August 20, 2025 • 55 mins
What if your knee pain could be managed—not with drugs or surgery—but with intelligent vibration timed to your movement?
In this episode of The Aging Well Podcast, Dr. Jeff Armstrong speaks Dr. Tom Andriacchi, Emeritus Professor at Stanford University and Jenny Erhart-Hledik, co-inventors of KneeMo®. Backed by decades of research, KneeMo® is a wearable smart device that uses motion-sensing technology to relieve pain and support muscle function during activity. We explore the science behind this innovation, how it may transform mobility for aging adults, and what it means for long-term joint health and independence.Whether you’re an athlete, a physical therapy patient, or simply trying to move pain-free, this conversation offers practical and forward-looking insight into how we can keep aging—and moving—well.
Learn more about KneeMo®: https://thekneemo.com/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
For millions of adults, knee pain isn't just a nuisance, it's
a barrier to independence, vitality, and long term health.
Welcome to the Aging Well podcast where we explore the
science, stories and strategies behind living a longer,
healthier and more purposeful life.
I'm your host, Doctor Jeff Armstrong.
I am joined by Doctor Tom Andorracci, Emeritus Professor
(00:24):
at Stanford University, and Jenny Earhart Helladic, the Co
inventors of Nemo, a groundbreaking wearable device
developed from cutting edge bio mechanics research.
Nemo uses intelligent motion sensing and precisely timed
vibration to reduce pain and improve muscle function,
offering a promising alternativeto drugs or surgery for those
(00:46):
looking to stay active. We'll explore the science behind
movement pain modulation and howthis technology could help more
people keep moving and keep aging well.
Jenny and Tom, welcome to the Aging Well podcast.
It's my pleasure to have you both on here to talk about your
(01:07):
Nemo product today and the science behind it.
But let's just kind of first start by having you introduce
yourselves and tell us a little bit about how you kind of came
to doing this type of research. So I'm professor of mechanical
engineering and former professorretired from Stanford and so I'm
now emeritus professor in mechanical engineering.
(01:30):
But I've spent my whole career studying the mechanics of
walking and how it affects the health of the body and, and
specifically health of the knee joint and hip joint and how
painful knees experience walkingchanges that can impact the
clinical outcome of a certain procedure.
(01:51):
So published a couple 100 paperson the topic.
So I feel you know a little bit about it right now.
So Jenny is graduated from Stanford and I'll let her now
give a little background on whatshe does.
Yeah, so Tom and I originally met when I went to Stanford to
(02:12):
do a pH D in his lab, actually. So I was very interested in
biomechanical engineering and was a big name in that field.
And I was actually really lucky.My PhD project was a shoe for
me, osteoarthritis, and it was aclinical trial.
And so I got to see that whole evolution from an idea in the
lab to a product that eventuallywas sold to the public.
(02:36):
And so it was really great to see how something that comes out
of research and understanding walking mechanics and how
loading at the knee can impact joint disease can actually be
taken just from an idea to a physical product.
After I did my PhD, I stayed at Stanford for a lot of years
(02:56):
doing research as an instructor and a research associate and
then eventually Nemo, which is then a 10 year journey.
Our product came out of that research.
It became a startup company and we finally eventually launched a
product which we're really excited about, but it was
(03:17):
another one of those research concepts that then took many
years to actually become a physical product that we had
available. Yeah, it's amazing how many
years it takes for these great ideas to actually come to life.
So. Yes, more than you think and
more than we want, I'm sure, Butit does take a long time.
And I think as academics you canhave great ideas, but it's a
(03:40):
whole different process to then actually make that into our
reality. And we've experienced all, all
the ups and downs that came withthat.
And. Yeah, I always tell my students
perseverance is a key to success.
You know, if you think you have a good idea, stick with it and
it will come to fruition. So what inspired the development
(04:00):
of Nemo and how did the concept evolve from research to a real
world application? Yeah, maybe I'll start with that
question. As I mentioned, I have studied
the Milwaukee mechanics of people with knee pain starting
in the mid 1970s. So it goes back a ways.
(04:21):
And I was able because when I finished my PHDI decided to take
a postdoctoral fellowship and I was embedded in an orthopedic
department for you know, I thought it was going to be 3
years. I stayed there 20 years because
the work was so fascinating. And what I found was that
walking was a critical factor inthe way orthopedic procedures,
(04:47):
the success of orthopedic procedures came about.
In particular, it was the mechanics of how the joint got
loaded and how it moved that wasimportant.
And what that meant was that we needed a better understanding of
walking mechanics related to clinical outcome.
So being in an orthopedic department, I had the facility
(05:12):
of a laboratory where I could measure not just how it looked
when people walk, but the forcesthat took place when people
walked. Now you can't see a force, so
you need a laboratory to pick upthat information.
And but I had it and I could start studying patients early on
that were being treated with various types of treatment,
(05:34):
including medication, analgesicsand anti inflammatories for
osteoarthritis, joint injections, braces of a variety
of kind types and even total joint replacement.
So I've studied all of those before and after the treatment.
Certain things emerged out of that.
(05:54):
And it took a while to 20 to 50 years to to find some of the
things that came out of that. But one of them was that walking
with pain, some people adapt to the pain one way and others
adapt another way. And there was what we call a
good adaptation to the pain and a not so good adaptation to the
(06:18):
pain. And that meant that if we tested
a patient say this year and we followed that patient say for
six years with a certain treatment for arthritis, if the
patient had adapted a good walking pattern and that meant
using their quadriceps properly and kind of dynamically
realigning in the joint when they walk, they did quite well
(06:41):
with a procedure for osteoarthritis.
In fact, in many cases the patients that we followed with
no treatment that but had the right walking pattern, the
disease, if they had early stageosteoarthritis, it progressed
slowly and they didn't need a joint replacement.
The opposite happened for patients where The Walking
(07:02):
pattern wasn't quite what we hadhoped for, or they should have,
and that those patients progressed more rapidly or they
didn't respond well to treatment.
So the key was to identify thosefeatures of walking.
There's a lot of things you can measure in walking, how the knee
moves, the forces, the differentwhen they're called, moments
(07:25):
that act at the joint, which is a mechanical equivalent of a
force. And what we found was there were
certain characteristics that were common to almost any
condition that was associated with knee pain.
And one of them was the inhibition to use the quadriceps
muscle. And clinically, what happens in
those patients is that muscle atrophies and they develop a
(07:48):
gait which is not good in the long term.
And it's what we would call the stiff knee gait.
And so during the support phase of walking, the knee would stay
straighter than normal. And you can walk that way and
use very little quadriceps muscle because the quadriceps
muscle, which is the largest muscle on the front of the knee,
(08:10):
is the one that would balance the knee when it flexed a little
bit during what weight bearing. So they didn't use that.
They had a reduced range of emotion as well.
And there are a few few other mechanical factors, but those
were two that were striking. So then over the years we kept
saying, well, can we find a way to get those people to walk, you
(08:33):
know, better and walk in a way that helps them and reduces
their pain? So we tried a lot of things and
you know, we tried the shoe which actually worked pretty
well. Like Jenny mentioned that that
realigns the knee like for example, if the car is out of
alignment, that shoe will help the dynamic alignment of the
(08:54):
knee to straighten out. That worked OK, but it didn't
really help too much with the quadriceps function, which is
something else that we wanted toto allow.
So we tried some things like gait retraining and teaching
them to block slightly differently.
That worked OK, but it requires some compliance and, and a level
(09:17):
of staying sticking with it, youknow, over after the training.
So that that didn't last. So we said, well, we can we do
something that we can just put on the knee and it does all the
work. It does the thinking and it does
the the IT provides the stimulusto change the gait.
(09:38):
And that's what led to Nemo. The name Nemo means knee in
motion. So we don't call Nemo a brace,
we call it a mobilizer because it helps reduce pain while
walking and it enhances quadriceps function.
And we could pick that up not just by asking people.
Did it feel better when you usedit?
(09:58):
Because there's a placebo effectthat happens when you give any
intervention. We did it in the laboratory
where we're actually measuring directly quadriceps metrics that
they told us they were using their quadriceps.
One of them was Emgs and, and sobased on that and then we did a
clinical study that was actuallymore rigorous where we had a, a
(10:24):
device that didn't provide the same activation as our device.
And what I think now I'm going to turn this over to Jenny, let
her describe the clinical because she was very involved in
that study, so. Yeah, maybe.
First of all, so just describe Nemo a bit more.
So Nemo, it's really slim design.
(10:45):
So it's 2 motion sensing bands. You put one above your knee, you
put one below your knee. As Tom said, we wanted to
develop something when we're doing this that would do the
thinking for you. So you didn't have to physically
think like, OK, now I need to activate my quadriceps because
it can be difficult, right? If for people to think that on
every single step to remind themselves.
(11:05):
And so Nemo senses your motion as you're moving and then
processes the data in real time through an algorithm so that it
applies intermittent vibration that synced to every step.
For example, if you're walking, so it's turning on right before
heel strike, turning off at mid stance, and then it'll catch
your next step. So if you're speeding up or
slowing down or if you're jogging, cycling, it's going to
(11:27):
adapt in real time to hit every step or every pedal stroke that
you're doing. And as we were developing it as
researchers, it was really important for us that we made
sure that we had the, the clinical studies behind it.
So we did first an initial studyto show what happens just in a
single time use. And so we looked at patients who
(11:49):
have knee pain, but knee pain due to those conditions that we
know reduced quadriceps. So KCL tears, unfortunately,
even if you have it repaired right, you're going to have
reduced quadriceps function, meniscus injuries and then knee
osteoarthritis. So conditions that affect a
large number of people, we had them wear Nemo just in our
(12:09):
motion capture lab. So the lab that's equipped to
study how people walk in the labhad them not wear Nemo and did a
test in the lab and then they put it on and we saw an
immediate improvement in their quadriceps muscles function.
So significant increase in our individuals and those who had
the worst quadriceps function atthe start had the best
(12:32):
improvement, which was great forus.
And so 95% of people responded immediately in that single
testing session. And then we went on and did a
longitudinal randomized crossover study.
So as Tom mentioned, we had themeither were Nemo for four weeks
or just off the shelf compression knee bands.
They're kind of that you buy offthe Amazon, right, for knee
(12:53):
pain. They wore both of them for four
weeks and had a washout period of two weeks in between.
And we saw with Nemo significantimprovements in pain when they
were walking and also going up and down stairs.
We didn't see it with the control device.
And then also when wearing Nemo,they had significant
improvements again after wearingit for four weeks.
