Discuss the various smartphone applications that can be applied in the clinic, discuss the validity and reliability of smartphone applications in clinical practice, describe some clinical applications of smartphone applications in clinical practice
Timestamps
(5:09) Where are we at with technology today
(6:12) What qualities of a smartphone can be used in practice
(8:53) Smartphone apps that could be implemented into practice
(16:21) Evidence behind smartphone applications and clinical practice
(29:37) Tips for using smartphone applications in clinical practice
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-Sandy & Randy
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Hey, this is Sandy. And Randy?
And we're here on at Corner. Being an Athai trainer comes
with ups and downs, and we're here to showcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of At Corner.
For this week's episode, we are going to be bringing another CEO
episode and we're going to be talking about technology.
(00:26):
Just like this podcast. Actually, yeah, I didn't think
of it that way. You're right.
Yeah, Athletic. Training didn't always have
podcasts, you're right. So Speaking of podcast, this is
a CEU podcast. So like Randy said, thank you so
much to Athletic Training Chat and Clinically Pressed for
making this AC EU. If you are interested in
(00:47):
claiming your free category AC EU as you're listening to this,
go to clinicallypressed.org slash courses.
I believe it's down in the show notes below for the exact link
and you can just complete the quiz and the course evaluation
and then you'll get your certificate.
If you're listening to this at alater date than when it comes
(01:09):
out, you can still purchase it for that certificate.
Absolutely. So for this episode, we are
going to be particularly talkingabout smartphones, right?
That's the actual technology that we're going to be talking
about. So we're going to discuss the
various smartphone applications that can be applied into the
clinic. We'll discuss their validity and
(01:31):
reliability on actually do they do what they say they're
supposed to be doing. And then we'll actually describe
some of just kind of some clinical applications and even
like maybe some tips on kind of implementing some of these
applications into your practice.Something right at your
fingertips. Yes, exactly.
And that is that's the theme of what this is, right.
(01:53):
So what does that like how can we actually apply a smartphone
into clinical practice? I feel like not a lot of people
think of this of like, oh, how can I use this thing or like
what is this thing actually capable of and.
I feel like more people sorry tointerrupt you or are like, I
don't want to use my phone to take notes or anything because
(02:15):
it looks like I'm just playing on my phone or just on my phone
instead of, you know, doing whatever I need to do.
Yeah, seriously, I think like checking e-mail or something
like that, like it looks you're right.
There's still that perception oflike, oh, that looks bad.
Like even stay crafty has a sticker that says I'm not
texting I'm documenting. I think that's what it says.
Oh, that's good. That's funny, right?
(02:36):
But like, kind of like what you're alluding to, right?
Technology like continues to advance just how we practice as
athletic trainers, like that, right?
And that now, like I said, of documenting on paper or having
to sit at a computer, right? Theoretically, you can do some
documentation on your phone now,right?
And again, the whole idea of that, the whole goal of
(02:56):
technology in general is to makeus more efficient, right?
It's supposed to help us like make our jobs easier, right?
Like again, documenting now is just.
It's never easier, but it's a little bit easier than probably
what it used to be because it's a little more accessible.
Right, right. And now they have like AI apps
that can listen to your eval andstuff like that and like
(03:17):
document it for you, right? That's crazy.
I mean, just like we were talking to Chad Starkey and he
was talking about how AI is basically like when people said
there was a you know, you do math by yourself or you use a
calculator. The calculator is going to be
the end of the world. Right.
And it wasn't so. We're still here.
So how do we use this technologyto actually help us?
(03:39):
Yes. And you know what?
Again, the whole goal of technology is to provide us with
quote UN quote, accurate objective data, right?
It's actually supposed to give us something that like, hey,
this is a true measure of what we're looking at, whatever
you're trying to evaluate. So the idea is, hey, you should
be able to make a better clinical decision based on
(04:00):
better data. But the problem that we've kind
of seen with technology in like sports medicine or even like
performance is it's always associated with this like huge
cost or it's not really accessible.
You need like 10 cameras, you need this big space and like all
this stuff and you read the research and like they have like
(04:20):
all these parameters and you're just like, holy smokes, what am
I ever going to do? Be able to do that all right, or
like even like strength testing,right isokinetic machine and you
got there's a certain way to do it.
You got to set them up and like,holy smokes, that's expensive.
And it's not very feasible for the everyday clinician.
And then even if you actually have all that stuff or access to
(04:40):
it, right, just getting the footage is not good enough.
You have to actually be able to,OK, now you have to process the
data, you have to analyze it andlike actually get the computer
to know what's going on. And there's literally degrees to
do this, right, right. So it's not feasible for like a
clinician to sit there and do that, right?
(05:01):
So where we're at today is really being able to bring that
technology to the actual clinician.
All right? So over the past decade, I would
say a lot of that technology of actually like video cameras and
like bio mechanics, like all thefancy marker stuff is getting a
lot more accessible to the clinician, all right.
(05:25):
And I think where we really see this at is that fancy
supercomputer that's at your fingertips all the time, right?
Right. And I think most people really
don't focus or appreciate what our smartphones are actually
able to do for our practice. Like I said, I think most people
feel like it's a communication device, right?
(05:47):
I can e-mail, I can text. You can do like your concussion
tests if you have like an app orsomething.
Yeah, Like you use it for a timer, right?
Yeah, but it can actually do a lot more.
And there are applications within whatever smartphone you
have, like application store, right?
There's actually stuff that could be clinically useful,
right? So before we actually dive in on
(06:09):
like what some of these apps areor like what it can be used for,
it's still important to understand how are phones even
able to do this. And I feel like, again, that
really gives you an appreciationof what these devices can do and
like how powerful they are and how accurate they actually are.
So our phones have accelerometers and gyroscopes in
(06:31):
them, right? So basically what that does is
it help kind of determines wherethe position of the phone is and
its movement, right? So if the if the if the phone's
like moving at a certain speed or moving in a certain
direction, right? So when you think of that, think
of maybe measuring joint angles,question mark, right?
(06:54):
That's one way that these phonesare able to do that.
And again, those accelerometers and gyroscopes are actually very
accurate. But I think what most people
kind of start to gravitate towards when we start talking
about like, oh, the phone can dofancy things is the camera,
right? And of course, this is what most
people make fun of iPhone 4 is like.
(07:16):
They'll create a new iPhone and throw an extra camera on there.
And they're like, oh, the camerajust got a hair better.
But really, these cameras are pretty darn good, right?
They're getting pretty close to just like the same like digital
camera, like expensive thing. You'd get it like Best Buy.
And let me tell you, the space on the phone camera is like a
lot better than the space like of our, for example, our podcast
(07:37):
camera, because that has like the amount of gigabytes that it
takes up. The compression on the phone is
so much better. Yeah, for sure.
All right. So these cameras are very high
quality in your phone, even though we drop our phones all
the time. But another key aspect of the
camera is how it samples like sohow many frames it's actually
(07:59):
taking in a video. And this is what makes those
really expensive setups very important because when the
computer or when you are analyzing movement, you're
analyzing it by frame, right? So the more frames that you
have, the better you are at capturing the motion.
(08:19):
And most of these like expensive, like 10 camera system
and like biomechanical studies, they film at what?
At a frequency of 240 Hertz. So that's basically 240 frames
per second. That's a lot.
That's a lot you want to know. It's crazy.
Your slow motion camera on your phone samples at 240 Hertz.
(08:42):
Well, that's sounds perfect. It's literally the equivalent of
what these biomechanical studiessample at, so you have that
literally in your pocket. OK, sweet.
At all times so. How do we use it?
