#120 - From Metrics to Movement: Performance Tech for Better Clinical Decisions, Part 1

Performance tech is everywhere. Force plates, dynamometry, movement capture. And the promise is simple: more objectivity, better decisions, and faster progress. The problem? Too much data can turn into zero action. Welcome to The Factor Podcast, where we talk about the stuff they didn't teach you in school: how to grow your practice, refine your clinical skills, and get better results for your patients. We're here to help you navigate the real-world challenges of being a healthcare provider, from delivering top-notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective, cutting-edge treatments to get patients better faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field. So you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts, industry innovators, and respected clinicians across a wide range of specialties, you are in the right place, my friend. Let's dive in. Welcome back to The Factor Podcast. I'm your host, Jessica Riddle, and this is where we challenge outdated thinking and explore smarter, more sustainable approaches to rehab, performance, and long-term athletic development. Today, we're kicking off a new 2-part conversation, From Metrics to Movement, with Dr. Michael Giammarco. Most of us know him as Dr. G. This series is also about performance technology, movement analysis tools, dynamometry, force plates, and how to actually use this kind of data in a way that improves clinical decision-making and patient outcomes without getting stuck in the loop of analysis paralysis. In part 1, we'll lay the groundwork— what this technology is and what it's not. Dr. G will also talk about why so many clinicians feel overwhelmed the first time they see a dashboard with 100+ metrics. And he'll talk about how he approaches this in real practice, starting with the patient's goal, then reverse engineering the few metrics that actually matter. Let's cue the intro music and get started.

First off, I just want to thank everybody for tuning in and taking out a little bit of their time during their afternoon on a Tuesday. Thanks again to Jessica, and thanks again to Factor for letting me present on this today. This has been something that's been very much in the front of my mind as a practitioner for the last couple years and has had a significant impact, not just on my practice, but on my patients. And I think especially when we're starting to look at some of the different trends that we're seeing within the world of chiropractic, of PT, of rehab and strength and conditioning in general, this is a topic that we need to make sure that we as clinicians are staying on top of because it's only going to become more and more prevalent. It's going to become even more and more of a demand for our patients and, and for us clinicians as we go forward. So starting off, a couple key things that we're going to work through today. Number one thing is I want to make sure that I introduce you guys to the technology. Now, I think I had one of the polls here. Biggest thing first is I know we have a couple of the polls. I see we have a lot of chiros in the group. I think we have a few students in the group, which is amazing. One thing I want to make sure that I also kind of understand as we kind of go forward as well is how much experience everybody has with technology. So before we even get started, I'm going to talk about exactly what is the technology that we're looking at. Some of you may be very familiar with some of them, some maybe not as up to date with some other ones, and we're going to go across the board through all of them. We're also going to dive a little bit into data and metrics and how exactly we as clinicians can benefit from it, especially because when you take that first foray into this stuff, it can be incredibly intimidating. Next is how do we then begin to implement this technology? How do we take this from being a concept into our clinics? How do we eventually get something from it? As many, I'm sure many of you are business owners or are working in clinics where The ROI of this technology is going to be something incredibly important. What are you as a clinician, as a business, going to be getting out of the investment that you get for this technology? And lastly, I'm going to finish with some case studies. I started using some of this technology back in 2024, and I will tell you guys, I think I said a couple times already, the impact that it has had on my patients has been amazing. Some of the results we've gotten, some of the things that we're able to get from looking at this information. I consider myself a bit of an early adopter on it, and I'm really glad that I did, that I got in when I did. So a couple things about me. This is the slide where I lie and say nice things about myself. My background is I was a strength and conditioning coach prior to becoming a chiropractor. I have worked extensively with rehabilitation and athletes from all levels, from pro all the way down to youth levels. As I said, this technology is something that I've, I've been using as a supplement To my skills that I have been using for a long period of time. I think that especially when it comes to my background, my extensive background in strength and conditioning has informed a lot of the things we're going to talk about today. And we'll talk a little bit more about that as we go through. If that's not your background, it's okay. And we'll get, we'll get there going forward. Couple disclosures and things that I want to make sure I talk about ahead of time. I am a clinician for a clinic in Wisconsin known as RehabLab Wisconsin. And I just want to make sure that there's going to be some branding on here that you guys recognize. The other thing is, even though I am not an official representative of either of these companies, Vault and Valor are the 2 types of technology that I use the most in my office. And it's going to be a lot of where I base the examples off of today. There are a ton of other products in the technology field that you can use. I'm going to be speaking a lot from my personal experience with these 2 companies. And, and not just my experience