How Physical Therapists Switched to Telehealth Overnight During COVID-19 Lockdowns

Vance Crowe [00:00:01] As the crow flies on the Vance Crowe podcast. Jesse Velo, welcome to the podcast.

Jesse Civello [00:00:09] Thanks for having me.

Vance Crowe [00:00:10] So I can see the Precision Physical Therapy logo behind you. Does that mean you are seeing patients right now? What are you, what are you doing?

Jesse Civello [00:00:18] I, I am seeing patients virtually similarly to how I'm seeing you right now. So I'm in the office, but I'm the only one here.

Vance Crowe [00:00:27] And why are you deciding to go into the office if you're seeing people over like Skype or, or telehealth or whatever?

Jesse Civello [00:00:34] Partially, you know, the table is still really helpful. I like to demonstrate things for, for patients over the video. I think that helps. I also just have two very loud little ones at home

Vance Crowe [00:00:45] So

Jesse Civello [00:00:47] That I, I have a hard time getting away from. So this, this gives me a little bit of a quiet environment.

Vance Crowe [00:00:52] So right now, when you've pivoted to telehealth, had you done this before, had you ever tried to treat somebody you're trying to fix the way they move or how they feel without being able to touch them? Had you ever done this before?

Jesse Civello [00:01:04] We have not. We actually, we already had the technology for it, so that part was easy, but we weren't utilizing that technology. We, we enjoy seeing people in the clinic. There's the laws can be sort of hard to understand. And so we just hadn't taken the time to do that. But it, the pivot was actually faster than we thought it could be. We were really pleasantly surprised. We pretty much had everything we needed. We just needed to hit go. So

Vance Crowe [00:01:34] And so tell me about, like, is it people clearly, like you guys do all kinds of people, you're an expert in golf swings that people have when they hurt their arm or shoulder or whatever?

Jesse Civello [00:01:46] Yeah.

Vance Crowe [00:01:46] Like what types of people right now are calling you up and say, Hey, I wanna get physical therapy.

Jesse Civello [00:01:51] You know, so in my mind, what I was hoping is that everybody's going to think, wow. Like, now's the time I should I have time to work on, you know, this nagging back pain or, you know, I'm going to learn to move better in my everyday life. But really who we've been seeing mostly are people who right now are, are actively having a problem that they, like, they kind of feel abandoned a little bit. They're like, oh no, you know, everybody's closed. Where am I going to go? My doctor said I need physical therapy. So that's been primarily who we've been seeing recently. And you know, of course our current patients, we kept up with their care. But I'm hoping as people start to settle into the routine of we're not going anywhere anytime soon, you know, this is, this isn't ending next week. That they start, you know, falling into a new routine, which I know my family's starting to, we're starting to figure out the whole working from home balancing to working parents that they start thinking about, okay, now that the initial shock is over, what can I do to carry on? You know, what, what can I do next? What, you know,

Vance Crowe [00:03:02] So I, in full disclosure, Jesse is my wife's business partner. And so this is a weird, bizarre land where I can be like, I don't know if you're doing this to your husband or, because we live kind of parallel lives when you have a physical therapist and a spouse. So, and in my family, my brothers and sisters live all over the country and they're all now in their houses, actually even all over the world. Right. And it's very interesting to see how they've set up their workstations. And if you think like, oh, I'm setting up this work station 'cause we're gonna have a long snow day or a long snow week, you set up one thing, right?

Jesse Civello [00:03:36] But if

Vance Crowe [00:03:37] You try and live like that for several weeks or several months and you don't know how to fix your workstation, you're gonna come out of quarantine like the hunchback of Notre Dame,

Jesse Civello [00:03:46] Right? And it doesn't even take several weeks. I mean, my sister called me after one week of working from home and she says, my next killing me. So let's hop on the video and, and, and adjust your workstation. Or you know, my husband's working at the dining room table right now, which seemed fine for about a week, but now it's like, okay, we need, we need to adjust this setup for you because he is starting to know, complain about this pain or that pain. And those little pains become bigger pains. And, you know, and we, so what

Vance Crowe [00:04:15] Things you see, because for me, my, when we started quarantine, I just kept working in my house. So it didn't, it didn't seem any different to me. But if somebody is now working at the dining room table, we'll say Camden, for example, what, what are the, what are the symptoms that something is going wrong?