Exactly. So how come, how does this, how
does this even translate to my practice?
Well, like we alluded to, you could do range of motion testing
(09:03):
and there are Goniometer apps. Literally you can like go into
an App Store and type in Goniometer and you're going to
get like 5 of them. So I've used the level as a
goniometer, the level on the iPhone OK.
Which I think, yeah, I think that's a valid way.
Which I have found it has. It helps if you are starting at
(09:30):
something that's like 90 or 0. But anything that like for
example I was trying to use it for hamstring return to play and
hamstring range of motion tests and I was trying to do one that
it's called the MH fake. I don't know how to say it, but
yeah, maximal hip flexion, active knee extension, I call it
(09:53):
the MH fake. I don't know how to, but you
bring their knee all the way into their chest and then you
have them extend their knee. Sorry.
Yeah. Bring their knee all the way to
the chest. Yep.
And so they're in maximal hip flexion.
And I found that it was like putting the the level app on
(10:13):
their shin and measuring that. I found that it was a lot harder
to like subtract the numbers rather than the active knee
extension test that I was doing where we started of a hip
flexion at 90° and had them kneeextend.
And so just like that, that mathwas like a lot easier than the
(10:35):
the math that didn't start like at a 0 or 90.
So I'm sure a goniometer app would be a lot better than that.
Yeah, 'cause I would say I've used it.
The app that I use doesn't isn'tsupported anymore.
Like I don't know what happened.It was really actually pretty
simple to use it really bummed out.
But yeah, it was a lot easier. Like it literally acted like a
goniometer. You'd put it on the the movement
(10:57):
part that you're trying to do and get your joint angle right
through that way. So yeah, there are plenty of
goniometer apps that you can look at.
Another one, a lot of kind of apps are geared towards like bio
mechanics. So there's a lot of different
ones that measure certain bio mechanics.
One thing that's really becomingcommon and not necessarily the
(11:19):
center of this of this episode, is markerless motion capture.
Oh, that's really cool. Yeah.
So like anytime we think of bio mechanics, most people commonly
think of, oh, the markers, right, the dots on people,
right, all that is, is really for the cameras to pick up that
joint's movement, right? That's all those markers are
(11:41):
for. But again, what that requires is
you basically film and you tell the computer this is what this
marker means, and then it just tracks it.
Markerless motion capture is basically artificial
intelligence looks at the video and the image and is able to
say, oh, that's a shoulder, and now I'm going to watch that
shoulder as it moves. Oh, that's cool.
(12:04):
There are applications that do that.
Crazy, right? There's also another app
specifically, and again, I'm not, we're not trying to
advertise for certain apps. This is just one that I've used
in the past and it, it is validated, they actually did
study on this particular app is Runmatic.
I mean, it's really geared towards actually looking at
(12:24):
someone's like gait mechanics for running.
So it can like calculate like stiffness and like flight time
and all that stuff, right? Specific towards kind of running
gait. And so it's called Runmatic.
I've used that one in the past. That one's pretty cool.
I got to check that out. Yeah, it's it's actually pretty
dope. It's actually pretty intuitive.
(12:46):
Another aspect that I don't think a lot of people think
about is it could be used for strength testing, not all
strength testing. There's actually one app in
particular that looks at hamstring strength, and it
basically calculates hamstring eccentric strength using the
Nordic hamstring curl. How?
(13:07):
We will talk about a little bit more, so it might be redundant,
but what it does is you basically film them doing the
Nordic hamstring curl and basically the air like the angle
at which point like they can't hold it anymore and they fail.
Based on that break point angle,it goes through an equation to
estimate their eccentric strength.
Interesting. I know it's pretty cool.
(13:27):
I've used that one before. Do you feel like it was user
friendly? Yes.
That's another thing about like using apps is I feel like
sometimes there are so many things at our fingertips, we
just don't necessarily know how to use them.
And we if we don't know how to use them like it's hard to
implement. For sure.
(13:48):
So the nice thing with these apps especially like the Run
Matic and this Nordic Hamstring curl 1 and then the next one I'm
going to talk about, it's very user friendly.
Like the, again, the problem with like a lot of video
analysis is not capturing the video, but processing the
videos. So you actually have to like,
(14:10):
oh, I have to identify this bodypart and make sure this looked
good and like stuff like that. These apps pretty much take most
of that out. The only processing that you
really have to do for like the Nordic hamstring curl is label
which one's the ankle joint? Where's the knee joint?
Where's the hip joint? Because it has to create that
angle. That's it.
(14:31):
And then the computer or the application does the rest,
right? Or like for the runmatic, right,
you have to define in your videowhen does the foot hit the
ground and when does the foot leave the ground, right?
So still some processing has to be done.
I think in the future, right, more of these apps will use AI
(14:52):
to do that. So then literally it's you
pointing a video, recording it, and then it'll analyze it for
you. Probably real time too.
Probably real. And actually, yeah, there is an
app that has looked at, that's funny you brought that up there.
There is an app that has looked at velocity training and like
actually able to do it in real time.
(15:13):
So you like say you're doing a bench press and this is what the
study did. They did bench press and they
had the camera watching the bench press and the camera's
able to determine the velocity and actually let you know real
time how your velocity's doing, if there's any change in
velocity throughout the workout.And crazy.
But yeah, I think over time it'll be real time stuff.
(15:35):
And then another one that's kindof been looked at is like for
power, and in particular vertical jump performance.
So there is an app that can actually tell you what your
vertical jump would be and how much power you're doing just by
videoing the actual jump. Again, there's the processing
part where you literally just have to go in and be like,
that's when their foot left the ground, that's when it came back
(15:57):
on the ground, right? So still an element of
processing, but when you look atwhat those high quality 10
camera systems have to do, this is very simple.
Yeah, I mean, you're not solvingany problems with this, you're
just using it as a part of your.Clinical Tool.
(16:18):
Exactly. Yeah.
So now that you kind of have an idea of what apps are out there,
what they can kind of do, do they even work right?
Should we even, like, do I bother, even like getting this
app and bother pulling out my phone for this stuff?
And actually what's crazy is theevidence behind it, it's very
solid, right? A lot of these apps perform very
(16:39):
identical to the gold standard methods of whatever method
they're kind of looking at. That's really nice.
Yeah. So like for goniometers, it's
like comparing to an inclinometer or an actual
universal. So that's actually why I started
doing it was because I was goingto have a lot of our like
students and other athletic trainers measuring all these
hamstrings. And so I was just trying to
(17:01):
figure out in a more objective way.
And I figured what would be moreobjective than like a phone like
measuring. But again, then I found it's
like your starting point. So as long as you're like
cognizant of some of these like confounding factors, I think you
(17:24):
can manage them. Yeah, and I think the nice thing
with like, OK, now let's look atlike the goniometers is like
especially goniometer in like range of motion.
Like I feel like it's like I'm not a hot topic, but I feel like
it's one of those things where like we're constantly told as a
profession, especially like students who are getting ready
(17:44):
to transition to practice that like, oh, you, you need to use
the goniometer like objective data, objective data in your
practice, which it is very important, right?
But like a goniometer can be time consuming.
It can be so time consuming and it's because, sorry to interrupt
you, but again, like I think thephone is just a lot faster.
(18:06):
You just put it on their shin and then they extend their knee
and you just look at the number like.
Yeah. Whereas like the goniometer, you
have to like make sure you line up the axis of rotation, like
make sure the access is where itshould be right, Make sure the
stationary arm is lined up correctly and then you make sure
the movement arm's lined up correctly and then do the motion
right, right. So it's like, yes, theoretically
(18:29):
that doesn't take that much time.
