From Probe to Practice

Advanced Musculoskeletal Ultrasound Center

From Probe to Practice is a weekly podcast on musculoskeletal ultrasound — diagnostic scanning, ultrasound-guided injections, and how MSK ultrasound changes the way clinicians practice regenerative and musculoskeletal medicine. Hosted by Colin Rigney and Ryan Martin, founders of the Advanced MSK Ultrasound Center, who have trained clinicians for years and bring the reps to prove it. This is not a 45-minute monologue on probe physics. It's a high-energy dialogue about what actually happens inside a practice: the diagnostic gaps nobody mentions, the injections that miss and why, the referrals you didn't need to make, the business of integrating ultrasound, and the case studies that only come from tens of thousands of scans. Plus, in Ryan's words, "a lot of dirt on each other." Every episode is built around one promise: take something you learned from a podcast on Friday and implement it on Monday. For physicians, regenerative medicine clinicians, sports medicine providers, anyone preparing for the RMSK exam — and anyone who works alongside them. Because you can't diagnose what you can't see. New episodes weekly. An Advanced MSK Ultrasound Center podcast.

Episodes

  1. 2d ago

    Cash Pay Practice: Why Insurance Is a Leash, Not a Lifeline | Matthew Gillogly

    Is insurance a physician's lifeline, or a leash? Colin Rigney is joined by Matthew Gillogly, founder and CEO of Mavrix Profit System and author of Out of the System. Matthew is not a physician: he built three cash pay clinics, sold them, and now helps doctors leave insurance dependency and build practices they actually own. They talk about the squeeze on doctors and patients, private equity in healthcare, and why Matthew sees no future in insurance-based care. Then the business of a cash pay practice: why it is not only for the wealthy or the big city, who the core patient is, how to price so that price signals your skill, and why volume medicine is a false gospel when the true cost of a PRP injection is higher than most clinics charge. Just as important is the internal shift: Dr Janet Ang's first year in her own practice, two-way doors, the future self, and why "I'm trying" keeps doctors stuck. Matthew previews his opening keynote for the AMSKU Annual Global Summit '26 on 5 December: what the next 10 years hold for regenerative medicine and the doctors who choose agency over their lives. Get Matthew's book, Out of the System Register for the AMSKU Annual Global Summit '26, Saturday 5 December 2026, online Work with us! https://links-amsku.vercel.app/ What this episode covers: Why regenerative medicine is growing worldwide, from England to Australia to DubaiThe squeeze on doctors and patients, and why Matthew sees no future in insurance-based carePrivate equity in healthcare and what it means for outcomesInsurance isn't a lifeline, it's a leash: a business model no investor would backWant to double your profits? Raise your prices 11 percentIs cash pay only for the wealthy? Practices in Skaneateles and Wichita Falls say noLeaving the system: the technical side and the future selfDr Janet Ang: from $12,000 to $60,000 a month in cashWhy "I'm trying" keeps doctors stuck: belief systems and the origin codeVolume medicine is a false gospel: the real cost of a PRP injectionHow Matthew built and sold Carolina Men's ClinicThe next 10 years in regenerative medicine: agency over your lifeFreeing 100,000 doctors by 2040, in the US and beyondLinks mentioned in this episode: Matthew's book, Out of the System: A Doctor's Guide to Reclaim Your Purpose, Power and PassionMavrix Profit SystemOut of the System podcast, AppleOut of the System podcast, SpotifyAMSKU Annual Global Summit '26, Saturday 5 December, online, opening keynote by Matthew Gillogly. Register or watch last year's playbackQuestions or comments? Reach usEvery AMSKU MSK ultrasound courseNew episodes every Tuesday. Watch on YouTube, or listen on Spotify and Apple Podcasts. Chapters:0:00 This week on From Probe to Practice0:21 From Probe to Practice0:34 Episode 10: Matthew Gillogly, founder of Mavrix Profit System1:59 Regenerative medicine is going global3:00 A massive shift in the medical landscape4:57 Why there is no future in insurance-based care8:17 The unintended consequences of the Affordable Care Act11:33 A $1,100 MRI on insurance, or $350 cash11:56 Private equity in healthcare14:18 Insurance isn't a lifeline, it's a leash17:51 Double your profits: raise prices 11 percent18:50 Is cash pay only for the wealthy?20:27 Cash pay in small towns and big cities21:47 Leaving the system: overnight or step by step?22:56 The future self: Dr Janet Ang's first year24:33 Two-way doors25:52 Price tells patients everything about your skill27:40 10 percent of patients will pay 3 to 4 times more28:20 The Mercedes dealership analogy29:50 The Gap and the Gain31:45 Rocky: filling the gaps34:25 Epigenetics and the origin code38:59 Why "try" keeps you stuck40:42 Effort alone doesn't make success42:05 Colin's father's practice44:12 Volume medicine is a false gospel45:11 Net profit, not revenue48:28 The real cost of a PRP injection49:42 Building Carolina Men's Clinic52:48 The more we raised price, the more we sold56:18 The next 10 years in regenerative medicine57:27 Lessons from Detroit: let go of the past1:00:04 Agency over your life1:01:03 A global movement1:01:29 Where to find Matthew: Out of the System1:02:56 Matthew's AGS 2026 keynote1:03:11 AMSKU Annual Global Summit '261:04:38 Watch last year's summit playback