Jesse Civello [00:04:31] So symptoms would be, you know, like maybe you're, you feel achy in your neck or you know, suddenly your legs feel stiffer than usual or headaches could be another one. Suddenly you're having headaches like you didn't used to. Or for Camden, he said, oh, my legs hurt are hurting with running. And I said, I don't think it's the running. I think it's the way you're sitting at the, at the table. And then you go run after you've been doing that. So I also just think that, you know, everybody's out of their routines. So maybe you used to exercise at a certain time of the day, but now you wake up and you wanna get things done before the kids are up, right? So you, you go right to your desk and then you get stuck there for the rest of the day or you know, I just think everybody's routines are all in flux and so their bodies are trying to figure it out too. Yeah,

Vance Crowe [00:05:22] Yeah. I definitely think that's right. I used to be wake up super early in the morning and work out, and that's always what I did. But now I've found that a lot of information flies around on the internet. People get online and they're talking about things at night. So if I'm not there at night, then I don't get to hear those things, right. So I've shifted my 4:30 AM wake up to like six 30 and now I have to find working out at some other part of the day. And I hadn't thought about it until now, but I go out there and work out stiff and I probably don't stretch or do any of those things 'cause I'm like, I just gotta get this done and then get back into the office. Right?

Jesse Civello [00:05:57] Or I think, you know, there's an excitement around like, how can I use this time? So if you've noticed everybody's putting out, you know, their quarantine workout program, so maybe they're trying something completely new that maybe is or is not appropriate for them, or their, their body's getting used to that, or the weather's changed. So like, I know I've been gardening a lot lately, so it is sort of the normal phases we see even in pt. You know, the seasons change, people's activities change, and so we see different sorts of pain complaints or Yeah.

Vance Crowe [00:06:26] Yeah. I mean that's definitely true. Annie and I have been pouring through yoga and yeah,

Jesse Civello [00:06:31] I,

Vance Crowe [00:06:32] I I can tell you that I was not ready for that. That is, you know, they make it look, the people that you see doing yoga are good at it, which is why you see them doing yoga. So you don't imagine that you can't just move your body like that and then all of a sudden you're like, ow, I can't do any of this. Yeah.

Jesse Civello [00:06:49] Well, and it's all over video, right? So you're not getting feedback where if you were in a class, they might come around and correct what you're doing.

Vance Crowe [00:06:56] Well, I am

Jesse Civello [00:06:56] Getting feedback. Well, you're, you have, you're lucky you have that concierge physical therapy at your house.

Vance Crowe [00:07:03] Yeah. I don't know that I'd call that lucky. It's good to have it in about an hour long block where it's like, what am I doing wrong? But no, Annie's, she

Jesse Civello [00:07:10] Lets me, I think my husband would say the same.

Vance Crowe [00:07:13] So talk about the, the pivoting that you did in your life. Like when did you start to realize that coronavirus was gonna be a big deal and that it wasn't just something that would get over right away?

Jesse Civello [00:07:27] Yeah, it's interesting, I think, and I, I think a lot of people felt this way. It, it changed really fast. It went from, we should put a sign in our lobby that says, if you are feeling ill, you shouldn't be here. Right? And that felt sufficient one day. And by the end of the day, it was like, I'm not sure we should have patients in the clinic, and so we should stagger them and make sure there's only one person here at a time with a buffer. And that was that day. And then the next day we switched to telehealth. So I mean, it, it all changed pretty fast. And we're a new business, so we are still sort of adjusting to me my work schedule. And then suddenly I was home. And then my husband works in trucking, which is an essential business. So at first it seemed like he was gonna go in the office, and then it quickly seemed like he shouldn't be in the office, and they had to adjust who should be there and who should be home. I mean, so the first week was a lot of change. And then I really think last week, like two weeks in, it kind of felt a little bit more like we could balance, like, I'm gonna work than he's gonna work and the kids are gonna play. And, and I have to say, I, it's sort of adjusted into less stress and sort of, we found a rhythm where, you know, at three o'clock we can all play outside and enjoy the sunshine. And that's really fun. We don't normally get to do that as a family. And it means Camden may have to start earlier or work a little bit later, but we get to enjoy these certain times of the day together, which has been, you know, a pleasant surprise as well.