Like like I, I heard someone onetime brought up like, Oh,
everyone should be doing it. It only takes a few seconds to
do it. I'm like, that was coming from
like someone who's more like research based.
Like, yes, you probably do it all the time, but like in the
clinic when you have 50 people waiting for you, right, right.
Those few seconds are going to add up.
(18:51):
And then of course, when we eval, you should be getting
multiple like areas evaluated, right.
So now I'm going to take a few seconds on like knee range of
motion, then ankle range of motion, then hip range of motion
for a knee eval, right, right, because all those could
influence the knee. All right, so I, I think there
(19:11):
needs to be a more efficient wayand here's the possibility right
again, using the phone, it's a lot easier to set up boom.
And they've actually been shown when compared to universal
goniometer. So everyone's favorite like
circle and thing with wings and inclinometer, it's very valid
and reliable and they're actually within 5° of each other
(19:32):
for most studies, right? Some are even less nice, right?
So again, when you think about agoniometer, I think this error
for goniometers about 3°, that'snot bad to be that within each
other. And this has been validated for
the spine. So like cervical, thoracic and
even lumbar, the hip, ankle, wrist, elbow, shoulder, it's all
(19:55):
been validated to actually get those ranges, ranges of motion,
right. So that's pretty huge.
And so that's something again, as we talked about like, oh, as
a professional, we need more objective data.
Hey, here's a way that we can kind of make it a little more
accessible and a little bit easier.
Right, that's what it sounds like.
Right. My thing with it, though, is
like putting my phone on like other people's bodies.
(20:20):
That's just. You know, I actually never
thought I'm movie because I'm putting it on their shin.
Yeah, I like never really thought about that.
But I've, I've kind of thought of some ways around it, like
just put your phone in a bag. I don't know, I don't know, I
get kind of weird about it 'cause I'm like, oh, now it's
going to be touching all these people.
You. Could just put a towel on them
and then that's true. Put the phone right on the
(20:42):
towel. Good point.
I feel like your phone is actually pretty dirty anyway.
I know, but it's just weird to think of like I'm just touching
it on all these people. But yeah, that's a good point.
The towels it I never thought I was actually going to start
putting in a bag and like towelseasier.
I don't think you have to be tooextra.
Yeah, that's true. So now looking at more like the
(21:05):
bio mechanics stuff, and I thinkthis is the really cool part,
right? Because when we talk about like
everyone wishes they could do like a biomechanical analysis on
someone and have like all 3D andall that fun stuff, but again,
expensive, inaccessible, all that fun stuff, right?
So actually having an app that might be able to do that would
be really, really cool. I think a lot of people would
(21:26):
really buy in on that. So for the running specific one,
right, that run Manic app that Iwas kind of talking about,
again, it was found reliable andvalid when compared to like an
instrumented treadmill. So a treadmill that again,
analyzes flight time like forcesand stuff like that.
And the results actually showed a very close relationship.
Like they were fairly identical for the markerless motion
(21:49):
capture. The the, the article that I saw
on this and there's more stuff coming out on markerless motion
capture, but there actually was a high correlation between a 2D
image, right? So like the actual application
filming and 3D motion capture. That's crazy.
(22:11):
Just with a regular video. Just the same, yeah, same
regular video. I think it was not necessarily
regular like the slow motion. Video.
So you needed that 240 OK framesper second, but same same
result. Very similar results as 3D
motion capture. The crazy part about this is it
(22:34):
was able to estimate the sagittal plane motion very
similarly to a 3D motion capture, with the camera only
filming in the frontal plane. I don't know.
One view is no view. I know, but it was able to get
similar results. That's really good.
Or like fairly close, fairly close, again within about 5°.
(22:57):
That's crazy. And I think one of the things
there is it really shows you thepower of AI and what it can do,
because that's how it basically estimated what those angles
would be. It did have like the ankle like
angle progression was a little bit more variable, but for the
(23:18):
most part hip knee looked pretty.
Good. Sure, both important joints.
Absolutely. And there's some other stuff,
again, not this isn't really geared towards markerless motion
capture, but there's also some stuff I think Stanford has like
an open one that you can do. I think it's open cap, I think
it's called that. Literally all you need are two
(23:40):
video angles and you can like get it analyzed through this
thing for free and it'll do all that for you just from 2 angles.
So even that is still more accessible than the whole 10
camera. Deal.
So kind of shifting away from like the actual bio mechanics.
Now going into, again, the strength, we already kind of
(24:04):
alluded to it, but using that Nordic hamstring curl app, it
actually is valid compared to isokinetic testing to quantify
eccentric hamstring strength. So again, that's really cool
considering like most time gold standard for strength is
isokinetic testing. You have an app that all you
(24:25):
have to do is film someone doinga Nordic hamstring curl, hit a
couple buttons and now you can quantify.
Here's what their hamstring strength is.
See, if you tell me the day thatI can use my phone as a a muscle
dynamometer that is would be cool.
Yeah, at basically you can rightthere.
(24:45):
Of course, the limitation is theNordic hamstring.
Coral is a bilateral exercise. So you're basically quantifying
the strength, the total strengthof both hamstrings.
So all you're telling me is we need to be have the our athletes
be doing single leg Nordic hamstring coral?
So what's crazy is in this app there actually is a way I think
it can test single leg. So then you can then quantify
(25:09):
each leg. Can you even do a single leg?
That's what I said. I was like, that's cool, but I
don't think any of my kids wouldbe able to do.
That like. I'm pretty sure they'd pop their
hamstring. Before I'm pretty sure I would
pop mine watching them do it right.
So it is possible, but the app initially was for bilateral.
That's funny. But it still does kind of tell
(25:30):
you information, at least anything it could help with
progress. But yeah, I thought that was
very interesting that it actually again could quantify
eccentric strength similar to what an isoconnect machine could
do. And then finally, power.
(25:50):
And I think power, this one's a really good one, especially
because as we start looking at return to play testing, right,
we have hop testing and all thatstuff, but single leg vertical
jump has been shown to be reallycrucial at looking at quad
strength and ACL return to play.So again, that's kind of hard to
do. Like you need like a Vertec to
(26:10):
do that And like who who remembers even how to like
calculate jump height from that?Or you use a jump map but that
costs like 700 bucks like or a force plate which is just you
might as well mortgage your house.
Not accessible. Not accessible, right?
So now you have an app that's like cost like 17 bucks, 18
(26:31):
bucks that can film, and you canactually quantify someone's
power and their jump height justfrom a video recording.
So the question is, is is it a subscription?
So the app itself is not, at least when I got these apps.
I haven't done the Jump 1 yet. I want to so I'm excited to
(26:53):
actually try to get that one. But like the hamstring one, the
running one, it was a one time purchase.
I believe the maker of this app is they do have like a newer set
called like I think it's like the My Jump Lab or whatever that
has like all these apps all in one.
(27:13):
I think that one's a subscription because it's using
more AI, but I think. See, that's, that's another
limitation that we run into withall these like these technology
because before like you get rehab equipment, you buy it and
then it's, yeah. Whereas now like we're just
running into like, oh, you want to use this technology, It's a
subscription. You want to use this, it's a,
(27:34):
it's a subscription. And like, you're not necessarily
going to use, if you like, you want this big toolbox, right?
And you're not going to necessarily use every single
part of your toolbox every single day for sure.
So and you're not going to it's,it's just a little bit more
fluid, I would say when you're using these things and it's hard
(27:57):
when there's a subscription because like those things are
just going to keep adding up. Yeah, no, for sure.
