Isokinetics 101: Testing, Treatment, and Return on Investment

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Dr.
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Daniel Bodkin, a physical therapist and athletic trainer, as well
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as the director of clinical education for CSMI. I had
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the privilege of learning about the HUMAC norm as well
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as isokinetics in general from you in person a few
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weeks ago. We had great clinical conversations as well as
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I'm excited for the audience to get the opportunity to
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learn from you as well. For those who are unfamiliar
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with you and isokinetics in general, can you give a
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brief introduction into both and then we'll get started.
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Yeah, thank you very much for having me on. So,
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you know, isokinetics, if You didn't learn about it in school.
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It's this mystic machine that we read about in a textbook.
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And they always say, oh, it's something that you'll never see.
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And there's a couple of barriers for that reason. But
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I learned it. So when I was an athletic training student,
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I did an internship with the old guru of isokinetics,
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John Hisamoto, down in Tampa. And then I worked with
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him all through PT school. When everybody else went home
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and studied, I went to the clinic and worked for
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a couple hours, two to three times a week. So
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then even after that and I graduated PT school, I
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worked for him for four years. And while my wife
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was finishing up her medical training and then just kind
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of got started with CSMI, they gave a system to
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him to have Him helped them modernize it. He helped
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Kincom back in the 80s bring eccentrics in. And so
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he kind of, you know, brought up not just, you know,
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how to do it, but how do you actually use
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it clinically for testing, for treatment? And so when CSMI
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bought the system, the norm from Cybex, they gave him
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a system and he basically ported over everything that he
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did with the Chattanooga system. And then they said, OK, well,
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what else can we do? And that's when I kind
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of came in. I was like, all right, let's see
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what can these systems do. And I know what we
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learned about in school, but what should we be doing
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with them? So we started doing a lot with, you know,
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changing the feedbacks. One of the issues with these machines
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is the learning curve, right? So how can we improve
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that just by changing what the patient sees? Just by
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the way we have the test set up. Isometrics were
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becoming a thing. You know, nobody did isometrics back before then.
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But so I was like, well, how can we like
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leverage isometrics? And you saw while you were there, all
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the dynamic isometrics you can do. Then we brought in
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long hold heavy ISOs. Then we recently, you know, took
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the work of, you know, University of Delaware trying to
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figure out with NMES, you know, how strong should your
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Russian stem be? How can we take advantage of that
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using the feedback? Rate of torque development kind of became
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a thing. It's like, all right, well, how do we
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test for that? How do we train that? You know,
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how can we use different modes of contraction to actually
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improve that muscle capacity? BFR, you know, that wasn't a
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thing when I was in PT school, not to date
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myself too much. But it's like, all right, well, how
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do we use the machine for BFR? You know, what's
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the best way to set that up? So it's just
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like modernizing, you know, this old tech that, again, we
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write about in school. And even if you look at
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a textbook now or the vast majority of the research
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out there, is just rehashing what was done in the
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70s and 80s. So that's why I love it when
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I show up with the system and people are expecting
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to get A, B, and C, and I take them
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all the way to like S, T, U in the alphabet.
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Just because there's just so much more with it that
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you can do because you had, you know, like clinicians
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like myself, like Eric Mehta, John Hisamoto, and a handful
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of others working with directly with CSMI to improve it
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or Just like, you know, when I was out there
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with you guys at Rehab to Perform, you know, somebody
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mentioned something to me like, hey, can you do it
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this way? It's like, all right, let's see. Let's see
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how it works. So it's just, we're just continuing to
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make it better. So that's isokinetics in a whole. If
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you really don't know the science of it, you're probably
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not a PT or an athletic trainer. And if you're
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really interested, you can always look that up because it's
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readily available. That's, you know, another 30 minute conversation or,
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you know, a two day conversation we could have. Now,
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with CSMI, I am the director of clinical education, and
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I do their installs. Before I came on, and with
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the other isokinetic companies out there, I won't say names,
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but they pretty much have a technician come in or
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a salesperson come in and install the machine. They show
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you the basic functions of it, and they're in and out.
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I know one company, their goal was to be in
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and out in an hour. Versus me, after I install
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it and set up and I load up as many
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protocols as I can in that time, then we do
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a three or four hour in-service. And then we do
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follow-ups online virtually afterward. And we have a course that
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I run for them. So my biggest thing is I
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just don't want to show up and show you what
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buttons to push, but I want to teach the clinical
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side of it as well. Most of the time I'm
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going out, nowadays it's a lot of clinicians, but whenever
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I go and I'm doing one, it's researchers. then I
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obviously have to modify what I'm going to teach for
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them to make it fit with their needs. Aside from that,
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here in Atlanta, I have a small little clinic where
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I'm mainly testing for other clinicians and other docs. So
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a handful of PTs, they send just about every athlete
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over here to me. Some of them send in just
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their ACLs or the ones if they're questioning it. Then
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I have a few companies that will send people to
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me to do pre-employment testing with. And between that and
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CSMI and I'm also the primary for my kids. I
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tend to stay pretty busy. I'm usually in the clinic
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most weeks. It's three or four days a week, and
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I might be out on the road one day. Lately,
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it's been a little bit busier. And then there might
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be a couple of weeks where I get to stay
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home for a few weeks. But even when I travel,
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if I leave at 10 p.m. on Tuesday night, I'm
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usually back by 10 or 11 p.m. on Wednesday. So
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they're real quick trips. Awesome.