And their quadriceps muscle function, better activation
(13:15):
going upstairs and quadriceps muscles.
And then when they were going downstairs, better control of
their movement, right, better appropriate reception.
So after we did those studies, that's what really motivated us
to say like, OK, this really does work.
It was a great idea. And we, we wanted to make sure
it actually worked in the way that we wanted it to.
And that's when at that point we, we said, OK, we have
(13:36):
something here and let's see if we can take this from the lab
and a device that works great inthe lab to something that'll
work in everyone's life every single day, whether wherever
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(13:59):
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viewers and listeners. Thank you.
And now back to the podcast. So a big part of this is the
vibration pain relief. And I find that fascinating
(14:20):
because I kind of stumbled on tothat when I was teaching at
college and I had rotator cuff surgery.
This this is probably pushing almost 20 years ago and kind of
in my post rehab and I did all my own rehab, which my physical
therapy, pre physical therapy students are like, why you not
going to physical therapist is like, I'm teaching you.
What do I need to pay somebody and have the inconvenience of
(14:41):
going to lab? But we had our basketball team
had been gifted with a whole body vibration platform and the
coach didn't know what to do with it.
He kind of turned it over to me and say, Hey, if you got some
research you can do with it. And so I was just playing within
a lot of different things. But what I would do prior to
going into a lifting workout is I would just kind of hold my arm
in varying positions and just let the vibration happen.
(15:02):
And it actually deadened the paint.
I can go in and lift without paying for that workout.
Can you kind of explain for our listeners, interviewers a bit
more the biomechanical principles behind Nemo's
vibration based pain relief? Yeah.
So similar to what you said. So Nemo, this is something a
neurological principle called gate control theory of pain.
(15:23):
So what that means is our body takes in inputs like vibration,
but also pressure and temperature.
And it, it senses those with larger, faster nerve fibers than
the pain signals travel which those travel along smaller,
slower nerve fibers. So I like to, when I'm kind of
explaining it, think of it as like a road where you suddenly
(15:45):
kind of bring 2 roads together. And so the, the vibrations that
is going faster is going to reach that section where they
meet quicker than the pain signal.
So if you can flood it with vibration, which feels good,
Nemo, it feels good when you're wearing it and the vibration
feels nice. That paint, that signal is going
to reach your brain faster than the pain signal and reduce some
(16:07):
the amount of pain that reaches your brain.
And we know from research that when you have knee pain, you
also have reduced quadriceps muscles function.
There's research studies that induce pain and then show
there's a reduction in in quadriceps muscle function.
So by doing that, that also allows people to better engage
quadriceps when you do that. So it has a kind of dual
(16:30):
mechanism there where you're reducing pain, which helps
people while they're walking. And Nemo does this while you're
walking, right? You have to be moving to have
the vibration activate or running or cycling, whatever you
want to do. And then at the same time, it
allows you to better engage those muscles that are so
important for joint stability and joint support and also
(16:51):
related to to out treatment outcomes and joint progression,
disease progression of atmosphere arthritis.
So fascinating concept and it's amazing that nobody came up with
it sooner. So it was it.
Only took us 10 years. It only took us. 10 years.
Well, technically it took you 50years, you said, right?
Yeah, right. Yeah, because, you know, it's
(17:14):
kind of nuanced, but inside the device is a microprocessor that
contains motion sensors, a Bluetooth communicator.
It communicates with a smart device like an iPhone.
So you can make settings that adjust to say you're going to go
jogging and moving faster. You'll it'll set some of the
(17:38):
metrics that control the sensingto set the vibration properly
for whatever your acting activities.
Now, the sensor will detect the rate that you're moving, but
sometimes we need to adjust the way it responds to that motion.
And so the other nice thing thatit does is it counts the number
(17:59):
of steps you do or the number ofmovement cycles and how long
you're using the device. So it gives feedback to the
user, but we also are making it available to healthcare
providers that are going to introduce it into their
practice. And they can get an idea of the
compliance of the patients. If there is, you know, if they
(18:19):
give it to the patient to say, you know, go walk, you know, for
an hour, do they really do that with the device?
And, you know, it's interesting,you know, I like to say it, it
does all the work. It, you know, you put it on, it
feels good and you walk better with it and that's all you have
to do. You don't have to learn any, you
(18:40):
know, feedback response to the device.
The device works through something called the
somatosensory system, which is the system that Jenny was
describing, describes the sensation of both mechanical
stimuli applied to the skin as well as pain.
The nerves are transmit pain. So when we did the clinical
(19:02):
trial, we asked the patients to use the device for at least one
hour per day when when they go out for a walk, when we came
back and I don't think we told them we could detect how much
they used it. And there were a few that didn't
use it as much as they said. But the average usage instead of
(19:22):
one hour was actually 3 hours because it felt good.
And so one of the barriers that we had overcome with this device
is compliance. I don't know if you've used some
of these other bulky kinds of knee braces or things that
people are you've probably seen them compliance.
Is it difficult because it's sometimes you got to strap it
(19:43):
on. It's got to be tight and it it
doesn't feel that good and it looks bulky.
This is a fairly sleek device that can be put Jenny, do you
have pick the device with you there that you.
Yeah, I actually, I was chargingI, I use mine on every run.
So I was actually charging mine.So it's currently in another
room. But, but no, and I think, you
(20:04):
know, we've done the research, we've done research on braces,
we've done research on a lot of different things and not
compliance is something that's always so difficult, right?
Even with things like physical therapy, it's, it's difficult
because you have to rely on people being motivated to do
either exercises at home or do the activity at home or to
(20:25):
consciously think. I've done a fair amount of work
in git retraining. It's difficult to to, for people
to think on every step that they're taking, like to how they
want to change the way that their knee is moving or their
foot is being placed on the ground.
So really when we set out to develop this, we were trying to
take that component out so we wouldn't have to rely so much on
(20:45):
people's will. I guess you want to call it to,
to do these things, but something that would be able to
still give them a benefit without them having to
consciously think about changingsomething with how they're
moving. So I mean, I think that's kind
of, and we also wanted it to be,we're going for some people who
are using it like they've tried all the different braces,
(21:06):
sometimes 2 at a time. And then if you actually want to
go be active, restricts motion. So that's not ideal either,
right? You want something that gives
you support but also doesn't hinder you from doing whatever
the activity. Is so I find this the motion
sensing technology pretty fascinating on money.
I got a couple questions that are on one.
You know, you talked about beingable to kind of track their
(21:26):
usage. Is that something has done more
kind of through like Wi-Fi whereyou have, where a practitioner
can actually get that information without having to
have the knee brace or have the patient present and download it
to where they can actually give feedback.
Or maybe there's even potential for a nap down the road where,
hey, we noticed that you only walked for, you know, 35 minutes
(21:48):
yesterday. Let's try and step that up.
Let's get in, you know, at least45 to an hour today and give
them that kind of feedback. Or is it something that they
again, they have to take it intotheir practitioner and there's a
downloading of the information and back.
And then the other common would be how does this vibration
technology personalize the vibration for each individual?
(22:10):
Is there like a system involved where it is kind of almost like
AI learning a bit more of their movements and and adapting
accordingly? I could keep that app.
I can take the app part. So we actually do have an app
right now. It's a totally free app right
now. And So what it does is you
connect your e-mail to it. And like Tom said, you can
(22:31):
choose different activities in there.
You can change actually the vibration intensity.
So what feels great to me might be slightly different than what
feels really good to you. And so you can play with that.
Or if you want to wear it over pants, for example, you might
want the vibration intensity a little higher.
But it's in the app where it's then counting your steps and how
much time you've been using it. And you can elect to send that
(22:52):
to someone if you'd like to. So that's a way that you could
send. There's how much I used it this
week. There's a lot of potential and
we don't have it integrated right now.
But what you were saying, right?Like trying to motivate people
here, you here's what you've done so far, like keep going.
Or we're collecting a ton of motion data as well, right?
(23:13):
Like it's using motion data. So eventually looking at using
that in some way as well throughour app to give even more
feedback to the healthcare providers on these specific
metrics, for example, on how people are walking.
And that's kind of where we envision it going, but we're not
there just yet. Tom, do you want to talk about
that algorithm and how? It yeah, yeah, yeah.
(23:35):
It's interesting that it has to work in real time, so it has to
take the motion that's sensed and within milliseconds know
what when the vibration should be applied.
And you know, the microprocessoris about the size of your the
tip of your thumb right now. It's it's, it's miniaturized, so
(23:57):
and it uses the motion sensing technology that's used in
drones. So it measures all what's called
6° of of motion. So it measures every possible
motion and accelerations. So it uses a combination of the
motion and the accelerations to detect the movement of that what
that patient is using at that time.
(24:19):
So if they walk fast, it will react faster.
And it had to be programmed intoa firmware, which is like
software that gets downloaded into the microprocessor at the
time during when it's manufactured.
It already has the smarts that was derived from our history of
(24:40):
studying gait analysis of the movement of the knee and the
accelerations and forces that take place.
It gathers all that data and in real time syncs the vibration to
that within a millisecond or less of when the stimulus should
take place. That microprocessor is more
(25:00):
powerful than the first computerthat my whole university had
that took the size of a room andmassive air conditioning to do
those calculations. And now it doesn't in real time.
So and it mentioned artificial intelligence that probably had
artificial intelligence before we knew it.
It was, you know, so it, it is using, we call it a smart device
(25:24):
because it has that intelligencebeing built into it to allow us
to do that. Not you don't sense something
and then a minute later you provide the stimulus.
It's got to be instant, almost instantaneous to the patient.
So that and, and we were able todo, you know, one of the reasons
we did so much testing over this10 year period was we wanted to
(25:47):
make sure it worked, you know, that it did what we thought it
was going to do. And actually it works so well
that when I retired, I said, we've got to get this out to the
public. So we, Jenny and I started a
business and we started developing the technology, but
taking it from the prototype that we developed in the
laboratory to something that we could manufacture at scale was,
(26:10):
I would say, challenging to say the least.
We had to go to a contract manufacturer that would first
understand our technology and then build it in and then we had
to test it. And then we got hit with, you
might recall a few years ago, the chip shortage.
There's fifty different microchips in that little device
(26:31):
that we put into the patient. Some of them weren't available
to us. And so, you know, when I
mentioned persevere perseveranceearlier, the company that was
going to do our manufacturing couldn't get all the chips we
needed. There was a market out there
that was selling the chips had amarked up price.
And I said, if I go out and buy those chips and give them to you
(26:53):
on consignment, will you build the product?
And he did. So we got it made much sooner
than we could have without taking those steps to get past
the the chip shortage. But and we did.