    Cash Pay Practice: Why Insurance Is a Leash, Not a Lifeline | Matthew Gillogly
  2. Oct 6

    The Future of MSK Ultrasound: AI, Point of Care and the Next 10 Years

    What will MSK ultrasound and musculoskeletal medicine look like in 10 years? Ryan Martin and Colin Rigney make their predictions. They start with AI assisted diagnosis: why AI will make smart clinicians smarter and expose the ones who use it poorly, why you should not rely on it 100 percent yet, and who takes the liability when an algorithm reads the image. Then robotic blood draws and needle guidance, what could replace today's injections, and why regenerative medicine will be market driven. On point of care, Colin makes the case that AI can already take a history more consistently than a human and that one appointment should send a patient home with all the answers, while Ryan pictures an AI guided ultrasound delivered to the patient's door. They close on the independent MSK clinic: same day diagnosis and treatment becoming the standard, and why corporate healthcare and the high-touch independent practice can both grow. These are the questions the speakers at the AMSKU Annual Global Summit '26 will answer on 5 December. Register for the AMSKU Annual Global Summit '26, Saturday 5 December 2026, online Work with us! https://links-amsku.vercel.app/ What this episode covers: AI assisted diagnosis in MSK ultrasound: will AI take my job?Why AI will make smart clinicians smarter, and expose the restWill a robot replace the sonographer?AI guided image acquisition: a learning tool, not something to rely on 100 percentWho takes the liability for an AI read: the clinician or the developer?More progress in the next 10 years than in the last 200Robotic blood draws, needle guidance and what could replace today's injectionsRegenerative medicine and a market driven futureThe future of point of care: one appointment, all the answersAI taking the patient history, and an ultrasound delivered to your doorSame day diagnosis and treatment as the standard for the independent MSK clinicCorporate healthcare vs the independent practice: two things can be trueComing up on the podcast: Matthew Gillogly, Marc Pietropaoli and Ariana DeMersVoices from the 2025 AMSKU Annual Global SummitLinks mentioned in this episode: AMSKU Annual Global Summit '26, Saturday 5 December 2026, live and online: see the speakers and their predictions for the next decade, register, or watch the playback from last year's summitQuestions, comments or a prediction of your own? Reach usEvery AMSKU MSK ultrasound courseNew episodes every Tuesday. Watch on YouTube, or listen on Spotify and Apple Podcasts. Chapters:0:00 This week on From Probe to Practice0:23 From Probe to Practice0:38 Episode 9: predictions for the next 10 years1:44 Robotic blood draws and AI needle guidance2:58 Will AI take my job? AI assisted diagnosis4:11 AI will make smart people smarter5:33 Will a robot replace the sonographer?6:12 Don't rely on AI 100 percent in image acquisition6:51 Who takes the liability for an AI read?7:15 More progress in 10 years than the last 2007:56 Predictions from the Global Summit speakers8:24 What will replace today's injections?9:14 If a robot can draw blood9:46 Regenerative medicine: a market driven future12:09 The future of point of care12:48 One appointment, all the answers13:54 An AI guided ultrasound delivered to your door15:05 At scale, but is that what patients want?15:46 Amazon or the human touch?17:06 Will patients leave the house for care in 10 years?17:22 The independent MSK clinic in 10 years18:53 Same day diagnosis and treatment as the standard20:33 Corporate healthcare vs the independent practice21:08 Two things can be true22:21 The next decade is in your hands24:11 Coming up on the podcast24:44 summit.amsku.com: speakers from six continents27:21 Voices from the 2025 AMSKU Annual Global Summit