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Well, thank you very much for the introduction. We're going
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to start at the end stage. We're going to start
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at like return to sport and where isokinetics fits into
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that stage. So we know how important functional testing is,
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as well as isokinetics, as you kind of briefly described.
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What does isokinetics do for that, like bridging the gap
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to that return to sport decision making that functional testing
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can't truly achieve?
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One, it's just isolating. So I use the isokinetic, you know,
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the humac norm. I also use a force plate system,
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but that occasional athlete, I'll even take them out and
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do a 505 drill with the laser gates. So just
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in a current example, about a month ago, I tested
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an athlete. He was, I think, seven or eight months out.
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He had his ACL reconstruction, and he was wanting to
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play lacrosse this summer. And he was going into his
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senior year of high school. He was wanting to be
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the quarterback again next year. So he tested out, and
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I always do my force plate system first, because if
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I hit you on my isokinic, you're going to be
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completely fatigued. So we did the force plate, and it
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was showing on a single leg countermovement jump, he was
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jumping only 17% higher. It's like, all right, that's pretty good.
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His RSI was like maybe 20% better on his uninvolved side.
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And when it came to his countermovement and his countermovement rebound,
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he was maybe 15% to 20%. you know, using that
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uninvolved side for like the eccentric or the concentric. And
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the only thing that was off of that was when
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he was landing, he was landing, I think 30% more
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on his healthy side. So it was like, all right,
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hey man, you're looking good. We go on the isokinetic machine,
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his quads down 47%. And it's primarily in the eccentric
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mode of contraction and it's worse as his knee flexes.
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And so the, if, if you guys have never taken
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Eric Maeda's course, the complex or simple solution to complex problems, like, sorry,
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if I messed that up, he does this whole really
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long introduction on AI learning using robots and computers. And
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it's showing how you can change the constraints of a task.
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And that robot and that AI will learn how to
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perform the task with repeated efforts and, you know, repeated trials,
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they'll figure out a way to do a thing when
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you eliminate one of the legs or you give them
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a constraint. Well, humans are going to do the same thing.
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So if I have a major quad deficit and I'm
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learning to jump, I'm going to learn how to jump
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without needing that quad. And even with a vertical jump,
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your quads only kind of perform about 30% of that task.
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The majority, you know, the other 60-ish percent comes from
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your ankle and your hip. If you're doing a vertical, sorry,
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a horizontal jump, like a triple hop, only 12 to
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13% of your propulsion comes from the knee. Now, when
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you're landing a horizontal jump, I think 65% of it
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becomes the knee on the landing, but that's not what
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we're testing. Because if somebody jumps so far and they
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drive it with their hip and their ankle, but they
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can't stick the landing with their knee, we don't count
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that trial. So we're testing somebody's ability to propel themselves forward,
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which is primarily looking at the ankle and the hip. So,
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you know, the functional task you need to have it, Because,
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you know, that's going to tell me things that the
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humac can't. It's going to give me power output. It's
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going to show me how the leg functions as a whole.
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But it's still very constrained. You know, I have soccer
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players and I'm having them vertical jump various ways. They
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don't do a whole lot of vertical jumping versus like
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my basketball players. But it's a proxy for when their
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demands of their sport like. making that high-speed decel or
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that cut. You know, that's where I could take them
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out and do the 505 drill, but it's not going
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to isolate like the Humac will. And so, you know,
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you're testing different things, right? Now it's when you bring
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them both together, that's the sweet spot. And so when
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I love that people are, if they have the force plates,
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because it does give some data, but just know if
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you're doing force plate by itself, you're missing a big
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part of it. So whether you, you know, if you
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have a Humac, if you have the ability to use
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that or another system, or even just using a handheld
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or an inline, if you guys haven't ever heard of it,
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the D & D, Dungeons and Dynamometers course, they do
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a great job of teaching people how to, you know,
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use handheld and inline dynamometry and force plates as, you know,
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an all-encompassing system or a testing battery if you don't
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have access to one of these systems. You might have
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one in your city. It might not be your facility,
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but if you know that there's a, you know, a
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humac or something in your city, get a relationship with
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that PT or with that clinic to where you can
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just send them over for a test. And then you
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can perform the rest of your battery independently. So you
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can have them do the hop testing. You can have
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them do, you know, the 505 or whatever your testing
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battery is, but, You know, our stats on ACLs, they
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still suck. You know, if 20% or even 25% or,
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you know, let's say 15%, which is low number. But
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if 15% are still re-tearing, that's a terrible stat. We've
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gotten so much better at rehab. The surgeries are better now.
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But the fact that we're still having that high tear rate,
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and it's primarily just because people aren't getting that testing in.
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So that's my long answer for that. Yeah.
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I'm glad you brought up the battery because that's what
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it takes, right? You can't just isolate one test and
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clinicians will say they don't have enough time to do
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all the tests they want in one session, but that's
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why you have another session following up. You don't have
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to do all the testing in one session.
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Well, when we're done today, I have a retired NFL
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athlete coming in and I tested his knees last week,
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but we also need to do a bunch of ankle testing.
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And when I say testing, right, it's our system is different.
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We're I'm doing a rate of torque development isometrically to
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look at speed of contraction. I'm doing concentric and eccentric testing.
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It just gives you a lot more data than the typical,
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you know, biodex test at three speeds. But he's going
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to come in today and we're going to test ankle inversion,
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knee versions. He's had a history of ankle sprains, but
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he also had an Achilles, a tendinopathy throughout his career.
