Boom, boom, boom. It's mine pump time. All right. Welcome back to the best fitness and health and entertainment podcast in the world Today's episode is awesome. It's all about physical therapy How do you know if you need it? What value do you get and also we introduce a new physical therapy technology? It's disrupting the market really cool episode, but I know why you're here. You want some free stuff Here's what we're giving away today Free access to maps prime and maps prime pro. Here's how you can enter to win Leave a comment below in the first 24 hours that we drop this episode make it a good comment Also subscribe to this channel and turn on your notifications. If we pick your comment you win free access to those two programs Also, there's only four days left for our 50% off sale maps performance in maps suspension Go find them at maps fitness products comm just don't forget to use the code September 50 for that discount. All right, here comes the show Let's start with just physical therapy and just define it like what is physical therapy? What's the goal of physical therapy? great question Sal so fundamentally physical therapy is Defined as therapists who are movement specialists. So physical therapy is a program that is covered by insurance Of course, it's a health care provision to ensure that you have received care to recover and bring you back to functional activity However, the definition of physical therapy physical therapists is changing So physical therapists, you would go to a physical therapist if you are injured if you're hurt You need to get better from something and most of the time you procrastinate on that because you don't know if you're hurt enough To actually go to physical therapy, right? So physical therapists if you think about them as movement specialists Musculoskeletal injuries is one of the most common, you know, health care expenditures and the largest health care expenditures So physical therapy truly can be taken a look as Primary care can be taken a look as rehabilitative post rehabilitative pre rehabilitative So there are a lot of times when physical therapy is what of what a patient needs or what a person needs And I think that definition is not very clear. Well, does it now? Okay. So let's say Somebody goes to a physical therapist because they've injured themselves Is the goal to get them to move without pain or is the goal to get them to move the way they did before they hurt themselves? Because those are two different things, right? Absolutely, I think that the most important thing is to understand as a therapist What is the right movement? What is the right? Ability for your muscles to recover why you're having pain is it because you're not moving right or are you moving less? Are you moving more and hence an assessment a thorough assessment of understanding what is the problem? What is the cause before you actually jump right into the pain area is the most important thing? So as a physical therapist, we're never treating the pain we're treating the cause and Identifying the cause is why we have an initial evaluation the first visit a lot of our patients are telling us Okay, but we didn't really do any treatment today and that's because you know, there's some science behind this We're actually spending all this time just trying to understand Do we need to move you through that pain or do we need to actually train something else so that as soon as you train Something else your pain is actually going to be better by not doing anything where the pain area was, you know You just actually fantastic you just hit on something that we we tell the our audience how to identify a good personal trainer or a bad one and that is if the first session is Mostly assessing and no working out You've probably got a good trainer if your trainer the first day you see them gets you into a workout right away You know you probably have a bad trainer Yeah, and what you were saying, you know, I just that I'm gonna kind of close that loop a little bit is you know Sometimes your knee pain because I think a lot of people for example, I'll just use it the knee your knee hurts And so you think something's wrong with my knee. It's my knee that hurts Therefore, it's my knee that gets needs to get fixed Whereas oftentimes it has nothing to do with the knee has a lot to do with I don't know the ankle or the foot or the hip or Maybe the ankle on the other side of the body in other words The root cause of the knee pain is not the knee itself And I think that's what you mean by not treating the pain but rather try treating the cause Absolutely, and I think knee pain the second largest condition that physical therapy treats, right? I mean if you're having pain inside your knee or underneath your knee cap Like why is it getting loaded more? Like what do we do when we are overworked? You know we crash we we kind of are like this is too much for me or get overwhelmed And that's exactly what happens when we hurt our knee has loaded has been loaded more than it could handle And we just got to figure out who is not doing the job. Let's go train that that muscle Oh, so knee pain would be like your number one in terms of people coming in number two for number two You said she said two yeah, so is low back pain number one Absolutely, so lower back pain and of course it depends even in physical therapy We're trying to improve awareness patients don't know when to come in and and so yes, but You know based on analysis lower back is definitely number one the highest musculoskeletal condition treated And prevalence wise to and knee pain definitely goes second in the active population That we're looking at now what what what percentage would you attribute? The rehab that you have to do is related to an acute injury versus somebody who has Either chronic pain for years and then showed up or injured themselves because of poor movement patterns And that's why they're there. Yes. Oh my gosh. I have percentage wise I think I don't really have that on the top of my head But what's most important is there a specialty of these physical therapists So not every PT can treat an acute patient And acute injuries can be lots of different type types like did you actually fall and then Yeah, or if you jammed your knee against something and that's why your knee started hurting versus well You just overloaded your knee doing really Heavy weight lifts and that loaded your knee So I think there is that importance of understanding but acute care in physical therapy can be after like an acute injury And there's so much evidence that when we see your patients within 15 days or 20 days of being injured Their you know ability to recover is significantly high and that's the reason why today when you go to an urgent care for a low back pain Oh my gosh, I can't even straighten up. We're really working as an industry in physical therapy to tell those urgent care physicians Don't send them to your PCP. Please send them to physical therapy.  