Vance Crowe [00:08:55] Yeah. You know, I've actually had that same kind of experience and have, have been tempted to be like, ah, you know, and now we're getting back into regular life, I'm gonna skip it. And you're like, no, the things that we've been doing that we've been learning about spending time with our families through the quarantine is really worthwhile. Like, Annie and I make bread now, and like, it'd be a lot easier if we could just have bread for us, but the activity of making it is what is, what makes that an enriching, fun experience.

Jesse Civello [00:09:23] Yeah, I mean, I have to say, my garden this year, I, I always try to garden, but I'm squeezing. I take care of my seedlings, not very well because I have work and I'm busy, and now they're getting so much attention that it's, they're looking great. So I think our garden is going to be more productive this year, and that's been really fun. So, I mean, finding the, the positives in all of us has been really helpful and, and nice.

Vance Crowe [00:09:47] And what, what kind of a garden are you growing?

Jesse Civello [00:09:49] Oh, I, it's just a, a vegetable garden. So I have lettuce and radishes, right? Right now I have all my cool weather crops in, and now I'm getting ready, you know, next will be, let's see, what did I just set out? I'm gonna be transplanting my cucumbers and squash soon, and then I've got some tomatoes and peppers started. And,

Vance Crowe [00:10:09] And is this a skill that you learned through your family or is this something that you've developed in the recent past?

Jesse Civello [00:10:17] It's, it's more recent. When I first started living on my own in PT school, I started, I had an apartment, so I would container garden, and then I, you know, I would say like 75% of things didn't make it. And then, you know, then, then I switched. And then one of my big things when we got married was I wanted a yard with that I could garden in. And so, so it's just, it's something I've, I'm self-taught and every year I've gotten a little bit better at and wasted a little bit less money doing it. So, and this year I'm trying to do flowers, which I think would be really fun. So I'm trying to do more, you know, what they call a cutting garden. So,

Vance Crowe [00:10:55] And that's, that's purely aesthetics. Then you, so you wanna spend some time and then you get a thing that's really only pretty for a little while. That's an interesting

Jesse Civello [00:11:02] Hobby.

Vance Crowe [00:11:02] Yeah.

Jesse Civello [00:11:04] So, but it's fun. You get to feed your family, right? So, you know, the, the vegetable garden is feeding my family. The flowers are making smile. It's especially fun with a toddler, you know, the concept. We planted the seeds and she asked if they would be, if they would be up after her nap, you know, so it's a lesson impatience that she planted the seeds, you know, in February and we might see the flowers in June. So

Vance Crowe [00:11:28] Yeah, time, really, that would be a really interesting concept for her to be able to imagine. It's not like Christmas where it's like, oh, it's getting cold, it's Christmas time. It's like now you add in another layer of we plant here and we see green there. That's really cool,

Jesse Civello [00:11:42] Right? Yeah. So it, it, you know, there's, it's fun. It's, it's my hobby, I would say.

Vance Crowe [00:11:47] And so you were talking about with your hobby, gardening, you know, bending over, things like that, that, so as a person that knows how the body should move, you're in the special physical therapy where you really think of the whole way that the body moves and works together.

Jesse Civello [00:12:03] Yeah.

Vance Crowe [00:12:03] What are things that you learn because you're like, you're gardening and something is feels off. Like I would imagine that those experiences are different now that you're an expert in this field.

Jesse Civello [00:12:14] Yes. Yeah. So every time I'm gardening, I'm usually thinking, okay, so this, I'm doing this in a way that's not ideal, but if somebody said, how do I do this better? What am I going to teach them? And what's realistic? So, you know, if I'm outside and I'm digging in my beds and I, I know I'm not doing it in an ideal, you know, way, my body mechanics aren't ideal, and then I try to fix it. I try to think, okay, would somebody do this? Like, would they take the time to correct it this way? Is this realistic? Okay, maybe if I try it this way, does that feel better? So

Vance Crowe [00:12:42] And so does that look like I'm, I'm bent over and I'm slouching? Or like, what, what do you mean? Like, could I do it better? The only thing I can think of when you guys talk of posture is like, oh, I'm supposed to be up, like, you know, point my back. But like, what

