Explained: Why feedback is important in Physical Therapy
You may have seen images of athletes you admire wired up to various high-tech devices as they go through their training sessions. These devices are giving the athlete and their coaches and physical therapists (PTs) biofeedback: critical information on how their body is performing, inside and out, so they can continuously evolve their training program.
You may have thought to yourself—why do they need all these fancy devices? Why don’t they just practice in front of a mirror?
Whether you’re an athlete trying to perform at your peak or a regular person trying to overcome pain, it’s important that you move your body in just the right way. For athletes, tiny increments in movement can be the difference between taking home Olympic gold and not even qualifying, nuances that mirrors—and our brains—can’t reliably recognize. For regular people, these tiny tweaks can be the difference between resolving pain and making it worse. Our FDA-listed sensor technology detects how a body is moving more precisely than human eyes, giving you feedback on how you’re moving in real time, and giving your PT important insight to help them guide you better. Here’s why biofeedback works so well.
It gets your unreliable brain out of the driver’s seat
The world’s best athletes have come to trust technology over their own brains for two reasons. The first is that your brain isn’t fully conscious of the way you’re moving. Once you’ve learned a movement pattern—even if it’s not the best one, or the more efficient —it becomes ingrained. Even elite athletes, whose job it is to be hyper-conscious of their movements, struggle to understand what’s really going on in their bodies. Their coach or PT can correct some of this, but only as much as they can observe.
The second reason is that our brains take time to adapt. Even if our reflexes are super quick, information takes time to travel from our eyes, ears, muscles and tendons to our brain, be processed, and travel back down. We are talking milliseconds here, but enough to render mirrors, and our own judgement, unreliable.
This is true for us mere mortals, too. If you know anyone who has been injured since they started a home workout routine in quarantine, this might be why. Watching videos on youtube or a trainer on Zoom can do wonders to motivate you to exercise, but they can’t help you correct your movements. And this is of crucial importance when you’re in pain, because your movement pattern needs to be corrected and pain changes how you move.
Our digital therapist overrides our unreliable brains and bodies by tracking exactly how you’re moving, and it’ll tell you when you’re doing it wrong. If you’ve been making the wrong move for years, the first few attempts may be frustrating as your body and brain learn new movement patterns, but eventually they’ll learn new habits that can benefit you for a lifetime.
It helps your PT see how you’re performing
If you have done in-person physical therapy, you might have taken home a piece of paper with a bunch of exercises on it. If you’re super conscientious, you may have stuck that piece of paper on your fridge and done the whole exercise routine five times a week as prescribed by your PT. If that’s you, congratulations… The problem is that you’re in a serious minority. Fewer than 30% of people actually engage in their exercise program between sessions. The large majority of us don’t do anything with that little piece of paper.
This is common, and a real point of frustration for physical therapists. Therapeutic exercise is the cornerstone of a PT program, and when you don’t do your exercises, you don’t get better. Our medical device effectively serves as the eyes and ears of your PT, allowing them to monitor your movements from afar. This is necessary for a digital solution, as it’s impossible to tell whether someone is moving in the right way through a phone camera. But unlike in the clinic, where the PT gets feedback on how you’re moving during your appointments but not between visits, our digital therapist sends data on how you’re moving every single time you complete a session. When our PTs join Sword, many of them are blown away by the amount of feedback they get.
Your PT can use this information to evolve your program: add or subtract exercises, and make them easier or harder, depending on how you’re progressing from day to day. Our PTs make adjustments to members’ programs between 2 and 4 times per week on average, which helps our members get better faster.
When you know you’re being watched, you perform better
Remember that exercise program your PT gave you at the clinic? When you got to your next session, what happened? Did you admit to your PT that that little piece of paper was still in your bag, untouched? Or did you tell them a little white lie? More importantly, did the therapy program work? Did you get better, or does that pain still rear its ugly head from time to time?
When there’s nobody watching, it’s harder to get motivated to put in the work—and it's easier to bend the truth than to bend your back. Your PT will never know, right? Wrong—we always know when people are lying about doing their exercises, because they’re not improving.
But as soon as you know we’re being monitored, everything changes. All of a sudden, you’re doing your exercises five times a week. This is known as the Hawthorne effect: our tendency to work harder when we know someone’s watching. If you have a smartwatch or ring, or track your workouts on an app, you may be familiar with this effect. Does tracking your run or bike ride on Strava help you go faster? Does tracking your sleep make you prioritize it? Do you complete your workouts even when you don’t want to because every time you work out, your Apple Watch sends a notification to your friends? These are all examples of the Hawthorne effect at work.
At Sword, our digital therapist sends the results of every exercise session to your PT, and they can not only see that you completed a session, but exactly how your body was moving through every rep, helping keep you accountable. That’s why our digital therapist is so effective. In fact, in clinical studies, Sword’s program achieved 30% better results than conventional PT.
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About the author: Dr. Fernando Correia, M.D.
Dr. Fernando Correia is the Chief Medical Officer at Sword Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.
He co-founded Sword with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.
Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.