So yeah, to my my experience, the ones that I have were not
subscription based literally onetime purchase and you have
access to the whole thing. But yeah, so the actual jumping
one, which again I think is my jump, I think it's called the
(28:21):
one that I've seen and the one that has been kind of analyzed
in the literature. Basically what it does is you
film them jump and you you basically tell the application,
here's when the foot left the ground and here's when it came
back. And through that it uses an
equation to determine, oh, here's how much power they used,
(28:42):
here's what their jump height was, stuff like that.
And again, this has been valid and reliable compared to a jump
mat or a force plate. Like the relationship between
the two was very close. Like we're talking like if you
remember from your stats class, like your correlation statistic
is the R statistic. It was like an R of like .9.
(29:03):
Like that's a darn near perfect relationship, right?
So like is it? Supposed to be close to 1.
Yeah, one would indicate perfect.
So these are like near perfect relationships that we're talking
about for across a lot of these apps.
That's really good. It's crazy to think just how
powerful just our phones are. Of course, the apps doing the
(29:25):
calculation like the this isn't a coding thing.
Chat chat. Actually, we'll probably know
the coding. I'm.
Sure, but that's basically what's happening, right?
The coding and the equations, what giving us the number, but
literally it's just, it's makingtechnology that seemed like holy
smokes, it's expensive, it's time consuming, just at our
(29:48):
fingertips. And it's really cool to see some
tips to actually like, how can Iactually use these apps?
Because it's not it's it's not as easy as just like point and
shoot, right? One of the biggest thing is if
it's a video thing, right? If you're like recording
something, make sure the camera's on a stable surface,
right? Like make sure it's on a tripod
(30:08):
or like make sure it's really locked in between like books or
something. Like something that's going to
keep it stable. Because if there's any movement
on the camera, it's going to affect the quality of the video.
And now your data is going to beaffected because the video
doesn't look great, right? So you get what you put in,
right? So make sure that you're on a
(30:30):
stable surface and it can actually like record stable and
just try and be consistent with that, right?
Don't try and hold the camera while you're doing it and that's
not going to work or have like atripod or something.
Most of these apps still kind ofneed some processing.
Like I said, like the Nordic hamstring one, right?
(30:51):
You actually have to go in like after the video and like let the
app know this is where their ankle joint is, this is where
their knee is, this is where their hip is.
So it knows how to measure. But again when you compare to
like what those 3D like assessments need like that
processing is way easier than the 3D models.
(31:12):
Well, also what I was going to say is like if I'm going to run
a functional test on someone in person, I still have to
calculate their differences by hand.
Yeah. So if even if this app needs
some sort of processing, it needs my hands on something,
it's going to be my hands on something that's a little bit
less than me doing it. Yes, by myself in person.
(31:34):
For sure, for sure. All right.
So I think over time, as AI continues to get better and more
integrated in into our practicesand our lives, I think AI will
remedy this. And we already see it with the
markerless motion, right? It's able to identify here's
what a shoulder is and here's how the shoulder moves with
these kind of movements. So I think Mai will remedy that
(31:56):
in the future. So hopefully it literally will
just be, oh, I just filmed it and here are my numbers.
So I think it'll get there. The last one that I like is more
of like a a thought that I had is like how does HIPAA play into
this? Absolutely.
Right. And like most of these apps, you
really don't need the patient's face, right?
So you could really just not film the face or just like crop
(32:18):
it out before you upload the video into like the application.
But like, so I would have reallyjust avoid filming the face of
your patient. And like I said, you can even
crop that out before you becauselike a lot of them are literally
looking at lower extremity and you just need to calculate, oh,
when the foot touched the ground, right?
We don't need to see people's face for that.
(32:40):
I mean, even if you did need to see their face, technically you
could record anyone's gait, you could record anyone's jump
height, you could record any, anyone's of these.
Like, it's not like it's you're putting into a system like, oh,
I'm looking for this injury and this is what happened.
(33:00):
And here's all the details. Exactly.
Yeah, yeah. Definitely some good
considerations. Yeah, for sure.
So I think it is all like a lot of this is all very accessible.
It's just feeling comfortable enough to purchase the app and
then trying to implement in yourpractice.
And I think you could just startsmall and like start using it on
(33:22):
like someone's return to play. What are some apps that you like
to use action item? So I've used the Runmatic one.
I used the Nordic Hamstring Curl1.
I really liked those. I used the Nordic Hamstring Curl
1A little bit more and it reallyeasy to do.
(33:44):
It doesn't take long to actuallytest somebody.
And then like I said, my goniometer one went away.
I liked that one and I think it was Goniometer Pro.
That's gone. That's a bummer.
I know it makes me sad but I am working on getting the my jump
one for doing jump height and power so that one I'm excited
(34:07):
for. There's also like some postural
control apps out there that you can, they like put a grid up so
you can like see. Posture Eval.
Yeah, for posture eval, you can also, I mean your standard
staples like sway concussion or or sway medical that we use like
(34:28):
for concussion. Yeah.
Or what's the other one I'm thinking of?
I mean we didn't even talk aboutanatomy apps.
Yeah, anatomy apps are super helpful and you can like.
Educating patients. Exactly this is what your.
Sartorius looks like. I mean technically Blaze pods
(34:52):
has an app. Oh yeah.
Yeah, a lot of blaze pods is technology.
Yeah, a lot of those, like you said, kind of subscription
things are like some of these rehab tools, right?
They have their app associated with it that you can monitor,
like you said. Yeah, the blaze pods 'cause
right, It can tell you the time.You can set.
You can, yeah. You can set.
Like if there's like, let's say I'm working with someone on
(35:16):
impulse control, like I can havelike only two colors, like red
and blue. And then I'll tell them like
only hit the red ones. And then I can see the reaction
time as they're doing it and I can see how many times they
missed. I can see how many times they
hit. Like, that's cool.
Yeah, I mean, shoot, even Norma Text now have an app.
(35:36):
Yeah, everything has. For for like their the recovery
and stuff. I'm like dude like you said
everything has an app. Yeah, but I think mostly I use
the level sway and blaze pods. Nice, I want blaze pods.
They're pretty cool. I I've heard.
We are not affiliated with them.So our true opinion, actually
(36:01):
everything we share is our true opinion for advertising, so.
For sure. So blaze pods, if you're
listening, I do want, I do want a pair or a set.
What a What's your action item for this?
I would say these are all very accessible apps and I think go
(36:22):
ahead and start small and just try one, right?
It even if you're like, I don't want to pay $18.00 for an app,
get a goniometer app, all right,like try that and like again,
like be able to apply. And now you can see how, wow,
it's easy for me to get objective data instead of
feeling the pressure if I have to pull out this whole thing and
like line things up and God, this takes forever and then next
(36:43):
thing you know, the goniometer goes flying.
Has that happened before? No.
In your head, not for me. I'm sure there's a lot of people
that have wanted to destroy thatthing.
So like we said before, this is ACEO episode.
So if you're interested, head toclinically pressed website down
(37:04):
in the show notes below. So you can take the quiz and
course evaluation for your certificate.
If you want to look at the references for this webs for
this, it's on our website. So Randy's going to put those up
there. If you guys are new, we do every
episode as either CE, US, Education episodes like this
(37:24):
where we where Randy reads a lotand then we kind of take it into
a conversational format. We also have interview episodes
and then we also have story episodes where we take stories
from real life athletic trainersacross various topics all around
the world and we bring them together to hear other people's
experiences. This is a reporting year, so
(37:48):
make sure you check out all of our CU opportunities down below
in the show notes, like I said before, and Medbridge, if you'd
like a subscription, Speaking oftechnology, they have on demand
C us and it is a subscription. So you're good for a year, which
is great because you have this cycle that you can start doing C
US for and then next cycle you can start doing C us for under
(38:10):
the same subscription. So you can use just code 80
corner for $101.00 off dope. So other than that.
