The Beyond Pain Podcast

Episode 57: Tech in PT, Friend or Foe?

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the evolution of technology in physical therapy, particularly in light of the COVID-19 pandemic. 

They explore the rise of telehealth, the importance of client engagement through apps like True Coach, and the role of wearables in health tracking. The conversation emphasizes the significance of walking as a fundamental health practice and the need for clients to commit to their health journeys. 

The episode concludes with reflections on how technology can enhance client-provider interactions and improve health outcomes.

Takeaways

  • COVID-19 accelerated the adoption of telehealth in physical therapy.
  • Phone consultations can yield similar or better outcomes than in-person visits.
  • Apps like True Coach enhance client engagement and communication.
  • Video feedback allows for more effective coaching and learning.
  • Tracking health metrics increases awareness and accountability.
  • Walking is a simple yet powerful form of exercise.
  • The 10,000 steps guideline is arbitrary and not scientifically backed.
  • Even small increases in daily steps can improve mental health.
  • Client commitment is crucial for successful health outcomes.
  • Technology can facilitate deeper conversations about health and wellness.

Joe Gambino (00:00)
Welcome back into the Beyond Pay podcast. I am one of your hosts, Joe Gambino. And I'm here with our other host, Joe LaVacca You can find us on Instagram. I'm at Joe Gambino DPT. LaVacca over there is at strength in motion underscore PT. You can find this podcast on Instagram as well, beyond pain podcast and on YouTube cups of Joe underscore PT. And there is an application form down in the show notes. If you do feel like you want to connect with us, ⁓ we're more than happy to chat. Joe boy, welcome back.

Joe LaVacca (00:29)
Good to be back. I just realized the chair I'm sitting in rotates. I'm not used to that. So I'm going to probably be spinning and fidgeting all episode as we chat together. So if you're watching this on YouTube, sorry for the distraction, but it's actually kind of very meditative for me. It's actually kind of keeping me relaxed. My neck, let's say some neck pain yesterday. So, you know, doing a little trunk rotations actually feeling pretty good right now. so apologize. Yeah, I know. Well, no, you always keep me very entertained and on my toes, Mr. Gambino. So.

Joe Gambino (00:34)
Yes.

You know, my rock is not to sleep.

Joe LaVacca (00:59)
⁓ looking forward to chatting today. And I think, ⁓ what we were kind of hinting at last week when we signed off, when we were reflecting on where we've been and where the field is going, we did maybe have like a little bit of a touch of a cliffhanger in terms of technology, the things that we use with clients, how our practices have changed. And to sort of like just pick things up where we left off. I think that really, mean, COVID

Joe Gambino (01:16)
Mm-hmm.

Joe LaVacca (01:28)
really pushed the technology idea forward for me and it had to. No one was able to come in person to see us. Even if you weren't all on board with the rise of telehealth or virtual consults, well, what was your option at that point? I mean, I was strictly forbidden from seeing people for three months. That wasn't ⁓ something where I can just kind of sit around and not have a job or an income for that amount of time.

So I would always be curious to hear like how a lot of other clinicians handled that and how clients handled that with their clinicians if they were opposed to telehealth and clinicians were opposed to telehealth. I mean, what did they do? They just kind of like not talk to each other. Yeah, ⁓ but I I imagine that Sword existed even prior to then, right? I mean, that's your virtual telehealth company.

Joe Gambino (02:14)
Not too sure.

Joe LaVacca (02:27)
Were they around then?

Joe Gambino (02:27)
Uh, yeah, sword.

don't even know when like the sword and the hinges and all those, um, when they started, um, 2015, the, um, hinges probably around the same time. I'm so it was like the two big, if anyone's listening kind of like virtual PT companies, they are both, um,

Joe LaVacca (02:41)
Okay.

Mm-hmm.

Joe Gambino (02:55)
employee benefits for people and they have their own technology. They're driven through AI specifically to scale physical therapy out to a number of different people. So there's definitely something interesting. We'll be definitely spend some time talking about those models and how they go hinge. I don't have that information. Very handy when they started. That one's hard.