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So I'm going to test him on plantar flexion, dorsiflexion
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on the humac, but also on the force plate. Because when,
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especially when it comes to plantar flexion, when I'm testing
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on the humac, that's going to look at muscle strength, right?
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And typically on the humac, you're not going to be
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able to put out quite body weight with each leg.
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But when I put you on my force plates, you have,
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you know, all your body weight coming down, but you
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have then the force that you're generating with the calf complex.
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You're going to get a little bit of triple extension
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out of the rest of your body. So when I'm
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testing him on my force plates, that's going to give
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me his Achilles tendon, tissue conditioning, right? How much tensile
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strength can that Achilles complex handle and generate? Versus when
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I'm testing them on the Humac, that's not nearly enough
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load to uncover a tissue intolerance. So that's going to
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give me strength. So I'm doing both of those because
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they're testing different things.
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One more follow-up question on like the return to sport
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decision making for like isokinetics. Do you see any common
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themes or gaps that clinicians... are kind of struggling with
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in this return to sport with isokinetics?
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Well, let's say you have a humac in your testing.
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I hope you're using our advanced test protocol because I
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see it regularly that someone will have in the concentric
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mode of contraction, let's say they're 13% weaker, but it's
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when you go to the eccentric, especially nowadays with these
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quads and in graphs, right? You go to the eccentric
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and now it's showing up at a 30 or 40% weakness. Or,
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you know, sometimes I'll see a weakness in both modes.
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And I'll look at, well, the eccentric, you know, that's
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usually a tissue intolerance. But I'll look at their concentric
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starting from 90 degrees kicking up and I'll look at
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the slope of their line. It's like, okay, they're not
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just weak, they're slow to get off the line. And
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that's when I look at my rate of torque development.
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It's like, oh yeah, your rate of torque development is
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still 45% slower. So you're not going to catch up
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to the speed of the machine fast enough to be
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able to generate force. So a lot of times it's like, hey,
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you know, if we look at you know, mid range
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to full extension, your strength isn't too far off there,
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but it's like on the concentric mode, it might be,
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you know, the tissue intolerance of the quad, but it
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also might be rate of torque development. So let's start
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working on some, you know, some jerks, some clean, some snatches, or,
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you know, medicine ball throws with us, you know, with
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a leg component. But then on the eccentric, if I
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see people that that torque just drops off as they
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get deeper into the range, Then I'll have them dysfunction like, hey,
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can you do just a split squat hold with that
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ACL leg as the back leg? And, you know, can
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you stay right above that knee? And if they do
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it and either they can't even hold that position without
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shifting toward the front leg or it's just too painful,
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then I know it's, hey, you're basically a really bad
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quad tendonitis patient at this point or tendinopathy. And, you know,
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the rest of your range of motion is not bad,
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but if you can clear up this quad dysfunction, this
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tendon dysfunction, your strength is going to go up because
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you're getting less inhibition from the pain. Really tells you
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what mode of contraction, where in the range of motion
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do they need to spend their time. I'm looking at
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a lot of times I'll test somebody and it'll uncover
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like a hamstring strain risk because we're looking at the
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eccentric hamstring. Also that kid that I've mentioned to you,
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that was still 47% weaker. When I tested his hamstring,
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00:14:58.000 --> 00:15:01.950
his His healthy hamstring was 20% weaker than his surgical hamstring,
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00:15:02.220 --> 00:15:05.159
only at end range and eccentric. And that line dipped down.
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It's like, dude, I don't want you to go back
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when you're ready. And, you know, then pull your hamstring
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on your other side. Like, let's start working on some
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lengthening under load at high velocities at higher loads for
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the other hamstrings. That way we're not just seeing you
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back here because you tweaked it. Now you're missing another
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four to six weeks. So it just, it uncovers a
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lot more with the modern testing.
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Yeah, I think my biggest takeaway from when you came
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in person was how many tests you can do and
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how many treatments you can do in the same position.
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So once you get them in the position, you have
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no excuse not to do these advanced tests that you're
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talking about, not to hit multiple angles, not to hit eccentric, concentric.
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And then also, if you're seeing something, you have more time,
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you can also get right into actual treatment-based styles, which
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is kind of where we're going to go now is
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it's kind of how we can use the humac norm
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and isokinetic machines to not only for testing, but also
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as a treatment tool. So kind of walk us through
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like a treatment session actually looks like for a post-surgical patient.
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00:16:04.120 --> 00:16:06.759
All right. So in general, some patients you can use
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CPM with. Not every patient, because not every patient needs it.
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00:16:10.240 --> 00:16:12.019
If you can get away with doing heel slides and
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00:16:12.139 --> 00:16:14.429
doing a recumbent bike for your range of motion, use that.
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But when you have that really stiff knee that's lacking
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that full extension because they've been sleeping with the pillow
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under their knee or they're not coming to reflection, you
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can use the machine for simple overpressures. But in general,
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most patients are going to start off with isometric, right?
336
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It's multi-angle isometrics, and we're just telling that muscle to
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generate torque and hold. Then we build up their tolerance
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00:16:35.019 --> 00:16:37.379
to load over a couple weeks, but we have it
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programmed to do the entire range of motion, which, like
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00:16:40.179 --> 00:16:43.570
Eric Mayer told me, it was basically isokinetic at zero
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degrees per second is our multi-angle isometric protocol, which was genius.