as a customer, but someone who has worked extensively with them in order to figure out how can we improve how we use this technology. So my biggest things I'm going to focus on today, by the end of this talk today, my hope is one, that you have a better understanding of how technology, especially this performance technology, can play a role in your practice and in the world of rehab and strength conditioning going forward. I want to make sure that you have an idea of when you're looking at these long reports and these long data sheets, you're able to make sense of what you're seeing. Make better clinical decisions from the metrics you get rather than it being a bottleneck, rather than it being an impedance on providing the really good care that you already provide. I want to give you a couple ideas on how you can begin to framework and build this stuff into your practice from point of entry. Where do we get it? How do we budget all the way to how can we fully integrate it into what we do? And also talk about how it can be used throughout a patient lifecycle. Many people, the question I get a lot is, we start with, this only begins at the assessment, right? This is how we just assess people. That's only scratching the surface on where you can get implementing these things. So let's start off at the very beginning. And the first part is we want to make sure we know exactly what we are dealing with. What are the different tools that I'm discussing when I say things like performance technology? And, and here, I want to make sure that I'm able to differentiate between Things that help us with movement assessment versus outputs. So starting off, one tool that I'm sure many of us in the field are familiar with are movement analysis tools. Here, this is a— I'm going to call them out— this is a horrible golf swing from my father-in-law that we did using the VALOR technology. And for those of you who already use this kind of technology in your practices, this may be something like the HumanTrack with Vault, KinetiSense, Things of that nature where we are able to measure specific ranges of motion throughout the joints during different movements. This could be something as simple as checking shoulder internal rotation versus external rotation. This could be how much hip flexion we get into a squat, how many degrees of valgus we get in a squat, and everything in that spectrum. The biggest thing with these is that we always want to make sure that it is something to add to the coach's eye that we already have. Many of us clinicians have years and years and years of experience looking and monitoring how patients move, and this should be something to help us with that. I was actually talking with a colleague of mine recently, and he was actually mentioning how they're beginning to use this in athletic training programs, where what they'll have the students do is they'll have the students assess a movement with their eyes, recording it with a movement analysis tool, and then comparing how accurate was their coach's eye to that movement. And the other thing too is now you also can get these different types of visuals to show patients some of the different mechanics that go into, say for example, a painful movement or whatever their goal is. The next one's going to be dynamometry and force. When I was first beginning to use this technology, I had actually looked almost exclusively at movement analysis tools. And I was talking with a PhD biomechanics friend of mine. And when I brought this up to him, he gave me a really good thought to focus on. And that was— Was movement analysis is great, but what are the biggest things that your patients want to know? They want to know, are they moving better? Are they stronger? Are they able to jump higher? Are they able to decrease asymmetries? Are they actually getting stronger and getting better? And with just movement assessment tools, it's limited in how we can do that. So that's where now we introduce things like dynamometry and different types of force measurements. The 2 images here, my poor intern Lauren had to be the model for these. But here the 2 examples I'm giving are the ForceFrame on the left from VALD, and then the other one is the NOR Board from VALD as well. But you also have your handheld dynamometry tools where we can measure things like strength and rate of force development with specific joint motions. And we can look at things like, hey, like, is there a significant asymmetry side to side? What does that do in terms of Risk of injury, return to play protocols. Are we hitting the benchmarks that we need to clear this athlete to return to play? So another tool in the toolbox when we're looking forward. The third one I'm going to talk about extensively today is going to be force plates. When I was in college for exercise and sports science, I remember that force plates were a brand new thing. It was something that we were all very impressed by. We all wanted to know what our vertical jump was. But these loading cells only— that's only the bare minimum of what they can do. With these cells, you're able to look at exactly how much pressure someone is putting on one foot compared to the other during global-type movement patterns. In this picture here, Lauren was demonstrating a single-leg hop test. So not only were we able to determine how high off the plate Lauren was jumping, we were able to tell how much extrusion she had when she was jumping around. Was she able to land in the same spot? How well was she able to generate forces and impulse going back into it? How, how much was she fatiguing during the course of the test? And providing all of this information through these plates can be incredibly helpful. Typically where I've seen a lot of these plates, they haven't made as big of a jump into the rehab space yet, but you will find these are very common within the professional space. I think every NFL team except for maybe one has these in their strength training room. Many of the professional teams in the EPL, the English Premier League, has these. Pro baseball, pro basketball. So force plates in general are a tool that while we look at it more on the performance side, I believe, and I've