will do is it'll
calculate the joint angles.
For example,
we have a module that's called lower limb
and we look at the anterior view,
auto detects the view.
Anterior view is going to look at the
pelvis, pelvic drop, pelvic hip hike,
Trendelenburg,
whatever you're looking for there.
And then valgus and then tibia to surface.
If you have the person face laterally,
then it'll pick up the lateral view.
So now we're detecting trunk lean,
hip flexion, knee flexion,
ankle dorsiflexion.
So you have the,
I'll just give a pretty good example.
I think that everyone has used before.
um surgeons in this area still will do
triple hop tests so we're looking at
distance and speed for triple hop tests
and symmetry but you're missing out on the
kinematic integrity so if you want that
kinematic integrity you want to build up
the relationship with the doc you want to
get the great you know assessments and the
objective data you can have them go
through the triple hop test but then
you're just filming them and getting the
actual objective data our system will give
you the target values and what you should
be hitting
So there's that realm.
It's a five second clip.
You open up the app and you just
start filming.
Then you have the IMU sensors that I
just showed you.
That's going to be like our gold standard.
So we validate everything against Vicon.
It's within one to two degrees of Vicon.
You place the sensors on the body.
I would say this is going to be
your go to for like return to play
testing.
It's a tool in your kit, right?
Like I would say,
I still want to know,
I'm thinking sports medicine.
So I still want to know what do
they look like on the field?
What are they,
what does their conditioning look like?
Surgeon, what does the graph look like?
But with the tech, the sensors,
you place them on the body and it's
capturing that data for you.
And it's looking at valgus,
speed of valgus, tibial inclination,
pelvic anterior tilt, right?
So that's some interesting information.
Time to stability.
So it's putting together a whole like
really good case of this is why they
should return to back to play or this
is why they shouldn't go back to play.
And again,
it's taking that subjectivity out.
But it's a quick assessment.
It's about fifteen minutes for a full AMI
screen or you can break it down into
some single leg movements.
And that takes about three minutes.
So super quick, super easy.
And like,
why wouldn't you be doing some objective
testing?
And then what is just some of the
dashboard of the data look like?
What are you getting in actionable
information?
Yeah, so you're getting for the AMI,
for example, we're putting it on.
So when you're actually doing the
assessment, it's live data tracings.
So you're seeing it live on the screen,
how much they're going into tibial
inclination.
And then when you're finished with the
assessment,
there's an auto-generated report.
And so what we'll give you is red,
yellow, green.
This is where you're scoring on these
specific movements.
We'll give you target key takeaways.
This is where you should look.
If you're going into a single leg hop,
and you're going into too much valgus and
your hip is going all over the place,
our key takeaways may sound something like
lack of neuromuscular control,
lateral hip weakness.
So it's giving the clinicians,
where do you need to look and how
do you need to work with this patient?
So it's saving you time with that
auto-generated report.
And then you can just drop it into
your EMR and bill nine, seven, seven,
five, zero.
And that's,
you don't have to do any additional
information on that.
It's all right there.
So we're currently not integrated with any
EMRs,
but that is something that we're
interested in.
Um, that would be, I mean,
extremely valuable for that to
auto-populate.
So right now it sounds like a simple
copy paste into the appropriate section of
the EMR.
And that's our, that's our AMI.
We also have a run assessment too,
which is so cool.
No one's doing the stuff that we're doing.
It's like ground reaction force during
mid-stance,
initial peak acceleration during foot
strike,
which we know is directly correlated with
stress fractures, shin splints.
And then you also get a video AI
component.
So we're putting the force data together
plus the video capability.
So you can map out like, okay,
during initial contact,
this is what your IPA is.
And this is what your hip flexion and
ankle dorsiflexion is or your knee
flexion.
So you're putting together a nice story
for that patient.
Understood.
So is this a this feels like it
could be a shortcut or a multiplier?
Or both?
Yeah,
test healthy people test patients in
clinic, check your progress, Jake,
test them when they're ready to be
released.
For sure.
And the shortcut is it's fast.
I mean, video AI, five seconds,
basically have someone do one or two
squats and you can get so much data
and information.
And obviously you can have them do
multiple reps and compare,
particularly as you give them verbal cues,
corrections,
and show them how they're improving
throughout a session as you told them to
maybe shift their weight to the right as
they get a little bit lower.
Things like that,
or correcting their running.
But like you said, a multiplier,
the amount of information and the quality
of data that we get with the sensors
is incomparable in clinical.
in clinic.