You can refer your patients Let's not get them into this chain of being going from one doctor to another until they really are coming back to physical therapy When it's evidence-based that it benefits. Yeah, the example I would give I used to get so I used to work a lot with physical therapists And and the examples I would give to kind of illustrate. We're saying it's like it's and this is simple example It's and it's you know, it's funny, but it's kind of true It's like you're banging your head against the wall and then you go to the doctor and you're like my head hurts And they said well, here's some ibuprofen Whereas somebody who's looking at the root cause is going to look and say Okay, let's stop banging your head against the wall and that's probably what's gonna, you know solve the problems You don't have to keep masking this particular issue Another thing that's very interesting is and you in this isn't so much of an issue now But even with older generations I worked a lot with people in advanced age and a lot of times You know if you go back decades when people had pain It was because of overwork hard labor nowadays pain comes from inactivity often, right or poor You know movement patterns and I think there's this kind of widely believed idea, which is a myth that Joints have you know a shelf life if you use a joint too much if you move it more It's just gonna get worse, which isn't necessarily true if you move it right It actually gets healthier and it has a longer it has even more longevity Is this an issue you ever have to talk with patients about all the time and in fact I find two opportunities and what you said Saul first was about You know the first is about this longevity of using your joints, right? When you are using your joints, but if you're using it, right? You have the right muscle balance and your body is able to handle that joint stress because you're Training your body to do more. So if you're training your body to do more you have the right muscle balance And you're doing an activity. That's not unrealistic. Like of course, you know, you don't really want to be doing something That's unrealistic for your body. So if you're doing all of that more activity is good But you are wearing down when it's high impact. So there's a difference between impact exercises versus stabilization exercises So what kind of exercise are you overdoing? Can be detrimental to your joints, right? So that's appropriate to the person absolutely and appropriate to your cause of training, right? So are you doing this so you wouldn't want to do heavy-weight lifts? Which is bursts of movements versus are there in sex exercises or endurance exercises that are high repetitive, but are not high impact So what kind of exercises are you doing to actually affect your joints is what I think every everybody can benefit from knowing like am I doing box jumps that are You know impact exercises and doing them three sets of 15 or are we doing five sets of five? You just hit one of our sweet spots. We love to just do we hate box jumps with trainers. That's like one of the number one things Nobody doesn't ride It's like a and the wrong people are doing it. They have they have my my lady who's 55 years old and 30 pounds over way and she's doing 15 jump boxes. No, exactly terrible person So I actually wanted to also hit this other thing which you mentioned which is we come from people who've been very Active and are hurting to come, you know from pain coming from inactivity But then we have this other category of people those are our weekend warriors, right? We're inactive the entire week and we're like, okay We're gonna be out this entire weekend either hiking uphill or doing activities or doing two days in a row of personal training I think that's another area where education becomes really important for a patient So we all the time are addressing lifestyle understanding where they come from and we're gonna get into Luna in a little bit But that's exactly where having the opportunity to be in your patient's environment as compared to a patient actually coming into a clinic environment Tells the therapist so much more to help them in a better way. Oh, yeah, I have a question about the pain like how How does that conversation look as a you know as a patient comes in and you know how can you actually talk them through in terms of like Defining what type of pain it is and then you know like a be able to to to bring that to a point of where they can understand You know like is this really something detrimental or is this something, you know, we can kind of work through sure I think that we as therapists during our initial evaluation Try to stay away from too much of a pain conversation What we're actually trying to give them is insight into their own self So when we do an evaluation we're talking about yeah, where are you coming from? What was your prior level of function? Did this really start hurting five days ago or was this something that's been going on for three years? And if somebody is coming in with pain and being there for three years They're more focused on things that they cannot do because of that pain as compared to get my pain away They're talking more about I can't run I have to give up on lifting up my kids or they're talking about things. They're not doing and that's where that mind Psychology comes and what is our patients and goal and this is not? Every therapist right and even for therapists This is an important question is at the end of our assessment Are we addressing their pain or are we addressing what they want to really get back to and working it towards that? Where says okay, let's fix your pain You got to do these five exercises that take care of pain Where says if you want to get back to lifting your kids without pain or putting them in the car seat without pain Let's talk about how you do that and figure out what your plan Such a great approach and this is how you how we found you know success as trainers was was focusing on those types of things Working on the person rather than necessarily the problem, you know earlier You were talking about weekend warriors and I'd love your comment your your commentary on this or your opinion I think a lot fundamentally people misunderstand Exercise they don't realize that movement is a skill in other words Someone says I want to start working out Let me go lace up my running shoes it go running and they haven't really run since they were 10 So they go put their shoes on and what they don't do is think to themselves. I never run I probably don't know how to run anymore. They don't think that they think I'm gonna go run until I get tired It versus somebody who understands this is a skill Let me go outside and practice running and get good at it and get the skill of it Before I go run to fatigue and get tired. Is this a conversation you have to have with people? Yes I think it's a really good Conversation and most importantly again, it comes from understanding the person right are they if a patient would be like I exercise a lot. I just go out running. I run like, you know, five times a week I go out every morning and I run and even if they're not running to fatigue and they're running 15 20 30 minutes They're doing it every day, but they forget the point that Exercising is slightly different from running because running you're you know exercising your heart But are you actually exercising all the areas that should help you in running so you don't hurt your joints? So what is the purpose of running running is helping your heart stay fit running is helping your muscles stay warm But if you're not running right then you're tightening someplace you're loosening someplace and and that could lead to Increase joint stresses and can cause pain So yes, I think communicating with our patients that You know, we're never actually try to tell them to stop doing something So if they are liking running and they're not hurting with running, please keep up because otherwise we lose them right there You know, you don't want to lose your patience by telling them not to do something that they're having fun doing and they're not hurting doing I'm not gonna say talk about what a challenge that that's where the hardest things as a trainer is like Takings knowing that you know, oh, this would be better for us But this is something they love to do and they've been doing consistently that fine dance that Therapists and trainers have to be able to make it's like getting them what they want what they would say that they should do And we will get into you know more specifics about how the industry is being disrupted and you know kind of where you're coming From but I do want to talk about the the clinical setting of physical therapy Oh as it is now or as a shade I should say as it is in the mainstream There's a couple issues that I've had with it in the past which you've already actually addressed Oftentimes I feel like and I've had physical therapists that were phenomenal and I've had some experiences that were like what's going on They're not focusing like you said on the person on me And then I've had these experiences where they'll say do these exercises and they're gone And I'm doing this movement on my own or I have some, you know Kinesiology student watching me for example