How to Improve Movement and Athletic Performance Using the DARI System with Certified Trainer Michael Sole

A health screening tool called DARI motion analysis system is being offered to patients at the MUSC Health and Wellness Institute. It uses the power of video cameras and motion data to objectively measure how efficiently you move. From there you may be prescribed targeted strengthening exercises that can help you meet your health and fitness goals. In this episode, Michael Sole, MS, ATC, CSCS, a human performance manager at MUSC Health, explains how DARI can help anyone looking to improve their fitness and mobility.

“(DARI) could help people shed light and be more cognizant of how they move. And if we can understand how we move, then I think we're more prepared to be able to fix it. And the more in tune we are with our bodies, I also believe, the healthier we're gonna keep ourselves, too.”
— Michael Sole, MS, ATC, CSCS

Topics Covered in This Show

• DARI Motion Analysis System is a health screening tool offered at MUSC Health and Wellness Institute. It utilizes video cameras and motion data to objectively measure movement efficiency. The purpose of DARI is to provide objective data to assess how individuals move and suggest targeted strengthening exercises to help achieve health and fitness goals.
• Sole is a human performance manager at MUSC Health and has used DARI with both high-performance athletes and the general public. Bringing DARI to the Institute helps it reach its mission to provide proactive healthcare, emphasizing exercise, nutrition and mental health to support both athletes and patients at MUSC Health.
• Once an athletic trainer with the New York Yankees, Sole now brings his experience and expertise to providing DARI technology and much more to people at the Institute.
• He says it is important to understand how your body moves as well as its limitations, especially for athletes and individuals aiming to improve their fitness. The DARI system uses eight cameras to create a markerless avatar of an individual, allowing for precise analysis of joint movements. It also helps identify areas for improvement.
• Based on data generated by DARI, Sole can create customized exercise plans, focusing on warm-up exercises, core strength, and specific joint movements to address individual needs.
• Some recent success stories include a surgeon who improved her posture and strength to alleviate discomfort from her work and a tennis player who enhanced her strength and stability to improve her game.
• Anyone can access DARI and other services offered at the MUSC Health and Wellness Institute by purchasing a package tailored to their individual needs, including exercise, nutrition and mindfulness services for all ages. While most services are available virtually, the DARI experience is not.

Read the Transcript Below

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. A health screening tool called DARI Motion Analysis System is being offered to patients at the MUSC Health and Wellness Institute.

It uses the power of video cameras and motion data to objectively measure how efficiently you move. From there you may be prescribed targeted strengthening exercises that can help you meet your health and fitness goals. Michael Sole, a human performance manager at MUSC Health is here with details of this system that can help high-performance athletes and everyday folks.

Welcome to the show, Michael.

[00:00:53] Michael Sole, ATC, CSCS: Hi, thanks for having me.

[00:00:55] Erin Spain, MS: First tell us about the MUSC Health and Wellness Institute. It's fairly new and some listeners may not be aware of it in all its offerings.

[00:01:04] Michael Sole, ATC, CSCS: Yeah, we've been open for a little over a year and a half now, and I would say we take medicine to the next level for MUSC and not just sick care, but in the wellness space.

So how do we get ahead of ourselves before we get sick, and how can we prevent that? And I think that's the next step in medicine. And that's where kind of athletics has your traditional medicine. I would say just like a step ahead because they're very proactive versus reactive due to, you know, investments in players, and, and really everything else of the, aspect of sports and how they take care of their athletes.

\So the idea of the Health and Wellness Institute is try to take that concept of great health care for an athlete applied to general population and our current hospital patients as well. So that way we could better support not just athletes, but the whole community.

And I think that goes to say, we all kind of view ourselves as athletes now, right? We like to use data to tell us how our health is, whether it be everything from steps to our sleep scores. And I think that's something else that gets hidden in sports is the recovery and how players go day to day throughout the rigors of a season.

But we could take that season and that's just a microcosm of our lives. So how do we prepare our lives for, "Hey, I have a big family event coming up. It's gonna be a long weekend. I need to make sure I get my rest, or I'm feeding myself well." And that's where it touches upon the Health and Wellness Institute, where we cover exercise, nutrition and then mental health slash mindfulness, I would call it. And we like to use those three pillars as, you know, a comprehensive, integrated way to go about medicine and really capturing the longevity of your life.

[00:02:35] Erin Spain, MS: You've mentioned athletics during this conversation already. You're a certified athletic trainer and strength and conditioning specialist as well as I mentioned, a human performance manager at the Institute. You have a lot of experience in athletics. Tell me about that experience and why you decided to come to MUSC Health.