Thank you for helping us showcase athletic training
behind the tape. Bye.
Hey, this is Sandy. And Randy?
And we're here on at Corner. Being an Athai trainer comes
with ups and downs, and we're here to showcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of At Corner.
For this week's episode, we are going to be bringing another CEO
episode and we're going to be talking about technology.
(00:26):
Just like this podcast. Actually, yeah, I didn't think
of it that way. You're right.
Yeah, Athletic. Training didn't always have
podcasts, you're right. So Speaking of podcast, this is
a CEU podcast. So like Randy said, thank you so
much to Athletic Training Chat and Clinically Pressed for
making this AC EU. If you are interested in
(00:47):
claiming your free category AC EU as you're listening to this,
go to clinicallypressed.org slash courses.
I believe it's down in the show notes below for the exact link
and you can just complete the quiz and the course evaluation
and then you'll get your certificate.
If you're listening to this at alater date than when it comes
(01:09):
out, you can still purchase it for that certificate.
Absolutely. So for this episode, we are
going to be particularly talkingabout smartphones, right?
That's the actual technology that we're going to be talking
about. So we're going to discuss the
various smartphone applications that can be applied into the
clinic. We'll discuss their validity and
(01:31):
reliability on actually do they do what they say they're
supposed to be doing. And then we'll actually describe
some of just kind of some clinical applications and even
like maybe some tips on kind of implementing some of these
applications into your practice.Something right at your
fingertips. Yes, exactly.
And that is that's the theme of what this is, right.
(01:53):
So what does that like how can we actually apply a smartphone
into clinical practice? I feel like not a lot of people
think of this of like, oh, how can I use this thing or like
what is this thing actually capable of and.
I feel like more people sorry tointerrupt you or are like, I
don't want to use my phone to take notes or anything because
(02:15):
it looks like I'm just playing on my phone or just on my phone
instead of, you know, doing whatever I need to do.
Yeah, seriously, I think like checking e-mail or something
like that, like it looks you're right.
There's still that perception oflike, oh, that looks bad.
Like even stay crafty has a sticker that says I'm not
texting I'm documenting. I think that's what it says.
Oh, that's good. That's funny, right?
(02:36):
But like, kind of like what you're alluding to, right?
Technology like continues to advance just how we practice as
athletic trainers, like that, right?
And that now, like I said, of documenting on paper or having
to sit at a computer, right? Theoretically, you can do some
documentation on your phone now,right?
And again, the whole idea of that, the whole goal of
(02:56):
technology in general is to makeus more efficient, right?
It's supposed to help us like make our jobs easier, right?
Like again, documenting now is just.
It's never easier, but it's a little bit easier than probably
what it used to be because it's a little more accessible.
Right, right. And now they have like AI apps
that can listen to your eval andstuff like that and like
(03:17):
document it for you, right? That's crazy.
I mean, just like we were talking to Chad Starkey and he
was talking about how AI is basically like when people said
there was a you know, you do math by yourself or you use a
calculator. The calculator is going to be
the end of the world. Right.
And it wasn't so. We're still here.
So how do we use this technologyto actually help us?
(03:39):
Yes. And you know what?
Again, the whole goal of technology is to provide us with
quote UN quote, accurate objective data, right?
It's actually supposed to give us something that like, hey,
this is a true measure of what we're looking at, whatever
you're trying to evaluate. So the idea is, hey, you should
be able to make a better clinical decision based on
(04:00):
better data. But the problem that we've kind
of seen with technology in like sports medicine or even like
performance is it's always associated with this like huge
cost or it's not really accessible.
You need like 10 cameras, you need this big space and like all
this stuff and you read the research and like they have like
(04:20):
all these parameters and you're just like, holy smokes, what am
I ever going to do? Be able to do that all right, or
like even like strength testing,right isokinetic machine and you
got there's a certain way to do it.
You got to set them up and like,holy smokes, that's expensive.
And it's not very feasible for the everyday clinician.
And then even if you actually have all that stuff or access to
(04:40):
it, right, just getting the footage is not good enough.
You have to actually be able to,OK, now you have to process the
data, you have to analyze it andlike actually get the computer
to know what's going on. And there's literally degrees to
do this, right, right. So it's not feasible for like a
clinician to sit there and do that, right?
(05:01):
So where we're at today is really being able to bring that
technology to the actual clinician.
All right? So over the past decade, I would
say a lot of that technology of actually like video cameras and
like bio mechanics, like all thefancy marker stuff is getting a
lot more accessible to the clinician, all right.
(05:25):
And I think where we really see this at is that fancy
supercomputer that's at your fingertips all the time, right?
Right. And I think most people really
don't focus or appreciate what our smartphones are actually
able to do for our practice. Like I said, I think most people
feel like it's a communication device, right?
(05:47):
I can e-mail, I can text. You can do like your concussion
tests if you have like an app orsomething.
Yeah, Like you use it for a timer, right?
Yeah, but it can actually do a lot more.
And there are applications within whatever smartphone you
have, like application store, right?
There's actually stuff that could be clinically useful,
right? So before we actually dive in on
(06:09):
like what some of these apps areor like what it can be used for,
it's still important to understand how are phones even
able to do this. And I feel like, again, that
really gives you an appreciationof what these devices can do and
like how powerful they are and how accurate they actually are.
So our phones have accelerometers and gyroscopes in
(06:31):
them, right? So basically what that does is
it help kind of determines wherethe position of the phone is and
its movement, right? So if the if the if the phone's
like moving at a certain speed or moving in a certain
direction, right? So when you think of that, think
of maybe measuring joint angles,question mark, right?
(06:54):
That's one way that these phonesare able to do that.
And again, those accelerometers and gyroscopes are actually very
accurate. But I think what most people
kind of start to gravitate towards when we start talking
about like, oh, the phone can dofancy things is the camera,
right? And of course, this is what most
people make fun of iPhone 4 is like.
(07:16):
They'll create a new iPhone and throw an extra camera on there.
And they're like, oh, the camerajust got a hair better.
But really, these cameras are pretty darn good, right?
They're getting pretty close to just like the same like digital
camera, like expensive thing. You'd get it like Best Buy.
And let me tell you, the space on the phone camera is like a
lot better than the space like of our, for example, our podcast
(07:37):
camera, because that has like the amount of gigabytes that it
takes up. The compression on the phone is
so much better. Yeah, for sure.
All right. So these cameras are very high
quality in your phone, even though we drop our phones all
the time. But another key aspect of the
camera is how it samples like sohow many frames it's actually
(07:59):
taking in a video. And this is what makes those
really expensive setups very important because when the
computer or when you are analyzing movement, you're
analyzing it by frame, right? So the more frames that you
have, the better you are at capturing the motion.
(08:19):
And most of these like expensive, like 10 camera system
and like biomechanical studies, they film at what?
At a frequency of 240 Hertz. So that's basically 240 frames
per second. That's a lot.
That's a lot you want to know. It's crazy.
Your slow motion camera on your phone samples at 240 Hertz.
(08:42):
Well, that's sounds perfect. It's literally the equivalent of
what these biomechanical studiessample at, so you have that
literally in your pocket. OK, sweet.
At all times so. How do we use it?
Exactly. So how come, how does this, how
does this even translate to my practice?
Well, like we alluded to, you could do range of motion testing
(09:03):
and there are Goniometer apps. Literally you can like go into
an App Store and type in Goniometer and you're going to
get like 5 of them. So I've used the level as a
goniometer, the level on the iPhone OK.