is also there's also five other people who are doing exercises I know as a trainer when I take my eyes off a client for ten seconds They don't have me where it occurs. Yeah, they don't have the aware in fact. This was a selling point You know, I'll be honest. I used to do this thing with people where I do an assessment I'd have them do a basic cable row and I would put them in proper position I'd you know have the scapula retract and depress and they'd be like oh my gosh This feels we're good. They would do two or three reps with me helping them I'd take my hands off They do two or three reps on their own and I'd show them on my phone when I'd film it I'd say do you see how your form changed but and I literally left you alone for two seconds And so when I saw this in that setting, I was like this can't be this can't be good Is this something that's gonna be remedied or is this an issue that is being discussed? Of course, it's always discussed and one of the things that as a physical therapist We keep in mind is empowering our patients, right? Our goal is to make a patient feel they can actually do it without us watching over them all the time That is our goal because we can't keep them in physical therapy all the time They're not gonna be covered by insurance and be able to see them for six months or one year And we don't have that privilege to do that. So our conversations with our patients are about Making them talk about what they're feeling. Okay, can you tell me what you're feeling? How does this feel different from what you just did and one really good example is about how we stand Like when we're standing is our weight on our entire foot or just the back of your foot or in the front of your foot So having the patient actually or a client actually talk about what are they feeling? Let's maintain that loading it to the level that the that's those small muscles that actually contribute and stabilization are able to handle So there are larger muscles and there are smaller muscles the smaller muscles are more You know filament it and then they have more stabilization role Whereas the larger muscles are actually the levers and they're actually doing the movement So they need to work together and if those stabilization muscles, you don't have the awareness for it Then you're losing that form So as a therapist what we're actually telling them is to focus on okay Can you feel how this feels to retract your shoulder and we don't have to really retract too much But just a little bit to set it on your body and on your rib cage and then you need to maintain this Can you do this with a yellow thera band or a yellow tube and then okay? I think you did it well And then we do another set with the red tube and we do another set with the green getting them to connect Yes, and then they will feel oh my gosh This green tube feels very hard and I can only hold that scapula for five time for five counts And so as a trainer or as a therapist I would say okay Let's stick to red because I want your brain to train how to maintain this and do 15 of those with the red in a correct way Before we move on to the green so that's a progression as a therapist We would go through a while the patient develops independence because we need them to do this at home every single day So that they retrain their brain right how to do it, right? So since we're talking about clinics I want to know why Different like private clinics have different ratios of dpt's pts and kines students I've experienced this enough times that there'll be this one clinic that will have You know for dpt's and then the rest all pts and then there'll be one where there's only one dpt And then there's all pta's and then and there are those one that's all dpt's like what a great question so Our dpt's better than pts, right? So there are two ways of looking at that Physical therapists had a master's degree for the longest time. So there are definite their accreditions are pts and in the last five or so years We've now started having dpt programs, which is you get a doctorate of physical therapy in the first three years of training So they are the newer generation of pts who are all receiving doctorates. There are no more just pt programs So one way of looking at it is I have a I have a pt, you know Title I don't have my dpt, but I have 15 years of work experience And here we have another dpt who has five years of work experience because that's the degree you receive when you are out of school However, there is a curriculum change, which is understanding red flags understanding when you should be referring patients back to the physicians understanding pharmacology understanding medical management that has been formally added to Physical therapy training. Oh, wow. Very recently, which is which has enabled the doctorate title for physical therapists That also comes along with a transition in direct access, which we're gonna talk in a second So now coming back to your question about the distribution in different. Yeah, why why? Yeah, I think it depends on who suits that clinic environment I think every clinic every location comes with its motive Are we treating and and you know demographics that they're treating, right? Are we mainly treating? Patients from sports injuries. What kind of relationships I have with my physicians and my surgeons. Am I treating mainly pelvic floor physical therapy? Am I treating vestibular rehab? I'm dizzy and I kind of can't even drive to my, you know, gym So what kind of condition are we treating? What kind of therapist training do we have that defines the different? Specialties between DPTs and PTs that have that experience in those fields difference between PTAs and PTs. I think that Again, I think it's a scaling question, right? Just the way we have teachers assistants We have teachers assistants because the teacher can do everything, but there are certain things that are safe and well trained and well Educated physical therapy assistance can handle which is continuum of treatment So the difference between a physical therapist and a physical therapy assistant is physical therapy assistants. Don't change the treatment plan Yeah, they will follow the treatment plan established by a physical therapist Okay Now how many times in that situation though is The you know owner of the clinic making that decision based off of the demographics that you talked about Versus the monetary reasons for them because I imagine business model DPTs PTs PTAs and kinesis, you know students or whatever are all getting different pays And is it a common practice for some of these clinics to you know, maybe Less about serving the client and more about serving my pocketbook of making sure that we make the most profits off of this Is that common? It is common It is common, but there are a lot of regulatory a lot of compliance Rules established by Medicare and in these insurance payers that decrease poor practices I have worked in a clinic where I saw my patient for 20 minutes and I had my next patient in 20 minutes But that patient would continue to do exercises with a physical therapy aid, right? So are you in that environment or then I went on to to Stanford where I was seeing my patients for 30 to 45 minutes and Billing only for times that I was providing care for my patients Quality was it as at its peak at Stanford? We brought that to Luna, which is one-on-one time with your physical therapist in your home for 45 to 55 minute sessions And there are no physical therapy assistance no aids So absolutely does that decrease the number of time you actually need to go into PT because your therapist is monitoring you for a whole Session that's a good question. You know, maybe you recover with lesser number of visits and you recover Of course, that's no different than if you saw me with 20 years experience as a personal trainer And then I have my kid who's coming through school right now And maybe I just do the first session with you and then I say here now My kid's gonna take you the rest of the way through and even if he's a smart kid and the years of experience that I have I know I could get that client to the