So, you know,
to get that sort of that level of
data anywhere else, I think it's Vicon,
which is like you have to be in
a studio with eighteen cameras and
sensors,
all the visual sensors all over the body.
This is four sensors you just stick on
and simple.
You can even send somebody out for a
run in the park and use that data
to show them how they're doing.
Or do some online coaching.
That's been a big hit lately and that's
been interesting.
So what would you do there?
You would talk someone through where to
place things and set that up and then
tell them what to do remotely?
You would use your video AI.
So if you have the video AI application
and you're on Zoom right now,
I can just hold open my iPad and
start filming any movement that I want.
And then I can scroll through and teach
them like, hey,
during your single leg squat,
you're going into valgus here, you know,
looking at the shin angle versus the trunk
angle on your on your squat from the
lateral view.
There's no good story without tension,
right?
There's got to be pain that you're
solving.
So let's ask this.
If PTs or healthcare professionals don't
evolve their movement standards,
what happens to our positions in MSK care?
I feel like we just did an episode
on this a couple days ago,
which is everywhere else in medicine,
which we like to say movement is medicine,
everywhere else in medicine is highly
measured, right?
Blood tests and blood pressure,
things are measured very, very precisely.
And maybe in our professions for a while
now, we've just said, you know,
good enough or things like about or we
all know how accurate a goniometer is or
is not, right?
Where's the tension in the story?
What happens if we don't evolve towards
something like this?
already happening right i i think the
value of pts are just not valued as
highly as they should be with the with
the amount of value that they're actually
adding to the healthcare system um showing
the numbers quantifying is one of the
pieces of the puzzle that can can help
add to our story um
The other part is efficiency.
That's really where I'm targeting a lot of
my energy,
which is if you can observe somebody doing
certain movements,
a video AI with the use of AI
algorithms can help PTs in their
decision-making process.
Now, that might be scary for some PTs,
like now I'm being replaced by AI.
No, you're being enhanced by AI.
You're being optimized, and you're
you know you're still the decision maker
as the pt but now you have a
now you have a partner an agent who's
helping you in that decision making and
we're really honing in on that now well
i think like i mean everyone's tracking
everything or rings apple watches so if
you're not jumping on board they're going
to find another clinic that will i was
just having a conversation about this
which is
The answer is usually fear or ego or
uncomfortableness or imposter syndrome,
right?
Like...
I would never put together an affiliate
list to suggest products to my patients.
That would be ridiculous.
But half of your staff on the way
out the door saying, well,
what would you get for this?
And you'd say, oh, I do that.
Just go on Amazon and search this.
But the fact that you'd curate a list
to do that is blasphemy.
The thing is what we've known or I've
seen in history,
the things that are blasphemy now,
are commonplace several years later like
and it's usually the people who embrace
the thing that's scary or uncomfortable or
blasphemous are the ones that usually i
don't know i would say get ahead but
like usually get ahead or stay that's the
reason they are ahead
Yeah.
Why don't you say that I'm actually
working on a partnership with a product
company that that can be something that we
might integrate to into our products.
Like as, as an assessment is done,
as analysis is done,
a product could be recommended to patients
right there.
Ultimately, there,
we could even include links and make it
really automate exactly that I'm a big fan
of not necessarily endorsing products,
but suggesting products to patients.
I think it's knowing who your patient is
too, right?
Like if there's someone who like runners,
they're typically going to want to know
all of the data right here, right now,
they'll tell other friends about it.
Um,
if it's someone who's not as tech savvy,
maybe I wouldn't recommend it.
I'd still do it in the clinic, but,
um, maybe not at home,
but you just have to know your patient
for sure.
Understood.
What didn't I ask or what are some
frequently asked questions that you get
that we didn't cover from people that are
leaning into adopt something like this
that maybe we didn't talk about yet?
Mako,
maybe you want to talk about some of
the use cases that we've already deployed
or that are in clinics and with sports
teams and other groups now?
Yeah, so the system...
typically we will sell the system to
clinicians um a lot of the time so
when i worked for a large outpatient
division i'm not a pt i was trying
to build a cash pay program i didn't
want so i'm an athletic trainer i didn't
want to be on the sidelines so what
i did is i did mass testings out
at the schools so i was capturing
healthy individuals so i was bringing the
system out capturing healthy individuals
that's getting my company's name out there
my name out there so if and when
they do get injured they can come see
us because we have that baseline
assessment
We typically charge cash for that.
And then we get gained referrals off of
it too.
So it's a tool in your toolkit to
gain referrals.
I also brought it into surgeons.
So we have a number of surgeons referring
directly in for our AMI assessment at six
months post-op,
whether they were our patient or not.