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But then we use a lot of our dynamics. Because
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then once I find, hey, you can generate torque, you
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can hold it, you can control it. Now let's make
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it to where you actually have to match your force
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output based upon this game or this maze. We're really
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00:17:00.799 --> 00:17:03.700
just trying to get muscle control back and torque control.
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But then we start off next with slow eccentrics. Get
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00:17:07.839 --> 00:17:10.619
rid of the concentric mode because we're going so slow.
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00:17:11.059 --> 00:17:13.339
And that time under tension with the high metabolic demand
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00:17:13.380 --> 00:17:16.019
of concentric, you'll fatigue out really fast. So We can
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00:17:16.039 --> 00:17:18.859
have the machine just do eccentrics only. And then over
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00:17:18.900 --> 00:17:21.230
the course of a few months, we built up the
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speeds that that muscle can control load through the range
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of motion into more advanced training. And then we've kind
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00:17:28.970 --> 00:17:32.779
of gotten a lot of those neurologic inhibition issues knocked out.
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00:17:32.819 --> 00:17:35.720
Let's start working on hypertrophy so we can go with
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higher speeds, concentric and eccentric. And then now let's start
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00:17:39.099 --> 00:17:41.980
working into some high speed decels. And then we're not
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really back to trying to go faster to get more
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torque output, but we're just trying to go back to
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controlling the muscle through the range of motion, but at
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00:17:49.799 --> 00:17:53.259
higher speeds. And then we can even get into, you know,
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00:17:54.200 --> 00:17:57.180
how fast can you generate that force in concentric so
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00:17:57.200 --> 00:18:00.519
we can do some power training. There's just a lot
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00:18:00.619 --> 00:18:04.549
more available treatments that you can do on these systems
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00:18:04.569 --> 00:18:05.480
now than you could before.
368
00:18:06.319 --> 00:18:08.660
You kind of mentioned like progressions. Is that how you're
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00:18:08.779 --> 00:18:11.200
structuring your progressions on the machine? Or do you have
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00:18:11.240 --> 00:18:14.680
like a standard progression that you typically follow across different?
371
00:18:14.740 --> 00:18:17.559
That's in general. Everybody's going to be at a different point.
372
00:18:17.720 --> 00:18:20.609
I might have somebody who's a five month ACL, but
373
00:18:20.619 --> 00:18:23.109
they're really presenting as a three month ACL just because
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00:18:23.130 --> 00:18:27.049
they still, they have so much quad, quad tendon pain
375
00:18:27.210 --> 00:18:29.289
and low dysfunction. So we're doing a lot of ISOs
376
00:18:29.329 --> 00:18:32.109
and slow eccentrics, but I might have somebody who's moving
377
00:18:32.150 --> 00:18:35.140
a little bit faster in their progression. So we can,
378
00:18:35.180 --> 00:18:37.119
you know, speed them through a little bit. So you
379
00:18:37.160 --> 00:18:39.509
have to take each one as it is. You can't
380
00:18:39.529 --> 00:18:42.029
just say, well, you're a week 12 or you're a
381
00:18:42.049 --> 00:18:44.549
week four. So we're going to do this even day
382
00:18:44.589 --> 00:18:47.349
to day. No, let's say you were my patient on
383
00:18:47.390 --> 00:18:50.390
Wednesday and we did a lot of eccentrics and I've
384
00:18:50.430 --> 00:18:53.829
seen you now on Friday and you're like, dude, I'm
385
00:18:53.869 --> 00:18:56.910
still sore. You know, physically the tissue is still sore.
386
00:18:57.369 --> 00:18:59.670
So I might just have you work on some concentric
387
00:18:59.789 --> 00:19:02.410
only training so that way we can still get loads
388
00:19:02.470 --> 00:19:04.819
of the system. But we're not doing it from a
389
00:19:04.960 --> 00:19:07.720
mechanical breakdown standpoint. We're doing it more like, hey, let's
390
00:19:07.740 --> 00:19:11.180
train the metabolic side of the muscle with concentrics. Or,
391
00:19:11.700 --> 00:19:14.789
you know, hey, let's just do some isos today. Let's
392
00:19:14.809 --> 00:19:17.589
just work on torque control without hitting you heavy. But
393
00:19:17.630 --> 00:19:20.069
then you also got to think, how does the system
394
00:19:20.210 --> 00:19:23.809
fit into a typical one hour session? If you're earlier
395
00:19:23.869 --> 00:19:27.519
in the process and we're just doing some isometrics, some
396
00:19:27.650 --> 00:19:30.180
easy things, you can pretty much do it at any
397
00:19:30.279 --> 00:19:33.089
stage after they've warmed up. But in general, if somebody's
398
00:19:33.109 --> 00:19:36.799
going to be like really like exercising aggressively on the machine,
399
00:19:37.259 --> 00:19:38.900
I generally like to do that at the end of
400
00:19:38.960 --> 00:19:41.440
a session. So we've already warmed up. We've got some
401
00:19:41.460 --> 00:19:44.190
of our closed chain work, some of our balance and proprio,
402
00:19:44.950 --> 00:19:47.029
any manual work. But then we're on the machine just
403
00:19:47.049 --> 00:19:51.839
to get that isolation work. Sometimes. I'll want to pre-fatigue somebody.