result or their goal faster than sure And I actually think that a lot of the new grads coming with a lot of expertise a lot of clarity in their approach Because there's definitely upkeep in the curriculum and the training and the kind of internships and exposure that we have So I'm not really thinking that there is a I'm not always just saying that an experienced PT is always better than a DPT or a newly grad but I do think that right training is so key and a Therapist is responsible for the care of the patient even if they're handing it off to a physical therapy assistant So coming back to your point about when the clinic owners are making this a business over You know over actually knowing what is right for our patients a therapist determines that if I think that this is scared that Somebody with chronic pain for example, we know this has been going on for a long time We're gonna need to condition this patient to actually before I change something Let's have a physical therapy assistant continue this program who can vary is very qualified to treat this patient Let them do that and as soon as the physical therapy assistant sees a need for transition They're gonna bring them back to a physical therapist Update the program and move forward. So is that actually a compromise not always? But if you're making it a business then that is a problem. So definitely as a patient I would want to ask am I actually getting better here? That's the question. I wouldn't really challenge it otherwise now you talked about updates to the curriculum and DPT's and How has physical therapy evolved like over the years and what kind of other modalities and other methods have been brought? You know into therapy. Yeah, I think As a physical therapist, we always want to have a toolbox because we think that not one thing fits everybody So lots of different approaches like even corrective exercises are progressive is like progressive corrective exercises You know movement impairments are concepts so there are lots of different approaches to care and I think they've all evolved by improved education improved Curriculums improved continuing education offerings to our to us as therapists Absolutely going virtual going remote Helps you start learning if those are your barriers to learn. So I think that's one, but there's so many things how does You know, how does restrictive blood flow work and how does I'm not an expert at it But I would agree like I think that there's so much including cupping and including, you know resistant restrictive work blood flow and You know even utilizing corrective exercises and PR exercises How does all of that change your approach? And I think as a therapist we're using those as toolkits as compared to that is all how I treat We love we love BFR actually in fact I love it for the physical therapy side more than the performance side Which is what is it's made its way actually into the fitness space as kind of performance a great way to build muscle Yeah, it's got great rehab application Yeah, and I did I was not familiar with it as a trainer when I was in the training space of found that we found this Actually, right when we first saw the podcast the very first episode it was the first new bit of Information or science that I brought to the podcast. I was experimenting with that I had just heard about I think they were using it on like hockey players first to rehab them from injury sports injuries And it's just a great way for a trainer and coach who that makes gets a client from PT They're now ready to strength train, but then we don't want to load too much yet So to restrict that way and get similar benefits is loading it heavier was I thought incredible, you know When we talked off air yesterday, we talked about there was a interesting statistic I wasn't familiar with which is it was like a certain percentage of people Stop their therapy after I think it was like three sessions and it was a lord Do you remember that percentage what that was absolutely? So it's pretty eye-opening actually because What we've noted is 70% of patients actually when they start physical therapy, they're motivated But they taper off and 70% of them don't complete their care They prematurely stop going to the clinic. They don't come back and Fundamentally how things work at a clinic are I'm gonna go in I'm gonna hear look at the receptionist telling me What is my schedule and what is the availability of the therapist? Okay, today. I have an opening at 7 a.m. In the morning and another day I have an opening at 2 p.m. In the afternoon as a normal human being I'm working full-time I'm not able to accommodate that so a lot of inconvenience kind of plays into that factor that we've noted That's one concept and then the other approach is also understanding not having a right therapist that educates you on What we are going to do next and not having that vision built up in their recovery process can also be that the Demotivator to continue. Yeah, I would imagine there's there's those roadblocks, right? I got a drive to the place Got to find the skin. That's always an issue. Yeah, I think another one would be I had this pain and the pain's kind of gone Now I'm done Not realizing that there's more to do because the pain tends to be one of the last signals you get From your body and there's a lot of stuff you can do, you know before that Exactly, and that's where I think that therapist communication becomes so critical Like what are we working towards? Are you able to do that? Are you able to do your tennis swing? Are you able to put your kid in the car seat? Are you able to do the heavy lifting that you wanted to do and telling them how it's going to progress like laying out the plan for them and giving them some prognosis which is Conditions like yours take about this much time and we don't have to see you two times a week for this entire six months But I would like to see you two times a week for the first four weeks till you get to know what we're doing And then let's go down to once a week for another couple months And then maybe I'll see you once in two weeks for the rest of it And that's where I think there's a beautiful way to connect with personal trainers Whether they're returning back to their activities, but they continue to need the insight and the expertise of a therapist So I recently I recently had a really interesting experience with therapy So my grandmother had a minor stroke lost some function on one side It was recommended that she get a therapist when it was appropriate and my mother my grandmother's you know She's in almost she's in her 80s, and she's old school immigrant Italian No way in hell would she go to a clinic and work with someone there's no way she'd go somewhere But this therapist came to her house and she was actually very consistent because the therapist showed up Helped her at home, and we were all delighted that my grandmother You know once or twice a week was doing these exercises and at no way She would have ever done it if we had to drive her somewhere What is home-based therapy like what is this and is this something relatively new is it disrupting the space? Well, I'm definitely sure from all our listeners and even from the people I know so many resonate with that story where we have had a need We haven't had the option to actually have physical therapy come home, but we actually get to experience it We know how it is something that we need and it's easier to stick to and we're able to get better faster So it is very disruptive because there hasn't been an option like Luna before which is outpatient physical therapy at home And there are a lot of benefits to that so until today if we talk a little bit about The history of it. There were home health agencies that are able to see patients right after an acute episode Where you're able to see your patients at home, but that trend is changing Luna's bringing out patient physical therapy to patients at home Which is more cost-effective. It's covered by your insurance And you're able to be seen in your environment, which is absolutely helpful so yes, I mean I think that It is disrupting because