    The Future of MSK Ultrasound: AI, Point of Care and the Next 10 Years
  3. Sep 29

    Is MSK Ultrasound Too User Dependent? Why Training Beats the Objection

    "It's so user dependent." It is the objection Ryan Martin and Colin Rigney hear more than any other about bringing MSK ultrasound into practice. In this episode they take it head on. X-rays are position dependent, MRI is reader dependent, surgery has its errors too, and every one of them is learned as a system. Ultrasound is no different: a systematic scan, enough reps with feedback, and a mentor beside you. They share how an ER physician got comfortable with a technical procedure in about 50 reps, how a resident went from no ultrasound at all in February to ultrasound guided PRP and bone marrow procedures a few months later, and why you cannot learn a hands-on skill from YouTube alone. Work with us! https://links-amsku.vercel.app/ What this episode covers: Why user dependence is the objection that comes up most about MSK ultrasoundOperator dependence in every modality: x-ray positioning, MRI reading, surgeryUltrasound as a system: shining a flashlight under the skin and working your checkpointsPlays are made to be broken, once you know the playbookNot operator dependent, system dependentHow many reps it really takes: 50 and a backboard to learn fromThe road to mastery goes through incompetencyFrom no ultrasound in February to ultrasound guided PRP and bone marrow procedures months laterWhy you can't learn a hands-on skill from YouTube, and why accountability mattersThe "I don't want to go back to school" mountainVoices from the 2025 AMSKU Annual Global SummitLinks mentioned in this episode: MSK Ultrasound Residency, 12 months of hands-on training with expert mentors. Book a free discovery callAll-inclusive MSK ultrasound course memberships, with step by step video tutorialsMSK ultrasound scanning guides and eBooks by anatomical regionEvery AMSKU courseTell us the objection you hear mostAMSKU Annual Global Summit, Saturday 5 December 2026, live and online. Register, or watch the playback from last year's summitNew episodes every Tuesday. Watch on YouTube, or listen on Spotify and Apple Podcasts. Chapters:0:00 This week on From Probe to Practice0:25 From Probe to Practice0:38 The objection: MSK ultrasound is too user dependent1:45 MRI is the gold standard, and still reader dependent2:41 A flashlight under the skin: ultrasound as a system3:24 A handheld skill still has a system4:08 "It's so user dependent." There's training for that5:15 Errors in MRI, CT scans and surgery too6:38 Plays are made to be broken7:18 Not operator dependent, system dependent7:38 Talking a clinician through the objection8:04 50 reps: how an ER physician learned a technical procedure9:02 15 orthopedic surgeons in one week9:56 The road to mastery goes through incompetency10:07 February to June: a resident's first guided procedures11:25 Learning MSK ultrasound without a fellowship12:29 A hundred books on riding a bicycle13:14 Accountability and a residency style program14:55 Why we welcome the objections16:00 The mountain: "I don't want to go back to school"16:39 Raising the standard at the point of care17:34 Coming up: more objections, and a live Q&A18:23 Voices from the 2025 AMSKU Annual Global Summit

    Is MSK Ultrasound Too User Dependent? Why Training Beats the Objection
  4. Sep 22