Jesse Civello [00:12:55] Do you mean? No, that's, that's a huge misconception. So like, I always tell people, show me what you think of when you mean good posture. And then I say, okay, forget it. That's, you know, there's not good posture. There's better, better posture for you given your body. So for instance, I was just on the on video with, with a patient earlier today, and she's a gardener, and so she's having trouble raking. She said, my back hurts when I'm raking the beds. And so we talked about ways that you can rake the bed that put less stress on your spine. So, you know, for example, you, you know, a lot of people use their rake and they really reach with their rake, and it's like, nope, you can move your feet. And a lot of things we do, we just do out of habit. So it's just reframing the, the habit with which they do it. So it's like, well move your feet. Oh yeah, that makes a lot of sense. That feels a lot better. Okay, great. You know, or you know, if they're stooping over their bed, taking the time to get a stool and sitting on a stool to do their gardening, or it's not the same for every person. You know, every, everybody has different body types that make one strategy better or not better for them. But yeah, so,

Vance Crowe [00:14:03] So when I, so is that gotta be confusing for patients? Because you can't just be like, here, let me show you a picture of what it would look like if you were sitting Correct. I mean, you can't just like, have a model do it because the body shapes are so different that the way somebody would be sitting stooping or raking would be different than another person.

Jesse Civello [00:14:20] Exactly. So, you know, that's what we, when we look at a patient, that's what we're learning about them. So we're watching how they perform that activity. And so we've already learned about their body, right? Because they, we've taken them through, you know, our assessment and then the beauty of this video, actually. So normally in the clinic, I would say pretend how, show me how you would rake. And, you know, people feel sort of weird doing it because they don't have a rake and they're pretending to rake the carpet. And I, and I still learn about them and I can still correct it, but the, the beauty of this, this telehealth has been, I can say, okay, like the other day I said, bring me to your kitchen, you know, and they carried the computer to their kitchen and they said their shoulder was hurting while they were chopping vegetables. And I said, well, get out of, get out of, you know, cutting board and get out a knife and set me up and let me watch you do it. And then I could see exactly what was happening and we could change it right there. And now they don't ping

Vance Crowe [00:15:11] In the kitchen. That's a whole different level of engagement with your patient. And while you can't feel them, you get to see where are you actually doing the moving.

Jesse Civello [00:15:20] Right? Right. And, and you know, and the movement is so, is so powerful because, you know, if you think from a dose perspective, you know, I can give you an exercise and tell you to do it 10 repetitions, two sets of them, and do that one time a day. Right. And that's 20 times. But 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 and, and I change that movement strategy and that changes your pain, now you have this huge dose of what I'm gonna call exercise. Right?

Vance Crowe [00:15:50] Yeah, that's right. So

Jesse Civello [00:15:51] It's powerful. Changing the way you move is in, in your functional activities is just, it's incredibly powerful way to take control of a, an ache or a pain that you're having. Well,

Vance Crowe [00:16:01] 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? When we got shaken up, and you were talking earlier in the podcast about people having their routines changed, I am emptying the dishwasher twice a day. Yeah. And so if I was like, I never really thought about the fact that the way that you bend over, over and over and over again in this new world actually, like if my back hurt doing that, I'd be pretty pissed off.

Jesse Civello [00:16:49] Yeah, yeah. Especially if then you had these grand plans of, well, while I'm on quarantine, I'm going to go, I'm gonna go garden. But you can't now because your back hurts from doing the dishes. You want your dishes to keep you from doing the thing you enjoy. Right. So, yeah. So take care of it. You,

Vance Crowe [00:17:06] Wow. This is a whole different way to think. In fact, there's things I'm even gonna have Annie do now. Like I hadn't really thought about the fact that, I mean, I know all about trying to fix my posture and things like that. Yeah. But I really hadn't thought about it is if you do it correctly, it is your exercise. And then if you can use your exercise time for the building muscles or getting faster or whatever you wanna do.