Joe LaVacca (03:19)
Well, what was even

cool though, before that, I mean, when you were thinking about the rise of technology and how we've worked with people, a lot of the early phone things or, know, quote unquote, telehealth things were done by the telephone. And I still cite those studies in a lot of the courses I teach because I do think it just kind of helps my message and my bias of listening and being empathetic and asking questions and building that alliance with people.

But I think people are often shocked where you compare it phone call to in-person care and there wasn't really big differences in outcomes. And in a lot of cases, phone calls worked better. So let's try to explain that one to insurance companies and clients who want to come in and only see us in person. So then that gave rise to obviously some of the FaceTime calls when the technology became available. ⁓ Obviously you and I are both all in on that.

Joe Gambino (03:56)
Mm-hmm.

Joe LaVacca (04:17)
post about it regularly. I try to push people to do more virtual work with me. Even if they just try it once, I often find that they are quite pleased. I'm sure that's what your transition has been going from only in person to now pretty much 99 or more percent of working with your clients the way you do. So I think it's been really fascinating to see these platforms grow. And you mentioned the

swords and the hinges of the world. mean, these are your big companies. But for someone like myself, who is trying that hybrid model, probably trying to push a little bit more of that virtual health, the thing that helps me is apps like Zoom, Google Meets. ⁓ It's quite amazing how well those video calls go. And as you mentioned with the AI, can develop transcripts, ⁓ can record the sessions for us. I mean, how cool is that?

Joe Gambino (05:01)
Mm-hmm.

Joe LaVacca (05:14)
Some clients typically ask me, hey, can you record this? And I was like, yeah, absolutely. I can't record a session with you in person. I'd have to set up a tripod. There'd have to be lighting. I don't even have the capacity on my phone to take an hour long video. And then what do I do with it? So I think it's really cool for those clients who want to dive in more or maybe rewatch a couple of sections, especially when it gets maybe a little bit more education heavy or

Joe Gambino (05:30)
Mm-hmm.

Joe LaVacca (05:42)
be more conceptual heavy on kind of like pain and movement. But I've sort of gravitated toward True Coach. And I think you've used True Coach in the past. ⁓ Yeah. And you still use True Coach. Is that correct? So True Coach has been awesome. And it is an app based program that I get clients to download directly to their phone. And it's sort of like having me in your pocket at all times. You can direct message me. You can send me videos. I know when you're doing your workouts.

Joe Gambino (05:50)
Yes, I do.

I do,

Joe LaVacca (06:12)
You can record them in real time, ask questions in real time. And for me, I just feel so much more connected day to day with people where even when I do see them in person or for these follow-up sessions, I already kind of know what's going on. Hey, how's the wrist feeling from the pushups the other day? Hey, back seemed like it was a little bit stiff on Wednesday, but hey, good news. It recovered really well on Thursday. It looked like you had a great weekend. So it almost helps us tell that story a little bit more.

What has your experience been like? mean, again, going from like a hard, seemed like a little bit of a harder turn for you from like all in person to that like quick transition. So have you noticed better rapport with clients or just different things like that? What's been the biggest change?

Joe Gambino (06:56)
Yeah, I actually just trying to think, because I've done virtual for very long.

15 started. And at that time, we had an online membership, which was done through Web Services. It was fine, but yet it was web-based. And then I was doing virtual calls. I was using Zoom because obviously that technology existed to have FaceTime calls. But I was doing all my programming through Google Sheets, same way I was kind of doing it in person.

Joe LaVacca (07:27)
Mmm.

Joe Gambino (07:30)
pretty much the way that we communicate was mostly through email and maybe some text messaging. ⁓ And that was kind of like that, that was it. You know, that's really all that they kind of started with and it worked fine. I mean, I didn't have anyone complain about it. Everyone got good progress, you know, things like that. But now I think the system with everything that we have today, this allows you to give more to somebody. So now, you know, we both use TrueCoach. So now it's app-based. So everything's right there on your phone.

It's, really like TrueCoach as compared to some of the other ones that I've seen because the interface is just much nicer. You can upload videos for coaching. You can message me whenever you wanted. You can leave notes on your session. It tracks your progress over time. So you don't have to have all of these like documents saved on your computer anymore or print them out. And I have folders from like my original workouts when I was training at

Joe LaVacca (08:20)
I know.