So that was a great opportunity for us
to say to the patient, hey,
do you want to continue to work with
us or while we have this test and
we keep you on track?
or we can send these results over to
the PT.
So it's not only are you capturing data,
it's a great referrals like tool.
So outpatient referrals into with the
docs,
current patients that we're using the
system on.
Yeah.
Anything else, Dan?
Yeah.
Yeah, I mean,
we also have workplace safety modules and
sensors.
So a bunch of companies are actually using
our sensors in the workplace to monitor
at-risk employees in factories or assembly
lines, things like that.
Return to work, of course,
we're working on workers comp,
building a partnership with workers comp
software company to facilitate FCEs.
That's something that is a huge headache
for a lot of PTs.
Could be a six hour test where we
have this idea that we could narrow it
down to four hours easily,
maybe somewhere between two and four
hours.
And Mac,
I'm not sure if you could talk about
it, but women's health.
So we're just in the very early stages
of working through pelvic health.
So we have a spine module.
Our spine module assesses active range of
movement of the spine.
So flexion, extension, lateral flexion,
rotation.
And now we're adding in an EMG sensor.
So for instance,
I had an IMU sensor on my spine
capturing the movement.
And then I had an EMG on my
transverse ab and then one on my QL.
And so what it's showing is biofeedback.
So it's showing me, oh,
I'm lighting up through my back a little
bit too much when I should be using
my core.
So being able to see that data on
the screen has been really helpful.
Those are early stages.
It's something that we'll release with our
spine module here in a little bit.
But the thing I think
What we do really well at Dorsivee is
we listen to our customers.
So we have been in pilots with our
large outpatient divisions to understand
what do you want to use?
What assessments are we lacking?
How would you like to assess these
patients?
And then we'll capture that information
and actually add it to our product.
So the EMG sensors are coming soon.
It's really exciting.
Yeah.
This is the direction things are going,
right?
I mean,
what used to cost a hundred thousand
dollars in a lab with force plates and
things you had to place on people.
are now going to be measurable by my
doorbell camera, right?
Yep.
Exactly.
Exactly that.
And we look at it as the –
I've been with this company for a few
months now,
and I really thought the whole thing was
about the sensors and the hardware.
This is a company that developed the
hardware to really high standards,
but it's really a software company.
So what we can do, like Maka said,
is we can listen to our customers and
customize just about anything when it
comes to measuring human movement.
And that's super fascinating.
You know, I've always been,
I've been fascinated by that.
Like when I was a kid, you know,
you'd see like robotics and things like
that.
As I got into PT, I was like,
this is the coolest part of PT,
looking how people move.
And then like being able to like really
understand
tech it out and measure it and then
apply it.
That's, that's awesome to me.
Perfect.
All right.
We have a tradition on the show.
It is called the parting shot.
This is the parting shot.
One last mic drop moment.
No pressure.
Just your legacy on the line.
I do want to say thanks to U.S.
Physical Therapy.
If you're tired of working for companies
run by people who just don't understand
PT, at U.S.
Physical Therapy,
they're clinician-led from top to bottom.
It means your voice matters,
your growth matters,
and your career can actually feel like
yours again.
Explore opportunities right now at
USPH.com.
That's USPH.com.
Two guests means two parting shots.
Who wants to go first?
I should say, who wants to go second?
Because usually it's harder to follow up.
But parting shot,
what would you leave the audience with?
What's your mic drop moment?
Ladies first, Macca.
Okay, my mic drop.
So being in sports med,
I would just say rehab athletes like
athletes.
Use the objective data.
Don't use just your eye.
Use our sensors.
Use the video AI.
Build the relationships with the athletes.
Build the relationships with your
patients.
And it'll be so much easier for you
for the long haul.
And they'll come back if they need you
again.
But rehab athletes like athletes is my mic
drop moment.
All right.
I am a practicing PT,
so I feel your pain out there.
Using this Dorsibee system has made my
life easier as a practicing PT for
education patients, documentation,
and facilitating decision-making.
We have to think about so many things
as a PT all at one time.
Having a partner in the clinic with me
has been super helpful.
Awesome.
And if people want more information,
we'll put it in the show notes,
but where would you send someone?
They can go to our website, dorsivee.com,
or they can connect with me directly,
mstewart at dorsivee.com.
Perfect.
All right.
Dan, appreciate the time.
Thank you, Jimmy.
This was awesome.
Keep up the great work, man.
Appreciate it.
That's it for this one,
but 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.
Bullshit!
See, Keith?
We read the script.
Happy now?