Virtual physical therapy during Coronavirus | Jesse Civello Precision Physical Therapy

About this episode

Vance interviews Jesse Civello, his wife Annie's business partner at Precision Physical Therapy in St. Louis, about the overnight pivot to telehealth PT during the early coronavirus lockdown. Civello walks through the compressed timeline of change (a lobby sign, then patient staggering, then full telehealth within days), the surprising upside of watching patients move in their actual homes and kitchens rather than mimicking activities in a clinic, and a craft-heavy discussion of movement strategy: most people use the same body mechanics across unrelated daily activities, so fixing one movement pattern (posture, raking, dishwasher-loading) fixes many downstream aches at once. The conversation turns institutional when Civello details Missouri's PT referral law — a physician's signed script required before a patient can see a physical therapist directly — and a pending legislative bill to remove that barrier, which Vance frames explicitly through his recurring "Overton window" theme: crises open space for policy change that would normally be unthinkable, and legalized cannabis is the comparison he reaches for. Lighter threads include Civello's gardening hobby as a hands-on case study in ergonomics, and Vance's own aside about accidentally announcing Annie's pregnancy on Facebook via an Instagram post.

“And you're totally right with the, i I keep referring to this thing called the Overton window, which is the, the window of acceptable thought in a given society. And when you have some giant event, the Overton window opens up and new things happen. So this could be like, remember when cannabis would've been the most insane thing to be legalized, and now there's shops in Illinois you can go buy it from? Right. That's, that's something coming into the Overton window, right?”

“Well, it's a perfect time, you know, when the Overton window is open, it's a perfect time to be like, Hey, do you wanna help a bunch of your citizens get rid of these laws? Right. Make it so we can see people and, and make it so we, or at least make it that while this pandemic is going on, we can stretch the rules and we can come back and visit 'em after we, after we get the all clear.”

“So from a telehealth perspective, so in the state, you know, so you can only treat people within your state... Missouri is still one of the states that requires a referral from a doctor. And because of that, I mean that's, that's, that's always challenging and that's always been a barrier where we're not, there's most states now, you can just go directly and see your physical therapist the way you would most of your healthcare providers. But in Missouri, you have to get a piece of paper from a physician, a dentist, a chiropractor that says that you need physical therapy.”

Key moments

• Civello explains why she still comes into the (empty) office for telehealth sessions despite having two young kids at home.
• The pivot timeline — a lobby warning sign in the morning, staggered patients by afternoon, full telehealth switch by the next day.
• Civello's gardening as an unplanned, ongoing personal case study in body mechanics and posture correction.
• "There's not good posture. There's better posture for you given your body" — Civello's core clinical philosophy, stated plainly.
• The "dose" framing — correcting a functional movement (chopping vegetables) delivers far more therapeutic repetition than a discrete exercise routine.
• Vance introduces the Overton window explicitly, using legalized cannabis as the reference case for crisis-driven policy shifts.
• Civello notes telehealth buy-in is higher than in-clinic because patients are observed in their actual "natural habitat."
• Missouri's physician-referral requirement for PT access described as a longstanding barrier now sharpened by the pandemic (no one wants to visit a doctor's office to get the referral).
• Vance's direct call to action — use the open Overton window to permanently repeal the referral requirement.

Notable quotes

“I keep referring to this thing called the Overton window... remember when cannabis would've been the most insane thing to be legalized, and now there's shops in Illinois you can go buy it from.”

“Missouri is still one of the states that requires a referral from a doctor... you have to get a piece of paper from a physician, a dentist, a chiropractor that says that you need physical therapy.”

“If you are in the kitchen three times a day and you're moving your shoulder a hundred times as you chop the carrots and the celery... now you have this huge dose of what I'm gonna call exercise.”