Joe Gambino (08:23)
the gym and the, and the matrix where I used to just print out sheets. Um, I literally have a folder like this thick of all my workouts still, which is, it's kind of fun to look back every now and again. Um, and everything's right there, which is, which is really nice. Um, and then like things like loom now, um, or actually I use, I still use zoom because they have a, they have a record. You know, I could record a clip for somebody. There's someone leaves me video feedback where I used to just like, you know, either have to get on a call with them or I would have to just send them like a little text.

Joe LaVacca (08:24)
Yep.

Joe Gambino (08:53)
I can now just watch their video, have it on my screen, have it recorded, have a little picture of my face here and coach it in real time and then send it to them. All right, so I think and stuff like that people love now. And that's something I'm more recently started doing, even though I probably had access to this doing it longer. But hey, they get to watch themselves do it they get to see how I coach it. And it's probably the closest thing that I can do to real life coaching in a sense, right? Because they can actually see the visual feedback, keep my hands on them.

Right. That's always limitation of virtual. ⁓ But having that visual feedback, I can like draw lines like, ⁓ when you're, you're squatting, you're tipping forward and I can like, this is where I want you to be or in bench press, right? Like this is how I want the bar path to look or whatever it look like. I can, I can give very, very ⁓ it's just, I think it's easier for people to kind of catch on what they need to do. And it's a little bit faster. Text still works fine. People still kind of get it and make progress week over week, but

People are definitely honing in on having a little bit more video feedback like that. I'm to think if there's anything else that I really use. mean, Truecodes really does so much for me as far as that goes. There may be a couple other things that I utilize on top of that.

Joe LaVacca (10:09)
Well, I think that

your point is the customization where, you know, let's go back just a little bit further because you mentioned the Google Sheets. And I think I got my original Google Sheets outline from you and Dan and Vikash because I think you guys did ⁓ some course with Exos and how to frame things out. And I love that. And that's sort of like really what started tipping the scales for me to kind of get back into this idea of, well, you know what, I do need to program and

Joe Gambino (10:12)
Hmm.

Joe LaVacca (10:38)
Think about how I communicate and interact with clients a little bit different. But if you are a super old timer, ⁓ you remember paper, right? I remember making photocopies of cards and then handing them to clients or just going into the old folder and like neck pain and everyone got the same handout recipe, almost like from ⁓ your grandma's old cookbook. You could barely read it. It was all faded.

Joe Gambino (10:48)
Mm-hmm. I do remember.

Hahaha.

Joe LaVacca (11:08)
⁓ The pictures were so like two dimensional and rudimentary. And I know a lot of places still do that because I have clients that come in and are like, yeah, well here's my, you my program for, you know, for home. And then I show them, you know, what True Coach can do. And they're like, my God, like I can see videos of you and you can see videos of me and we can actually communicate real time rather than, you know, still pictures. Cause I think what the still

Joe Gambino (11:25)
Mm-hmm.

Joe LaVacca (11:36)
the stillness of a lot of the old ways of doing things on the piece of paper, clients will show me pictures of them doing it. Like, oh, here's a picture of me squatting at the bottom. I'm like, where's the video? And they're like, what do mean? Because I think it just like, you went hand in hand with the technology that you had. Like, well, here's me at the top of the squat, here's me at the bottom, here's me doing this, here's where I have the band. I'm like, well, I don't really see how you're doing the motion. And a lot of people are like, I didn't even really think to take a video because you're just handing me these two dimensional cards.

And I'm like, yeah, no, we could do a video. So I do think that True Coach and all those other apps out there, ⁓ if you are a client in those clinics, those probably have to be really great for you. I know everyone really has great feedback when they utilize it. I mean, look, you have to be ready for a program like that because it is going to give you prompts. It is going to email you. You're to have me messaging you like, hey, how are you? And now you're doing so that idea of, you know,

Committing to the process. I think it does force you to do that a little bit more or it actually has opened up some conversations for me with people and this is a little bit of a flip side of you're saying hey look, you know, you came in guns blazing you thought you were ready for this and you know, It's been four weeks and you haven't logged a single workout. You haven't replied to a single message Maybe you aren't ready and that's okay and I've had that conversation now with two or three people over the last two or three months and

Joe Gambino (12:51)
Mm.