Which I think, yeah, I think that's a valid way.
Which I have found it has. It helps if you are starting at
(09:30):
something that's like 90 or 0. But anything that like for
example I was trying to use it for hamstring return to play and
hamstring range of motion tests and I was trying to do one that
it's called the MH fake. I don't know how to say it, but
yeah, maximal hip flexion, active knee extension, I call it
(09:53):
the MH fake. I don't know how to, but you
bring their knee all the way into their chest and then you
have them extend their knee. Sorry.
Yeah. Bring their knee all the way to
the chest. Yep.
And so they're in maximal hip flexion.
And I found that it was like putting the the level app on
(10:13):
their shin and measuring that. I found that it was a lot harder
to like subtract the numbers rather than the active knee
extension test that I was doing where we started of a hip
flexion at 90° and had them kneeextend.
And so just like that, that mathwas like a lot easier than the
(10:35):
the math that didn't start like at a 0 or 90.
So I'm sure a goniometer app would be a lot better than that.
Yeah, 'cause I would say I've used it.
The app that I use doesn't isn'tsupported anymore.
Like I don't know what happened.It was really actually pretty
simple to use it really bummed out.
But yeah, it was a lot easier. Like it literally acted like a
goniometer. You'd put it on the the movement
(10:57):
part that you're trying to do and get your joint angle right
through that way. So yeah, there are plenty of
goniometer apps that you can look at.
Another one, a lot of kind of apps are geared towards like bio
mechanics. So there's a lot of different
ones that measure certain bio mechanics.
One thing that's really becomingcommon and not necessarily the
(11:19):
center of this of this episode, is markerless motion capture.
Oh, that's really cool. Yeah.
So like anytime we think of bio mechanics, most people commonly
think of, oh, the markers, right, the dots on people,
right, all that is, is really for the cameras to pick up that
joint's movement, right? That's all those markers are
(11:41):
for. But again, what that requires is
you basically film and you tell the computer this is what this
marker means, and then it just tracks it.
Markerless motion capture is basically artificial
intelligence looks at the video and the image and is able to
say, oh, that's a shoulder, and now I'm going to watch that
shoulder as it moves. Oh, that's cool.
(12:04):
There are applications that do that.
Crazy, right? There's also another app
specifically, and again, I'm not, we're not trying to
advertise for certain apps. This is just one that I've used
in the past and it, it is validated, they actually did
study on this particular app is Runmatic.
I mean, it's really geared towards actually looking at
(12:24):
someone's like gait mechanics for running.
So it can like calculate like stiffness and like flight time
and all that stuff, right? Specific towards kind of running
gait. And so it's called Runmatic.
I've used that one in the past. That one's pretty cool.
I got to check that out. Yeah, it's it's actually pretty
dope. It's actually pretty intuitive.
(12:46):
Another aspect that I don't think a lot of people think
about is it could be used for strength testing, not all
strength testing. There's actually one app in
particular that looks at hamstring strength, and it
basically calculates hamstring eccentric strength using the
Nordic hamstring curl. How?
(13:07):
We will talk about a little bit more, so it might be redundant,
but what it does is you basically film them doing the
Nordic hamstring curl and basically the air like the angle
at which point like they can't hold it anymore and they fail.
Based on that break point angle,it goes through an equation to
estimate their eccentric strength.
Interesting. I know it's pretty cool.
(13:27):
I've used that one before. Do you feel like it was user
friendly? Yes.
That's another thing about like using apps is I feel like
sometimes there are so many things at our fingertips, we
just don't necessarily know how to use them.
And we if we don't know how to use them like it's hard to
implement. For sure.
(13:48):
So the nice thing with these apps especially like the Run
Matic and this Nordic Hamstring curl 1 and then the next one I'm
going to talk about, it's very user friendly.
Like the, again, the problem with like a lot of video
analysis is not capturing the video, but processing the
videos. So you actually have to like,
(14:10):
oh, I have to identify this bodypart and make sure this looked
good and like stuff like that. These apps pretty much take most
of that out. The only processing that you
really have to do for like the Nordic hamstring curl is label
which one's the ankle joint? Where's the knee joint?
Where's the hip joint? Because it has to create that
angle. That's it.
(14:31):
And then the computer or the application does the rest,
right? Or like for the runmatic, right,
you have to define in your videowhen does the foot hit the
ground and when does the foot leave the ground, right?
So still some processing has to be done.
I think in the future, right, more of these apps will use AI
(14:52):
to do that. So then literally it's you
pointing a video, recording it, and then it'll analyze it for
you. Probably real time too.
Probably real. And actually, yeah, there is an
app that has looked at, that's funny you brought that up there.
There is an app that has looked at velocity training and like
actually able to do it in real time.
(15:13):
So you like say you're doing a bench press and this is what the
study did. They did bench press and they
had the camera watching the bench press and the camera's
able to determine the velocity and actually let you know real
time how your velocity's doing, if there's any change in
velocity throughout the workout.And crazy.
But yeah, I think over time it'll be real time stuff.
(15:35):
And then another one that's kindof been looked at is like for
power, and in particular vertical jump performance.
So there is an app that can actually tell you what your
vertical jump would be and how much power you're doing just by
videoing the actual jump. Again, there's the processing
part where you literally just have to go in and be like,
that's when their foot left the ground, that's when it came back
(15:57):
on the ground, right? So still an element of
processing, but when you look atwhat those high quality 10
camera systems have to do, this is very simple.
Yeah, I mean, you're not solvingany problems with this, you're
just using it as a part of your.Clinical Tool.
(16:18):
Exactly. Yeah.
So now that you kind of have an idea of what apps are out there,
what they can kind of do, do they even work right?
Should we even, like, do I bother, even like getting this
app and bother pulling out my phone for this stuff?
And actually what's crazy is theevidence behind it, it's very
solid, right? A lot of these apps perform very
(16:39):
identical to the gold standard methods of whatever method
they're kind of looking at. That's really nice.
Yeah. So like for goniometers, it's
like comparing to an inclinometer or an actual
universal. So that's actually why I started
doing it was because I was goingto have a lot of our like
students and other athletic trainers measuring all these
hamstrings. And so I was just trying to
(17:01):
figure out in a more objective way.
And I figured what would be moreobjective than like a phone like
measuring. But again, then I found it's
like your starting point. So as long as you're like
cognizant of some of these like confounding factors, I think you
(17:24):
can manage them. Yeah, and I think the nice thing
with like, OK, now let's look atlike the goniometers is like
especially goniometer in like range of motion.
Like I feel like it's like I'm not a hot topic, but I feel like
it's one of those things where like we're constantly told as a
profession, especially like students who are getting ready
(17:44):
to transition to practice that like, oh, you, you need to use
the goniometer like objective data, objective data in your
practice, which it is very important, right?
But like a goniometer can be time consuming.
It can be so time consuming and it's because, sorry to interrupt
you, but again, like I think thephone is just a lot faster.
(18:06):
You just put it on their shin and then they extend their knee
and you just look at the number like.
Yeah. Whereas like the goniometer, you
have to like make sure you line up the axis of rotation, like
make sure the access is where itshould be right, Make sure the
stationary arm is lined up correctly and then you make sure
the movement arm's lined up correctly and then do the motion
right, right. So it's like, yes, theoretically
(18:29):
that doesn't take that much time.
Like like I, I heard someone onetime brought up like, Oh,
everyone should be doing it. It only takes a few seconds to
do it. I'm like, that was coming from
like someone who's more like research based.
Like, yes, you probably do it all the time, but like in the
clinic when you have 50 people waiting for you, right, right.
