Moving Past Pain

Why Feelings Are Poor Indicators of MSK Health

Jack Seitz
Feb 6, 20245 min read
Moving Past Pain

During my recent conversation with FIGUR8 investor, David Daglio, we talked at length about how the FIGUR8 Platform can improve MSK health.

As an avid athlete at the age of 53, David says he’s injured almost every part of his body. He’s spent a lot of time in rehab and tried everything from physical therapy, to acupuncture, even cryotherapy. He feels that for the most part, most of these modalities work. However, some worked more than others, and if often felt random as to when something would work, and why. Ultimately, the only way of knowing whether something worked was by answering the question, “how do you feel?”

David dislikes that question, especially as a data and analytically driven person. “Pain level is a function of a complex number of factors – what I ate, how I slept, how much coffee or water I’ve been drinking, have I taken any ibuprofen. Also, the data that’s produced from that question takes too long to collect. Even if I was good at answering that question, it would take weeks of therapy before you would start to see a trendline and actually get something measurable.”

David’s been fortunate to work with some of the best physical therapists in the country, but that has taken him considerable time and effort, with likely several misdiagnoses along the way. When he recently tore his hamstring while surfing in Costa Rica, he visited with a couple of surgeons and asked if he needed surgery. Both surgeons told him he did in fact need surgery to repair the muscle.

David then met with two physical therapists. The first said that most people get surgery for this type of injury, but David’s function was better than most, which made him wonder if surgery was actually necessary. The other said he felt confident David would be fine without surgery.

David was encouraged by what the physical therapists told him, but he wanted evidence. He had no data to inform his decision and an image that was inconclusive. “I started to wonder, what if I had a score that could tell me, based on a couple thousand data sets – a couple thousand people with similar injuries – and we could score my muscle function against those that had surgery and those that did not, and as a result we could say there’s a 90% chance of getting full function if you have surgery. There’s only a 20% chance based on your activity today that you improve under physical therapy. I may still choose the PT route, but that’s an informed decision based on data rather than a roll of the dice.”

Aside from the lack of objective data, there’s another issue at play here. The judgement of the surgeon is inherently biased, in that they’ve really only seen patients with poor outcomes – torn hamstrings that haven’t healed. No one that tore their hamstring and healed would end up at a surgical center. They’re out waterskiing. The other issue is surgeons can’t be rockstars at surgery and deciding if someone needs surgery, because there’s inherently a conflict of interest there.

The judgement of the Physical Therapist is also biased because he sincerely believes he can heal you without surgery. We need to remove the bias by evaluating more possible outcomes from larger sets of data.

That’s what ultimately brought David to FIGUR8. He had sprained his ankle a little bit, and as a potential investor, wanted to put the FIGUR8 Platform to the test. He ran through the FIGUR8 Lower Body Assessment, and even after spending the last two years rehabbing the hamstring and scored very low, with flexibility and balance issues, which was shocking after all that physical therapy. Until he was able to look at data, he had no real idea how much that small tweak in his ankle had affected his entire biomechanical chain, including some back pain he was experiencing.

Over the next 6 weeks, David continued to do physical therapy on the ankle and then returned for another assessment. The data showed that the vast majority of issues had cleared up, which was incredibly close to how he was feeling. But without the ability to objectively measure the musculoskeletal health of his lower body, he would be forced to rely solely on how he was feeling to guide his therapy, which could possibly lead to further injury.


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