Joe LaVacca (13:00)
You know, they come in, they love the app, they love their first session. They're like, wow, this is amazing. It's just so different. ⁓ I can't wait to get rolling with this, write them a program and then it's just crickets. Yep. And then they come back in, you know, I'm, I'm, no, I'm going to do it now. I'm going to do it now. And I'm like, look, really? I mean, these are important conversations to have because I've, I've been able now to save people time and money and realize that it's okay not to have time.

Joe Gambino (13:17)
in

Joe LaVacca (13:28)
You know, it's okay for this not to be a priority right now for you. I know you want to get out of pain. I know you want to get stronger, but those are things that really take commitments. And over the last 30 or 60 days, you know, we're seeing that that's a problem for you. So what else can we do rather than the app rather than this or what other avenues maybe do you need to explore? And I never forget this one time I had a conversation with a client about a year or two ago and two little kids like yourself. ⁓ He's working, his wife is working.

He's not sleeping and missing workouts, skipping appointments, and he finally comes into one. And I'm like, look, man, if we halted everything right here, you would probably save yourself over the course of the next like, you know, six weeks, eight weeks, whatever, maybe like a thousand dollars. What could you do with that thousand dollars to make your life easier? And I'm like, it sounds like, you know, maybe hiring a maid service to come in once a week.

Maybe hiring like a nanny so you and your wife can go out on Friday. Like, what do you think about taking that thousand dollars and investing it to something else in your life right now? And he was like, this is the most amazing conversation I've ever had with a healthcare provider because yeah, my life is spinning out of control. I don't see my wife anymore. We can do a lot of good with that thousand dollars. And I was like, okay, here's the caveat. You can't use it to like pay a credit card bill. ⁓ You can't use it to like, you know, put it back in savings. You have to do something with it to like.

Joe Gambino (14:38)
Yeah.

and

Joe LaVacca (14:53)
make a positive impact in your life. But I would have never been able to have that conversation unless we were able to sit down, look at the app, look at the trajectories, see what he was making time for, not making time for. So I do think my conversations have gotten deeper with people because you're just more involved with their day to day rather than just, hey, you any questions on your home exercises? No? Great. Cool. Here we go. We're moving onward then. No questions. I'm assuming you're doing them, right?

So it has been really, really cool. ⁓ as far as the other ideas for tracking with clients, do you like one or the other? I know we talked about Hinge and True Coach just now and ⁓ Sword, but there's Garmin's, there's Aura Rings, there's ⁓ Fitbits. Do you?

Joe Gambino (15:43)
Mm-hmm.

Joe LaVacca (15:48)
have those conversations with your clients in terms of using wearables to track health? And if you do, is there a favorite and more preferred one? Do you use any?

Joe Gambino (15:58)
Yeah, I don't really use any and I don't really promote any or tell anyone they have to get anything because those are usually things that people, you know, like why spend money on something if you don't want it, first of all, right. And most of these things, they don't necessarily I'm not too sure of like how accurate all of them are. mean, even like, you know, Apple Watch is probably the one I use the most. You know, it's very apparent, at least to us, right. Where like, you know, how many calories you burn, those numbers are way off.

Joe LaVacca (16:27)
They make me feel good though.

Joe Gambino (16:27)
They're not very accurate at all.

Yeah, they do they do but what I do like about wearables in general It doesn't matter if it's whoop or you name it ⁓ Is it just brings more attention to whatever you're tracking right? if you're just tracking steps on your watch Great track steps on your watch because you'll get a good idea of what you're doing and how much you're moving but I like about true coach and ⁓ Is that all the wearables that you can use sink right into it? So if you wanted to have eyes on

recovery, on how many steps you're doing. ⁓ My fitness pal also connects in there from a nutrition standpoint. Everything's all in one place. So you have all the data right in front of you. ⁓ But that's what I really like about them. You use an Oro ring, you're tracking your sleep better. You're tracking what your recovery looks like. You're tracking a whole lot of good things and whether or not it's accurate or not. Just putting your brain power towards it will make you sleep a little bit more. Right. You might go to bed a little bit earlier.