seen personally, we can have extensive benefit using them more frequently in the rehab space for clients all across the spectrum, not just athletes. Now I want to get into some of the limitations and some of the things that we as clinicians oftentimes are hesitant about When it comes into using this technology. And especially for those of us that may not have a sports science background, when I talk about these things like concentric peak force, eccentric peak force, eccentric deceleration impulse, and all these different things, it can be incredibly intimidating to see all this data and feel, oh, for me to be able to even implement this at all, I have to know everything across the board. And I think one of the really cool things about this technology is it doesn't have to be as complex. It can only be as complex as you want to make it. And a caveat with this too is there's also going to be some places where this won't fit into your practice, and that's okay. And we have to try to figure out where can this fit, where can we change things, how can we build it up, and not only to improve ourselves as clinicians, but also help our patients and give them better outcomes over the long run. So the first part I really want to get into is that, that idea of analysis paralysis. So the example I gave here was when we're talking about the ForceDecks specifically. The ForceDecks by VALD, that was one of the first pieces of technology I added into my office. And I remember my first day looking at it, I saw that there was a ton of options. They have 41 different lower extremity tests. 13 of those are jump variations. And within just the counter movement jump, we have Over 100 total metrics, 90 of them just in the takeoff phase. And especially for new clinicians that are first looking at this, that's a ton of information. We ask ourselves the question of, do I know what this means? How does this actually translate to what's going on with my patients? How can I then communicate this to the patient? How can then I then be able to track this? Do I know what a normative value of this is? Do I know? How I can apply this to a normal general population patient. And the biggest thing that I hear from people that want to do this is, is like, this is way too much work for me. This is way too much to think about. I can't do this. This is just going to confuse me. And it's a very valid point, but it doesn't have to be that way. We also, when we look at this data, have to look at, is it a chicken or the egg? So going back to even comparing our movement analysis to the dynamometry and the force that we're looking at, when we look at how a patient moves, is it a result of their strength and their speed that's causing them to move this way? Let's say, for example, if I have a patient where they go into a squat, or let's even say a countermovement jump, and in their descent on the countermovement jump, we see that they have significant knee valgus in the descent. Is that because of a hip weakness or is it also a movement strategy? This is how they've always jumped. Does that actually increase their risk of injury? What's the context of the player that's in front of us? If we're looking at some of these metrics, are there some that we value higher than others? Is there one that we're going to have to say, hey, this one needs to be our primary focus while we put someone else to the wayside? As I mentioned on the last slide, we have tons of metrics to look at when we access this data. How are we able to figure out where the most important points are? And how can we then build a rehab plan around those specific metrics? And that's my number one focus whenever I meet with a new patient. So to give you guys a little bit of an insight of how my practice has been over the last couple years, I've incorporated this. At my initial patient evaluation, every single patient gets a performance test baseline. I have them get onto the force plates. I have them use the ForceFrame. I have them doing a movement assessment. And before I even get them on there, I need to know ahead of time exactly what are the goals of that person in front of me. I'm assuming that if you've tuned into this, you're a very rehab-based chiro, or you're someone that's very focused on using things like movement to help get your patients better. That is always going to be our number one priority because a lot of those goals you cannot provide an objective number towards. It has to be, hey, I want to be able to pick up my grandkids. I want to be able to throw a 90-mile-an-hour fastball, whatever that goal is, we have to start off with whatever that very, very specific thing is. I was listening to a podcast earlier this week with Corey Schlesinger, who is the head of performance with the Detroit Pistons. And he was talking about even getting as specific as working with the player saying, all right, do I want to jump higher or do I want to get rebounds? Being that specific, making sure that you know exactly what the intent of whatever movement the patient is trying to achieve and getting to the root of that. Once we understand what that goal is, we have to be able then to reverse engineer it into, okay, based on that, what are some of the key things I need to know? If it's a speed issue, okay, I'm looking at things like rate of force development. I'm looking at things like impulse. If it's a strength issue, cool, I'm looking at peak force. I'm looking at different things like that. With some of our older populations, is it a balance issue? Right. How much asymmetry do I have side to side when I'm doing a sit-to-stand-to-sit test with some of my older patients to see how are they able to get up from a chair? How well are they fatiguing? What's their time to sit to stand? And all of these different things, when we bring them together, is going to be how you can develop a really good test battery for those patients. How do I know which tests to choose? A lot of times you want to make sure that you know what the metrics you want to get first are. So then that way you can then dive into the test. And even if you're starting off as simple as, I want to know peak force, I want to know rate of force development, that's