Dr. Frank Wen, DC
As my patients already know firsthand, the way that I practice is anything but the typical chiropractic they've encountered over the years.
For the past several months at Integrity Chiropractic I've been experimenting with and integrating a new device called Plantiga in the assessment of several patients that present with pains and complaints in the lower back and lower extremities as part of my never ending obsession to understand and treat the human body better.
I think it's an exciting new tool that has great potential to help elucidate some questions that patients and I have about what's going on with their bodies, and I wanted to take time with this post to share some information about it, as well as how I've been using it at the clinic to help patients-- so read on.
What is Plantiga?
Plantiga is a company based out of Vancouver, BC that has created a measurement device that fits comfortably and conveniently at the bottom of the feet via a custom insert that it attaches to.
While there are and have been similar measurement devices out there throughout the years, Plantiga is unique in that it's placed right under the foot, which believe it or not, has been difficult to do and they are the first to successfully bring this design concept to the market.
These measurement devices, also known as inertial measurement units (IMUs), obtain linear and rotational acceleration measurement data in all three movement planes that is then coupled to machine-learning in Plantiga's cloud, which allows it to analyze and generate useful metrics about human gait and other types of movement (more on that in a moment).
The unique design allows me and the patient the freedom to take movement assessments to another level when needed, including the ability to go outside to do testing in the real world.
Using Plantiga is kind of like being in your college 100-level physics lab, but way more fun and interesting.
What kind of data is Plantiga able to gather and provide?
Plantiga records accelerations at the foot at a very high frequency as you move. From this data, Plantiga is able to leverage its AI to determine spatiotemporal parameters of walking and running gait such as speed, cadence and stride length- just to name a few.
I recently used these features to help me better understand what was happening to my lower limbs and body for a review of a floating backpack. But check out this short video of me using Plantiga to do the basic walk test:
It's also able to generate performance metrics of jumping movements like the Reactive Strength Index and jump height.
But those are just a couple of examples of what it can do.
Being an engineer first, one of my favorite things about Plantiga is the ability to download the acceleration data for an activity and dive deeper with a detailed analysis about my patient’s movement.
The following snippet is from a graph I created in Excel, tracing the rotational acceleration of the left and right foot with respect to the flat ground (transverse plane) during walking gait. The purple trace is the left foot and the green trace is the right foot.
This particular patient presented with right lower back and buttock area pain several months after a hip surgery in addition to residual hip flexor tightness.
We will assume that the left uninjured limb is the patient's "normal".
I have phase-matched the graphs so that the left and right leg movement cycles are matched up in time.
In a perfect scenario both sides would be reflections of each other assuming there is balanced anatomy, mobility, muscular control and strength between the limbs (usually not though, unless we're measuring a robot).
However, general observations can still be made by looking at large peaks and troughs in the acceleration traces.
Look at the interval between the two inner blue lines. This interval is the swing phase of gait.
The first small peak that lies at the start of the interval represents the acceleration imparted to the limb to turn it outward a bit for toe-off to help with ground clearance.
After that, things become different between the sides. The right limb exhibits a different acceleration trace as it has an extra "peak" which I have circled in red. Remember, the images should be rough reflections of each other. In swing phase, the entire limb needs to undergo a subtle but inward rotation back toward the midline of the body after it turned slightly outward as the person toed-off for leg swing.
In the left limb, you can see the slope and direction of acceleration after that small initial peak gradually directing the limb back inward before it hits another trough at which the acceleration is then traced in the opposite direction. This represents the slowing down of the limb before the foot makes contact with the ground again.
That extra peak in the right limb trace suggests that there was a sudden "hitch" in the rotational movement outward right after toe off, followed by a small acceleration peak to bring the leg back straight.
What's the relevance of this "hitch"?
Well, as you probably know from experience, the presence of injury or pain can mess with the smoothness of many of your movements and the manifestation of the "hitch" may be due to pain in the hip and low back at certain angles.
This patient also had limited rotational hip mobility, especially with inward rotation. It happens to be that this patient also had very tight hip outward rotator muscles which work to smooth inward rotation in the limb, but too much tension could arrest that inward rotation which could potentially be a problem. During gait examination, it was observed that the patient was occasionally demonstrating a crossover step on the right limb. As this patient's low back pain was able to be pinpointed to the glutes and sacroiliac joint, it is very plausible that this limitation in inward hip rotation is creating excessive motion or torque over the sacroiliac joint. Throw in thousands of repetitions of this movement over time and you get the picture.
The important take away here is that by having this data, you're able to help the patient figure out the possible "why and how" they are hurting by being able to marry clinical findings to real world movement; because the eyes don't always see everything clearly. Identifying painful areas is often not the most difficult part of the job as patients usually can point to where they feel it. Understanding what's causing the problem under typical movement patterns that patients go through helps to make treatment and rehab more meaningful.
This second example is much simpler to understand. This graph below is a composite acceleration graph generated by Plantiga which represents the load or effort from performing a cyclic jumping test during take off and landing. This particular individual was a Crossfit patient that was complaining of left calf and Achilles tendon soreness after going through a recent training cycle that had a high load of double-unders and running. The top (yellow) represents the left limb and the bottom, the right.
As you can see, the individual was generating more peak g-forces jumping off the left foot (the first large peaks), likely representing a preference for that side. Many injuries like this are often classified as repetitive or over-use. Here you can clearly see how many cycles of jumping over time could lead to such an injury where you wouldn't be able to see that otherwise.
Why am I using Plantiga?
You may be surprised to hear that clinical practice still depends on many eyeball assessments that can often be subjective and not easily observed, felt, or always understood by patients. I came from outside of healthcare, so I was just as surprised as you to learn this fact in my training.
Using the two examples I illustrated above should make the significance of Plantiga clear. It allows me, your chiropractor, to help the lowest activity level patients to high level athletes treat their issues more effectively without super expensive or cumbersome equipment in a lab. It also helps me to see if we're making meaningful progress with treatment beyond alleviating pain.
Going back to the example of the individual with Achilles tendon and calf tightness. It's relatively easy to treat in the office at home with soft tissue work and give them home stretches and foam rolling. They'll likely feel better after each treatment. If the person is fortunate, the problem will go away or be managed well enough that it stays off the radar. But they aren't going to stop training. And if they clearly have a preference for driving through that left limb more, then there's a chance that the problem may rear its ugly head again. However, using what the data told us, I or their trainer could set them on a training program focused on developing more drive on the right limb to bring about neuromuscular balance.
Combining Plantiga’s information with my knowledge of biomechanics can yield useful insight into a patient’s movement strategy. By being able to collect quantitative data, this allows me to form a more complete hypothesis as to your problems as well as allows me to gauge if your treatment or training program is achieving its intended result.
All in all, this allows me to go beyond treating pain and helping clients achieve optimal function. Because my goal as a chiropractor has always been to help patients obtain a high state of function so that they can partake in activities with the least amount of hindrances and remain pain-free as long as possible- keeping you out of my office more in the long-term.
Thanks for reading!
If you're looking for a chiropractor near you in Kirkland that wants to help you go beyond just temporary relief, then don't hesitate to contact me today.