And now we have a product that we're so proud of that we want
to help a lot of people with this device.
And the testimonies have been astounding to us of people,
(27:16):
people using it. We have one person after total
knee replacement, he still had alot of pain and playing was that
the pain was not explainable andit turned out it was a nerve
issue that it looked like it was.
He tried everything, nerve blocks, different types of
braces and that we still had theprototype of Nemo.
(27:39):
He lived near us near Stanford. And so I knew him from for other
reasons and we said try this prototype and it helped him.
And so now he is our longest user of Nemo.
It's been several years now thathe uses it now every time he
wants to go out and take a walk because it takes the pain away
when he walks. So, yeah, we were so surprised
(28:00):
at work that we had to get it out, you know, to the public.
So it's a fun thing in research to to have an idea and take it
from, you know, they use a term in research from bed to from
bench to bedside. And that's kind of what we did
with this device. And for the listener who doesn't
really understand processing andthe amount of information that
(28:23):
has to be perceived and decisions made and in actions
initiated through a computer, I mean, it's amazing how the human
mind is able to do that, let alone know a computer.
And it seems like, you know, youreally just kind of hit the
right time and development that,you know, 10 years ago, 20 years
ago, this probably would not have been possible without the
(28:45):
processors that were available. To us, you could have carried
that big computer around. Yeah.
And I think as Tom mentioned, I mean, it's, it's very different
to design something that works in a lab where we can be hands
on and like troubleshoot something to then have to
develop something that's going to work seamlessly in someone's
home and also not require them to do anything when we want when
(29:06):
we built it, we wanted they would just be able to turn it
on, put it on and go. And that's what we, you know, we
can do that now. So it's not like you have this
big setup process where you put it on your leg and you have to
do all kinds of calibrations or anything.
There's none of that. You you turn it on and you start
walking and it comes pre programmed.
There's just the app if you wantto like for me, I run.
(29:27):
So it uses a slightly different algorithm to make sure it's
hitting every step. But I think that too was, I
mean, it took us 10 years because we had all these
different things we had to thinkabout and especially think about
it being used at home and potentially by, you know, a lot
of people who have osteoarthritis and mobility
(29:47):
issues might be on the older endwho don't necessarily want to be
always interacting with an app or having to do all kinds of
things on a computer. So we wanted to make it as easy
as we could for them, but that took a fair amount of time for
us to figure out the right way to get it packaged into the
small design. And then every time you change
(30:07):
the design, it slightly changes.You know, it kind of made us
rethink the algorithm to make sure that that still was hitting
every step that we needed. It wasn't interesting and long
process. So who did the coding?
I, well both of us, I mean we work together and we started
with the contract manufacturer, but they, they didn't have the
(30:29):
background in the gate mechanicsthat we had.
So once, you know, they had sometrouble with the coding and we
decided to do it ourselves and then provide it to them.
And that works, you know, and, and, and it made it efficient
because it responded so quickly,because we could take all the
shortcuts we needed, knowing thefeatures of, of the forces and
(30:53):
accelerations and motions that needed to be used.
And so I didn't anticipate we had to do that.
But, you know, again, that was another one of these
perseverance issues. It we were going to do it and
make it work. And it did.
Yeah, it worked. But we still had a test, you
know. A lot of testing, a lot of
(31:14):
testing, analyzing data to look at the profiles of what it was
collecting and then making sure trying it, it was interesting
trying it then like, hey, I usedit on my right knee today.
Did you use it on your left knee?
And making sure that you know itwas going to collect the data
the same no matter who was wearing it or how fast they were
walking. Or like we would look and say,
like, did you walk slowly today?Is it catching you?
(31:35):
Or it would be like, I need to go for a run to make sure it's
going to work when we're someone's running.
Or, you know, somebody would say, like, I'm going to go try
it on the elliptical or on the if I'm going out for Tom Pig, a
lot of tennis, he would take it and and do that.
So we were tweaking all of thosecustomizations that we had in
the app to make sure if someone wanted to play pickleball with
(31:56):
it, they could, and they had. There was a setting for that.
There just seems to be so many variables involved in this.
I mean, there's, yeah, kind of the more linear motion of of
running, there's impacts, there's surfaces that you're
running on shoes. All of those, yeah.
If you looked at the raw signal coming out of the the motion
(32:17):
sensor, you would say this is just noise.
And when part of the algorithm had to take apart that noise to
pick out all of those key features.
So it it, you know, it took time, I have to say.
Lot of the research that I've been doing lately has been with
McKenna, my ography, which is the vibration of the muscle as
(32:37):
it contracts. Just trying to sort through that
signal alone to me it's mind blowing and to be able to take
more information than that and process it in such a short
fraction of a second. That was a trick.
Yeah, that's crazy. But I'm, I'm impressed with the
work and I just, you know, I think there's got to be so much
(33:00):
application for this tool to be used.
And So what populations do you think will most benefit from
pneuma? Will be older adults, post op
patients, people with arthritis?There's actually, yeah, there's
actually. It's helped people with ACL
injuries with pain afterwards. It's helped people with meniscus
injuries. And interestingly and
(33:22):
surprisingly for us, it's helpedthe patient post stroke because
it also provides a signal for where their limb is in space,
which after stroke they have trouble sometimes detecting when
their foot is going to strike the floor.
And this device, this has reallyhelped this person and he's
(33:44):
using it every day for therapy and for improving his gait.
And then we had also a few people at Johns Hopkins that
tried it post stroke, same result.
They thought it was fantastic. So we haven't promoted that
application yet because we're still gaining experience.
We don't want to over claim whatit can do before we know you
(34:07):
know what it can do. We know that it's helped a few
people with with post stroke kinds of needs to help improve
their gait. And just to add to what Tom, we
have users really who kind of span you asked about older
versus younger. We have a really a bit of a wide
range there. We have the younger people
who've had knee injury because of ski accidents or ACL tears
(34:29):
when they were playing soccer. And then unfortunately you get
set on that pathway of 50% getting post traumatic OA 10 to
15 years later. So they're dealing with knee
pain even if they've had that reconstruction.
So we have, we had in, in our clinical studies too, we had
younger patients. But then it goes all the way to
the people who have knee osteoarthritis who don't
(34:51):
necessarily want to go the invasive route and want to try
and hold off on as long as they can on getting a surgery or
perhaps even if you're getting ajoint injections, you can use it
as well, right. Sometimes those wear off.
They don't necessarily take awayall the pain or people who don't
wanna take medications, pain medications don't wanna be
(35:13):
taking that every single day. And this is something you can
use when you need it to help youstay active.
And then Tom mentioned the individuals who after total knee
replacement, unfortunately a fair number still have some
residual pain even after they have a joint replacement.
And we're finding they can help them with pain relief.
(35:34):
But also we know that's also a population that has reduced
quadriceps function. So it can help them with that as
well. So we have really kind of a
range of people. Research has always focused a
lot on the osteoarthritis and the ACL tears, meniscus tears.
But I'm a runner. I actually get anterior knee
pain and I use Nemo now every single round.
(35:56):
I've gone through the physical therapy, I've done the taping,
I've done all kinds of things. But with Nemo, it helps helping
me get back to like those longerdistances.
And we have some actually ultra runners who are using it too,
which is something helping. I mean, their knees go through a
lot. So that's been an interesting
one as well for us some ultra runners.
(36:17):
Using it? Have you done any runners
research these? Are runners that go 200 miles
yeah race so. Have you done any work with like
athletes in return to play, you know, maybe somebody with an ACL
tear? Because I know I've worked with
basketball players that have hadkind of just inhibitions that
their knee should be fine, they should be able to compete, but
(36:39):
for whatever reasons the nervoussystem is kind of preventing
them from competing. Have you worked with any
athletes in in those regards We.Have Tom go ahead if you want,
but we haven't yet. Our ACL individuals are farther
from bit six months or longer from surgery.
We actually have a new study coming out looking at three
months post op and saw improvements there.
(37:00):
But we don't have any specific case studies, unless Tom is one.
I'm not thinking. Yeah.
No, that's something that I think could benefit because
because one of the things that helps also is with rehab that
sometimes going to rehab and doing the exercises in rehab
pain will limit the capacity forpeople to do the rehab.
(37:25):
We have now people that have hadmeniscus terror and we actually
it was a tear of the medial collateral ligament, one of the
major ligaments of the knee and he was quite incapacitated and
needed to go to rehab. But it hurts so much without
using Nemo that he couldn't do the types of things he needed to
(37:47):
do. He put Nemo on and the pain was
reduced enough during rehab thathe was able to quickly rehab the
device. So we really want to look at
that opportunity for athletes that can get back to activities
and sports more quickly. The other thing it does is it
(38:07):
helps restore the quadriceps function, which is a big issue
in long term conditions associated with knee pain.
And even if you do rehab with the therapist, if you then go
out and, and walk where you're not using your quadriceps, you
still have the risk of not getting that quadriceps capacity
(38:27):
back. Nemo lets you get out and walk.
The other thing we haven't mentioned is the idea that
people with knee pain become more sedentary.
And there are other conditions that happen when you're
sedentary and not walking around.
And cardiovascular health is dependent on being active.
(38:50):
And you know, I just saw a recent paper which I really, you
know, one of push a little bit more.
And they say that the biggest mistake people make with knee
osteoarthritis is they reduce their activity because they
lose. What happens is the structures
of the joint deteriorate as well.
It doesn't help the joint stay inactive.
(39:11):
The ligaments, the cartilage in the joint need activity to be
active. It's like an astronaut going
into space. When they are not weight bearing
and not stressing those tissue, they degenerate and and for
young people that can come back,but for older people that
doesn't, the knee becomes less healthy and actually degenerates
(39:32):
more rapidly to conditions whereyou need something like a total
joint replacement. So one of the fringe benefits
and I don't think it's much of Afringe benefit is it feels good
to use Nemo. People will use it when they go
out and walk and it will take that limitation of not being
active and a sedentary lifestyleaway.
(39:54):
Also, mental health benefits from the idea that you can stay
active with and do things you like to do.
Like Jenny, she loves to jog, but she had to have something
that took away the pain so she could enjoy the jogging.
I played tennis, you know, and, and the other thing with tennis
is sometimes because of the adrenaline of the competition, I
(40:17):
don't feel the pain in my. Knee or the stiffness till after
I stop and so it hurts sometimesand it's stiffed when I walk
around. After I stopped playing tennis,
I used Nemo for an hour to just go out and walk with it and the
stiffness is reduced because it keeps the joint moving and
removes some of that inflammatory response that takes
(40:39):
place because of lack of movement and and that activity
recovering from the activity. So it sounds like the technology
is going to play a pretty critical role in the future of
aging and preventative health. Yeah.
