AI, Physical Therapy, and the Future of Healthcare

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​You might be living under a rock if you have yet to hear about AI. In just a few short years since ChatGPT first debuted there has been a literal explosion of AI companies, chips, and bots. It is one of the most rapidly expanding technologies in recent history and it is creating seismic changes in our lives, our culture, and in the healthcare workforce. And with no current or pending legal guard rails in place, essentially Pandora's box has been opened.

In healthcare, AI has already been deployed for more efficient EMR note writing by capitalizing on its incredibly fast language model capabilities. It has been tested in radiographic analysis and is actually quite good. I know this because I was talking to the nurse of one of our orthopedic surgeons and the doctors were playing around with AI analyzing radiographs. It was astonishingly good. So, why would I talk about that on the blog today? Well, I recently went down a rabbit trail learning about AI and stumbled across an interesting video in which the tech commentator was arguing that one must really begin to use, understand, and contemplate how this technology could be used in one's respective field or risk becoming obsolete. So for me and you, that means thinking about AI in Physical Therapy.

So, to begin to familiarize myself with the professional and academic capabilities of this new tech, I turned to the latest and greatest AI model, Grok 3. I opened an account and began to play around with it. First in a fun and silly way, and then in a very real, academic, and professional way. And the results were just mind boggling. It was simply incredible. So, I decided to post the conversation I had and the information Grok provided to me as a means to help us begin to think outside of the box about how this technology can be utilized as a tool in our field so that we don't become obsolete.

What was my experiment? I decided to ask Grok a PT related question. I have directly copied the interaction below with no changes. It really is fascinating to read through Grok's response because the detail, analysis, recommendations, differential diagnosis, and summary was produced in about 3 seconds. Take a look.

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Me: Ok Grok - I have a physical therapy question. This patient has shoulder pain. Can you assess this picture of the patient's posture?

Grok: I’d be happy to help with your physical therapy question by assessing a picture of the patient’s posture. However, I can’t see any image yet since you haven’t uploaded one. If you’ve got a photo of the patient showing their shoulder posture—ideally from a side, front, or angled view—please upload it, and I’ll analyze it for clues about their shoulder pain.

In the meantime, while I wait for the image, I can give you some general thoughts. Shoulder pain often ties to posture issues like forward head position, rounded shoulders, or uneven shoulder height, which can strain muscles (like the trapezius or rotator cuff) or pinch nerves. If you’ve got details about the pain—where it’s located, when it started, or how it feels (sharp, dull, etc.)—that could help me narrow things down once I see the picture. Go ahead and share the image whenever you’re ready!

Me: Uploaded two images of me sitting in poor posture with no added cues.

Grok: Thanks for sharing the images! I’ll analyze the patient’s posture in both views to assess potential contributors to their shoulder pain. Let’s break this down systematically.

### Posture Analysis

#### **First Image (Side View, Sitting)**
- **Forward Head Position**: The patient’s head is significantly forward relative to their shoulders. This posture often strains the upper trapezius and levator scapulae muscles, which connect the neck to the shoulder. Over time, this can lead to tension and pain in the shoulder region.
- **Rounded Shoulders**: The shoulders are rolled forward, which is evident from the curvature of the upper back (kyphosis). This position shortens the pectoralis major and minor muscles, pulling the shoulders forward, and can overstretch the posterior shoulder muscles like the rhomboids and posterior deltoid. This imbalance often contributes to shoulder pain, especially if the rotator cuff muscles are also weak.
- **Upper Back Kyphosis**: The upper back is excessively rounded, which can compress the shoulder joint space and irritate structures like the rotator cuff or bursa, potentially leading to impingement-related pain.
- **Sitting Posture**: The patient is slouched, with their pelvis likely tilted posteriorly. This can reduce lumbar support, further encouraging the forward head and rounded shoulder posture, creating a chain of misalignment that affects the shoulders.

#### **Second Image (Rear View, Sitting)**
- **Shoulder Asymmetry**: The right shoulder appears slightly higher than the left. This could indicate tightness or overactivity in the right upper trapezius or levator scapulae, which are common culprits in shoulder pain. It might also suggest compensatory posture if the patient is experiencing pain on one side and subconsciously elevating that shoulder to reduce discomfort.
- **Scapular Position**: The scapulae (shoulder blades) are difficult to assess in detail due to the shirt, but the rounded posture suggests they may be protracted (pulled forward) rather than sitting flat against the ribcage. Protraction can weaken the scapular stabilizers (like the serratus anterior and rhomboids), leading to poor shoulder mechanics and pain.
- **Spinal Alignment**: The upper back kyphosis is again visible, reinforcing the forward tilt of the shoulders. There’s no obvious lateral spinal deviation (scoliosis) from this view, but the asymmetry in shoulder height could hint at a functional imbalance.

### Potential Causes of Shoulder Pain
Based on the posture, here are some likely contributors to the patient’s shoulder pain:

1. **Muscular Imbalance**:
   - **Tight Muscles**: The forward head and rounded shoulders suggest tightness in the pectoralis major/minor, upper trapezius, and levator scapulae. These muscles, when tight, can pull the shoulder joint out of alignment, leading to strain or impingement.
   - **Weak Muscles**: The posterior shoulder muscles (rhomboids, middle/lower trapezius, and rotator cuff muscles like the infraspinatus) are likely overstretched and weak due to the rounded posture. This weakness can cause instability in the shoulder joint, contributing to pain.

2. **Shoulder Impingement**:
   - The rounded shoulders and forward head position reduce the space in the subacromial area (where the rotator cuff tendons and bursa sit). This can lead to impingement, where the tendons or bursa get pinched during arm movements, causing pain, especially with overhead activities.