Jesse Civello [00:17:29] Right? And, and it's the same thing for sports, right? So sometimes people like to pick on a certain sport, they say, you know, like if you think of tennis, people are like, oh, well, tennis is a lot of twisting, right? But you could, you don't wanna, so you don't wanna waste your twisting, right? So you don't wanna twist while you're loading the dishwasher. You wanna twist while you're playing your sport that you love. And then it's probably fine. It's, you know, so it's, it's kind of like an allowance and where do you wanna spend your allowance?

Vance Crowe [00:17:57] Wow. Yeah. And I bet right now under the all kinds of stress, people have the physical pain and they're probably not even thinking like, I could get rid of this. They're like thinking about work and taking care of kids and, and all the chaos that's going on in the news.

Jesse Civello [00:18:15] Yeah. Or they're thinking of, you know, physical therapy. I would maybe say traditional physical therapy includes, it's a lot of exercise base. So they're probably thinking I don't have time to add a new rehab program or, but it, what if they just changed what they're already doing and that's the rehab, right? So then it's no extra time except for maybe a little extra brain time to, you know, create the changes. But that

Vance Crowe [00:18:41] Is what physical therapy is for me. So when I've had problems, like when I was running and, or I still jog and I'd have back pain and would tell me how to fix something, and then it wasn't that it was difficult to do, it was that it took up mental energy. Yeah. And it was a challenge. And the craziest thing is you do it for like three days thinking, I, I, I'm gonna have to think about this forever. And then one day you wake up and you don't have to think about it anymore, and it's just a part of your life, and then you get that added into your allowance forever.

Jesse Civello [00:19:11] Exactly. So, you know, the most people don't realize that they tend to use the same movement strategy for everything that they do. So they think of different activities as unique from each other, but if you watch the way they move, those activities are not that unique on their musculoskeletal system. So like, you know, whether, so, you know, maybe you wake up and you sit down and you have your coffee, and then you get into the car, and then you get to the office and you sit at your desk or you know, at home that might be waking up and sitting at the table and having your coffee than sitting at the table and doing your work, than sitting at the table and doing your dinner. Right? But they, they think all these activities, they're doing them differently, but if you watch them, they're using the same movement strategy. And so that's why if you can optimize that movement strategy or put more variety into the way that they move, you can take stress off of tissues that are irritated and, and now they're feeling better without having thrown in a ton of exercises into their day.

Vance Crowe [00:20:08] This is, this is, I'm, I'm really excited, you know, Annie has been talking about how much you guys have been working on it, but I have to say, I don't always take the hour to sit in front of her and just be like, now tell me exactly what's going on here. So this is, this is very interesting. Yeah.

Jesse Civello [00:20:23] And I have to say that's not, that's not all that different from what we do on our practice prior to telehealth. I mean, we, we care a lot about function. I think the buy-in is greater when, when you're doing it over the camera, because it, you're actually seeing people in their sort of like natural habitat, right? So when, when somebody comes into their c the clinic and they're expecting exercises, and so you try to give them, you know, a little bit of exercise to address what they need. And then you talk about the functional activities, it's not as, it, it doesn't sink in as much as when they're laying in their actual bed. I actually had someone bring me into their bedroom the other day too. And I said, okay, well show me how you're sleeping. And then I'd say, okay, there's that pillow behind you. I think that one's a better size. Try that one. Okay, now, you know, and so they get to experience the difference right there, live in the activity that matters to them. And so the buy-in is greater, so then they do it, and then I think they, they feel better a lot faster. I mean, it's, again, it's a dose thing

Vance Crowe [00:21:23] That's exciting. I mean, like, I've got a big, it's exciting, big smile on my face because it's really funny because in this regard I'm fine, you know, have my wife go visit stranger's houses because you've got this like mental telepathy or whatever you wanna call it. Yeah. Like, you get to be in this virtual space. What an exciting time to be alive. Yeah. Really. So how is the, how have the laws been? How has it been to make this all? What, what's going on with that?