And I think, I think that a lot of people, you know, the thought
process used to be that we needed to protect the joint.
But the research is showing actually you need to stay
active, but it's hard if you're in pain, like it's just, it's
(41:03):
difficult. So I think we, you know, if we
can provide something that can help people to actually continue
to do activity. And like Tom said, for mental
health, like if you, there's a lot of big loss that people
feel, I think when they, they can't do those activities that
they, they really like because they're in too much pain.
And there's a social aspect of that too.
(41:23):
A lot of people, you know, that's how they do social
connection. So for us, that's an exciting
thing to help people have that quality of life, have that
better quality of life potentially, you know, by
reducing pain, but but by letting them do those
activities. So for me, that's supporting
part of it. I always teach my exercise
science students that, you know,the solutions that we're after,
(41:44):
always biomechanical, psychosocial, and we tend to
forget the mechanical piece and all that.
You hear a lot of physicians saybiopsychosocial, but what do you
have any really interesting feedback stories or, you know,
stories of, you know, success stories of people who have used
a device for some period of time?
(42:05):
Yeah, inspirational ones. Yeah, we I like one individual
who reached out in particular. He he struggled with me
arthritis for quite a while, tried multiple braces, tried the
medication route, tried all different things.
Was finding he was someone who had played like badminton for a
really long time and then had tostop and had mentioned like it
(42:26):
gets depressing, right? You, you're not doing that thing
that you always liked. So he found out about Nemo and
tried it at first, right? You don't know a new technology,
but he said once he put it on, he realized like he was able to
go walk 10,000 steps, which was really huge at that point for
him, right? And now he's up to 15,000 and
back to playing badminton a couple of times a week.
(42:49):
So things like that is really great to hear for us.
And then, you know, another individual who is a younger
person who had had knee injuriesagain, has tried all different
things and just hadn't found something that worked really
well for her. And she found out about Nemo has
been trying it. Now she's jogging with it and
biking with it. It's a really active person who
(43:11):
was missing those that ability to do that.
And then like Tom mentioned thatyou know, some people who have
had total knee replacements thatare struggling with pain and
it's like you've already had thesurgery.
Like why isn't it fixed? And, and now they're using Nemo
to help them so they can still do activity.
Even if they had the surgery, that wasn't the perfect outcome.
(43:34):
Now this might be an early question to ask, but do you see
any other future joint applications for the technology?
Yes, Tom, you can talk about that back we think is going to.
Be yeah, because I mean the sameplatform with the the motion
(43:55):
activated vibration stimulus. Yeah, I've already built the
prototype for the back, you know, and one of the other
conditions I get after tennis isbackache and it helps.
And we're, you know, the steps there are interesting because
the back pain is also sensitive to the abdominal muscles.
(44:18):
And one of the things because they compress and increase the,
the they reduce the compression on the spine when they contract.
And, and So what we're trying todo is perhaps a device that
senses emotion of the abdominal muscles related to the pain on
the back. But again, we want to keep it
(44:41):
simple. You know, that's, that's a key.
The other area that you know, it's, it's funny how selfish
this is because I have shoulder problems when I play tennis too.
And so I've tried it for the shoulder and it seems I had a
friend who had a rotator cuff. He couldn't lift his arm above
(45:02):
his head. He and we put, I just put a mock
up of Nemo on his shoulder and almost after two reps he was
able to lift his arm above his head.
So we're targeting his shoulder.Obviously, tennis elbow is
another place we want to apply this because the platform of the
mechanical stimulus that vibration introduces onto the
(45:26):
same nerves or the same nerve pathway that transmits pain is
effective. And so we want to really take
advantage of that. I think the group in Israel is
working on the ankle too. Yeah, We have one of our
advisors. I started in my lab at Stanford
(45:50):
on the project and is now at theTechnion University in Israel
and has been applying it to other areas of joints.
Yeah, that platform has a lot ofpotential for mitigating pain
and enhancing movement and the benefits of movement that you
get. Well, if you ever need anybody
to test out a back or the shoulder prototype, yeah, I'm
(46:13):
here because that's the backs coming next.
Yeah, I wake up with back stiffness every morning.
I mean, it doesn't impair me. I'm, I'm, I'm able to push kind
of through it and I lift weightsand do all that kind of stuff
and it's not an issue. The shoulder, you know, limits
me a little bit because, you know, just the pain.
But I, I know from experience that the vibration would really
(46:35):
help because it's going to get kind of past that inhibitory
piece that prevents you from doing the movements.
So this is fascinating technology and you, you got a
believer right here. So.
Good here. So, I mean, sometimes you see
this technology that's put out there and you're like, yeah, I
don't know. That just doesn't really make
good physiological sense. I think they're selling snake
oil. Yeah.
(46:56):
But this is something that makesphysiological sense.
I think it can benefit a tremendous number of people.
And I think you you've only scratched the surface of what
the technology can do. And processors are only going to
get faster. So it's going to make it a lot
easier to be able to apply much of this technology.
(47:18):
So in in the health landscape, which is often dominated by
surgery, medications and those types of treatments, how do you
see non evasive solutions like this one really changing the
game? I think there's a growing trend
of people who want to hold off right on those invasive options
and they're looking for something that either prolongs
(47:40):
how long they can wait to do that or, you know, like I said,
you Nemo can be used in conjunction.
If you are having some of this, you're still not getting the
exact relief that you need. You can do both.
And it's the nice thing about itis you're not taking a
pharmaceutical, you're not doingsomething else that potentially
is causing damage. It's something to try and see if
(48:01):
it can give you relief. And I think there's going to
continue to be this trend. And it seems like that's the way
the landscape is going. We're trying to give options
that are non pharmaceutical thataren't necessarily immediately
going straight to a surgery, which I think you know, there's
people who are getting injuries younger and younger and we don't
want them to necessarily have togo get a total joint when
(48:23):
they're, I know some people who have gotten total hips in their
30s, right? That's young to be getting a
total hip replacement. So same thing for the knee.
If you can, if you can wait and prolong that, and I think people
want to that they're going to try and do that as much as they
can. If we can give them new options
to try, I think it's good for people to have different options
to see what works best. For you.
(48:44):
All right, so I asked this question of all of my guests.
So you can't escape it and you can take it one at a time here.
What are you doing personally toage well?
Well, I'll start because I'm I'maging.
We're all aging. Yeah, so I'm 78 years old.
I still play tennis, I still keep my mind working on these
(49:05):
algorithms to make new devices. I also collect classic cars then
redo them, which has been fun. And and I play with my daughters
for Malinois and a German Shepherd, so.
(49:27):
So what's your favorite classic car?
Getting active physical activityfor me is like a non negotiable.
So every single day I have to dosomething and for me it's
running or boxing. Actually I love boxing and I
(49:50):
think the reason I like it so much is because you have to
think while you're doing it. You actually actually be engaged
and your brain has to be working.
So for me, it's it's those two that that I like travelling a
lot. So our family tries to explore
new places all the time. And so for me, like just
exploring the world is what's something I want to keep doing
(50:13):
and see new cultures and and learning about different places.
So how did you get into boxing? I mean, I understand the
running. You look like a runner.
Were you a college runner or anyof that?
Out of college runner. No.
Just for fun. I was a pacer for several years
for marathon training. I did that to make some money as
a grad student. But no, I was a dancer growing
(50:33):
up and I think a lot of like that same like thinking of
combos and thinking of things like that.
It translated into when I couldn't run for a bit trying
boxing classes and then I fell in in love with them.
So now I do that every week too.But.
I've learned something here. I didn't know Jenny was in into
boxing. I'll have to be careful when
we're debating things now. Yeah, just keep outside of her
(50:56):
reach. Hey.
Well, is there anything we've missed talking about that you
wanted to address and kind of the technology and the product?
I think the only other thing is if you want to learn like more
about the science, we have a website so you can check it out,
its.com and it's KN EE MO, not like the Disney fish, but so
(51:17):
like the knee MO and there's more about like our clinical
trials on there and the science of how it actually works.
If you want to do a deeper dive and and read it and also like
hear about people who have used it and testimonials and see
those as well. And we'll include links to all
that in the description notes. But if there's one thing that
you want our listeners and viewers to understand
differently about pain, movement, and aging well after
(51:41):
hearing your story, what would that be?
Stay active, you know, find a way.
You know, a lot of the treatments don't necessarily
address staying active. You know, you can take a pill
and sleep on the couch and maybethe pain feels better, but
things are your body is going downhill and that happens.
And that's what Nemo does. It's it's it, we call it pain
(52:04):
relief in motion because it encourages movement to continue
and by reducing the pain. And so I would say that's the
key message that I would suggest.
Yeah, I agree totally. And I think it's find something
that works well for you. Find what makes you happy and
(52:25):
what you can do that stay active, whether it's hiking or
if it's cycling, like find the thing that you actually are
going to enjoy doing and then you know find a way to make time
for that. Do it because it's really not
just your joint health, but yourwhole health.
It's kind of. Bad.
And eventually you'll have a full body Nemo suit that you can
wear. Yeah, it'll allow you to play
(52:45):
pickleball, do whatever you want.
One of our one of our active influencers is going as a
pickleball player because you know, that's a sport that people
take up maybe later in life where they may not have been
super athletes younger in life. And there's a lot of injuries
that take place. And I just talked to another
(53:08):
pickleball player this weekend, and they said, boy, we've got
people that fall down on their knees and then twist their
knees. And so I think one of the things
that happens is injuries take place when people switch to an
activity that they haven't done before.
In other words, they may have run short distances or take long
(53:30):
walks, and all of a sudden they're going to do a marathon.
You can bet they're going to getan overuse injury without the
proper training to work themselves in.
Because what happens? The tissues will slowly adapt to
a new activity. They won't quickly adapt, but
they'll slowly adapt. And if you train up to the kind
of level you want to do in a sport, it will help to not get
(53:53):
an overuse or even worse type ofinjury.
So So again, stay active, use anemo to take the pain away and
you'll be happy. Yeah, I teach my students that
overuse problems are really justa problem of poor coaching or
poor implementation of an exercise program, that the
biggest issue for most Americansis not overuse, it's under use.
(54:15):
And it seems like Nemo is a perfect tool to be able to get
us active again. And we know, we know that.
I think it's like 2/3 of the American population are not even
hitting the minimum guidelines for active physical activity.
And part of that is probably dueto pain.
And so if we can alleviate that and get more people moving,
we're going to have a healthier America.