there isn't an organization like Luna that is doing it at the scale Today we're in 19 different states and 32 metro markets across the country And that's because patients need this patients understand the importance of physical therapy physicians health systems Doctors everybody understands the importance of physical therapy. We know that you know, 70% of the patients quit going to the clinics When we did a major study or a major analysis with one of our health system partners It was identified that 87% of the people that actually go to a clinic can be seen at home without compromising their quality of care So if you can start receiving care sooner at your home Why procrastinate why wait to go to a clinic and drop off versus start PT with Luna Are we seeing a little better stick rate with this with people having I mean I would assume for sure But what do you what are you guys saying? Absolutely, so even in terms of adherence to care. So that's a very important metric we look at at Luna Which is adherence to care? Did you drop off after three or four visits Luna's average today is about 12 to 13 visits, which is also very evidence-based If we are looking at evidence-based care because we don't we're not really just seeing our patients more We're seeing our patients more to actually see better completion of care and better outcomes So when it comes to health care, we're looking at all of those things as well that how is patient engagement? How is the actual technology? Driving better quality of care. Okay So here's a big question and I know the answer is I asked you guys earlier But I did not know this before and I was really upset that I didn't because this would have been a huge roadblock Typically when you get physical therapy you got to go to your primary care physician my knee hurts Then they refer you to physical therapists now your insurance those options are limited Yeah, they can approve they can the insurance that approves it and then you're set and then you're good And so I'm like, okay Well, why would boy this is a big problem because Luna which is the company that you're representing Which we think is the best in this particular space They send people to your home, but they're disrupting a market that is that's largely being clinic-based Why would a primary care physician refer to this this you know at-home thing when they've been working with this? But what I learned from you guys and correct me if I'm wrong You don't have to get referred if you have insurance you go straight to Luna and your insurance will approve someone coming right to your house Yes, so that is one of the other things that's changing in the PT industry, which is direct access So now with a lot of congressional activity all 50 states in the country have some sort of direct accessibility which is For example, the state of California a patient can be seen for 12 visits or 45 days without a referral Wow because there is a Understanding that physical therapists when being the primary care providers are able to contain most of You know the injury or support a patient to the best possible And they're great at recognizing when this patient needs to maybe get an x-ray or needs to be referred back to the primary care physician or to a orthopedic doctor So that level of training and that level of trust in the healthcare team has come in where direct access is actually now a Regulation of state and federal ability For all of we have such a large Personal trainer audience and I know so many times where I'd get a client that was still battling something that I it was Just above my pay grade I wasn't ready to at that time in my career to help that client figure out what was going on with their shoulder They knew they had a problem hurting. I could tell by the way they moved They weren't moving properly But how to address it and fix it and if I could send them to a place without having to send them to their you know Their general practitioner to then refer them to then go through all it to be able to go directly to Luna and maybe hopefully work with Them for four to six weeks to address it fix it and now they know and then they come back and see me So to be clear Now physical pts are being considered Primary care in the sense that they can refer so they're the front line So let's say I'm at home in that sense, right? Let's say I'm at home and I'm like my my back hurts I need to figure this out. I could go to Luna Luna will send a PT to me Who can then assess me and my insurance will cover treatment based on what the PT? You know recommends or the PT could say look This is something you need to see an orthopod for and they can refer me in that direction Yes, and referral in the health care system means different we can really write a prescription Got it send you somewhere But yes, we are basically identifying if this is within the scope of our practice. So as a licensed therapist I know what I can treat so when the moment is where I can't treat this I'm gonna tell you to go to your doctor. Wow So that is ethical practice and it's under our license and you know, we are we're bound to our licenses So yes, I mean, there is a lot of trust when you go to a doctor They're gonna write a prescription for physical therapy that says low back pain But is your low back pain coming from a potential disc irritation or is it coming from a facet joint irritation? What is this a neuromuscular limitation or a neurological tension? The therapist is determining that and so we're doing like PT diagnosis. We're not really saying you have Or you have a disc herniation a therapist would never do that because those are medical diagnosis, but we know what's Causing you the limitation or the restriction in your functional movements and we're treating that interesting and covered by insurance This is the part that blew me away the most the second thing that I think is fascinating is when you go to a clinic We just described Kind of what typically happens in a lot of clinic clinics The PT gives you the program and then there's a PTA that kind of watches you and maybe they're watching four different people So you're spending maybe 15 to 20 minutes with the the main, you know physical therapist when people come to your home Like with Luna is it just you and them and that's it and they stay with you that basically the entire time That is actually absolutely it So as you said before if I have low back pain, I can call Luna Luna can send out an experienced skilled Therapist who has trained in orthopedics to be your play to you know to provide care to you It's covered by insurance It'll be a one-on-one 45 to 55 minutes session with just your therapist and of course you have the Luna technology So we have an amazing Luna patient app which when the therapist provides Exercises you could actually use the workout program in the Luna app Oh wow and then if the therapist says do your exercises three times a week You're actually seeing if your patient did them three times a week or did they do them once a week so you know What's realistic? Wow? Wow? That's interesting now is okay Is this like way more expensive than because if I have someone like that with me for 45 minutes versus you know Two or three people watching, you know ten people do extras It's got to be a lot more expensive or is there were there a lot of things that were cut out a lot of middlemen That made up that difference like how does that work? You're setting up for amazing answers from me I mean that's what I would wonder, you know, I'd be like this must be so much more expensive Yes, because the the hard to believe truth is it's magical because there is no added cost to a patient to get care in this manner To have a therapist in your home to have an application that monitors you when you're not in PT to have an application Where you can actually chat with your therapist even between your treatment sessions all of this comes free But it's basically health care. It's great care Our goal was to actually bring good quality care outside the four walls of a clinic because that improves access access Is one of the biggest problems in physical therapy? It's not