    MSK Ultrasound Learning Curve: What Changes Across Your First 100 Scans

    How many scans does it take before MSK ultrasound starts to click? Colin Rigney and Ryan Martin get honest about their own first 100 scans: the moment Ryan nearly quit, the mentors who kept them going, and the phases every learner moves through on the ultrasound learning curve, from taking 50 pictures of a shoulder to streamlining your sequence to finally bringing real assessment into the scan. Work with us! https://links-amsku.vercel.app/ What this episode covers: The ultrasound learning curve in phases: 0 to 25, 25 to 50, 50 to 75 and on to 100 scansWhy the first 25 scans are the "what am I looking at" phaseDon't sleep on the physics: knobology, gain, focal zone and depth from day oneWhy even a strong anatomy background gets humbled by sonoanatomyBuilding trust with a mentor, and why you cannot second guess the coachingMoving from technician to diagnostician between 50 and 75 scansA near miss: the gastrocnemius tear that looked like a Baker's cystThe anterior hip, the deep gluteal space, and why piriformis is not a diagnosisThe AMSKU Annual Global Summit, Saturday 5 December 2026Links mentioned in this episode: AMSKU Annual Global Summit, Saturday 5 December 2026, live and online. Early bird tickets available now: summit.amsku.comIntroduction to Musculoskeletal Ultrasound: MSK Ultrasound Physics and Machine OptimizationEvery AMSKU courseNew episodes every Tuesday. Watch on YouTube, or listen on Spotify and Apple Podcasts. Chapters:0:00 Harder than you think0:27 From Probe to Practice1:20 What your first 100 scans really teach you1:56 Behind the eight ball: when Ryan nearly quit4:13 Mentors, and getting the nod5:15 Why the shoulder clicks first7:25 Don't sleep on the physics8:29 Practicing for a job that didn't exist yet10:34 Know your equipment11:43 Humbled by anatomy on ultrasound13:47 Unlearning three dimensional expectations14:51 Old habits and trusting the coaching15:50 Scans 0 to 25: what am I looking at?17:46 Scans 50 to 75: from technician to diagnostician20:37 A good plan executed sooner21:00 50 stellate ganglion blocks: a physician's learning curve24:34 The near miss: a gastroc tear, not a Baker's cyst28:25 The anterior hip Bermuda Triangle30:53 Not everything is the piriformis32:39 The AMSKU Annual Global Summit35:34 Raising the standard37:59 Why we do this38:45 Voices from the 2025 summit

    MSK Ultrasound Learning Curve: What Changes Across Your First 100 Scans
  5. Sep 16

    MSK Ultrasound Infraspinatus: The Normal Findings That Look Like a Rotator Cuff Tear

    Is an isolated infraspinatus tear real, or is it the zebra? Colin Rigney and Ryan Martin take apart the most heavily taught and least often seen tendon in the rotator cuff: why the infraspinatus rarely fails on its own, the two normal anatomic findings that get read as pathology, and how to tell an overlap artifact from a genuine tear. Work with us! https://links-amsku.vercel.app/ What this episode covers: Why a cuff fails anteriorly to posteriorly, and what that means for your scan orderThe elongated myotendinous junction that gets called a bursal sided tearCortical irregularity across the middle facet, and why it is not a Hill-SachsWhere the infraspinatus overlaps the supraspinatus, and the echogenicity change that fools people early in their scanningAnisotropy versus pathology when the two tendons sit 30 to 45 degrees obliqueAssessing fatty atrophy in the posterior fossa, using teres minor as the landmarkTreating the whole organ rather than one tendonCourses mentioned in this episode: Live Shoulder Scanning ProtocolMSK Ultrasound Evaluation of Rotator Cuff Tear vs TendinopathyEvery AMSKU courseNew episodes every Tuesday. Watch on YouTube, or listen wherever you get your podcasts. Chapters:0:00 The zebra, and the overlap that fools you0:20 From Probe to Practice1:04 Why the infraspinatus, and why now1:59 The honest reason behind the post4:15 How often is it isolated?4:57 The wrestler: a tear nobody predicted5:43 Ultrasound is a tool, not the whole answer7:01 Two normal findings that look like pathology8:44 Where the infraspinatus overlaps the supraspinatus9:56 Anisotropy versus pathology11:07 Fatty atrophy and the notch of no name12:22 Teres minor is your lighthouse14:43 This is beyond beginner level15:41 The courses that cover this16:54 Treating the whole organ19:46 The distal biceps window debate22:37 The new machine24:12 Wrap