We give yourself a little bit more sleep at night. You're probably going to, you're tracking your food, you're going to be a little bit more conscious about what you're putting in your mouth. Little things like that go along when it has nothing to do with how accurate the tech is. Like if you're tracking your food, you have to pick from a list. It's not exactly what you're eating. Some of those numbers are going to be different, right? So you're gonna have to get your trends over time and make some sort of adjustments based on what you're seeing. But what you're getting is, wow, I'm actually eating.

3000 calories when I thought I was eating 2500 or I'm only eating 1600 when I'm supposed to be eating 2300, which is super common. Maybe we have some room to start to add more meals in there. That'll make a big impact for somebody. So again, I think tracking these things are great. And I think it's just more of an awareness of these things. And when you have awareness to it, whatever you're tracking typically gets better because you have eyes on it.

Joe LaVacca (18:00)
Yeah, yeah, yeah.

Right, right. And I think I like the big picture approach. And I think, again, this is even like a very scalable sort of conversation for people who are more sedentary, not moving as much, not exercising. When, you know, I asked them about something as simple as walking, you know, getting their steps in during the course of the day. And this is something, you know, Courtney is so adamant about, and she's taught me a lot about the whole power of walking.

and how important it is for just overall health and well-being. And I've completely bought into the idea that it is such a low-hanging easy fruit for people to start using. However, whenever I bring walking to the table, everyone thinks they're getting enough steps. Everyone thinks, yeah, I'm at 10,000. I'm good, you know, just because you're moving around all day. So the easiest thing I'll have for a lot of those people is to start with just buying a pedometer. Right. I mean, they're so cheap.

I mean, talk about a barrier of entry is like, think some of them are 10 bucks on Amazon. Just clip it to your waist, clip it to your watch, clip it to something, go. Again, I know it's going to rustle and bustle and you'll get some credit for a step when you turn right or just sneezed or something like that, but that's okay. But now you have at least an average and it costs you eight or $9 to just have that average. And then we want to look at that over the course of seven, 14, 21, 28 days, whatever our agreed upon timeline is.

If you're hitting steps, great, cool. What's the next thing that we can look at? If it is something a little bit more involved like sleep or recovery, then I'm just looking at hours slept. I'm not looking at your sleep score, okay? I'm not like necessarily thinking my Garmin knows when I'm in REM and non-REM and all these other different phases. So I'm a little bit more skeptical on the technology on that end, but let's just see what time you're going to bed, what time you're waking up.

what's the average for each week? Are we actually hitting more than six, preferably a little bit closer to seven to eight each night? And if that's not the case, let's just work on that number. How can we get there? For recovery, it's like, well, what's your resting heart rate? No one really knows their resting heart rate off the top of their head. No one knows what their heart rate is when they're sleeping, right? ⁓ I know you do, because you're a model citizen, But... ⁓

I think those things are just really, really helpful because now when we are then saying to people or preaching to people, hey, look, I want you to do more aerobic training. And here's the fun part. Now, because we know your resting heart rate, you don't have to work that hard. Like we just need to get that heart rate into a certain number, keep it there, and that's it. And your heart rate, I know, might be off 10 % or this percent or that percent, but we just want something that is consistent.

that's reliable and that we can kind of just keep coming back to. And I think the validity of it, right, how truthful it is, that's maybe the question. However, I'm not necessarily worried about that too much because I just want it to be a reliable indicator for people to just start to monitor progress, monitor health, and that's a bigger thing for me. And then they can go into nuances and different things like that. I mean, you mentioned the fitness stuff. And I always say I know enough to be a...

Dangerous, but I'm not gonna get you know, my hands too dirty there I mean I only took a precision nutrition course, you know a while ago I read here and there but More consistent than goals with that counting your calories and your macros and blah blah blah. I'm like, well, yeah There are apps there are you know coaches who know a little bit more about it who maybe can guide you a little bit better and here's the thing like now we can share all this data with them and you can transfer right on over to

Joe Gambino or someone else and they're gonna be able to help you now even further throughout your journey. Because I think I realized more and more like I'm just probably stops on people's journeys. I'm not supposed to be there from the very beginning to the very end. So all these things, the apps, the watches, the pedometers, they've really helped I think kind of just tracking health and wellness and just different goals for clients. And those are probably the ones that I use the most with people day to day.

