Moving Past Pain

Why Feelings Are Poor Indicators of MSK Health

Jack Seitz
Jun 15, 20205 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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    Using Technology to Make Humans Feel More Human

    I recently had the opportunity to speak with FIGUR8 investor, David Daglio. As the former Chief Investment Officer at Mellon, David helped design, launch and manage a unique equity investing approach that drove industry-leading performance and won numerous awards. My question for David was this: how can you introduce a new technology without making the people who can benefit the most from this new data feel as though they’re being replaced?

    David began investing in companies 22 years ago. He was basically attempting to forecast which company would be successful, simply by reviewing their financial statements. Back then, analysts like David would receive a fax from the company and highlight what the executives had said and compare that with what they had said in previous quarters.

    As data on companies became easier to collect, measure and score, David began a transition that started slowly at first, but began to gather momentum as his model was proving to be successful. He was taking a process that had traditionally been very human-driven and was trying to augment it with data. However, his biggest obstacle was not learning to use this new tool, but rather convincing the team around him to adopt this new data-driven approach.

    “The battle is that, as humans, we want to believe our judgement is perfect. Whatever the field someone has chosen, they chose that because they felt they had good judgement when it came to that field. And the longer they have been doing it, the higher the value they place on their own judgement. When you introduce a new technology, whose judgement is more repeatable than yours, you’re often quick to dismiss it.”

    It wasn’t until David really tried to understand the problem of “why are they fighting this?” that he realized his colleagues’ response was deeply human – it wasn’t about the computer at all, it was really more reflective about how they viewed themselves and their value. His colleagues were dismissive because they wanted to believe they were truly great at what they did. No one wants to be replaced or feel the time they’ve invested in gaining experience and judgement could quickly be replicated by a computer.

    So how do you show someone that the tool they’re using is as good as they are? David found that it has to be in a non-confrontational way. “You need to work with the data and really adopt a growth mindset – you must be willing to learn something new.”

    David’s approach was to pique his colleagues’ curiosity enough to get them to play with the tool and test it for themselves. They would begin to work with the tool and begin to get an understanding of how it worked, gradually becoming more comfortable with its ability to help them be better at what they did. Once they did, they begin to trust it more and more until they internally adopted it themselves. It happens over time, not overnight. The bottle neck in implementing new technology is often adoption, not innovation.

    As an advisor, David often challenges those responsible for running large facilities or organizations by asking “how much can you make repeatable so that humans can focus on the tasks they’re really good at?”

    This is at the cornerstone of the debate: as you begin dehumanizing the world by replacing work historically done by humans with machines, how do you make humans feel more valuable?

    “Our brains are like thoroughbreds,” says David. “They want to be running really, really hard. They want to be challenged to figure out answers to ‘why?’ When we shackle our brains with mundane things over and over again, we get tired and feel unfulfilled. For me, the value in FIGUR8 is it creates a much more fulfilling experience because it allows us to offload those menial, repetitive tasks to the system and engage in the type of thinking that makes us feel more valuable. More human.”

    Dec 15, 20235 min read