    MSK Ultrasound Infraspinatus: The Normal Findings That Look Like a Rotator Cuff Tear
  6. Sep 8

    MSK Ultrasound Training: Why a Weekend Course Is a Launchpad, Not a Finish Line

    "There's no shortcuts with ultrasound." A weekend course can hand you momentum. It cannot hand you competence. Colin Rigney and Ryan Martin come off a weekend of teaching and take the question straight on: I did a weekend course, what are your thoughts? The answer starts with intent. Where is your skill set right now, why are you adding this one, and what do you actually want to be able to do at the end of it? Two clinicians can sit at the same table for the same two days and walk away with completely different things, and the difference is almost never the course. Then there is the objection underneath all of it. "I don't have time." Ryan's answer is that you have time, everybody has time, and what you are really describing is a priority. That answer tells you more about the intent than any registration form does. Also in this episode: the physician assistant who is genuinely proficient at ultrasound-guided hip injections and does everything else blind; why people try to learn a new skill through the lens of how they learned the last one, and why that turns into resistance; how industry money shapes what gets taught in a big conference room, and how to find the trusted sources when you cannot tell hype from evidence; why ultrasound is the gateway to regenerative medicine and the only imaging tool that lets you assess, discuss and treat in the same visit; and what AMSKU built its own weekend immersion to do differently, with five learners, one instructor for every one to two attendees, no slide decks, and chalk talk straight to scanning. To be clear, because the hosts are: good weekend courses exist and both of them teach at them. A weekend is a launchpad. The reps after it are the actual work. Work with us! https://links-amsku.vercel.app/ The Monday-morning takeaway: before you book the next course, write down what you want to be able to do when it ends. If you cannot name that, another weekend will not get you there. If you can, you have just turned a course into a starting point. In this episode: 0:00 — No shortcuts, and everybody has time0:24 — Welcome to episode five0:45 — Teaching the AANA workshop in Phoenix3:30 — Ultrasound as a bolt-on to an existing practice4:08 — Guardrails, and raising the standard4:35 — There are no shortcuts with ultrasound5:04 — Not one, two, or even three weekend courses5:20 — A launchpad, or dipping your toe in6:18 — Operator dependent, every time6:50 — Today's question: I did a weekend course6:59 — It all comes down to intent7:45 — Start with the end in mind9:00 — The elbow injection nobody had shown him9:43 — Meet people where they are10:10 — Proficient at the hip, blind everywhere else11:43 — What is the real intent for going?12:57 — Industry, money, and influence in the room14:07 — Shiny objects, and the charlatan problem15:13 — Finding the trusted sources16:42 — The objections to starting MSK ultrasound17:10 — Learning a new skill through an old lens19:51 — Time, money, and what you actually prioritize21:29 — Everybody has time22:41 — The person who goes to the gym23:35 — Ultrasound is the gateway to regenerative medicine24:26 — Inside the AMSKU immersion: five learners26:10 — Weekend courses are a launchpad27:05 — The anti-weekend course28:46 — Good weekend courses do exist30:35 — No slide decks, chalkboard to practice33:46 — Where to start: select.amsku.com35:03 — The Diagnostic Awakening35:56 — Sign-off Mentioned in this episode: AMSKU Select, the weekend immersion both hosts describe as the anti-weekend course — five learners, one instructor for every one to two attendees, 13 hours of guided scanning, in Mesa, Arizona: https://select.amsku.com Introduction to Musculoskeletal Ultrasound — the online course to start with if time or bandwidth is the real constraint right now: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/ The Diagnostic Awakening — Colin and Ryan on how they got here, and what integration actually took: https://awakening.amsku.com New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    MSK Ultrasound Training: Why a Weekend Course Is a Launchpad, Not a Finish Line
  7. Sep 2