doing an annual visit once a year with your primary care physician I'm seeing your patient two times a week for six weeks 12 15 20 sessions Are you actually gonna make that you know and So I think it's really really important that you're able to stick to it You're able to return to your function and you're not giving up on it Yeah, another question is and I know the answer this because I know what's What is typically required for rehab or for correctional exercise, but the average person may be listening and thinking I Don't have equipment at my home. So how can they possibly help me? You know when I don't have all this machines or things to work with now I know with rehab that's very you don't need much any bands and maybe body weight in a chair or something like that So is it can you effectively treat someone at home without lots of fancy equipment? So that's where that statistic about 87% of the patients that go to an outpatient clinic can benefit from at home But that doesn't mean that there is no fancy equipment There is equipment which actually is something you can do even when you're not at a gym or when you're not in a PT clinic So the most important thing is how do our patients get empowered to do something even after physical therapy, right? So if I discharge them, I still want them to keep up with their program So we're basically therapists are bringing in this entire toolkit It has all the assessment tools that they need to do your assessment It has treatment tools like there events there are loops some proper reception training materials But those are portable things you as a patient if you're going to a hotel room for work You're still able to take your things with you Okay, you're tailoring the program to what a patient needs a therapist brings in a treatment tables You're not being treated on a bed or on a couch or on the floor. You're actually being treated in a professional workspace on a treatment table You are receiving infection control practices with COVID that has become super important So all of that is done legitimately And the way we kind of put it is the clinic comes home. You're not going to the clinic So we're maintaining all of those That's a good point with that was a very good point with the with COVID because that's changed It's changed the environment so Significantly that there are probably people who are afraid of going especially if they don't think it's necessarily my knee hurts But it's not super bad. So I don't want to go to the clinic with lots of other people So I'm assuming that this particular environment is probably only boosted the popularity of in-home services Am I am I correct or is it well? I would say we've been longer than the COVID so Patients had already started recognizing this benefit. We're moving in this industry in this world where Everybody wants good quality care While it's convenient and convenience was never focused on before however, it is delaying receiving care So how do we improve access? So Luna started Patient care in 2018 and of course COVID stuck more so like last year definitely increase in understanding and need We've supported so many surgeons who couldn't do elective surgeries and how do we maintain our patients pain levels? How do we maintain their recovery? How do we help them? Sustain their ability while they're waiting for their surgeries to happen. So definitely a huge uptake We've expanded significantly in the Bay Area We def we have about 10% of outpatient physical therapists that actually now work for Luna Which is huge Therapists love it They love the ability to see their patients in the home and patients absolutely love it because they don't want to delay care If there is a great offering like Luna now, what does it take for a physical therapist to become a Luna practitioner in? And how does that benefit their current practice like is this something that you know? They could do in conjunction with their clinic. Yeah Home-based care isn't necessarily near there has always been home health agencies. It's just that we weren't really supporting Active population or we weren't really supporting outpatient population, which is just how the the business is structured Or the offering is structured But the most important thing to think about as a therapist is how am I getting exposure to different? upcoming innovative solutions for Luna it was really important how our therapists experiences because as clinicians and This happens in all clinical world as clinicians We are doing a lot of administrative work and we're doing a lot of clinical work and we're doing everything We're staying hours and hours after actually seeing our patients to get all of that stuff done So that Luna it was really important for us to make sure our therapists are able to stay focused on what they do best Which is patient care In order for therapists. Yes, so therapists can work at a clinic in fact all of More than 95% of therapists at Luna are moonlighting with Luna hence the name Luna For supplemental income, but there is a lot that goes into it to maintain consistency in care So yes outpatient therapists most of Luna therapists are three plus years of work experience We actually have 10.5 years of average work experience of the therapists on the platform We don't have new grads. We don't have Students we don't have physical therapy assistants So if you are a licensed therapist without patient PT experience who can be successfully treating Independently not being in a clinic environment. You're fit for Luna Okay, now you mentioned paperwork and I remember talking to you guys a little bit about that like some some of the benefits You provided in terms of lightening that load somehow was that look like yeah PT's hate that yeah An hour paperwork for each patient wow, that's a lot when it comes from you know personal trainer PT's cribbing about that but yes burden of documentation is absolutely well known So that's what I think we did really well, which is focused on the therapist experience. We recently did a stat where At Luna we've developed this process called auto charting. It's voice enabled So a therapist can actually finish a documentation in eight minutes versus 30 minutes that I did at a clinic Or three minutes for a standard visits where it would take me like 15 20 minutes so It saved us a lot of time and we recently did an under a look at it And it was enough time to go to Mars and come back We do you want to join that group? Do you want to be saving time in documentation and enjoying patient care? So therapists absolutely love it. Are they just they just speak into the app. Is that what it is? Yes, and you know To make anything simple goes a lot of work So I don't want to undermine how not comprehensive this is because it's a very comprehensive documentation system But for a therapist is as simple as okay, I have a visit with Adam. I'm gonna come I'm gonna start my session so it starts actually geographically looking at where I am It's making sure that you're actually at your patient's home I finished my session and then I'm driving to my next patient's visit and I click a button I get an interview. I'm prompted questions I answer those questions and by the time I go home at night or wake up the next morning my charts already ready for me I can edit all of that and sign off on it And the way we're also driving behavior is as soon as you sign off on that chart You're getting paid for that visit So you now don't have to wait for your two-week check to come in you're actually getting paid as soon as you sign off So in theory, so in theory, could I do this as a peak? Could I be dry? Pretending I'm a physical therapist. Could I go to a patient's house and then Set myself up to go to another patient's house on the way from this patient's patient I could be recording all that stuff. Can that be done that can be done and it only takes you eight minutes So or three minutes. Well, okay So, you know, if I'm so I'm gonna from the PT's perspective, right? So I normally work in a clinic. I see this new company I like the fact that I could spend more time with my patient, but I got a drive I'm going from person to person. Am I getting compensated for all this? Am I making more or less? Is it competitive? Like what does that look like for me as a therapist? It definitely has a higher earning potential to work with Luna because we're paying by the visit However, there is a difference in how outpatient gets reimbursed and so their Luna definitely Pays therapists really well compared to a clinic When you think about drive times, that's where Luna technology comes in We're not really expecting our patients to our therapists to spend an hour and a half to see one patient, right? So it's really important that their drive times are maintained within 30 minutes from one patient to another and That's where we increase the capacity and density of the patient population where they live So they're not really driving back and forth across town or spending the entire day just seeing three or four patients It's about how do you leverage technology to restrict your time?  