a great starting point for most patients and most clinicians when they first begin to use this technology. So now that we've talked a little bit about the technology, we talked a little about some of the roadblocks, some of the different things that— the questions that someone may have, the fear, the aversions behind incorporating some of this stuff. What then does it look like when you want to bring it into your practice? Because it's, in theory, it's amazing, but there also has to be an ROI to it. There also has to be— it cannot be a workflow issue. It has to be something that will fit into the passage of a patient throughout their lifespan in the clinic, and it has to be something that you can use as a boon, not as a hindrance. So when we talk about roadblocks, Where are going to be the different places within the clinic that we might have bottlenecks, we might have conflict, we might have things that affect how it gets implemented, how often it gets used. I heard a phrase earlier today is, I don't want to add this stuff to my office and then it sits in the corner and collects dust. So obviously the staff that are going to be using it are going to be the first point. You have to make sure that we're getting staff buy-in, right? There might be issues with staff education. As I mentioned, not all of us have sports science backgrounds. It might be experience with this technology or how how to integrate into practice. Some people may have come from more traditional chiropractic backgrounds and may have different issues in terms of shorter appointment times and incorporating this into their shorter appointments becomes an issue. Again, the operations, obviously there's a cost for adding these things. Speaking from the experience of working with, with VALD, VALD is a subscription-based model. I know that there's other types of force plates where you buy them outright and there are thousands and thousands of dollars to buy them outright and own them. That's a big issue. The workflow. A lot of times you're adding these to clinics that are already really well established and you have to then figure out, okay, based on our current volume of patients we're seeing, based on our current systems in terms of assessments, in terms of treatments, where are we able to plug these in? And is it going to slow us down? Does it affect, does it affect our bottom dollar on some of these things? And Last, and also there's the space that it occupies. The ForceDecks are relatively compatible depending on, compactable depending on which ones you get. The Dynamo, for example, is a handheld dynamometer. It takes up zero space. The ForceFrame is large. So if you want to get something like that, it can take up space. So if you have a very small office, it can be a bit of an issue there. When I first got the ForceDecks, I was in a 400-square-foot office space and I had to struggle to find space to use it with my patients. And the last thing, and, and probably the most important thing, is the patient themselves. Patients are always gonna ask, what does this even do for me? How does this even help me? So helping develop that communication with patients in terms of them understanding what exactly these metrics mean for them. How do we then communicate that with them so that they actually understand that we're just getting a baseline on them and not trying to Really push them towards, hey, like, you're broken. This is— we have a huge asymmetry. You're incredibly weak. And getting into like a lot of those biopsychosocial points that a lot of us talk about where we're creating these nocebos instead of, hey, here's some additional context to really help us build you up and build these more intricate programs for you. Lastly, obviously, is alienation. We are all— obviously you're sitting on this— we're very, very smart people. We go through extensive education where we learn what Newtons are. We learn things like force and, and a lot of times we struggle to remember that the layperson may not know all this stuff and it may also turn people off. So that communication piece with patients is also an extremely important factor. When you're looking at this data, the most important thing is how does it add context to the person in front of you? As I mentioned earlier, if we're talking about either a basketball player or we're talking about a grandmother, Obviously, a squat test is going to mean very different things to those 2 people. And we have to also make sure that we're drawing a line on, do we know at what point does the data help us make better clinical decisions, or is it just adding noise? And that can be something that takes time and takes practice. The other thing that falls into this a lot is you'll see different people saying, hey, we can diagnose your injury based on different movement assessments. We can diagnose different types of movement patterns based on what we see on the force plates. I can tell you that you are gonna— we're gonna prevent injuries by doing this. That is not what this is meant to do. I wish it was. That is not what this stuff is meant to do. It is meant to help give you additional context to different risk factors that may come with it, right? If we're talking about ACL injuries, we know that different types of asymmetries between quad and hamstring strength, we know that different types of imbalances in the hip Can cause that. With our coach's eyes, we can watch an athlete, see how they move, and go, hey, like, that wasn't great, and I might want to intervene on this and help you move a little bit better. But when we then get into the rehab portion, we can say, hey, I can— I'm looking at you all day, and I can tell you you're moving better. It looks like you're stronger. Like, we're able to put more weight on the bar. If they're strong but they can't access it, We're not filling up that whole picture. And that's where we're now adding this context. If I get an athlete incredibly strong, but I now need to worry about them getting on a soccer field and be able to cut and be able to access that strength very quickly, but they can't do that, have we actually reduced that risk? Maybe. But that's just another thing we have to ask ourselves