Those few seconds are going to add up.
(18:51):
And then of course, when we eval, you should be getting
multiple like areas evaluated, right.
So now I'm going to take a few seconds on like knee range of
motion, then ankle range of motion, then hip range of motion
for a knee eval, right, right, because all those could
influence the knee. All right, so I, I think there
(19:11):
needs to be a more efficient wayand here's the possibility right
again, using the phone, it's a lot easier to set up boom.
And they've actually been shown when compared to universal
goniometer. So everyone's favorite like
circle and thing with wings and inclinometer, it's very valid
and reliable and they're actually within 5° of each other
(19:32):
for most studies, right? Some are even less nice, right?
So again, when you think about agoniometer, I think this error
for goniometers about 3°, that'snot bad to be that within each
other. And this has been validated for
the spine. So like cervical, thoracic and
even lumbar, the hip, ankle, wrist, elbow, shoulder, it's all
(19:55):
been validated to actually get those ranges, ranges of motion,
right. So that's pretty huge.
And so that's something again, as we talked about like, oh, as
a professional, we need more objective data.
Hey, here's a way that we can kind of make it a little more
accessible and a little bit easier.
Right, that's what it sounds like.
Right. My thing with it, though, is
like putting my phone on like other people's bodies.
(20:20):
That's just. You know, I actually never
thought I'm movie because I'm putting it on their shin.
Yeah, I like never really thought about that.
But I've, I've kind of thought of some ways around it, like
just put your phone in a bag. I don't know, I don't know, I
get kind of weird about it 'cause I'm like, oh, now it's
going to be touching all these people.
You. Could just put a towel on them
and then that's true. Put the phone right on the
(20:42):
towel. Good point.
I feel like your phone is actually pretty dirty anyway.
I know, but it's just weird to think of like I'm just touching
it on all these people. But yeah, that's a good point.
The towels it I never thought I was actually going to start
putting in a bag and like towelseasier.
I don't think you have to be tooextra.
Yeah, that's true. So now looking at more like the
(21:05):
bio mechanics stuff, and I thinkthis is the really cool part,
right? Because when we talk about like
everyone wishes they could do like a biomechanical analysis on
someone and have like all 3D andall that fun stuff, but again,
expensive, inaccessible, all that fun stuff, right?
So actually having an app that might be able to do that would
be really, really cool. I think a lot of people would
(21:26):
really buy in on that. So for the running specific one,
right, that run Manic app that Iwas kind of talking about,
again, it was found reliable andvalid when compared to like an
instrumented treadmill. So a treadmill that again,
analyzes flight time like forcesand stuff like that.
And the results actually showed a very close relationship.
Like they were fairly identical for the markerless motion
(21:49):
capture. The the, the article that I saw
on this and there's more stuff coming out on markerless motion
capture, but there actually was a high correlation between a 2D
image, right? So like the actual application
filming and 3D motion capture. That's crazy.
(22:11):
Just with a regular video. Just the same, yeah, same
regular video. I think it was not necessarily
regular like the slow motion. Video.
So you needed that 240 OK framesper second, but same same
result. Very similar results as 3D
motion capture. The crazy part about this is it
(22:34):
was able to estimate the sagittal plane motion very
similarly to a 3D motion capture, with the camera only
filming in the frontal plane. I don't know.
One view is no view. I know, but it was able to get
similar results. That's really good.
Or like fairly close, fairly close, again within about 5°.
(22:57):
That's crazy. And I think one of the things
there is it really shows you thepower of AI and what it can do,
because that's how it basically estimated what those angles
would be. It did have like the ankle like
angle progression was a little bit more variable, but for the
(23:18):
most part hip knee looked pretty.
Good. Sure, both important joints.
Absolutely. And there's some other stuff,
again, not this isn't really geared towards markerless motion
capture, but there's also some stuff I think Stanford has like
an open one that you can do. I think it's open cap, I think
it's called that. Literally all you need are two
(23:40):
video angles and you can like get it analyzed through this
thing for free and it'll do all that for you just from 2 angles.
So even that is still more accessible than the whole 10
camera. Deal.
So kind of shifting away from like the actual bio mechanics.
Now going into, again, the strength, we already kind of
(24:04):
alluded to it, but using that Nordic hamstring curl app, it
actually is valid compared to isokinetic testing to quantify
eccentric hamstring strength. So again, that's really cool
considering like most time gold standard for strength is
isokinetic testing. You have an app that all you
(24:25):
have to do is film someone doinga Nordic hamstring curl, hit a
couple buttons and now you can quantify.
Here's what their hamstring strength is.
See, if you tell me the day thatI can use my phone as a a muscle
dynamometer that is would be cool.
Yeah, at basically you can rightthere.
(24:45):
Of course, the limitation is theNordic hamstring.
Coral is a bilateral exercise. So you're basically quantifying
the strength, the total strengthof both hamstrings.
So all you're telling me is we need to be have the our athletes
be doing single leg Nordic hamstring coral?
So what's crazy is in this app there actually is a way I think
it can test single leg. So then you can then quantify
(25:09):
each leg. Can you even do a single leg?
That's what I said. I was like, that's cool, but I
don't think any of my kids wouldbe able to do.
That like. I'm pretty sure they'd pop their
hamstring. Before I'm pretty sure I would
pop mine watching them do it right.
So it is possible, but the app initially was for bilateral.
That's funny. But it still does kind of tell
(25:30):
you information, at least anything it could help with
progress. But yeah, I thought that was
very interesting that it actually again could quantify
eccentric strength similar to what an isoconnect machine could
do. And then finally, power.
(25:50):
And I think power, this one's a really good one, especially
because as we start looking at return to play testing, right,
we have hop testing and all thatstuff, but single leg vertical
jump has been shown to be reallycrucial at looking at quad
strength and ACL return to play.So again, that's kind of hard to
do. Like you need like a Vertec to
(26:10):
do that And like who who remembers even how to like
calculate jump height from that?Or you use a jump map but that
costs like 700 bucks like or a force plate which is just you
might as well mortgage your house.
Not accessible. Not accessible, right?
So now you have an app that's like cost like 17 bucks, 18
(26:31):
bucks that can film, and you canactually quantify someone's
power and their jump height justfrom a video recording.
So the question is, is is it a subscription?
So the app itself is not, at least when I got these apps.
I haven't done the Jump 1 yet. I want to so I'm excited to
(26:53):
actually try to get that one. But like the hamstring one, the
running one, it was a one time purchase.
I believe the maker of this app is they do have like a newer set
called like I think it's like the My Jump Lab or whatever that
has like all these apps all in one.
(27:13):
I think that one's a subscription because it's using
more AI, but I think. See, that's, that's another
limitation that we run into withall these like these technology
because before like you get rehab equipment, you buy it and
then it's, yeah. Whereas now like we're just
running into like, oh, you want to use this technology, It's a
subscription. You want to use this, it's a,
(27:34):
it's a subscription. And like, you're not necessarily
going to use, if you like, you want this big toolbox, right?
And you're not going to necessarily use every single
part of your toolbox every single day for sure.
So and you're not going to it's,it's just a little bit more
fluid, I would say when you're using these things and it's hard
(27:57):
when there's a subscription because like those things are
just going to keep adding up. Yeah, no, for sure.
So yeah, to my my experience, the ones that I have were not
subscription based literally onetime purchase and you have
access to the whole thing. But yeah, so the actual jumping
one, which again I think is my jump, I think it's called the
(28:21):
one that I've seen and the one that has been kind of analyzed
in the literature. Basically what it does is you
film them jump and you you basically tell the application,
here's when the foot left the ground and here's when it came
back. And through that it uses an
equation to determine, oh, here's how much power they used,
(28:42):
here's what their jump height was, stuff like that.