How do you have an amazing? Administrative concierge team supporting you so you're not now calling the doctors trying to figure out paperwork So how do you solve that documentation burden administrative burden? Which really makes a sweet spot to get what you get paid for that visit for for a Luna therapy isn't and isn't that like the Secret sauce of Luna like I think I remember talking to Matt and don't you guys didn't you guys acquire someone from Luna on the team? I mean, excuse me from uber who actually did all the geo location and stuff that is true so one of our so our CTO is from uber and of course He's he's a mastermind behind the matching and the routing so it's not just your graphical location But we're now looking at is this therapist or orthopedic is this a neuropathy is this a vestibular PT? What does a patient need? What is their time availability was the therapist time availability? What's their drive time going to be from one patient to another are they going to get back home without driving 45 minutes? So so many amazing components, and of course, I think we have a really awesome CTO to do that. I mean, okay, so everything you're explaining right so you get someone to your house, which that's a big difference People are gonna adhere to it longer because of that. It's much more convenient Therapists make more money do less paperwork. I can't imagine something more disruptive to the market Are people upset like are you are you guys making other like like other organizations upset? Or is this something that everybody's starting to adopt because I can't see how you would compete against that what we want people to Be upset, okay That was our goal to be good friends because we because we want them to not be super comfortable It's you're never making innovation when it's something everybody can accept the very first time you see it So it's okay where we're okay with people being upset and it starts with at the the most bottom level, right? When a therapist is referring a patient over to a personal trainer or massage therapist and a massage therapist is sending a patient to a Therapist you're always thinking okay. Am I going to lose my patients? Am I going to have less patients in my clinic or if you know, why wouldn't everybody want Luna? Absolutely, why wouldn't everybody want Luna? There's a lot of questions that would arise So there is definitely disruption because of that, but is it not challenging? It is very challenging to build what Luna has built It's not an easy problem to solve. So I think we have a lot of amazing support We have a lot of amazing support from all the partners at Luna. We have health system partners We have orthopedic group partners. We have individual more than 2000 physicians who love Luna and refer to Luna today So I think we need both we need people who are upset and we need people who love us Well, so it's something that I've noticed a lot just you know being in the space the health space for over two decades I've noticed more than ever Children with posture deviations and pain. I know kids I read a statistic I remember the exact percentage, but you know if you are a doctor you probably on 20 years ago You rarely ever saw kids show up with low chronic low back pain or neck pain now. You're seeing that quite a bit Do you guys also work with with children for things like forward head and shoulder pain and back pain and is this Is this starting to grow are you guys seeing more of this? You know, I think that's where is the amazing thing Which is the potential and the opportunity is so huge Luna sees patients from 13 to 103, right? So it sees the whole spectrum. We don't see patients below 13 years of age today Could we yes we could but our focus is 13 and over And yes, I think that awareness that education athletic trainers re like coaches all of those Opportunities where we identify send these patients or send these children This population to actually receive care sooner than later because they're sitting in front of the computers And then they're going and playing PE and soccer for like an hour. They're half postural deviations They have forward head. They have length and nerves and they have lack of you know, Physic and tonic muscle balances. So how are we actually being proactive? Education is never gonna end. There's so much evidence even though WHO identified that there is underutilization of physical therapy So how do we actually improve awareness amongst all of these people? So yes, we can absolutely see those people those Kids and we would love to see those kids because that's where you It's a huge market because as a parent you got three kids you got your child You're like man that his neck is not you know, it's not moving it right. He's got a forward head I could see some problems. He has a little but I got to take him to the clinic and I got these other kids Instead of being like just come to the house. I'm gonna be with the other kids over here You guys do your thing. That's got to be like an exploding market. I would imagine yes one of those exploding markets Definitely a great opportunity We have a lot of parents doing that you sprained your ankle after a soccer practice Don't procrastinate that don't just ice it take care of it Let's figure out how to get it stronger because we want you to continue playing soccer How do you do that? So so so the process would be instead of taking my kid to the doctor to have it looked at I could call you guys Tell you guys listen my kid Spraying their ankle playing soccer then we'd set up an appointment and someone would come and do the end Initial assessment there that is correct. Oh wow that makes a huge and it'll be covered by your insurance That makes a huge difference. Okay, so what kind of people then should seek out physical therapy aside from the obvious like I had knee surgery Or I've got major pain like what are what are some areas that are that are common that maybe people aren't super aware of that? They probably would benefit from from physical therapy, right? Well, I would say don't wait to be injured if you're having aches and pains You're having lack of ability to do what you want to do best if you're a golfer and if you can golf and your swings not great And you're having some shoulder pain see a physical therapist If you're having low back pain sitting from working all day long go see a physical therapist If you're having neck pain and which hasn't gone away for 10 15 days see a physical therapist So the earlier you see a therapist your prognosis is better you there's a higher chance you're gonna get better without needing x-rays and without needing medication and Internally, you always have this fear of wanting more medical care. I'm paying for my insurance. I should get an extra I should get an MRI I should get this. I'm paying for this. I think we need to shift away from that and actually Do something ourselves take charge of our care and actually even though it's not as easy as taking pills We need to invest in our own body You know what the irony of it is is let's say you're listening and you're like cool I'm gonna have a therapist come to my house and help me so now my insurance is gonna