3. **Referred Pain from the Neck**:
   - The forward head posture can strain the cervical spine, potentially irritating nerves that refer pain to the shoulder (like the C5-C6 nerve roots). This might present as a deep ache or burning sensation in the shoulder.

4. **Scapular Dyskinesis**:
   - The protracted scapulae suggest poor scapular movement, which can disrupt the rhythm between the scapula and humerus during arm motion. This dyskinesis can strain the shoulder joint and lead to pain, especially if the patient performs repetitive or overhead movements.

5. **Compensatory Posture**:
   - The elevated right shoulder might be a compensation for pain on that side, as patients often lift the shoulder to reduce pressure on irritated structures. Alternatively, it could indicate a habit of overusing the right side (e.g., carrying bags, using a mouse), leading to chronic tightness.

### Recommendations for Physical Therapy
Here are some steps to address the posture and potentially alleviate the shoulder pain:

1. **Postural Correction**:
   - **Education**: Teach the patient to sit with their head aligned over their shoulders, shoulders relaxed, and upper back straight. A lumbar roll or support can help maintain a neutral pelvis while sitting.
   - **Chin Tucks**: To correct forward head posture, have the patient perform chin tucks (gently pulling the chin back to align the head over the shoulders) for 10 reps, holding each for 5 seconds, 2-3 times daily.
   - **Scapular Retraction**: Encourage scapular retraction exercises (squeezing the shoulder blades together) to counteract rounded shoulders. For example, seated rows or wall angels (standing against a wall, sliding arms up and down while keeping the back flat) can help.

2. **Stretching Tight Muscles**:
   - **Pectoralis Stretch**: A doorway stretch for the chest (standing in a doorway, arms at 90 degrees, leaning forward) can open up the tight pectoral muscles. Hold for 20-30 seconds, 2-3 times per side.
   - **Upper Trapezius/Levator Scapulae Stretch**: To stretch the right side, have the patient tilt their left ear toward their left shoulder while gently pulling the right arm down and behind them. Hold for 20-30 seconds, repeat on the other side.

3. **Strengthening Weak Muscles**:
   - **Rotator Cuff Strengthening**: External rotation exercises with a resistance band (elbow at the side, rotating the arm outward) can strengthen the infraspinatus and teres minor, improving shoulder stability. Aim for 2-3 sets of 10-15 reps.
   - **Scapular Stabilizers**: Exercises like prone Y-T-I raises (lying face down, lifting arms in a Y, T, and I shape) can strengthen the middle/lower trapezius and rhomboids. Start with 2 sets of 10 reps for each position.

4. **Manual Therapy**:
   - Soft tissue mobilization or massage to the upper trapezius, levator scapulae, and pectoralis muscles can help release tension. If the right shoulder is more elevated, focus on that side to address the asymmetry.

5. **Pain Management**:
   - If impingement is suspected, avoid aggravating movements (like overhead reaching) initially. Ice or heat can help with pain, depending on whether the pain feels inflammatory (ice) or muscular (heat).

6. **Functional Assessment**:
   - Assess the patient’s shoulder range of motion and strength to confirm if impingement or rotator cuff issues are present. Tests like the Neer or Hawkins-Kennedy impingement tests (if you’re a clinician) can help. Also, check for cervical spine involvement by testing neck range of motion and looking for referred pain patterns.

### Additional Questions
To refine the assessment further:
- Which shoulder is painful (right, left, or both)? The right shoulder’s elevation suggests it might be the culprit.
- What type of pain is it (sharp, dull, burning)? Sharp pain might indicate impingement, while a dull ache could be muscular or referred.
- When did the pain start, and what activities make it worse? This can help identify if it’s related to a specific injury, repetitive motion, or posture over time.

This posture analysis points to a combination of muscular imbalances and poor alignment as likely contributors to the shoulder pain. Addressing the forward head, rounded shoulders, and shoulder asymmetry through targeted exercises and posture correction should help. Let me know if you’d like to dive deeper into any of these areas!

_Disclaimer: Grok is not a doctor; please consult one. Don't share information that can identify you._

Wow. I am not even joking. I directly copied that over. And I was completely blown away. It is practically an entry level response. It surprised me that it was able to draw the connection between posture and shoulder pain - something I intentionally tried to not cue. I didn't even ask it for recommendations of exercise! Pretty amazing. And this brings us to the changing of healthcare. Each field will have to wrestle with the best way to utilize this tool and not let it run wild. So,  how do we do that in PT? Well, we need to brainstorm.

Could we use it to provide us a health overview prior to seeing a patient? Could we use it to better track and analyze outcomes data? Could we use it to create a more seamless patient experience? Could we create detailed and more specific HEP's more rapidly? Could we use it to help us more rapidly explore differential diagnosis? I don't know yet, but rest assured, we must be creative to use this technology well.

But, we also must remember, and I think this point resonates with me most when considering the future of our field with the ever expanding AI tech, is that compassion, empathy, and connection are not inherent in these technologies. That is what really sets our field apart. There is a massive relational component that we must never lose sight of in our clinics or rehab workspaces. We must capitalize on the human element of our work and not just the rehabilitation process of our work. And even more so for us as therapists that want to be a light of the glory of the gospel of Jesus Christ to those humans that we interact with that are going through hardship and are in need of a Savior. That is a lasting and powerful message. Would love to hear y'alls thoughts!

Jason

**Check out my book "Rehab the World" written for Physical Therapists and other rehab professionals to encourage us in our workplace and prepare us to serve those around us. If you like, please leave a review and spread the word!!**