And again, this has been valid and reliable compared to a jump
mat or a force plate. Like the relationship between
the two was very close. Like we're talking like if you
remember from your stats class, like your correlation statistic
is the R statistic. It was like an R of like .9.
(29:03):
Like that's a darn near perfect relationship, right?
So like is it? Supposed to be close to 1.
Yeah, one would indicate perfect.
So these are like near perfect relationships that we're talking
about for across a lot of these apps.
That's really good. It's crazy to think just how
powerful just our phones are. Of course, the apps doing the
(29:25):
calculation like the this isn't a coding thing.
Chat chat. Actually, we'll probably know
the coding. I'm.
Sure, but that's basically what's happening, right?
The coding and the equations, what giving us the number, but
literally it's just, it's makingtechnology that seemed like holy
smokes, it's expensive, it's time consuming, just at our
(29:48):
fingertips. And it's really cool to see some
tips to actually like, how can Iactually use these apps?
Because it's not it's it's not as easy as just like point and
shoot, right? One of the biggest thing is if
it's a video thing, right? If you're like recording
something, make sure the camera's on a stable surface,
right? Like make sure it's on a tripod
(30:08):
or like make sure it's really locked in between like books or
something. Like something that's going to
keep it stable. Because if there's any movement
on the camera, it's going to affect the quality of the video.
And now your data is going to beaffected because the video
doesn't look great, right? So you get what you put in,
right? So make sure that you're on a
(30:30):
stable surface and it can actually like record stable and
just try and be consistent with that, right?
Don't try and hold the camera while you're doing it and that's
not going to work or have like atripod or something.
Most of these apps still kind ofneed some processing.
Like I said, like the Nordic hamstring one, right?
(30:51):
You actually have to go in like after the video and like let the
app know this is where their ankle joint is, this is where
their knee is, this is where their hip is.
So it knows how to measure. But again when you compare to
like what those 3D like assessments need like that
processing is way easier than the 3D models.
(31:12):
Well, also what I was going to say is like if I'm going to run
a functional test on someone in person, I still have to
calculate their differences by hand.
Yeah. So if even if this app needs
some sort of processing, it needs my hands on something,
it's going to be my hands on something that's a little bit
less than me doing it. Yes, by myself in person.
(31:34):
For sure, for sure. All right.
So I think over time, as AI continues to get better and more
integrated in into our practicesand our lives, I think AI will
remedy this. And we already see it with the
markerless motion, right? It's able to identify here's
what a shoulder is and here's how the shoulder moves with
these kind of movements. So I think Mai will remedy that
(31:56):
in the future. So hopefully it literally will
just be, oh, I just filmed it and here are my numbers.
So I think it'll get there. The last one that I like is more
of like a a thought that I had is like how does HIPAA play into
this? Absolutely.
Right. And like most of these apps, you
really don't need the patient's face, right?
So you could really just not film the face or just like crop
(32:18):
it out before you upload the video into like the application.
But like, so I would have reallyjust avoid filming the face of
your patient. And like I said, you can even
crop that out before you becauselike a lot of them are literally
looking at lower extremity and you just need to calculate, oh,
when the foot touched the ground, right?
We don't need to see people's face for that.
(32:40):
I mean, even if you did need to see their face, technically you
could record anyone's gait, you could record anyone's jump
height, you could record any, anyone's of these.
Like, it's not like it's you're putting into a system like, oh,
I'm looking for this injury and this is what happened.
(33:00):
And here's all the details. Exactly.
Yeah, yeah. Definitely some good
considerations. Yeah, for sure.
So I think it is all like a lot of this is all very accessible.
It's just feeling comfortable enough to purchase the app and
then trying to implement in yourpractice.
And I think you could just startsmall and like start using it on
(33:22):
like someone's return to play. What are some apps that you like
to use action item? So I've used the Runmatic one.
I used the Nordic Hamstring Curl1.
I really liked those. I used the Nordic Hamstring Curl
1A little bit more and it reallyeasy to do.
(33:44):
It doesn't take long to actuallytest somebody.
And then like I said, my goniometer one went away.
I liked that one and I think it was Goniometer Pro.
That's gone. That's a bummer.
I know it makes me sad but I am working on getting the my jump
one for doing jump height and power so that one I'm excited
(34:07):
for. There's also like some postural
control apps out there that you can, they like put a grid up so
you can like see. Posture Eval.
Yeah, for posture eval, you can also, I mean your standard
staples like sway concussion or or sway medical that we use like
(34:28):
for concussion. Yeah.
Or what's the other one I'm thinking of?
I mean we didn't even talk aboutanatomy apps.
Yeah, anatomy apps are super helpful and you can like.
Educating patients. Exactly this is what your.
Sartorius looks like. I mean technically Blaze pods
(34:52):
has an app. Oh yeah.
Yeah, a lot of blaze pods is technology.
Yeah, a lot of those, like you said, kind of subscription
things are like some of these rehab tools, right?
They have their app associated with it that you can monitor,
like you said. Yeah, the blaze pods 'cause
right, It can tell you the time.You can set.
You can, yeah. You can set.
Like if there's like, let's say I'm working with someone on
(35:16):
impulse control, like I can havelike only two colors, like red
and blue. And then I'll tell them like
only hit the red ones. And then I can see the reaction
time as they're doing it and I can see how many times they
missed. I can see how many times they
hit. Like, that's cool.
Yeah, I mean, shoot, even Norma Text now have an app.
(35:36):
Yeah, everything has. For for like their the recovery
and stuff. I'm like dude like you said
everything has an app. Yeah, but I think mostly I use
the level sway and blaze pods. Nice, I want blaze pods.
They're pretty cool. I I've heard.
We are not affiliated with them.So our true opinion, actually
(36:01):
everything we share is our true opinion for advertising, so.
For sure. So blaze pods, if you're
listening, I do want, I do want a pair or a set.
What a What's your action item for this?
I would say these are all very accessible apps and I think go
(36:22):
ahead and start small and just try one, right?
It even if you're like, I don't want to pay $18.00 for an app,
get a goniometer app, all right,like try that and like again,
like be able to apply. And now you can see how, wow,
it's easy for me to get objective data instead of
feeling the pressure if I have to pull out this whole thing and
like line things up and God, this takes forever and then next
(36:43):
thing you know, the goniometer goes flying.
Has that happened before? No.
In your head, not for me. I'm sure there's a lot of people
that have wanted to destroy thatthing.
So like we said before, this is ACEO episode.
So if you're interested, head toclinically pressed website down
(37:04):
in the show notes below. So you can take the quiz and
course evaluation for your certificate.
If you want to look at the references for this webs for
this, it's on our website. So Randy's going to put those up
there. If you guys are new, we do every
episode as either CE, US, Education episodes like this
(37:24):
where we where Randy reads a lotand then we kind of take it into
a conversational format. We also have interview episodes
and then we also have story episodes where we take stories
from real life athletic trainersacross various topics all around
the world and we bring them together to hear other people's
experiences. This is a reporting year, so
(37:48):
make sure you check out all of our CU opportunities down below
in the show notes, like I said before, and Medbridge, if you'd
like a subscription, Speaking oftechnology, they have on demand
C us and it is a subscription. So you're good for a year, which
is great because you have this cycle that you can start doing C
US for and then next cycle you can start doing C us for under
(38:10):
the same subscription. So you can use just code 80
corner for $101.00 off dope. So other than that.
Thank you for helping us showcase athletic training
behind the tape. Bye.
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