pay more The reality is insurance will end up saving money in the long run because it's much It's it's much cheaper to treat Chronic low back pain through exercise than it is to have to do surgery later on so that's the irony It's actually say it'll actually save money That you think saving everybody on both ends. That's what I'm saying Everybody saves money as a result of doing things right so I have an uncle I was having this conversation with them the other day I'm like we need to do some correctional exercise like why I don't hurt But I was watching him put on his shoes and He has to put them on really in a weird way He's got like sit down and use his finger and he's got like a really bad movement like we got to do some correctional exercise Why who cares I can still put my shoes on like these are these are simple things that I think that's supposed to be sweating though And taking 15 minutes Yeah, you should never take a break uncle from one shoe to the other Yeah, but you know or sitting down and having to you know twist your leg like these are things I think people don't realize that they could benefit from therapy like if you used to be able to Put one sock on while standing and now you have to sit down Because you're losing your balance or you know It's hard for you to tie your shoes or you used to be able to reach up to the top of something And now you can't really reach it because you can't fully extend even though you may not you may not feel pain That those people would benefit greatly in fact I would make the argument that those are the best people because it's before they hurt Absolutely, and before they deteriorate or continue to stay away from things that they could be actually doing Seeing independent, right? So today we're able to put the shoe on but tomorrow you actually might need a shoe Shoe hook and the day after that you actually might need a caregiver to help you with your shoe So how could you actually not you know postpone that so you mentioned something else? Just it you know in passing about pelvic floor rehab This one's really important to me now because I've dived a little deeper in this because my wife had a baby about 10 months ago and so many women Do not understand the symptoms of poor pelvic floor muscle strength, especially after Having a baby like it is so important that if you have a baby that you you do some type of pelvic floor exercise Afterwards, otherwise you could end up with the chronic issue. I remember when I was a early trainer This one I was like 20 so imagine my shock when I had a client trying to jumping jacks. No, I can't do them Why I end up peeing myself a little bit.  I Think it's amazing. It's amazing the more and more people know about this. It's great so thanks for asking that question because It's very important to be just aware of your muscles to be aware of how you could be doing things How you could be compensating things you're weak, so you bend a different way. You're not fully recovered So you're actually Lifting things wrongly or overloading your muscles. So I think it's really really important after normal things like birthing That you're able to pay attention to yourself and there is no way a newborn Baby's mom is going to be able to go into a clinic. That's that's another amazing thing Just even sick sessions of becoming more aware How do you identify where your core is after giving childbirth or where are those small muscles in your sacrum? And you're lower back and you're you know your core stabilizers and re-engaging those In order to have that stability that holds your upper body and your lower body together Another exploding market like you were talking about I think it's super underutilized because there hasn't been a convenient offering to have care like that It's also a niche practice. They're not as many pelvic floor therapists out there So when you actually find a great pelvic floor therapist pay attention to yourself What about like fitness enthusiasts? So somebody's listening. I'm like I work out all time. I really fit But you know, I stopped deadlifting a while ago because it just tends to bother my back So I don't do that anymore. I just stopped squatting. I do other leg extra So I don't squat anymore because it bothers my knee Is that are those are those people gonna benefit from working with a therapist? 100% as I said, you know as a trainer you might say okay Let's not do this exercise because it's hurting but as a therapist I might say let's figure out why you can this can't do this exercise because if we're telling our patients don't do this Then we're not doing our job because we need to figure out why they're not able to do this and help them get back To that or help them navigate that so one really good example is sciatica, right? What is sciatica sciatica is actually a symptom But is the sciatica coming from your lower back? Is it coming from an impingement in your muscle? Or is it coming from like a nerve tension? You know you need a physical therapist to help you guide to it So that now you're not hurting every time you bend and do a deadlift or you're bending over and coming up wrong So if you have stayed away from a deadlift you absolutely want to say see your therapist because if you're so fit Figuring out where is that muscle imbalance would be perfect to help you get back to it And you have a reason where which is why you need skilled physical therapy. Oh, excellent So I have one last question for me and it's a personal question I'm just curious because we didn't talk about this off-air there Did Luna find you or did you find Luna and what was like the I mean you've had to been learning all this stuff Just like we are for the first time and there was something that went holy shit. I'm in or whatever Wow, that is a that is a pretty personal question, but I think we found each other Because I'm like soul mates. Yes. I would a hundred percent agree I do get told at at Luna often that I have purple blood in me So yes, I think it was perfect timing. I was at Stanford really enjoying I grew a lot I was treat I was co-lecturing for residency programs and I was You know a senior physical therapist getting trained in a lot of different innovative approaches to care and You are in this feeling where I don't necessarily know it all am I like good enough But then it comes a point where you're like, okay, no, I do know a lot I want to bring this to a larger number of people and that's where when I met the CEO of Luna The conversation was am I a therapist at Luna? No, I think I definitely want to take a take on Helping this at scale bringing the quality at scale and leveraging technology to do this at scale So I was in a transition of starting my own practice and that could keep me limited to like five therapists ten therapists a few different clinics But doing this across nineteen states thirty two markets a thousand two hundred therapists on the platform today has been an incredible opportunity Excellent. So most most big city metropolitan areas. Would you say is where people have access? Yeah, if we go to get Luna comm there is our coverage map across the nation and We have a phone number. You can call Luna.  Wow. Yeah So I predict this to explode unless there's some weird law that comes out to prevent, you know What you guys are doing, but I can't see this not completely taken over because There's absolutely no the therapist makes more they have to do less paperwork the patient gets better care So yeah, that's why we wanted you on because this is exceptional very disrupting. I can't think of the last time I've felt like something, you know as established as PT got to get is gonna get this disrupted So very cool. That's really exciting to hear and along with all the business side as a clinician. I just feel There is a space for everything. There's a space for digitization of care But there is a space where in-person care is gonna help you solve your problem And so don't think that one thing can replace another start taking care of yourself If you need a PT in home, there is an amazing opportunity like this for sure. Excellent. Great. Thank you very much. Yeah