Some of the most persistent challenges in musculoskeletal care have little to do with the quality of the care itself. The providers are dedicated and skilled, and the treatments are sound. The problem we're interested in exploring lives outside the clinical encounter.
Three gaps stand out. The first is time. The average wait for a new-patient appointment has climbed to 31 days, up 19% since 2022, and the workforce expected to close that gap is shrinking — a projected shortfall of up to 86,000 physicians by 2036, alongside a physical therapist shortage that saw more than 15,000 leave the profession between 2021 and 2022. The second is distance. Rural Americans live roughly twice as far from the nearest hospital as those in urban areas — 10.5 miles on average, compared with 4.4. The third is language. More than 27 million Americans have limited English proficiency, and in one 2024 survey, 30% reported difficulty understanding their provider's instructions.
What makes these gaps hard isn't that they're invisible — it's that the obvious fix doesn't work. The most direct way to close them would be more provider time: longer appointments, more follow-up, more clinicians in more places. But that's precisely what the system doesn't have. Asking already-stretched providers to absorb more is not a solution; it's the same problem wearing a different face. Whatever helps here has to do so without adding to the load the clinical workforce already carries.
This is the question we've been sitting with: could self-directed, AI-powered software ease any of these gaps without adding to the provider's burden? Something a patient could use on their own — before an appointment, far from a clinic, in their own language — that extends care into the spaces where, right now, very little reaches them. We don't assume the answer is yes. But the question seems worth taking seriously, and worth studying carefully.
The tool we're studying is an app we built called Motion. A person uses it to assess how they move, and from that assessment it generates a customized exercise program — self-directed, multilingual, available wherever they are. We try not to think of it as a finished product, but more as an instrument: a way to test whether the question above has a real answer. The assessment method itself is not fixed — it can change, and we expect it to. What we're actually examining sits beneath any particular method: whether self-directed guidance shaped around an individual's specific needs can make a meaningful difference.
So we've started to study it in the open. Rather than wait for a finished answer, we're publishing what we find as we go — beginning with a series of case studies drawn from real use. These are early. The questions outnumber the conclusions, and we expect what we learn to reshape how we think about the problem, and how we study it.
For now, the honest version is the simplest one. We don't yet know whether self-directed care can meaningfully ease the wait, the distance, or the language gap — or whether it can do so without quietly shifting more work onto the people already holding the system together. Those are open questions, and we intend to follow them wherever the evidence leads. What we can say is that the space around musculoskeletal care is not empty. It's full of people the current system struggles to reach — and that, to us, is reason enough to keep looking.