404
00:19:51.960 --> 00:19:54.160
So I'll have them go on the machine and just
405
00:19:54.180 --> 00:19:57.400
do a bunch of concentric only high speed work, just
406
00:19:57.569 --> 00:20:00.009
really fatigue that muscle out. And now I'm going to
407
00:20:00.049 --> 00:20:01.930
make them do some of their closed chain work, but
408
00:20:01.970 --> 00:20:03.990
then we might have hype back on for like another
409
00:20:04.029 --> 00:20:05.910
five minutes at the end, just get some of that
410
00:20:05.990 --> 00:20:08.940
eccentric overload. And then, you know, if you're the only
411
00:20:08.980 --> 00:20:10.680
person in the clinic like I am, you can do
412
00:20:10.720 --> 00:20:12.599
it whenever you want. But, you know, you might have
413
00:20:12.640 --> 00:20:15.369
a patient that you want to work on with, along
414
00:20:15.390 --> 00:20:18.269
with myself and somebody else. So you're trying to plan
415
00:20:18.309 --> 00:20:21.150
and coordinate, all right, well, when should I use it
416
00:20:21.190 --> 00:20:23.710
for this patient? Then it gets a little bit more challenging.
417
00:20:24.170 --> 00:20:27.700
Are you having them use the isokinetic machine in some
418
00:20:27.740 --> 00:20:31.400
capacity every session? Or are you like, hey, let's give
419
00:20:31.420 --> 00:20:34.000
it a break today. We've been using it for arbitrarily
420
00:20:34.059 --> 00:20:35.920
four weeks in a row. Do they need a break?
421
00:20:36.240 --> 00:20:39.400
How do you find yourself using it on a weekly basis,
422
00:20:39.440 --> 00:20:41.000
daily basis? Where do you find that?
423
00:20:41.440 --> 00:20:43.480
Yeah, I try to get them on there for something
424
00:20:43.900 --> 00:20:47.400
every session. But if you're coming back and your knee
425
00:20:47.440 --> 00:20:51.710
is irritated or swollen, we would make better use of
426
00:20:51.769 --> 00:20:54.809
our time that session to just back off of it
427
00:20:54.930 --> 00:20:58.220
and not, because you don't want to over-treat. Or maybe
428
00:20:58.279 --> 00:21:00.119
that day I'll have you just, you'll hop on, but
429
00:21:00.140 --> 00:21:03.119
we'll do BFR. Just do a real quick BFR protocol.
430
00:21:03.559 --> 00:21:05.559
That way it's lower loads, but it helps with that
431
00:21:05.579 --> 00:21:08.539
recovery as well. So yeah, you just got to take
432
00:21:08.619 --> 00:21:10.920
each session as it comes. But in general, I do
433
00:21:10.980 --> 00:21:14.130
try to get everybody on. If I have the ability to,
434
00:21:14.269 --> 00:21:16.910
and I'm not competing with somebody for the machine, if
435
00:21:16.970 --> 00:21:18.849
I just worked your right leg, let's say we did
436
00:21:18.869 --> 00:21:22.839
three sets of 10 of quad and hamstring eccentrics. Well,
437
00:21:22.859 --> 00:21:24.740
you need a break. So I might just swing the
438
00:21:24.759 --> 00:21:27.359
machine to the other side and just have you murder
439
00:21:27.420 --> 00:21:30.759
your other leg with some more advanced training. That way
440
00:21:30.779 --> 00:21:33.680
we work that side, keep its strength up. We get
441
00:21:33.700 --> 00:21:37.220
the little crossover effect neurologically. But really, you're going to
442
00:21:37.240 --> 00:21:40.069
be resting for three to four minutes anyway. So I
443
00:21:40.109 --> 00:21:42.390
might as well take advantage of that. But again, it
444
00:21:42.410 --> 00:21:44.269
all depends on what you have going on that day
445
00:21:44.309 --> 00:21:44.910
with that patient.
446
00:21:45.390 --> 00:21:49.190
Are you using that like crossover effects even like first
447
00:21:49.289 --> 00:21:51.470
month post ACL? Like are you getting them on the
448
00:21:51.509 --> 00:21:51.950
other side?
449
00:21:52.549 --> 00:21:56.109
Yeah, as much as I can. If you haven't gotten
450
00:21:56.150 --> 00:21:58.170
the knee happy yet, you need to spend your time
451
00:21:58.470 --> 00:22:00.900
getting a quiet knee. You know, take care of the
452
00:22:00.940 --> 00:22:03.299
things that must be done first. But if you have
453
00:22:03.319 --> 00:22:05.799
the ability, you know, just even once a week to
454
00:22:05.819 --> 00:22:07.680
have them, you know, just hit the other leg for
455
00:22:07.700 --> 00:22:10.730
more advanced exercise, you'll get a lot out of that.
456
00:22:10.950 --> 00:22:13.230
I always like to test early on too. It might
457
00:22:13.250 --> 00:22:16.190
just be isometric. And everybody thinks of this as the
458
00:22:16.230 --> 00:22:19.559
return to sport machine. But you can do your isometric
459
00:22:19.599 --> 00:22:22.380
test is basically a manual muscle test with a number.
460
00:22:22.940 --> 00:22:26.349
And so I try to use isometric testing throughout because
461
00:22:26.390 --> 00:22:28.809
it's real fast to do and just kind of like
462
00:22:28.869 --> 00:22:31.750
a spot check. But if nothing else, early on those
463
00:22:31.789 --> 00:22:33.349
first few weeks, I want to see what the strength
464
00:22:33.410 --> 00:22:35.930
is of your other leg just to see where you're at.