    MSK Ultrasound Echo Texture: Know Normal Before You Call It a Rotator Cuff Tear

    "How do you know what abnormal is if you don't know what normal is?" Every tissue has a signature. Bone is bright white. Tendon and ligament are fibrillar, like a guitar string. Nerve in short axis is a bundle of grapes, or a honeycomb. Muscle is sinuated and feathery. Fat is marbled. Learn those cold and pathology announces itself, because pathology is a departure from a picture you already hold. Skip that step and the screen will hand you a diagnosis you invented. Tip the probe a few degrees and a normal tendon goes dark, and dark reads as pathology. As Ryan Martin puts it, you check the contralateral side, you do everything right, and really all it was was a difference in how you held the probe. Colin Rigney and Ryan Martin spend this episode on reading echo texture and the pattern recognition underneath it. Also in this episode: how to tell nerve from tendon when they look identical in short axis (make the tendons glide and watch what stays still), how to separate a fat pad from the quad tendon by pushing on the skin, the three questions Colin asks at every tendon-bone interface, why a cortical change on the infraspinatus means something different from the same change on the supraspinatus, the little dip before the enthesis that will let you invent a tear at the critical zone, and why an isolated infraspinatus tear is rare enough to make you look again. Work with us! https://links-amsku.vercel.app/ The Monday-morning takeaway: before you grade anything, ask whether you have seen enough normal of that exact tissue to know what you are looking at. If the answer is no, that is not a reading problem. That is a reps problem. In this episode: 0:00 — Thirty scans a week, and why reps win0:32 — Hosts, dogs, and a drive to Tempe2:02 — Welcome to episode four3:59 — Today's topic: reading echo texture4:41 — Start with the machine, not the anatomy4:59 — Echogenicity, and 256 shades of gray5:37 — What each tissue should look like6:11 — Know normal, then judge the departure from it7:20 — Echo texture can lie to you8:06 — Anisotropy: the same tendon, two pictures9:01 — Telling nerve from tendon in short axis9:58 — Tendons glide, nerves stay still10:48 — Fat pad or quad tendon? Push on the skin11:55 — Grading the departure from normal12:50 — Why we start with the shoulder13:24 — Three questions at the tendon-bone interface14:15 — Not all cortical changes are equal16:04 — Fooling yourself at the critical zone16:38 — Rarely an isolated infraspinatus tear17:46 — In clinic, the first thing you see is abnormal18:33 — The limiting factor is how many scans you do19:53 — Tendinopathy or tear: what to look for21:47 — Google will not teach you this23:18 — Reading echo texture is the foundation25:47 — Thirty scans this week27:29 — Where to start if you are new29:01 — Course links and sign-off Mentioned in this episode: MSK Ultrasound Evaluation of Rotator Cuff Tear vs Tendinopathy — Ryan's case-study course on grading tendinopathy and telling it from a tear. 1.0 AMA PRA Category 1 Credit: https://www.amsku.com/courses/musculoskeletal-ultrasound-evaluation-of-rotator-cuff-tear-vs-tendinopathy-with-case-studies/ Introduction to Musculoskeletal Ultrasound — the physics, machine optimization and normal sonoanatomy course Ryan points to when he says start with normal: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/ Free shoulder e-book, if you want somewhere to start at no cost: https://zfrmz.com/RwwBmQJTGwgnyUJItYdy New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    MSK Ultrasound Echo Texture: Know Normal Before You Call It a Rotator Cuff Tear
  8. Aug 25