Jesse Civello [00:21:48] So from a telehealth perspective, so in the state, you know, so you can only treat people within your state. So that's, you know, that's fine. So anyone, it's a little hard since we're in St. Louis. So maybe somebody who's from Illinois that might have normally traveled to see us, we could, we wouldn't be able to see them because they're in another 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. And that's even harder now, right? Because nobody

Vance Crowe [00:22:41] Is gonna go, wants to see their doctor. The, this is insane. So this system, yeah, we talked about it with Shirley Sarin as another guest. I think Anne and I have talked about it. The, I hope that the new c post coronavirus world, we get to wipe this stuff out because it's so important that people be able to see, get rid of physical pain because that's what can keep you outta the operating room. It can keep you healthy and exercising

Jesse Civello [00:23:08] Well. Yeah. And I, I think, you know, a a minor bite back ache by the time you make it to a, a script could be a, a bigger backache. And now it's, you know, it's a six visit problem instead of a two or three visit problem, or it's a larger financial burden by that point because you had to seek out healthcare or, you know, multiple providers. So, you know, and there's a, the Missouri has put a bill out, there's a, a bill to change that this year. So I know, I don't know what's happening now that everybody's Oh,

Vance Crowe [00:23:44] Tell it, it to me, if there's somebody for, for me to call, I'll, I'll, yeah,

Jesse Civello [00:23:48] I'll do this. I'll, I wanna hear about this.

Vance Crowe [00:23:49] I'll

Jesse Civello [00:23:49] Find the name and, and give it to you. But I, what I, I guess what I mean is I don't know what's happening in the legislature now with all of this going on. So,

Vance Crowe [00:23:56] 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.

Jesse Civello [00:24:16] Right. Right. Well, and there's plenty of research to suggest that there's, there's not a danger in going straight to physical therapy without a referral. I mean, you could go see your massage therapist if you would like, you could go see an acupuncturist if you'd like. So, you know, a lot of people have tried a lot of these things before they get to us, simply because they, they didn't have a prescription for physical therapy, which is a piece of paper that says physical therapy, evaluate and treat.

Vance Crowe [00:24:46] You know, and it's an interesting time because there's a lot of people that aren't able to get in to do other ways that they treat their pain. We're going to see a physical chiropractor going to see a, an acupuncturist or those types of things. So now to not be able to do telehealth with the one thing that can be done remotely.

Jesse Civello [00:25:03] Right.

Vance Crowe [00:25:03] Seems insane.

Jesse Civello [00:25:05] Yeah. Yeah. So hopefully, you know, hopefully that's something that'll change in, in Missouri.

Vance Crowe [00:25:12] So Jesse, what do you think the world will look like in two weeks? It is April 10th, it's the afternoon on a Friday, two weeks from today. What do you think the world will look like?

Jesse Civello [00:25:26] You know, I, I know we'll all still be at home, but I, I honestly think with each week that passes, it gets a little bit less chaotic. And, and I still just think people are gonna continue to settle in and find new ways to engage. Right. So I'm hoping maybe more people will start, you know, physical therapy again because they think like, you know what, all right, this isn't going anywhere, and I wouldn't like to be able to do the things I love. Or maybe my shoulder was hurting me prior and I just thought I'll deal with it when this is over in three weeks. And now they're realizing like, okay, I should, I should just do something about this. I, I'm hoping with nicer weather, people get to enjoy being outside. I know. I, I have just had a blast being with my family, which I mean, life is so busy. It's sort of nice to be forced home with my kids. And I'm hoping more people start to succumb to that.

Vance Crowe [00:26:24] Yeah. Like make it the adaption that, that allows you to really embrace the new post corona world. Right. Instead of saying, yeah,

Jesse Civello [00:26:31] We're

Vance Crowe [00:26:31] Just on a break, why don't you say, Hey, this is how we're living now.

Jesse Civello [00:26:35] Right. And I think it's fun to see so many businesses being creative. Right. I mean, I think this has been really hard. I mean, it's been hard on our business. It's been, I think it's really hard on a lot of businesses, but I've also seen a lot of people adapt whether they're moving their, what they sell in their store, they're, you know, moving in online would be something that's easy and straightforward, or like, we're offering telehealth. And I think even when this is over, we'll continue to offer this service because it's been such a good experience for us and for our patients. Or, you know, I, I think there's gonna be a lot of creativity that comes out of this that that will remain even when hopefully we've, we've moved on a little bit from it.