465
00:22:36.009 --> 00:22:38.680
And then I can track how that leg is progressing
466
00:22:38.819 --> 00:22:41.799
throughout without doing the full return to sport test.
467
00:22:41.960 --> 00:22:43.960
We're going to transition to like our last topic is
468
00:22:44.019 --> 00:22:47.220
like kind of what the marketing pitch looks like for
469
00:22:47.240 --> 00:22:51.339
a clinic that advertises performance and return to sport-based physical therapy.
470
00:22:51.380 --> 00:22:53.920
So what does a machine like this kind of signal
471
00:22:53.960 --> 00:22:56.559
to athletes and referral sources to kind of get them
472
00:22:56.579 --> 00:22:58.509
in the door and also ensure confidence?
473
00:22:58.940 --> 00:23:00.769
I would say if you have an athlete who's never
474
00:23:01.130 --> 00:23:03.930
heard of this, but they see this equipment that you
475
00:23:03.970 --> 00:23:06.069
have that they haven't seen anywhere else, and maybe even
476
00:23:06.109 --> 00:23:09.470
with their pro or their college team. Again, it's still
477
00:23:09.490 --> 00:23:12.730
just a piece of metal in the corner. So once
478
00:23:12.779 --> 00:23:15.609
you get them on there, That's really when they see it.
479
00:23:16.220 --> 00:23:19.019
I had a lot of NFLers this off season Cummings,
480
00:23:19.039 --> 00:23:21.200
their PT sent them in and they were a little
481
00:23:21.220 --> 00:23:23.299
bit like, okay, fine, we'll hop on. And as soon
482
00:23:23.319 --> 00:23:25.500
as they got on the test and they saw what
483
00:23:25.539 --> 00:23:27.920
was happening, like, oh, wow, I didn't know my hamstring
484
00:23:27.960 --> 00:23:32.509
was 30% weaker. They buy into it really fast. Any
485
00:23:32.549 --> 00:23:35.670
of your docs you mentioned as a marketing tool or
486
00:23:35.769 --> 00:23:37.970
even your athletic clubs or a team, you know, I
487
00:23:37.970 --> 00:23:40.180
always say to the new clinics, like just do a,
488
00:23:40.230 --> 00:23:43.920
do a free test for every doc or for every team. Say, hey,
489
00:23:43.970 --> 00:23:46.150
send me somebody. I'll do a free test for you
490
00:23:46.349 --> 00:23:48.410
just so you can see, so the doc and the
491
00:23:48.650 --> 00:23:51.710
athletes can see what it is. That goes a long
492
00:23:51.769 --> 00:23:56.069
way to getting a returning referral source when they can
493
00:23:56.150 --> 00:23:59.029
actually see the difference and see what it provides to them,
494
00:24:00.089 --> 00:24:04.250
how easy that handoff between you and the doctor is.
495
00:24:04.369 --> 00:24:06.349
So if you ever get somebody and you're like, oh,
496
00:24:06.430 --> 00:24:08.059
how do I get the word out? Just do a
497
00:24:08.079 --> 00:24:10.450
free test. Or you tell that doc, hey, send me
498
00:24:10.519 --> 00:24:13.839
that patient that has failed other places. And this is
499
00:24:13.859 --> 00:24:16.329
all things that I learned from my mentor, John Hisamoto.
500
00:24:16.849 --> 00:24:20.170
He would want the hard cases from other docs. He's like, hey,
501
00:24:20.210 --> 00:24:21.849
send me to the guy that, you know, didn't do
502
00:24:21.910 --> 00:24:25.950
well at this location or this one. You know, if
503
00:24:25.990 --> 00:24:28.579
you just do just as well as them, you didn't lose.
504
00:24:28.670 --> 00:24:31.759
But most likely you're going to do better just wanting
505
00:24:31.779 --> 00:24:36.059
because you can test, you can be very strategic with
506
00:24:36.099 --> 00:24:39.579
your interventions. But also that person has, you know, more
507
00:24:39.640 --> 00:24:43.269
time under their belt. So you'll probably do better. just
508
00:24:43.289 --> 00:24:46.009
from those standpoints. So that was always a big one
509
00:24:46.329 --> 00:24:48.829
is that, you know, he wanted the hard cases because
510
00:24:48.849 --> 00:24:51.029
he knew that he would at least move the bar
511
00:24:51.089 --> 00:24:53.609
or move the needle a little bit for that patient.
512
00:24:54.109 --> 00:24:56.170
I've had a couple of people that had femoral nerve
513
00:24:56.210 --> 00:24:59.329
injuries from their ACLs and I need to follow up
514
00:24:59.349 --> 00:25:00.970
with one of them, but they, you know, they were
515
00:25:00.990 --> 00:25:03.930
just like, wow, at least I know where I'm at
516
00:25:03.970 --> 00:25:06.710
and I can see it. And they really liked being
517
00:25:06.750 --> 00:25:08.769
able to just have that connection. It really helps with
518
00:25:08.789 --> 00:25:12.960
that mind muscle connection. when you can get that biofeedback.
519
00:25:12.980 --> 00:25:15.950
And they really felt a big, the juice was worth
520
00:25:15.990 --> 00:25:17.509
the squeeze for them on that one.