(54:36):
So I really appreciate all that you're doing.
Just I look forward to future developments.
So we'll have to have you back on when you get the back brace
done. And although, you know, the
studies are done on that. And until then, just keep doing
what you're doing to keep aging well.
Thank you. Thanks.
You're welcome. Thank you for listening.
Hope you benefited from today's podcast.
(54:58):
And until next time, keep aging well.
For millions of adults, knee pain isn't just a nuisance, it's
a barrier to independence, vitality, and long term health.
Welcome to the Aging Well podcast where we explore the
science, stories and strategies behind living a longer,
healthier and more purposeful life.
I'm your host, Doctor Jeff Armstrong.
I am joined by Doctor Tom Andorracci, Emeritus Professor
(00:24):
at Stanford University, and Jenny Earhart Helladic, the Co
inventors of Nemo, a groundbreaking wearable device
developed from cutting edge bio mechanics research.
Nemo uses intelligent motion sensing and precisely timed
vibration to reduce pain and improve muscle function,
offering a promising alternativeto drugs or surgery for those
(00:46):
looking to stay active. We'll explore the science behind
movement pain modulation and howthis technology could help more
people keep moving and keep aging well.
Jenny and Tom, welcome to the Aging Well podcast.
It's my pleasure to have you both on here to talk about your
(01:07):
Nemo product today and the science behind it.
But let's just kind of first start by having you introduce
yourselves and tell us a little bit about how you kind of came
to doing this type of research. So I'm professor of mechanical
engineering and former professorretired from Stanford and so I'm
now emeritus professor in mechanical engineering.
(01:30):
But I've spent my whole career studying the mechanics of
walking and how it affects the health of the body and, and
specifically health of the knee joint and hip joint and how
painful knees experience walkingchanges that can impact the
clinical outcome of a certain procedure.
(01:51):
So published a couple 100 paperson the topic.
So I feel you know a little bit about it right now.
So Jenny is graduated from Stanford and I'll let her now
give a little background on whatshe does.
Yeah, so Tom and I originally met when I went to Stanford to
(02:12):
do a pH D in his lab, actually. So I was very interested in
biomechanical engineering and was a big name in that field.
And I was actually really lucky.My PhD project was a shoe for
me, osteoarthritis, and it was aclinical trial.
And so I got to see that whole evolution from an idea in the
lab to a product that eventuallywas sold to the public.
(02:36):
And so it was really great to see how something that comes out
of research and understanding walking mechanics and how
loading at the knee can impact joint disease can actually be
taken just from an idea to a physical product.
After I did my PhD, I stayed at Stanford for a lot of years
(02:56):
doing research as an instructor and a research associate and
then eventually Nemo, which is then a 10 year journey.
Our product came out of that research.
It became a startup company and we finally eventually launched a
product which we're really excited about, but it was
(03:17):
another one of those research concepts that then took many
years to actually become a physical product that we had
available. Yeah, it's amazing how many
years it takes for these great ideas to actually come to life.
So. Yes, more than you think and
more than we want, I'm sure, Butit does take a long time.
And I think as academics you canhave great ideas, but it's a
(03:40):
whole different process to then actually make that into our
reality. And we've experienced all, all
the ups and downs that came withthat.
And. Yeah, I always tell my students
perseverance is a key to success.
You know, if you think you have a good idea, stick with it and
it will come to fruition. So what inspired the development
(04:00):
of Nemo and how did the concept evolve from research to a real
world application? Yeah, maybe I'll start with that
question. As I mentioned, I have studied
the Milwaukee mechanics of people with knee pain starting
in the mid 1970s. So it goes back a ways.
(04:21):
And I was able because when I finished my PHDI decided to take
a postdoctoral fellowship and I was embedded in an orthopedic
department for you know, I thought it was going to be 3
years. I stayed there 20 years because
the work was so fascinating. And what I found was that
walking was a critical factor inthe way orthopedic procedures,
(04:47):
the success of orthopedic procedures came about.
In particular, it was the mechanics of how the joint got
loaded and how it moved that wasimportant.
And what that meant was that we needed a better understanding of
walking mechanics related to clinical outcome.
So being in an orthopedic department, I had the facility
(05:12):
of a laboratory where I could measure not just how it looked
when people walk, but the forcesthat took place when people
walked. Now you can't see a force, so
you need a laboratory to pick upthat information.
And but I had it and I could start studying patients early on
that were being treated with various types of treatment,
(05:34):
including medication, analgesicsand anti inflammatories for
osteoarthritis, joint injections, braces of a variety
of kind types and even total joint replacement.
So I've studied all of those before and after the treatment.
Certain things emerged out of that.
(05:54):
And it took a while to 20 to 50 years to to find some of the
things that came out of that. But one of them was that walking
with pain, some people adapt to the pain one way and others
adapt another way. And there was what we call a
good adaptation to the pain and a not so good adaptation to the
(06:18):
pain. And that meant that if we tested
a patient say this year and we followed that patient say for
six years with a certain treatment for arthritis, if the
patient had adapted a good walking pattern and that meant
using their quadriceps properly and kind of dynamically
realigning in the joint when they walk, they did quite well
(06:41):
with a procedure for osteoarthritis.
In fact, in many cases the patients that we followed with
no treatment that but had the right walking pattern, the
disease, if they had early stageosteoarthritis, it progressed
slowly and they didn't need a joint replacement.
The opposite happened for patients where The Walking
(07:02):
pattern wasn't quite what we hadhoped for, or they should have,
and that those patients progressed more rapidly or they
didn't respond well to treatment.
So the key was to identify thosefeatures of walking.
There's a lot of things you can measure in walking, how the knee
moves, the forces, the differentwhen they're called, moments
(07:25):
that act at the joint, which is a mechanical equivalent of a
force. And what we found was there were
certain characteristics that were common to almost any
condition that was associated with knee pain.
And one of them was the inhibition to use the quadriceps
muscle. And clinically, what happens in
those patients is that muscle atrophies and they develop a
(07:48):
gait which is not good in the long term.
And it's what we would call the stiff knee gait.
And so during the support phase of walking, the knee would stay
straighter than normal. And you can walk that way and
use very little quadriceps muscle because the quadriceps
muscle, which is the largest muscle on the front of the knee,
(08:10):
is the one that would balance the knee when it flexed a little
bit during what weight bearing. So they didn't use that.
They had a reduced range of emotion as well.
And there are a few few other mechanical factors, but those
were two that were striking. So then over the years we kept
saying, well, can we find a way to get those people to walk, you
(08:33):
know, better and walk in a way that helps them and reduces
their pain? So we tried a lot of things and
you know, we tried the shoe which actually worked pretty
well. Like Jenny mentioned that that
realigns the knee like for example, if the car is out of
alignment, that shoe will help the dynamic alignment of the
(08:54):
knee to straighten out. That worked OK, but it didn't
really help too much with the quadriceps function, which is
something else that we wanted toto allow.
So we tried some things like gait retraining and teaching
them to block slightly differently.
That worked OK, but it requires some compliance and, and a level
(09:17):
of staying sticking with it, youknow, over after the training.
So that that didn't last. So we said, well, we can we do
something that we can just put on the knee and it does all the
work. It does the thinking and it does
the the IT provides the stimulusto change the gait.
(09:38):
And that's what led to Nemo. The name Nemo means knee in
motion. So we don't call Nemo a brace,
we call it a mobilizer because it helps reduce pain while
walking and it enhances quadriceps function.
And we could pick that up not just by asking people.
Did it feel better when you usedit?
(09:58):
Because there's a placebo effectthat happens when you give any
intervention. We did it in the laboratory
where we're actually measuring directly quadriceps metrics that
they told us they were using their quadriceps.
One of them was Emgs and, and sobased on that and then we did a
clinical study that was actuallymore rigorous where we had a, a
(10:24):
device that didn't provide the same activation as our device.
And what I think now I'm going to turn this over to Jenny, let
her describe the clinical because she was very involved in
that study, so. Yeah, maybe.
First of all, so just describe Nemo a bit more.
So Nemo, it's really slim design.
(10:45):
So it's 2 motion sensing bands. You put one above your knee, you
put one below your knee. As Tom said, we wanted to
develop something when we're doing this that would do the
thinking for you. So you didn't have to physically
think like, OK, now I need to activate my quadriceps because
it can be difficult, right? If for people to think that on
every single step to remind themselves.
(11:05):
And so Nemo senses your motion as you're moving and then
processes the data in real time through an algorithm so that it
applies intermittent vibration that synced to every step.
For example, if you're walking, so it's turning on right before
heel strike, turning off at mid stance, and then it'll catch
your next step. So if you're speeding up or
slowing down or if you're jogging, cycling, it's going to
(11:27):
adapt in real time to hit every step or every pedal stroke that
you're doing. And as we were developing it as
researchers, it was really important for us that we made
sure that we had the, the clinical studies behind it.
So we did first an initial studyto show what happens just in a
single time use. And so we looked at patients who
(11:49):
have knee pain, but knee pain due to those conditions that we
know reduced quadriceps. So KCL tears, unfortunately,
even if you have it repaired right, you're going to have
reduced quadriceps function, meniscus injuries and then knee
osteoarthritis. So conditions that affect a
large number of people, we had them wear Nemo just in our
(12:09):
motion capture lab. So the lab that's equipped to
study how people walk in the labhad them not wear Nemo and did a
test in the lab and then they put it on and we saw an
immediate improvement in their quadriceps muscles function.
So significant increase in our individuals and those who had
the worst quadriceps function atthe start had the best
(12:32):
improvement, which was great forus.
And so 95% of people responded immediately in that single
testing session. And then we went on and did a
longitudinal randomized crossover study.
So as Tom mentioned, we had themeither were Nemo for four weeks
or just off the shelf compression knee bands.
They're kind of that you buy offthe Amazon, right, for knee
(12:53):
pain. They wore both of them for four
weeks and had a washout period of two weeks in between.
And we saw with Nemo significantimprovements in pain when they
were walking and also going up and down stairs.
We didn't see it with the control device.
And then also when wearing Nemo,they had significant
improvements again after wearingit for four weeks.
And their quadriceps muscle function, better activation
(13:15):
going upstairs and quadriceps muscles.
And then when they were going downstairs, better control of
their movement, right, better appropriate reception.
So after we did those studies, that's what really motivated us
to say like, OK, this really does work.
It was a great idea. And we, we wanted to make sure
it actually worked in the way that we wanted it to.