[00:02:51] Michael Sole, ATC, CSCS: My undergraduate degree is in specifically athletic training. I went through my board exam and then my master's degree is in health promotion and fitness management. I interned with the New York Yankees’ minor league system.

MUSC was the medical provider for the Charleston RiverDogs. So I built a relationship with the physicians and some of the physical therapists and as I moved on throughout my career above the Charleston level I decided that I wanted to kind of, you know, get out of baseball and see where else this profession could take me.

Athletic training certainly lends itself more towards the sports arena, but I think something that's really nice about the profession itself is now we're expanding our roles as athletic trainers to hospital systems, to roles I'm in now. And it's not just seen as those are the folks that run onto the field when someone's injured, but now we could take that to, well, how do we help the geriatric population with whether it be fall risk or how can we give them exercises to improve their bone density? How can we help them with joint replacements or create better outcomes by making them stronger?

Or in your traditional sense of physical therapy, how do you take it to the next level? Right? You know, once you've finished, you're usually pretty functional, but sometimes you're striving for that little extra bit of, " How do I get back on the court? Or, How do I now prepare myself to run another marathon or half marathon?"

[00:04:07] Erin Spain, MS: How critical is it for athletes and people who just want to improve or maintain their fitness to understand how their body moves and possible movement limitations

[00:04:18] Michael Sole, ATC, CSCS: So athletic training is really an orthopaedic-based profession. So looking at, you know, ankle sprains and then the rehab process from there of how do we get you back on the field? And that's one reason why I sought out the strength conditioning certification.

So I could put the fitness piece together with it, but then also, work in concert with the strength and conditioning staff, so that way there was a bridge between medicine and getting the athlete or anyone stronger. But making that a good transition and a good bridge from those rehab type things to now something more functional on the field or something you might do in your activities of daily living, or back at work if you have a very labor intensive job.

[00:04:54] Erin Spain, MS: The DARI Motion Analysis System at the MUSC Health and Wellness Institute is the only place in South Carolina offering this service to the general public. Tell me about this system and why MUSC Health decided to bring this to the Institute.

[00:05:03] Michael Sole, ATC, CSCS: I think they saw a similar vision that I did where we have a chance to bring something that's innovative to the population here, we can really use it in every sense of the imagination. We could use it from, you know, youth athletes. We have the ability to mark down, what's the throwing motion look like? And evaluate people's throwing motions so that way we can reduce the risk of injury.

And that was one of my main goals of coming here to MUSC was to educate people. I felt like, with the exception of working with professional athletes, when I worked with recreational athletes or I'd be talking to some of their parents, there was so many questions that I felt like they were misinformed about, because there is so much information out there, it's hard to navigate the waters, and everyone is unique too.

So you kind of need a professional opinion because all of our bodies are unique, therefore how we move is unique and so on and so forth. So that's why I think the DARI is great because we can use it from the youth to the aging population, to really anything. And I like it because in one day I'll see someone who's a surgeon, someone who likes to play pretty competitive tennis, and then I might see somebody who says that they want to get ready because they wanna hike Europe.

And they're like, I haven't done it in a while, but I wanna make sure that, you know, I'm investing this time and money into this trip. I wanna make sure I do it well or it's something I've been really wanting to do with my family. So it's not just the achievement of your body feeling well, but then also the achievement of these folks from their own personal goals.

[00:06:34] Erin Spain, MS: I want you to walk me through how the system works, the process, what it's like for individuals who come through. It's important to note this is a non-contact system, so there's no wires or gadgets hooked up to you. Walk me through the DARI motion.

[00:06:49] Michael Sole, ATC, CSCS: Yeah, so traditionally we'd have to put markers on people, like the little dots you see when they make Avatar and Lord of the Rings it's kinda like CGI type images. With this, it's markerless, which saves us countless hours and picking up the little markers when they fall off.

So we have eight cameras and what you'll do is you'll step into the ring of cameras. And it'll do a scan of your body through the cameras, so that way it picks up different points on your body and it creates a skeleton or an avatar to lay over you. That's how we know that everywhere that you move, the cameras are then picking it up.

I'll then go through a number of different exercises or balance tests that is specific to that, person, athlete, age group, whatever, you know, our intent is for that session or consultation and we'll predetermine some goals beforehand, and that kind of helps guide us in the motion capture aspect of it.

Once we collect our exercises, our balance test, DARI will then tell us, you know, what are our top three priority areas. And it judges that based off of how well did we move each joint of our body through each motion. And it compares it to normative ranges of those joints, you know, based on the literature.

So we would like to fall within the range, but I think it's also important to know too, if we're not in that range, how do we get back there? And, the second piece of it is what's the compensation for that? Because that helps us solve the puzzle of maybe why this person has discomfort or maybe why you know, it's difficult for them to perform some activities, but they get there, and how do they get there, is they compensate. And we all compensate and we figure out ways to get from point A to point B. And there's some nice printouts that help again, make this much better to look at and digest and understand ourselves from the general public's point of view.