521
00:25:17.970 --> 00:25:19.549
Yeah, I'll kind of add my two cents in here
522
00:25:19.650 --> 00:25:22.910
of my experience with being the actual patient on the
523
00:25:22.950 --> 00:25:25.609
humect norm is as a competitor, as someone who wants
524
00:25:25.650 --> 00:25:27.890
to be the best version of myself, like not only
525
00:25:27.930 --> 00:25:31.569
the visual aspect of the data, but also like your
526
00:25:31.609 --> 00:25:33.690
education piece of telling me like, hey, I have to
527
00:25:33.730 --> 00:25:36.299
be here in order to kind of be where I
528
00:25:36.339 --> 00:25:39.259
should be for either athletic competition or return to sport testing,
529
00:25:39.279 --> 00:25:41.410
whatever it may be. I think those two pieces, like
530
00:25:41.430 --> 00:25:44.410
the visual and like the motivation of the numbers and metrics,
531
00:25:44.470 --> 00:25:47.490
I think that really sold me. If I were a patient,
532
00:25:47.509 --> 00:25:49.750
if I were an athlete, that this is giving me,
533
00:25:49.829 --> 00:25:52.119
like you said, the juice for my squeeze, but also
534
00:25:52.700 --> 00:25:55.140
just like knowing where I stand in regards to either
535
00:25:55.160 --> 00:25:57.079
my peers, where I need to be on the competition
536
00:25:57.119 --> 00:25:58.400
field or so forth.
537
00:25:59.200 --> 00:26:01.000
One of the things I'm excited about with the new
538
00:26:01.240 --> 00:26:04.309
software we're putting out is if I test you or
539
00:26:04.349 --> 00:26:07.049
just have you do an exercise protocol, when you do
540
00:26:07.089 --> 00:26:10.309
that a second time, it's going to put what you
541
00:26:10.329 --> 00:26:12.799
did last time as like a shadow in the background.
542
00:26:13.130 --> 00:26:14.559
And so I can, you know, leave it where it is,
543
00:26:14.599 --> 00:26:16.910
or I can scale it up or down and be like,
544
00:26:16.990 --> 00:26:19.440
all right, I'm going to go 5% more than yesterday.
545
00:26:19.500 --> 00:26:21.559
So I can, so you can try to compete with
546
00:26:21.579 --> 00:26:25.220
yourself on that day-to-day basis. So I'm excited for that
547
00:26:25.259 --> 00:26:28.220
new piece with the, the humac insight we're putting out. Yeah.
548
00:26:28.779 --> 00:26:32.420
That definitely drives competition, which is your ideal patient from
549
00:26:32.440 --> 00:26:35.099
what it seems is those higher level athletes, those athletes
550
00:26:35.119 --> 00:26:37.579
looking to get back to competition. If you're a true competitor,
551
00:26:37.640 --> 00:26:39.000
you're going to want to beat yourself. You're going to
552
00:26:39.019 --> 00:26:40.720
want to beat your peers. So I think that that
553
00:26:40.740 --> 00:26:43.279
definitely is a great marketing tool. Last question to follow
554
00:26:43.339 --> 00:26:45.769
up with. You're in a conversation with a clinic director
555
00:26:45.809 --> 00:26:48.230
who's on the fence about the investment. What would you
556
00:26:48.289 --> 00:26:51.529
say to them to kind of sell them this equipment?
557
00:26:52.319 --> 00:26:55.400
So anytime you're buying new equipment, you always think about
558
00:26:55.440 --> 00:26:58.559
your return on investment. You can buy the equipment, but
559
00:26:58.799 --> 00:27:01.920
never really market it outside. And then it doesn't matter
560
00:27:02.240 --> 00:27:05.299
what equipment you have. If you're the best chef in
561
00:27:05.339 --> 00:27:08.079
the city, but nobody knows about your restaurant, it's not
562
00:27:08.099 --> 00:27:10.920
going to do anything for you. So it depends on
563
00:27:10.940 --> 00:27:14.480
what relationships you have with the docs in the town.
564
00:27:15.460 --> 00:27:18.420
It can get you more direct referrals from the docs,
565
00:27:18.920 --> 00:27:21.869
whether they're coming to you as Like you're going to
566
00:27:21.890 --> 00:27:25.009
do their entire plan of care or just a treatment
567
00:27:25.549 --> 00:27:28.559
or just a testing. Same thing with other PTs in town.
568
00:27:29.259 --> 00:27:33.119
There's going to be a lot more ACL reconstructions, total knees, meniscus,
569
00:27:33.420 --> 00:27:36.539
rotator cuff repairs for athletes in town than you are
570
00:27:36.579 --> 00:27:39.819
going to see. So try to get that good relationship
571
00:27:39.880 --> 00:27:42.279
with the PTs. Be like, hey, you know, I'm not
572
00:27:42.500 --> 00:27:45.349
doing this as a way to be your competition, but
573
00:27:45.509 --> 00:27:47.730
I have this equipment. You have the patients that would
574
00:27:47.789 --> 00:27:51.339
benefit from getting that. Let me be a testing facility
575
00:27:51.380 --> 00:27:53.839
for you. And that's my entire business model right there.