as we dive into these things. So when we go then and we look at how do you actually implement these things into your practice, similar to what I tell my patients when I'm giving them an exercise program, I always want to pick out the hardest things you do well. If it's something that's way incredibly easy, it's obviously probably not going to be our time. But if it's something that's very, very hard and very unattainable, you're not going to do it. And it's going to limit the growth that you're going to have along that journey. And it's the same thing when it comes to implementing these things within your practice. So at the very beginning, we start with a needs analysis. You want to make sure that, hey, if I'm adding this stuff, where do I need to use this? Is this something that I want to use primarily in the assessment? Is this something I want to be able to use during rehab? During— is this going to be a lead generator for my business? And those are all things you need to look at. Budgeting. Can I afford it? Am I able then to get enough ROI on it to make sure that I can get more people in the door? As we just talked about bottlenecks, knowledge gaps, what kind of education does my staff need in order to use this stuff effectively? Is there anything in our workflow that's going to become a hindrance if I implement this stuff? Some of the technology I use, when I first started using it, I used it during my assessment. I no longer use it during my assessment because it slows me down and I end up using it elsewhere. And that's okay. And it comes with experience, comes with learning. It comes with Knowing how to do this. The next phase then is then the implementation of it, introducing it to the staff and finding out where that easiest point of entry is going to be. Is it something as simple as, hey, now when we start to do our evaluations, I want you to just do a grip strength test with every patient over 65, so then that way we can get a baseline measurement for them. We can tell them that this is a very important metric for us to use to help monitor their longevity and their strength through their lifespan. If that's your point A where you gotta start, great. If it is, hey, every athlete that comes in, I want to get them on the force plates and I want to see what their vertical jump is, awesome, fantastic. Older patients, concussion patients, getting them on the force plates and doing balance tests. We had a hockey team coming in, we're going to have them do an abduction-adduction test to test out their hip strength. Perfect. Those are the kinds of things that you, you begin with and then building in systems and how to do those, making sure the staff understands step by step how to put in a new patient profile, how to run each of the tests, how to evaluate the data when you have that. Then you go into the refinement, especially in that early stage when you're first implementing the technology. There's going to be growing pains. There's going to be people that are going to really understand what's happening. There's going to be people that are going to catch on very, very quickly. There's some that are going to struggle. That's where you really want to make sure that you understand really well where those bottlenecks are. How do we address them right away? So then that way, as you're implementing this even deeper into the process, there's an answer for when those questions pop up. Along with that too is making sure that you're able to communicate with the patients. That's going to be obviously the most important thing, making sure that patients understand why you are using this testing with them. And getting their buy-in with it. I'll talk a little bit more when I get into my case studies on some of the impacts that having these different metrics has had on patients of mine and how that has changed the course of their programs. Not just that, but also for them to commit to longer plans of care with me because we saw that there was some progress and now we need to continue with it. Lastly is full integration. This will not happen with every clinic. Some people will probably look at some of this stuff and say, hey, You build a better product for your patients. You build better outcomes. You build better systems. Lastly, there, obviously, continuing education, growth for the staff. This technology is changing constantly as well. And just like the world of healthcare is, there are plenty of options to continue to educate yourselves on what are some of the different metrics that we want to look at for testing? What are some of the different importance and normative values and standards that we have for different types of injuries. Say, for example, if you're working with athletes and you want more return to play, that's going to be some significant things that you'd want to look at and keep up to date on.

That wraps up part 1 of our conversation with Dr. Michael Giammarco. If there's one theme that carries throughout this first episode, it's It's that more data doesn't create clarity. Context creates clarity. Because the goal here isn't to just collect metrics, it's to use the right measurements at the right time for the right reason. So you can make better decisions, build stronger plans, and help patients see meaningful progress. In part 2, Dr. Giammarco will take this from framework to application with 2 powerful case studies. Including one that talks about how objective testing can shift patient confidence, guide progression, and reveal improvements that patients don't always feel day to day. Then we'll talk about which metrics matter most, how to communicate these results effectively without causing confusion, and how all of this fits into the return to performance decision-making that is so crucial for practices that deal with performance athletes. Make sure you hit the subscribe button so part two lands directly in your podcast feed, and as always, check out the show notes for a link to the full recorded webinar replay or to share this episode with a friend. Thanks for listening. Part two will drop in two weeks. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F A. Ktr-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.