And that's when at that point we, we said, OK, we have
(13:36):
something here and let's see if we can take this from the lab
and a device that works great inthe lab to something that'll
work in everyone's life every single day, whether wherever
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(13:59):
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viewers and listeners. Thank you.
And now back to the podcast. So a big part of this is the
vibration pain relief. And I find that fascinating
(14:20):
because I kind of stumbled on tothat when I was teaching at
college and I had rotator cuff surgery.
This this is probably pushing almost 20 years ago and kind of
in my post rehab and I did all my own rehab, which my physical
therapy, pre physical therapy students are like, why you not
going to physical therapist is like, I'm teaching you.
What do I need to pay somebody and have the inconvenience of
(14:41):
going to lab? But we had our basketball team
had been gifted with a whole body vibration platform and the
coach didn't know what to do with it.
He kind of turned it over to me and say, Hey, if you got some
research you can do with it. And so I was just playing within
a lot of different things. But what I would do prior to
going into a lifting workout is I would just kind of hold my arm
in varying positions and just let the vibration happen.
(15:02):
And it actually deadened the paint.
I can go in and lift without paying for that workout.
Can you kind of explain for our listeners, interviewers a bit
more the biomechanical principles behind Nemo's
vibration based pain relief? Yeah.
So similar to what you said. So Nemo, this is something a
neurological principle called gate control theory of pain.
(15:23):
So what that means is our body takes in inputs like vibration,
but also pressure and temperature.
And it, it senses those with larger, faster nerve fibers than
the pain signals travel which those travel along smaller,
slower nerve fibers. So I like to, when I'm kind of
explaining it, think of it as like a road where you suddenly
(15:45):
kind of bring 2 roads together. And so the, the vibrations that
is going faster is going to reach that section where they
meet quicker than the pain signal.
So if you can flood it with vibration, which feels good,
Nemo, it feels good when you're wearing it and the vibration
feels nice. That paint, that signal is going
to reach your brain faster than the pain signal and reduce some
(16:07):
the amount of pain that reaches your brain.
And we know from research that when you have knee pain, you
also have reduced quadriceps muscles function.
There's research studies that induce pain and then show
there's a reduction in in quadriceps muscle function.
So by doing that, that also allows people to better engage
quadriceps when you do that. So it has a kind of dual
(16:30):
mechanism there where you're reducing pain, which helps
people while they're walking. And Nemo does this while you're
walking, right? You have to be moving to have
the vibration activate or running or cycling, whatever you
want to do. And then at the same time, it
allows you to better engage those muscles that are so
important for joint stability and joint support and also
(16:51):
related to to out treatment outcomes and joint progression,
disease progression of atmosphere arthritis.
So fascinating concept and it's amazing that nobody came up with
it sooner. So it was it.
Only took us 10 years. It only took us. 10 years.
Well, technically it took you 50years, you said, right?
Yeah, right. Yeah, because, you know, it's
(17:14):
kind of nuanced, but inside the device is a microprocessor that
contains motion sensors, a Bluetooth communicator.
It communicates with a smart device like an iPhone.
So you can make settings that adjust to say you're going to go
jogging and moving faster. You'll it'll set some of the
(17:38):
metrics that control the sensingto set the vibration properly
for whatever your acting activities.
Now, the sensor will detect the rate that you're moving, but
sometimes we need to adjust the way it responds to that motion.
And so the other nice thing thatit does is it counts the number
(17:59):
of steps you do or the number ofmovement cycles and how long
you're using the device. So it gives feedback to the
user, but we also are making it available to healthcare
providers that are going to introduce it into their
practice. And they can get an idea of the
compliance of the patients. If there is, you know, if they
(18:19):
give it to the patient to say, you know, go walk, you know, for
an hour, do they really do that with the device?
And, you know, it's interesting,you know, I like to say it, it
does all the work. It, you know, you put it on, it
feels good and you walk better with it and that's all you have
to do. You don't have to learn any, you
(18:40):
know, feedback response to the device.
The device works through something called the
somatosensory system, which is the system that Jenny was
describing, describes the sensation of both mechanical
stimuli applied to the skin as well as pain.
The nerves are transmit pain. So when we did the clinical
(19:02):
trial, we asked the patients to use the device for at least one
hour per day when when they go out for a walk, when we came
back and I don't think we told them we could detect how much
they used it. And there were a few that didn't
use it as much as they said. But the average usage instead of
(19:22):
one hour was actually 3 hours because it felt good.
And so one of the barriers that we had overcome with this device
is compliance. I don't know if you've used some
of these other bulky kinds of knee braces or things that
people are you've probably seen them compliance.
Is it difficult because it's sometimes you got to strap it
(19:43):
on. It's got to be tight and it it
doesn't feel that good and it looks bulky.
This is a fairly sleek device that can be put Jenny, do you
have pick the device with you there that you.
Yeah, I actually, I was chargingI, I use mine on every run.
So I was actually charging mine.So it's currently in another
room. But, but no, and I think, you
(20:04):
know, we've done the research, we've done research on braces,
we've done research on a lot of different things and not
compliance is something that's always so difficult, right?
Even with things like physical therapy, it's, it's difficult
because you have to rely on people being motivated to do
either exercises at home or do the activity at home or to
(20:25):
consciously think. I've done a fair amount of work
in git retraining. It's difficult to to, for people
to think on every step that they're taking, like to how they
want to change the way that their knee is moving or their
foot is being placed on the ground.
So really when we set out to develop this, we were trying to
take that component out so we wouldn't have to rely so much on
(20:45):
people's will. I guess you want to call it to,
to do these things, but something that would be able to
still give them a benefit without them having to
consciously think about changingsomething with how they're
moving. So I mean, I think that's kind
of, and we also wanted it to be,we're going for some people who
are using it like they've tried all the different braces,
(21:06):
sometimes 2 at a time. And then if you actually want to
go be active, restricts motion. So that's not ideal either,
right? You want something that gives
you support but also doesn't hinder you from doing whatever
the activity. Is so I find this the motion
sensing technology pretty fascinating on money.
I got a couple questions that are on one.
You know, you talked about beingable to kind of track their
(21:26):
usage. Is that something has done more
kind of through like Wi-Fi whereyou have, where a practitioner
can actually get that information without having to
have the knee brace or have the patient present and download it
to where they can actually give feedback.
Or maybe there's even potential for a nap down the road where,
hey, we noticed that you only walked for, you know, 35 minutes
(21:48):
yesterday. Let's try and step that up.
Let's get in, you know, at least45 to an hour today and give
them that kind of feedback. Or is it something that they
again, they have to take it intotheir practitioner and there's a
downloading of the information and back.
And then the other common would be how does this vibration
technology personalize the vibration for each individual?
(22:10):
Is there like a system involved where it is kind of almost like
AI learning a bit more of their movements and and adapting
accordingly? I could keep that app.
I can take the app part. So we actually do have an app
right now. It's a totally free app right
now. And So what it does is you
connect your e-mail to it. And like Tom said, you can
(22:31):
choose different activities in there.
You can change actually the vibration intensity.
So what feels great to me might be slightly different than what
feels really good to you. And so you can play with that.
Or if you want to wear it over pants, for example, you might
want the vibration intensity a little higher.
But it's in the app where it's then counting your steps and how
much time you've been using it. And you can elect to send that
(22:52):
to someone if you'd like to. So that's a way that you could
send. There's how much I used it this
week. There's a lot of potential and
we don't have it integrated right now.
But what you were saying, right?Like trying to motivate people
here, you here's what you've done so far, like keep going.
Or we're collecting a ton of motion data as well, right?
(23:13):
Like it's using motion data. So eventually looking at using
that in some way as well throughour app to give even more
feedback to the healthcare providers on these specific
metrics, for example, on how people are walking.
And that's kind of where we envision it going, but we're not
there just yet. Tom, do you want to talk about
that algorithm and how? It yeah, yeah, yeah.
(23:35):
It's interesting that it has to work in real time, so it has to
take the motion that's sensed and within milliseconds know
what when the vibration should be applied.
And you know, the microprocessoris about the size of your the
tip of your thumb right now. It's it's, it's miniaturized, so
(23:57):
and it uses the motion sensing technology that's used in
drones. So it measures all what's called
6° of of motion. So it measures every possible
motion and accelerations. So it uses a combination of the
motion and the accelerations to detect the movement of that what
that patient is using at that time.
(24:19):
So if they walk fast, it will react faster.
And it had to be programmed intoa firmware, which is like
software that gets downloaded into the microprocessor at the
time during when it's manufactured.
It already has the smarts that was derived from our history of
(24:40):
studying gait analysis of the movement of the knee and the
accelerations and forces that take place.
It gathers all that data and in real time syncs the vibration to
that within a millisecond or less of when the stimulus should
take place. That microprocessor is more
(25:00):
powerful than the first computerthat my whole university had
that took the size of a room andmassive air conditioning to do
those calculations. And now it doesn't in real time.
So and it mentioned artificial intelligence that probably had
artificial intelligence before we knew it.
It was, you know, so it, it is using, we call it a smart device
(25:24):
because it has that intelligencebeing built into it to allow us
to do that. Not you don't sense something
and then a minute later you provide the stimulus.
It's got to be instant, almost instantaneous to the patient.
So that and, and we were able todo, you know, one of the reasons
we did so much testing over this10 year period was we wanted to
(25:47):
make sure it worked, you know, that it did what we thought it
was going to do. And actually it works so well
that when I retired, I said, we've got to get this out to the
public. So we, Jenny and I started a
business and we started developing the technology, but
taking it from the prototype that we developed in the
laboratory to something that we could manufacture at scale was,
(26:10):
I would say, challenging to say the least.
We had to go to a contract manufacturer that would first
understand our technology and then build it in and then we had
to test it. And then we got hit with, you
might recall a few years ago, the chip shortage.
There's fifty different microchips in that little device
(26:31):
that we put into the patient. Some of them weren't available
to us. And so, you know, when I
mentioned persevere perseveranceearlier, the company that was
going to do our manufacturing couldn't get all the chips we
needed. There was a market out there
that was selling the chips had amarked up price.
And I said, if I go out and buy those chips and give them to you
(26:53):
on consignment, will you build the product?
And he did. So we got it made much sooner
than we could have without taking those steps to get past
the the chip shortage. But and we did.
And now we have a product that we're so proud of that we want
to help a lot of people with this device.
And the testimonies have been astounding to us of people,
(27:16):
people using it. We have one person after total
knee replacement, he still had alot of pain and playing was that
the pain was not explainable andit turned out it was a nerve
issue that it looked like it was.
He tried everything, nerve blocks, different types of
braces and that we still had theprototype of Nemo.