Vance Crowe [00:27:19] Yeah. I mean, I see it, you know, Annie is trapped in the, in the prison of just being at our house and working. It forces her to be creative in, in very interesting ways. And I've seen like, well, I've been a model now for lots of like demonstrations where she wants to say like, this is how you do this exercise, so we're taking this photographs. And like, if you resist it, if you're like, ah, this is a pain and I can't believe I have to do this. It's all work and it's terrible. But if you embrace it, then it's like, oh, remember the time when we were doing all those photos with the, with the soup can, so it looked like a weight. You know? And that's, it just

Jesse Civello [00:27:54] Makes

Vance Crowe [00:27:54] Life more fun.

Jesse Civello [00:27:55] Right, right. So, and I think, you know, I'm hoping, you know, we start to see more of those people who are, you know, like you mentioned, I work with golfers. I, I love working with golfers. And this would be the time of year that I normally would be doing that a little bit more. But I've been, I've been thinking through about like, how can I help them over video? You know, like I can analyze a video swing over, you know, I don't need to see somebody in person to do that or, so I'm,

Vance Crowe [00:28:21] Yeah, it's amazing. I mean, Annie and I made a video on how to capture running Gate. Yes. So like, if you're having pain running and made a video saying, this is how you can take a video of yourself running and then send it to me, and then I can give you an evaluation. And I was like, that's really cool. 'cause everybody, like, there are a lot of people that have iPhones with slow motion cameras on them. Right. And you can use that as like, legit, let's get some really good high quality video and have this analyze. It's kind of a cool time.

Jesse Civello [00:28:50] It is, yeah. Yeah. To see what technology can and can do for us. Now, don't get me wrong, I can't wait to see people in person again and be able to work with patients face-to-face. But I, I do think there's been a lot of value that has come out of this. You know, I, I used to think I'd like to offer a service where I go to people's homes and watch the way they move in their home. And, and now that's what I'm doing. Right. But just through video, which, so I kind of forced us to take that step sooner than maybe we would've. So.

Vance Crowe [00:29:20] Well, I am delighted that you are Anne's business partner. You are always bringing a fresh perspective, and you're exciting and curious and, and an excellent clinician because Annie is a very harsh judge and she loves what you do. So thank you so much for coming on the podcast. And if people wanted to get a hold of you and Precision Physical Therapy, how would they do that?

Jesse Civello [00:29:44] So they could always email me, it's Jesse, JESS e@precisionsstl.com. They can check out our website, which is precision s stl.com or, or they can check us out on Instagram. We've been trying to put out content on, on changing the way that you move. So that's at Precision tl.

Vance Crowe [00:30:03] So hilarious thing happened yesterday in that I have been talking about Annie being pregnant on the podcast for like, for weeks, you know, months. And, but we hadn't put it on Facebook and I had kind of forgotten that. And so I took a photo of her doing, like, having this hilarious conversation about how she could use geometry to fit somebody. The cycle is that she's giggling.

Jesse Civello [00:30:26] Yeah.

Vance Crowe [00:30:26] And she's happy. So I take a photo and then I write, my pregnant wife is doing geometry and iPhone videos to fit a bike, and I post it on Instagram

Jesse Civello [00:30:35] And let

Vance Crowe [00:30:35] It go to Facebook. And that's when I made my announcement that my wife was pregnant. So we got like, you know, dozens or a hundred people just being like, oh my God, congratulations. And I'm like, it's just a single symbols shot. What's the, oh, I told everybody on Facebook, my wife's pregnant.

Jesse Civello [00:30:55] Well now you can turn it around on her and make her the subject. 'cause pregnancy definitely creates some unique movement challenges. And so she's gonna become the subject for a while here so that we can take advantage and get some photos of the way that she's moving. We

Vance Crowe [00:31:10] Have, we've been taking photos of like how to wear a belt so that it like holds your posture and how to walk, you know, without having too much sway back. So she's using

Jesse Civello [00:31:20] Yeah.

Vance Crowe [00:31:21] Her own pregnancy to be like, and she's like, how do people do this? If they don't have a, a doctorate in physical therapy, how do they fix their pain? Like, yeah. So apparently being pregnant is tough. But anyway. All right, Jesse,

Jesse Civello [00:31:35] Thank

Vance Crowe [00:31:35] You so much. It was a great time, and we'll see you again soon.

Jesse Civello [00:31:38] Thank you.