    MSK Ultrasound Anisotropy: The Artifact That Makes Normal Tissue Look Torn

    "It's the only imaging modality that you can create your own pathology with the flick of a wrist." Tip the probe a few degrees off perpendicular and less sound comes back to it. Less sound back means a darker picture. A darker tendon reads as hypoechoic, and hypoechoic reads as torn. The image still looks fine. The finding is invented. Colin Rigney and Ryan Martin spend this episode on the two things that decide whether you can trust what is on your screen: anisotropy, the artifact that fools everyone early and that experienced scanners turn into a tool, and the vocabulary underneath it — hyperechoic, hypoechoic, anechoic, homogeneous, heterogeneous — which most clinicians use loosely and the RMSK exam does not. Also in this episode: how to toggle the probe to make peroneus longus and brevis wink at you one at a time, how far off 90 degrees you can be before it costs you (about five degrees, and it is obvious by fifteen), why the Achilles is the tendon most people position wrong, Dr. Joel Sellers' wall test for telling homogeneous from heterogeneous, what a denervated muscle looks like as it loses water and takes on fat, and why the contralateral side is the cheapest control you have. Work with us! https://links-amsku.vercel.app/ The Monday-morning takeaway: put the tissue on tension before you judge it. A slack Achilles bows, a bowed tendon changes your angle, and a changed angle changes the diagnosis. In this episode: 0:00 — Anisotropy, the artifact that fools you0:54 — Welcome to From Probe to Practice2:33 — The only modality where you can create your own pathology3:32 — Why this shows up on the RMSK exam3:56 — It clicks after the first 50 to 100 intentional scans5:21 — What anisotropy actually is6:41 — Using it on purpose: making the tendons wink7:36 — Where it bites: supraspinatus, patellar, Achilles7:56 — How far off 90 degrees can you be?9:47 — Hyperechoic, hypoechoic, anechoic12:32 — 256 shades of gray, and why it is all relative13:40 — Patient positioning, starting with the Achilles16:12 — Put the tissue on a stretch19:01 — Homogeneous vs heterogeneous: the wall test19:52 — Acute hematoma vs chronic ossification20:59 — What a denervated muscle looks like22:53 — Always check the other side24:13 — RUSI, a topic for another day26:32 — The machine will lie to you all day long Mentioned in this episode: Introduction to Musculoskeletal Ultrasound, the physics and machine-optimization course Ryan built: https://www.amsku.com/courses/introduction-to-musculoskeletal-ultrasound/ New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    MSK Ultrasound Anisotropy: The Artifact That Makes Normal Tissue Look Torn
  9. Aug 18

    If You Can't Diagnose It, You Can't Inject It | Greg Zakas, DO

    "That's actually the easy part, is the injection. If you can't diagnose it, you can't inject it." Dr. Greg Zakas trained in physical medicine and rehabilitation, did an interventional pain fellowship, and spent years in clinics where the model was opioids first and procedures second. He came out the other side as a full-time regenerative orthopedics physician. This is the whole route, told honestly — including the $400,000 of debt that shaped which specialty he picked, the forty-to-fifty-patient days that made real conversations impossible, and the VA research that settled the opioid question for him. Colin Rigney and Ryan Martin take him through the part most clinicians get wrong: the assumption that ultrasound-guided injection is the hard skill. Zakas argues the needle work is the easy half. What separates practitioners is whether they can see the thing they are treating in the first place — and he makes the case that in trained hands, diagnostic ultrasound matches MRI for finding rotator cuff tears. Also: why showing a patient their own tear on the screen builds more trust than any explanation, how the ability to talk about ultrasound and the ability to do it feed each other, why he refused to post about anything he had not seen dozens of times, and what he would tell a physician who is ten years behind him and wondering whether it is too late. Work with us! https://links-amsku.vercel.app/ The Monday-morning takeaway: the diagnostic skill is the bottleneck, not the needle. If you are getting your orthobiologic into the joint but not to the lesion, more injection practice is not the fix. In this episode: 0:00 — If you're not embracing it, you're going to be left behind0:54 — How the three of us met1:55 — PM&R, pain fellowship, and $400,000 of debt2:22 — When prolotherapy was still considered voodoo5:59 — Mission trips: Lima and Guadalajara7:35 — Meet your hosts11:42 — Why traditional pain medicine broke for him12:52 — The VA study that changed his mind on opioids15:30 — Insurance volume vs. time with a patient16:17 — The slow pivot into orthobiologics18:14 — Which courses were actually worth it21:16 — The injection is the easy part21:54 — Ultrasound vs MRI, and the naysayers23:47 — What ultrasound does to patient trust26:35 — Ultrasound as a communication tool32:12 — Imposter syndrome and earning the right to teach35:08 — What he's working on next41:29 — Advice to a doctor ten years behind him49:50 — Where to follow the work New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    If You Can't Diagnose It, You Can't Inject It | Greg Zakas, DO
  10. Aug 11