(27:39):
He lived near us near Stanford. And so I knew him from for other
reasons and we said try this prototype and it helped him.
And so now he is our longest user of Nemo.
It's been several years now thathe uses it now every time he
wants to go out and take a walk because it takes the pain away
when he walks. So, yeah, we were so surprised
(28:00):
at work that we had to get it out, you know, to the public.
So it's a fun thing in research to to have an idea and take it
from, you know, they use a term in research from bed to from
bench to bedside. And that's kind of what we did
with this device. And for the listener who doesn't
really understand processing andthe amount of information that
(28:23):
has to be perceived and decisions made and in actions
initiated through a computer, I mean, it's amazing how the human
mind is able to do that, let alone know a computer.
And it seems like, you know, youreally just kind of hit the
right time and development that,you know, 10 years ago, 20 years
ago, this probably would not have been possible without the
(28:45):
processors that were available. To us, you could have carried
that big computer around. Yeah.
And I think as Tom mentioned, I mean, it's, it's very different
to design something that works in a lab where we can be hands
on and like troubleshoot something to then have to
develop something that's going to work seamlessly in someone's
home and also not require them to do anything when we want when
(29:06):
we built it, we wanted they would just be able to turn it
on, put it on and go. And that's what we, you know, we
can do that now. So it's not like you have this
big setup process where you put it on your leg and you have to
do all kinds of calibrations or anything.
There's none of that. You you turn it on and you start
walking and it comes pre programmed.
There's just the app if you wantto like for me, I run.
(29:27):
So it uses a slightly different algorithm to make sure it's
hitting every step. But I think that too was, I
mean, it took us 10 years because we had all these
different things we had to thinkabout and especially think about
it being used at home and potentially by, you know, a lot
of people who have osteoarthritis and mobility
(29:47):
issues might be on the older endwho don't necessarily want to be
always interacting with an app or having to do all kinds of
things on a computer. So we wanted to make it as easy
as we could for them, but that took a fair amount of time for
us to figure out the right way to get it packaged into the
small design. And then every time you change
(30:07):
the design, it slightly changes.You know, it kind of made us
rethink the algorithm to make sure that that still was hitting
every step that we needed. It wasn't interesting and long
process. So who did the coding?
I, well both of us, I mean we work together and we started
with the contract manufacturer, but they, they didn't have the
(30:29):
background in the gate mechanicsthat we had.
So once, you know, they had sometrouble with the coding and we
decided to do it ourselves and then provide it to them.
And that works, you know, and, and, and it made it efficient
because it responded so quickly,because we could take all the
shortcuts we needed, knowing thefeatures of, of the forces and
(30:53):
accelerations and motions that needed to be used.
And so I didn't anticipate we had to do that.
But, you know, again, that was another one of these
perseverance issues. It we were going to do it and
make it work. And it did.
Yeah, it worked. But we still had a test, you
know. A lot of testing, a lot of
(31:14):
testing, analyzing data to look at the profiles of what it was
collecting and then making sure trying it, it was interesting
trying it then like, hey, I usedit on my right knee today.
Did you use it on your left knee?
And making sure that you know itwas going to collect the data
the same no matter who was wearing it or how fast they were
walking. Or like we would look and say,
like, did you walk slowly today?Is it catching you?
(31:35):
Or it would be like, I need to go for a run to make sure it's
going to work when we're someone's running.
Or, you know, somebody would say, like, I'm going to go try
it on the elliptical or on the if I'm going out for Tom Pig, a
lot of tennis, he would take it and and do that.
So we were tweaking all of thosecustomizations that we had in
the app to make sure if someone wanted to play pickleball with
(31:56):
it, they could, and they had. There was a setting for that.
There just seems to be so many variables involved in this.
I mean, there's, yeah, kind of the more linear motion of of
running, there's impacts, there's surfaces that you're
running on shoes. All of those, yeah.
If you looked at the raw signal coming out of the the motion
(32:17):
sensor, you would say this is just noise.
And when part of the algorithm had to take apart that noise to
pick out all of those key features.
So it it, you know, it took time, I have to say.
Lot of the research that I've been doing lately has been with
McKenna, my ography, which is the vibration of the muscle as
(32:37):
it contracts. Just trying to sort through that
signal alone to me it's mind blowing and to be able to take
more information than that and process it in such a short
fraction of a second. That was a trick.
Yeah, that's crazy. But I'm, I'm impressed with the
work and I just, you know, I think there's got to be so much
(33:00):
application for this tool to be used.
And So what populations do you think will most benefit from
pneuma? Will be older adults, post op
patients, people with arthritis?There's actually, yeah, there's
actually. It's helped people with ACL
injuries with pain afterwards. It's helped people with meniscus
injuries. And interestingly and
(33:22):
surprisingly for us, it's helpedthe patient post stroke because
it also provides a signal for where their limb is in space,
which after stroke they have trouble sometimes detecting when
their foot is going to strike the floor.
And this device, this has reallyhelped this person and he's
(33:44):
using it every day for therapy and for improving his gait.
And then we had also a few people at Johns Hopkins that
tried it post stroke, same result.
They thought it was fantastic. So we haven't promoted that
application yet because we're still gaining experience.
We don't want to over claim whatit can do before we know you
(34:07):
know what it can do. We know that it's helped a few
people with with post stroke kinds of needs to help improve
their gait. And just to add to what Tom, we
have users really who kind of span you asked about older
versus younger. We have a really a bit of a wide
range there. We have the younger people
who've had knee injury because of ski accidents or ACL tears
(34:29):
when they were playing soccer. And then unfortunately you get
set on that pathway of 50% getting post traumatic OA 10 to
15 years later. So they're dealing with knee
pain even if they've had that reconstruction.
So we have, we had in, in our clinical studies too, we had
younger patients. But then it goes all the way to
the people who have knee osteoarthritis who don't
(34:51):
necessarily want to go the invasive route and want to try
and hold off on as long as they can on getting a surgery or
perhaps even if you're getting ajoint injections, you can use it
as well, right. Sometimes those wear off.
They don't necessarily take awayall the pain or people who don't
wanna take medications, pain medications don't wanna be
(35:13):
taking that every single day. And this is something you can
use when you need it to help youstay active.
And then Tom mentioned the individuals who after total knee
replacement, unfortunately a fair number still have some
residual pain even after they have a joint replacement.
And we're finding they can help them with pain relief.
(35:34):
But also we know that's also a population that has reduced
quadriceps function. So it can help them with that as
well. So we have really kind of a
range of people. Research has always focused a
lot on the osteoarthritis and the ACL tears, meniscus tears.
But I'm a runner. I actually get anterior knee
pain and I use Nemo now every single round.
(35:56):
I've gone through the physical therapy, I've done the taping,
I've done all kinds of things. But with Nemo, it helps helping
me get back to like those longerdistances.
And we have some actually ultra runners who are using it too,
which is something helping. I mean, their knees go through a
lot. So that's been an interesting
one as well for us some ultra runners.
(36:17):
Using it? Have you done any runners
research these? Are runners that go 200 miles
yeah race so. Have you done any work with like
athletes in return to play, you know, maybe somebody with an ACL
tear? Because I know I've worked with
basketball players that have hadkind of just inhibitions that
their knee should be fine, they should be able to compete, but
(36:39):
for whatever reasons the nervoussystem is kind of preventing
them from competing. Have you worked with any
athletes in in those regards We.Have Tom go ahead if you want,
but we haven't yet. Our ACL individuals are farther
from bit six months or longer from surgery.
We actually have a new study coming out looking at three
months post op and saw improvements there.
(37:00):
But we don't have any specific case studies, unless Tom is one.
I'm not thinking. Yeah.
No, that's something that I think could benefit because
because one of the things that helps also is with rehab that
sometimes going to rehab and doing the exercises in rehab
pain will limit the capacity forpeople to do the rehab.
(37:25):
We have now people that have hadmeniscus terror and we actually
it was a tear of the medial collateral ligament, one of the
major ligaments of the knee and he was quite incapacitated and
needed to go to rehab. But it hurts so much without
using Nemo that he couldn't do the types of things he needed to
(37:47):
do. He put Nemo on and the pain was
reduced enough during rehab thathe was able to quickly rehab the
device. So we really want to look at
that opportunity for athletes that can get back to activities
and sports more quickly. The other thing it does is it
(38:07):
helps restore the quadriceps function, which is a big issue
in long term conditions associated with knee pain.
And even if you do rehab with the therapist, if you then go
out and, and walk where you're not using your quadriceps, you
still have the risk of not getting that quadriceps capacity
(38:27):
back. Nemo lets you get out and walk.
The other thing we haven't mentioned is the idea that
people with knee pain become more sedentary.
And there are other conditions that happen when you're
sedentary and not walking around.
And cardiovascular health is dependent on being active.
(38:50):
And you know, I just saw a recent paper which I really, you
know, one of push a little bit more.
And they say that the biggest mistake people make with knee
osteoarthritis is they reduce their activity because they
lose. What happens is the structures
of the joint deteriorate as well.
It doesn't help the joint stay inactive.
(39:11):
The ligaments, the cartilage in the joint need activity to be
active. It's like an astronaut going
into space. When they are not weight bearing
and not stressing those tissue, they degenerate and and for
young people that can come back,but for older people that
doesn't, the knee becomes less healthy and actually degenerates
(39:32):
more rapidly to conditions whereyou need something like a total
joint replacement. So one of the fringe benefits
and I don't think it's much of Afringe benefit is it feels good
to use Nemo. People will use it when they go
out and walk and it will take that limitation of not being
active and a sedentary lifestyleaway.
(39:54):
Also, mental health benefits from the idea that you can stay
active with and do things you like to do.
Like Jenny, she loves to jog, but she had to have something
that took away the pain so she could enjoy the jogging.
I played tennis, you know, and, and the other thing with tennis
is sometimes because of the adrenaline of the competition, I
(40:17):
don't feel the pain in my. Knee or the stiffness till after
I stop and so it hurts sometimesand it's stiffed when I walk
around. After I stopped playing tennis,
I used Nemo for an hour to just go out and walk with it and the
stiffness is reduced because it keeps the joint moving and
removes some of that inflammatory response that takes
(40:39):
place because of lack of movement and and that activity
recovering from the activity. So it sounds like the technology
is going to play a pretty critical role in the future of
aging and preventative health. Yeah.
And I think, I think that a lot of people, you know, the thought
process used to be that we needed to protect the joint.