576
00:27:53.900 --> 00:27:57.130
So you'll capture patients that would never be your patient
577
00:27:57.589 --> 00:27:59.730
just to come in and get testing. Same thing with
578
00:27:59.769 --> 00:28:02.930
like the sports teams, right? You know, reach out to
579
00:28:03.430 --> 00:28:06.789
the high school athletic trainer, to the local colleges, the
580
00:28:06.890 --> 00:28:09.869
local teams, try to get some kind of affiliation with
581
00:28:09.910 --> 00:28:12.170
them to where, you know, they can come in and,
582
00:28:12.289 --> 00:28:15.539
you know, get the equipment. So it's all depending on
583
00:28:15.829 --> 00:28:17.529
what you do with it. The same thing if you
584
00:28:17.549 --> 00:28:21.049
bought the shockwave, right? You buy a shockwave, who knows
585
00:28:21.109 --> 00:28:23.230
about it? You have to then, you know, you have
586
00:28:23.269 --> 00:28:25.289
to do that next step. So that's the return on
587
00:28:25.329 --> 00:28:28.400
investment side for bringing more, you know, boots in the door.
588
00:28:28.940 --> 00:28:31.819
But then you got to think about what it brings
589
00:28:31.900 --> 00:28:35.700
to your patients, right? The quality of rehab that they're
590
00:28:35.720 --> 00:28:39.420
going to get is going to be vastly superior because of,
591
00:28:39.569 --> 00:28:42.299
you know, bringing on this or other equipment. So you
592
00:28:42.319 --> 00:28:45.430
just got to think, I'm wanting to provide that high
593
00:28:45.490 --> 00:28:48.049
level care for the people that are already coming in,
594
00:28:48.130 --> 00:28:51.089
but I also want to bring in more revenue with it, obviously.
595
00:28:51.490 --> 00:28:55.779
These machines are going to outlast most people's careers. I'll
596
00:28:55.799 --> 00:28:58.500
go out to machines that are 20 plus years old.
597
00:28:58.940 --> 00:29:01.940
The machine's still doing great, just the computer, it still
598
00:29:01.980 --> 00:29:04.980
has Millennium Edition on it. And the computer finally gave out,
599
00:29:05.769 --> 00:29:07.829
and I'm changing out of board just because computers now
600
00:29:07.910 --> 00:29:10.740
are 64 bit. So I'm changing out one of the
601
00:29:10.779 --> 00:29:12.799
boards in the system and giving them a new computer,
602
00:29:13.240 --> 00:29:15.619
but that machine is still there. All of our systems
603
00:29:15.640 --> 00:29:19.240
at CSMI, the Humac are backwards compatible. So you don't
604
00:29:19.279 --> 00:29:22.130
need to say, well, your system two isn't any good anymore.
605
00:29:22.150 --> 00:29:24.009
You have to buy a system four, nothing like that.
606
00:29:24.150 --> 00:29:26.170
So that's, you know, you buy this one piece of equipment,
607
00:29:26.269 --> 00:29:29.170
it's going to be there for your, the life of
608
00:29:29.210 --> 00:29:31.710
your career. And then you'll probably end up, you know,
609
00:29:32.029 --> 00:29:34.170
selling it along with your clinic when you retire.
610
00:29:34.460 --> 00:29:37.990
Yeah, return on investment, longevity, and ideal patient population kind of,
611
00:29:38.049 --> 00:29:40.839
I feel like, summarizes what you're saying there. So I
612
00:29:40.880 --> 00:29:43.539
appreciate your time, Daniel. Any closing thoughts before we wrap
613
00:29:43.559 --> 00:29:43.759
it up?
614
00:29:43.980 --> 00:29:46.240
No, just, you know, reach out to me. I'm very
615
00:29:46.339 --> 00:29:48.559
open if you guys are ever questioning. I mean, that's
616
00:29:48.579 --> 00:29:51.019
how we got started with Rehab to Perform. I saw
617
00:29:51.099 --> 00:29:54.880
Josh made a comment on the Clinical Athlete Facebook group
618
00:29:55.279 --> 00:29:57.539
asking about, you know, the different systems. And I was like, dude,
619
00:29:58.170 --> 00:30:00.750
Let's talk. And then, so it's just, I'm very quick
620
00:30:00.789 --> 00:30:03.190
to respond to people too. I love nerding out on
621
00:30:03.230 --> 00:30:05.829
this stuff. I'm a terrible salesman. I'm not going to
622
00:30:05.869 --> 00:30:09.059
tell you something that, you know, sucks. I'm great selling it,
623
00:30:09.089 --> 00:30:11.390
the Humac, just because it's just that great of a system.
624
00:30:11.759 --> 00:30:13.519
So I love to talk about this kind of stuff.
625
00:30:13.539 --> 00:30:15.799
So go ahead and reach out to me on Instagram,
626
00:30:16.460 --> 00:30:19.900
my clinic's name, Proactive Athletic Performance. I did that, you know,
627
00:30:19.980 --> 00:30:23.019
that way I could have a local following as well.
628
00:30:23.059 --> 00:30:26.079
And I just, you know, the national following that you
629
00:30:26.099 --> 00:30:28.589
can reach out to me. Email if you want. It's
630
00:30:28.609 --> 00:30:34.089
just Daniel at ProactiveAthleticPerformance.com. Then we can talk about it.
631
00:30:34.539 --> 00:30:36.400
Awesome. I'll put all that stuff in the description of
632
00:30:36.440 --> 00:30:40.390
the podcast. Hopefully you get some emails and DMs on Instagram.
633
00:30:40.990 --> 00:30:42.029
Thank you very much for your time.