    MSK Ultrasound Probe Selection: Linear vs Curvilinear

    Linear or curvilinear? Which frequency? And what should you actually be doing before the probe touches the patient? Colin Rigney and Ryan Martin open From Probe to Practice with the decisions that quietly set the ceiling on every MSK ultrasound exam you run — probe selection, frequency, gain, and the positioning nobody talks about until an injection goes sideways. Ryan's rule, from his mentor Wayne Smith: "Scan everything with a linear probe until you cannot." Colin's version of the same idea: "Ultrasound is an extension of your clinical brain." Both come back to intent — why are you scanning, and will it change what happens to this patient? Also in this episode: a case from that same morning where a patient's anterior hip sat almost 12 cm deep and the linear probe simply could not reach it, why the curvilinear's crossing arrays can make a straight bone look curved, what to do when your clinic owns exactly one probe, and the scouting habit that prevents the most common avoidable injection problem. Work with us! https://links-amsku.vercel.app/ The Monday-morning takeaway: always scout in the position you're going to inject in. A shoulder scouted seated and injected supine is a different shoulder. In this episode: 0:00 — Ultrasound is an extension of your clinical brain0:53 — Welcome to From Probe to Practice1:51 — Before you touch the probe: why are you doing this?3:02 — Scope of practice and clinical reasoning4:24 — Optimisation starts before the patient5:37 — Linear, curvilinear, hockey stick6:32 — Use a linear probe whenever you can7:03 — Trading depth for resolution9:35 — The case that forced a curvilinear10:51 — When you only have one probe11:53 — The physics caveat nobody mentions14:01 — Patient position, practitioner position15:17 — Scout in the position you'll inject16:02 — Start with why17:18 — If you're not optimising the gain New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    MSK Ultrasound Probe Selection: Linear vs Curvilinear
  11. Aug 3

    MSK Ultrasound Is the Gateway to Regenerative Medicine - The Intro Episode

    "Whether you know it or not, you have a gap in your practice." Colin Rigney and Ryan Martin — the founders of the Advanced MSK Ultrasound Center — introduce From Probe to Practice: what it is, who it's for, and why they built a show about musculoskeletal ultrasound that deliberately isn't a lecture. This is not a 45-minute monologue on probe physics. It's two people who've trained clinicians for years talking about how MSK ultrasound actually works inside a practice — the diagnostic gaps nobody mentions, the injections that miss and why, the referrals you didn't need to make, the business of integrating it, and the case studies that only come from tens of thousands of reps. Plus, in Ryan's words, "a lot of dirt on each other." Guests this season include Greg Zakas and Don Buford, among others from across regenerative and musculoskeletal medicine. Stay to the end for a look at what's coming. Work with us! https://links-amsku.vercel.app/ In this introductory episode: 0:00 — The gap in your practice0:12 — From Probe to Practice0:30 — Who's talking0:57 — What the show is2:01 — Why it exists2:23 — Who we made it for3:07 — The moment you reach for it3:45 — Why ultrasound, why now4:37 — What this show is not5:47 — What you can expect7:37 — What one episode gets you8:56 — Who else this is for10:17 — The invitation11:07 — This season on From Probe to Practice New episodes every Tuesday. From Probe to Practice is brought to you by the Advanced MSK Ultrasound Center — courses, residency and live workshops: https://amsku.com

    MSK Ultrasound Is the Gateway to Regenerative Medicine - The Intro Episode

About

From Probe to Practice is a weekly podcast on musculoskeletal ultrasound — diagnostic scanning, ultrasound-guided injections, and how MSK ultrasound changes the way clinicians practice regenerative and musculoskeletal medicine. Hosted by Colin Rigney and Ryan Martin, founders of the Advanced MSK Ultrasound Center, who have trained clinicians for years and bring the reps to prove it. This is not a 45-minute monologue on probe physics. It's a high-energy dialogue about what actually happens inside a practice: the diagnostic gaps nobody mentions, the injections that miss and why, the referrals you didn't need to make, the business of integrating ultrasound, and the case studies that only come from tens of thousands of scans. Plus, in Ryan's words, "a lot of dirt on each other." Every episode is built around one promise: take something you learned from a podcast on Friday and implement it on Monday. For physicians, regenerative medicine clinicians, sports medicine providers, anyone preparing for the RMSK exam — and anyone who works alongside them. Because you can't diagnose what you can't see. New episodes weekly. An Advanced MSK Ultrasound Center podcast.