But the research is showing actually you need to stay
active, but it's hard if you're in pain, like it's just, it's
(41:03):
difficult. So I think we, you know, if we
can provide something that can help people to actually continue
to do activity. And like Tom said, for mental
health, like if you, there's a lot of big loss that people
feel, I think when they, they can't do those activities that
they, they really like because they're in too much pain.
And there's a social aspect of that too.
(41:23):
A lot of people, you know, that's how they do social
connection. So for us, that's an exciting
thing to help people have that quality of life, have that
better quality of life potentially, you know, by
reducing pain, but but by letting them do those
activities. So for me, that's supporting
part of it. I always teach my exercise
science students that, you know,the solutions that we're after,
(41:44):
always biomechanical, psychosocial, and we tend to
forget the mechanical piece and all that.
You hear a lot of physicians saybiopsychosocial, but what do you
have any really interesting feedback stories or, you know,
stories of, you know, success stories of people who have used
a device for some period of time?
(42:05):
Yeah, inspirational ones. Yeah, we I like one individual
who reached out in particular. He he struggled with me
arthritis for quite a while, tried multiple braces, tried the
medication route, tried all different things.
Was finding he was someone who had played like badminton for a
really long time and then had tostop and had mentioned like it
(42:26):
gets depressing, right? You, you're not doing that thing
that you always liked. So he found out about Nemo and
tried it at first, right? You don't know a new technology,
but he said once he put it on, he realized like he was able to
go walk 10,000 steps, which was really huge at that point for
him, right? And now he's up to 15,000 and
back to playing badminton a couple of times a week.
(42:49):
So things like that is really great to hear for us.
And then, you know, another individual who is a younger
person who had had knee injuriesagain, has tried all different
things and just hadn't found something that worked really
well for her. And she found out about Nemo has
been trying it. Now she's jogging with it and
biking with it. It's a really active person who
(43:11):
was missing those that ability to do that.
And then like Tom mentioned thatyou know, some people who have
had total knee replacements thatare struggling with pain and
it's like you've already had thesurgery.
Like why isn't it fixed? And, and now they're using Nemo
to help them so they can still do activity.
Even if they had the surgery, that wasn't the perfect outcome.
(43:34):
Now this might be an early question to ask, but do you see
any other future joint applications for the technology?
Yes, Tom, you can talk about that back we think is going to.
Be yeah, because I mean the sameplatform with the the motion
(43:55):
activated vibration stimulus. Yeah, I've already built the
prototype for the back, you know, and one of the other
conditions I get after tennis isbackache and it helps.
And we're, you know, the steps there are interesting because
the back pain is also sensitive to the abdominal muscles.
(44:18):
And one of the things because they compress and increase the,
the they reduce the compression on the spine when they contract.
And, and So what we're trying todo is perhaps a device that
senses emotion of the abdominal muscles related to the pain on
the back. But again, we want to keep it
(44:41):
simple. You know, that's, that's a key.
The other area that you know, it's, it's funny how selfish
this is because I have shoulder problems when I play tennis too.
And so I've tried it for the shoulder and it seems I had a
friend who had a rotator cuff. He couldn't lift his arm above
(45:02):
his head. He and we put, I just put a mock
up of Nemo on his shoulder and almost after two reps he was
able to lift his arm above his head.
So we're targeting his shoulder.Obviously, tennis elbow is
another place we want to apply this because the platform of the
mechanical stimulus that vibration introduces onto the
(45:26):
same nerves or the same nerve pathway that transmits pain is
effective. And so we want to really take
advantage of that. I think the group in Israel is
working on the ankle too. Yeah, We have one of our
advisors. I started in my lab at Stanford
(45:50):
on the project and is now at theTechnion University in Israel
and has been applying it to other areas of joints.
Yeah, that platform has a lot ofpotential for mitigating pain
and enhancing movement and the benefits of movement that you
get. Well, if you ever need anybody
to test out a back or the shoulder prototype, yeah, I'm
(46:13):
here because that's the backs coming next.
Yeah, I wake up with back stiffness every morning.
I mean, it doesn't impair me. I'm, I'm, I'm able to push kind
of through it and I lift weightsand do all that kind of stuff
and it's not an issue. The shoulder, you know, limits
me a little bit because, you know, just the pain.
But I, I know from experience that the vibration would really
(46:35):
help because it's going to get kind of past that inhibitory
piece that prevents you from doing the movements.
So this is fascinating technology and you, you got a
believer right here. So.
Good here. So, I mean, sometimes you see
this technology that's put out there and you're like, yeah, I
don't know. That just doesn't really make
good physiological sense. I think they're selling snake
oil. Yeah.
(46:56):
But this is something that makesphysiological sense.
I think it can benefit a tremendous number of people.
And I think you you've only scratched the surface of what
the technology can do. And processors are only going to
get faster. So it's going to make it a lot
easier to be able to apply much of this technology.
(47:18):
So in in the health landscape, which is often dominated by
surgery, medications and those types of treatments, how do you
see non evasive solutions like this one really changing the
game? I think there's a growing trend
of people who want to hold off right on those invasive options
and they're looking for something that either prolongs
(47:40):
how long they can wait to do that or, you know, like I said,
you Nemo can be used in conjunction.
If you are having some of this, you're still not getting the
exact relief that you need. You can do both.
And it's the nice thing about itis you're not taking a
pharmaceutical, you're not doingsomething else that potentially
is causing damage. It's something to try and see if
(48:01):
it can give you relief. And I think there's going to
continue to be this trend. And it seems like that's the way
the landscape is going. We're trying to give options
that are non pharmaceutical thataren't necessarily immediately
going straight to a surgery, which I think you know, there's
people who are getting injuries younger and younger and we don't
want them to necessarily have togo get a total joint when
(48:23):
they're, I know some people who have gotten total hips in their
30s, right? That's young to be getting a
total hip replacement. So same thing for the knee.
If you can, if you can wait and prolong that, and I think people
want to that they're going to try and do that as much as they
can. If we can give them new options
to try, I think it's good for people to have different options
to see what works best. For you.
(48:44):
All right, so I asked this question of all of my guests.
So you can't escape it and you can take it one at a time here.
What are you doing personally toage well?
Well, I'll start because I'm I'maging.
We're all aging. Yeah, so I'm 78 years old.
I still play tennis, I still keep my mind working on these
(49:05):
algorithms to make new devices. I also collect classic cars then
redo them, which has been fun. And and I play with my daughters
for Malinois and a German Shepherd, so.
(49:27):
So what's your favorite classic car?
Getting active physical activityfor me is like a non negotiable.
So every single day I have to dosomething and for me it's
running or boxing. Actually I love boxing and I
(49:50):
think the reason I like it so much is because you have to
think while you're doing it. You actually actually be engaged
and your brain has to be working.
So for me, it's it's those two that that I like travelling a
lot. So our family tries to explore
new places all the time. And so for me, like just
exploring the world is what's something I want to keep doing
(50:13):
and see new cultures and and learning about different places.
So how did you get into boxing? I mean, I understand the
running. You look like a runner.
Were you a college runner or anyof that?
Out of college runner. No.
Just for fun. I was a pacer for several years
for marathon training. I did that to make some money as
a grad student. But no, I was a dancer growing
(50:33):
up and I think a lot of like that same like thinking of
combos and thinking of things like that.
It translated into when I couldn't run for a bit trying
boxing classes and then I fell in in love with them.
So now I do that every week too.But.
I've learned something here. I didn't know Jenny was in into
boxing. I'll have to be careful when
we're debating things now. Yeah, just keep outside of her
(50:56):
reach. Hey.
Well, is there anything we've missed talking about that you
wanted to address and kind of the technology and the product?
I think the only other thing is if you want to learn like more
about the science, we have a website so you can check it out,
its.com and it's KN EE MO, not like the Disney fish, but so
(51:17):
like the knee MO and there's more about like our clinical
trials on there and the science of how it actually works.
If you want to do a deeper dive and and read it and also like
hear about people who have used it and testimonials and see
those as well. And we'll include links to all
that in the description notes. But if there's one thing that
you want our listeners and viewers to understand
differently about pain, movement, and aging well after
(51:41):
hearing your story, what would that be?
Stay active, you know, find a way.
You know, a lot of the treatments don't necessarily
address staying active. You know, you can take a pill
and sleep on the couch and maybethe pain feels better, but
things are your body is going downhill and that happens.
And that's what Nemo does. It's it's it, we call it pain
(52:04):
relief in motion because it encourages movement to continue
and by reducing the pain. And so I would say that's the
key message that I would suggest.
Yeah, I agree totally. And I think it's find something
that works well for you. Find what makes you happy and
(52:25):
what you can do that stay active, whether it's hiking or
if it's cycling, like find the thing that you actually are
going to enjoy doing and then you know find a way to make time
for that. Do it because it's really not
just your joint health, but yourwhole health.
It's kind of. Bad.
And eventually you'll have a full body Nemo suit that you can
wear. Yeah, it'll allow you to play
(52:45):
pickleball, do whatever you want.
One of our one of our active influencers is going as a
pickleball player because you know, that's a sport that people
take up maybe later in life where they may not have been
super athletes younger in life. And there's a lot of injuries
that take place. And I just talked to another
(53:08):
pickleball player this weekend, and they said, boy, we've got
people that fall down on their knees and then twist their
knees. And so I think one of the things
that happens is injuries take place when people switch to an
activity that they haven't done before.
In other words, they may have run short distances or take long
(53:30):
walks, and all of a sudden they're going to do a marathon.
You can bet they're going to getan overuse injury without the
proper training to work themselves in.
Because what happens? The tissues will slowly adapt to
a new activity. They won't quickly adapt, but
they'll slowly adapt. And if you train up to the kind
of level you want to do in a sport, it will help to not get
(53:53):
an overuse or even worse type ofinjury.
So So again, stay active, use anemo to take the pain away and
you'll be happy. Yeah, I teach my students that
overuse problems are really justa problem of poor coaching or
poor implementation of an exercise program, that the
biggest issue for most Americansis not overuse, it's under use.
(54:15):
And it seems like Nemo is a perfect tool to be able to get
us active again. And we know, we know that.
I think it's like 2/3 of the American population are not even
hitting the minimum guidelines for active physical activity.
And part of that is probably dueto pain.
And so if we can alleviate that and get more people moving,
we're going to have a healthier America.
(54:36):
So I really appreciate all that you're doing.
Just I look forward to future developments.
So we'll have to have you back on when you get the back brace
done. And although, you know, the
studies are done on that. And until then, just keep doing
what you're doing to keep aging well.
Thank you. Thanks.
You're welcome. Thank you for listening.
Hope you benefited from today's podcast.
(54:58):
And until next time, keep aging well.
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