[00:08:27] Erin Spain, MS: And you're able to hold onto that data and then kind of track progress over time by doing more of these analyses down the road.

[00:08:34] Michael Sole, ATC, CSCS: Yes, we like to test and retest to make sure the intervention that we put in actually worked. And if not, Why didn't it work? The neat part about it is, we can do it at a certain time. Let's just take like a sports team, for example, and do it in the fall and then the next fall do it. But you might have that player for three or four years on your team, and now you can track a trend for them of “Hey, each year we notice this person's losing X amount of range of motion in this body part.” Is it vital to that sport or what they do for work? Yes or no? I like to view it as a piece of the puzzle, right? It helps you make more informed decisions. It's by no means telling you how to do certain things, but it points us in the right direction, and I think it brings up some good questions.

[00:09:13] Erin Spain, MS: Do you think it could also uncover a movement disorder?

[00:09:17] Michael Sole, ATC, CSCS: I think it could help people shed light and be more cognizant of how they move. And if we can understand how we move, then I think we're more prepared to be able to fix it. And the more in tune we are with our bodies, I also believe, the healthier we're gonna keep ourselves too.

[00:09:30] Erin Spain, MS: Tell me about some of the success stories that you have seen both in athletics and maybe folks who are in the hospital population.

[00:09:37] Michael Sole, ATC, CSCS: My favorite one is a surgeon came in, and she does a lot of robotic surgeries so general surgeries. But she was talking about how she wants to get into better shape, but she's also starting to have some numbness and tingling go down her arms and some negative effects of the posture she has to be in for such long periods of time based on the ergonomics of the robotic apparatus she has to use.

So, it's been a good three and a half months or so with, using the DARI and kind of looking at her posture mainly and how do we adjust her posture to now working. And we had her take pictures of her inside the robotic apparatus too, so that way I could get a sense for what it looked like, 'cause I can't be in the OR.

But through some of the numbers we got on the DARI, looking at her posture we helped loosen up some of the musculature in, you know, the upper part of her chest and her neck. And now she's much stronger and we also worked on her core too, which a lot of people probably wouldn't think makes sense in that case, but because it improved her balance and she was able to get stronger and work out more. All those things in combination with each other.

So she's got better grip strength now, which is huge because when they use the robotic apparatus, you have to use your pointer finger and your thumb in order to move it around and get the small areas of the body. So she doesn't have any numb and tingling there.

he has improved strength and she's like my headache is in the back of my head if they do happen, they're very few and far between and they're not as intense because we kind of repositioned her, you know, for that to happen.

So, that's a story where we use that as a piece of the puzzle, right? Like, we know something's wrong and we have a general idea, but let's try and pinpoint this. And I think that's the missing key, is we can use this for general things and maybe I see it, but I can't communicate it accurately to the patient, let's say.

So we can show them on the DARI, Hey, this is what's happening, but now we can also go through with like a fine tooth comb as well and say if you move your shoulder blade this way for this period of time, you know, that might help.

Or if you look at it from an athletic point of view, you might be able to clean up somebody's mechanics, which might not only lead them to a decrease in injury, but also might improve performance too. That's a larger piece of the puzzle with that.

I just had a client, and when she first came in, she had an ankle injury that was pretty severe. She had surgery, she'd gone through PT, but she was still having some chronic strength and instability issues. And with that it was negatively affecting her tennis and she loves to play tennis. She's played it all her life. It's essentially like her outlet.

So, now we're getting into how does that affect this person mentally as well. And it started her off like somewhere in the twenties and after we're going on month three, three and a half going into four. We took another scan and she was in the 40 percentile, so she made significant improvement. And she's like, my tennis coach has made comments. She's like, I'm hitting the ball better. So we take her to the next level because she's not where she used to be and that's where she wants to go.

That was really neat too, to see her progress of that, but then also to see the enjoyment of her seeing the results pay off. You know, we can increase a weight here or improve someone's balance, but it's not as enjoyable as when they hit a good shot on the court and things fall into place for them.

[00:12:39] Erin Spain, MS: You've mentioned things like changing posture, weightlifting, working on your core. Walk me through some of the plans that you have with patients after they go through the DARI system and they realize what they need to work on.

[00:12:51] Michael Sole, ATC, CSCS: The way I like to create the programs for all the clients is, address it of how do we make something that's digestible for them? And by that I mean, a good time for them if they're not gonna be completing it with me and someone's gonna do it on their own, time is a big issue and making it conducive to their schedule.