Joe Gambino (22:39)
Yeah, no, I like that. I think, you know, it's always go after the low paying fruit, right? What can you what can you easily do now to make a make a change long term? And you always add on top of this goes back to our habit based conversation, right? Instead of trying to make all these different things work, ⁓ you know.

Joe LaVacca (22:45)
Yeah, for sure.

Joe Gambino (22:58)
I need to walk more, I need to eat better, I need to get in the gym more, right? Like just pick one of those things, track it, make sure you're doing it. Once it gets easy, you don't need to track it anymore unless you want to. And then you move on to the next thing and the next thing and the next thing. And then that snowball effect ⁓ really does play. But ⁓ walking is such an underrated ⁓ form of exercise because we do it naturally and people always think it's enough. When we were in New York, both, my wife and I walked a whole lot.

And when my wife started her dog walking business at the time, she probably went from doing eight to 10,000 steps to doing more like 15 to 20. And just that shift alone after a few months, like she dropped weight, she felt better, like just walking a little bit more. And it kind of comes back, you 10,000 steps is this number that we arbitrarily, you know, we.

Joe LaVacca (23:28)
Mm-hmm.

Mm-hmm.

Joe Gambino (23:53)
just selected this number. Ah, this is like what we need in a day. And when we give these numbers to people, that's where we stop. Oh, I only need 10,000 steps a day and then I'm good. So the goal is 10,000. You don't go more than that, but there is benefit. You know, if you did 15,000 steps, right, there's still, there's going to probably be at some point, you know, you do more, the benefits not going to really have much of a change at that point. But if you did 12 or 15, right, you're going to be burning a little bit more calories. Like if you're trying to lose weight or stuff like that, or just be healthier, a little bit more is not going to hurt.

Joe LaVacca (24:23)
Right, right. And I think that's the biggest thing. what I've learned from, you know, doing some research, teaching with court, listening to Court speak, the funniest story about the pedometer 10,000 steps conversation was it was an invention in Japan and they were just trying to population, like how much the population moved, but the pedometer stopped at 10,000. So it didn't count any higher than that. Then you had to reset it. So that's actually where the old 10,000 step a day

idea or mantra came from, there was not really a whole bunch of science behind it back then. And then like to your point, now more and more people are studying these things and it turns out, well, just getting to 5,000 steps a day can help people lower depression scores. Getting to 9,000 steps a day might reduce the risk of neurological illness as we age. And then you will get benefit. Like you said, the arc or that sort of like

slope of benefit just sort of like starts to flatten out a little bit. So I tell people, you know, the same thing with training, like, hey, get to two days a week, get to, you know, 90 to 150 minutes of aerobic work, right? Whatever the number we want, you're going to see a direct line straight up. The more you do to that number, the better. And then if you want to go past 10,000 or three days a week strength training or this or this or this, it's just, you're still going to get benefit. It's just going to flatline just a little bit, right?

It's not going to be the sharp spike you got from just hitting your base and staying there if you weren't already. So there's always benefit to doing more, but I think the most benefit comes from just getting that low hanging fruit, getting that initial work done like you were saying.

Joe Gambino (26:06)
Perfect. Anything else you want to add in here on this, Joe?

Joe LaVacca (26:09)
No, think ⁓ that was a good sort of like round out gives people some time to think about, you know, how they're exploring their therapy, if they're exploring their therapy in the most technologically advanced way that 2025 can offer. And if they're out for a little bit stagnant or stuck, you know, what are just kind of low hanging tools to, you know, just start paying attention to. And, you know, again, that won't cost an arm and a leg and a subscription on top of a gym membership on top of a nutrition coach and everything else.

Joe Gambino (26:19)
Thank you.

Right. Yeah.

Fair enough, man. Awesome. Well, take us home.

Joe LaVacca (26:39)
All right, well, Joe, love you. Listeners, we love you. Thank you for listening to another episode of the Beyond Pain podcast. And don't forget to come back next week where we'll have more exciting information to hand out. See you then.