That's priority number one for me, honestly, because if we don't have compliance, then we don't do anything. The warmup essentially is corrective exercises, I like to call them or you know, warmup exercises, but they're specific to that person. So, if someone shows that they might favor their left leg versus their right leg in terms of mobility, let's say. Then in that warmup, I'll put an exercise that either balances that out or maybe helps to promote the other side.

So each person's warmup is unique to them, which goes a long way. And then we address core. You know, when I say core, I don't mean like our six pack, because that's not truly kind of what indicates how well we hold our center of mass and our balance. It's those deeper muscles, our obliques and some of the transverse abdominis in there as well.

So the idea is if we can build endurance through that, that's gonna help with our posture, because that's the center of our body and that's where we hold our center of mass. So those two things are incorporated in the beginning, and then we look at, okay, we kind of go joint by joint and what's this person really need?

So if we need to improve general lower body strength, you know, a squat would be great, but the key is, well, does this person have a previous history of let's say low back injuries? Well, they don't need to put a bar on their back. How can we make this exercise for this person attainable and successful so that way they don't walk away in pain or discomfort?

And that's for me, the beauty of it all because now I know from gathering data from the DARI, seeing the person walk, looking at their posture. Where do we put that weight on that person? Me, you, anybody can do a squat, but I might hold it in front of me here. You might hold it on the side. There's different ways to go about the same exercise and achieve the same goal without putting this person in pain or without making it a very cookie cutter type fashion.

And for me as a clinician, if I can incorporate the gait or the walking motion into a lot of the exercises, that makes it more functional for people. Because it helps make sense of like, okay, when I go to take this step, I need to be strong here so that I don't fall. So always reinforcing, We're gonna do this exercise because it's gonna help with X, Y, Z. Or, Hey, you saw on the evaluation you got this number. We're gonna do this exercise so that way you know, the number that popped up on the DARI in this category improves because we know that you're more stable.

[00:15:20] Erin Spain, MS: So getting access to this DARI system is part of packages that you offer at the Institute. Tell me about some of these offerings and how people can learn more.

[00:15:29] Michael Sole, ATC, CSCS: Yeah, I would certainly visit our website and we say the packages work best because what happens is you'll come in for a consultation, you'll meet with myself or one of the other providers based on the specialty that you picked, whether it be exercise, nutrition, or a mindfulness. But sometimes throughout the evaluation we find out, you know, you might need exercise and nutrition, and that sounds like a good idea. So then we'll make a package just for that person of exercise and nutrition together. But they might need more exercise than nutrition, so we'll balance out their visits.

[00:15:58] Erin Spain, MS: are these packages available to people of all ages?

[00:16:00] Michael Sole, ATC, CSCS: Packages are available to people of all ages. Throughout my day I see people in their teens to their eighties and anywhere in between.

[00:16:09] Erin Spain, MS: How unique do you feel this Institute is not only in South Carolina, but in the country?

[00:16:14] Michael Sole, ATC, CSCS: It's something that I find to be unique and it's kind of been a dream of mine to create for people because you know, as an athletic trainer and talking to other people in my field, we need something to educate the public. But they don't need something formal, right?

It's always difficult to get a doctor's appointment, to go through the formal process of things. So if there was kind of like this intermediary space for them to go and get a good resource and then also learn about themselves and work through exercise and nutrition, for me is very unique, and almost all of our services are offered virtually, which is great as well.

The only thing would be, unfortunately the DARI can't be virtual, but if you were to come in person to get the initial evaluation, then we could do all the follow-up sessions virtually and such too.

So I think that's also something nice, even if someone's just visiting you know, we could still work remotely.

[00:17:02] Erin Spain, MS: what do you do to optimize your health and live well?

[00:17:05] Michael Sole, ATC, CSCS: Honestly I've gotten into a lot of posture and breathing within the last few years; I just turned into my thirties. I feel like I'm getting old, so I'm like, I can't do power lifting anymore. So, you know, what kind of exercises do I do that are like, good for my body and to stay healthy?

So a lot of it's core body weight exercises and not so much like dead-lifting hundreds of pounds but certainly more core oriented exercises that are gonna work on endurance, but then also how to breathe through all that. And I say that because if you can breathe through an exercise, then you've mastered that motor pattern or that exercise. So how can I become the best at a certain exercise?

[00:17:41] Erin Spain, MS: Well, thank you so much, Michael Sole for coming on the podcast and sharing all the exciting work that you all are doing at the MUSC Health and Wellness Institute. We appreciate your time.

[00:17:51] Michael Sole, ATC, CSCS: Thank you so much. I appreciate it.

[00:17:53] Erin Spain, MS: For more information on this podcast, check out advance.muschealth.org.