An online physio service. Does it work?

We are living in very strange times. Restrictions are gradually being lifted but uncertainty of the future is the only thing we can be certain about. Physiotherapy is rapidly evolving, and the telemedicine industry has experienced a huge boost in popularity. Despite Covid-19, people are still hurting. People still get injured. People still suffer from chronic injuries, and people still need help.

Perceptions of what exactly a physiotherapist does have been challenged in the last decade. Traditionally physios assess you, perform some sort of manual, hands on intervention and then give you exercises. We have always been a ‘hands on’ profession. I am not disputing that; I believe manual treatment interventions to be significant. I miss treating my clients in person, and there is something very healing about human touch. But the evidence for manual therapy all indicates that it helps only in the short term to reduce pain. It does not correct any movement fault, weakness, or dysfunction. Manual therapy must be combined with exercise-based interventions in order to be effective in the long term. Evidence based treatments point towards exercise, strengthening and education. So if you were to walk into my clinic and expect to have a rubdown and walk out without lifting a finger, I would have a job on my hands to try to adjust your expectations of what I do as a physiotherapist. If after that you still expect ONLY a passive treatment like some spinal manipulations or soft tissue work, then I am not the right physio for you. I can help you to get better, but you have to take the initiative to work with me and follow my instructions.

Thankfully, telehealth physio, or online physiotherapy, can allow for the deliverance of clinically effective assessments and exercise programmes. But do not be fooled! This is not a new idea. It has been around for years, often being delivered to people who cannot make their appointment or have had to travel last minute for work. It is very popular in Denmark and Sweden and is an established means of delivering high quality care. Telemedicine is also effectively used in the treatment of diabetes, cardiac rehabilitation, and general medicine to name but a few. I would like to shed light on the process of how it works for a typical client. Once I have invited my client to our video call via a privately shared link, the session begins:

1)     Medical Screen and Red Flags

First and foremost, I ask my client about their previous medical history and red flags. These are symptoms which may allude to an underlying medical illness. Pain can often manifest due to a systemic sickness, and mask itself as a muscular strain or discomfort. If anything unusual presents which may be of concern or medical significance, I will refer that person to their GP first.

2)     Symptom Investigation

The nature of symptoms can give clues as to the particular structures which may be responsible for pain. The type of pain, the pattern, and aggravating and easing factors all help to paint a picture of a person’s experience of pain and lead us closer towards make a diagnosis. Simple and specific clinical tests exist which I can ask you to perform at home, providing instructions and guidance along the way.

3)     Establish potential diagnoses

Having talked over the characteristics of the injury, we arrive at 2-3 potential diagnoses of what COULD be responsible for the presented problem.

4)     Process of clinical elimination

By further investigating potential causes we can become more specific and closer to finding the root cause of the problem. For example, a common presentation is a niggle in the front of the hip, reproducing pain when you sit up from lying down, or when you go up the stairs. Potential structures here which may be responsible are the hip flexor or the hip joint. A strain to the hip flexor would usually present as pain on stretching and upon mechanical exertion of the injured tissue. An injury to the joint itself may have been caused by an awkward twist, creating inflammation in the joint, which leads to night pain. OR perhaps that person is beginning to suffer from arthritis in their joints, where I would ask about morning and stiffness, which should be relieved with exercise and movement. All of a sudden, conditions that all present with the same dull localised pain become very different entities. The plot thickens!

5)  Arrival at primary diagnosis

Consequently, we can now establish a diagnosis, that I explain to you and answer any questions you may have. If there are any uncertainties as to the ‘WHY’, we can delve a little deeper and try to fill in all of the gaps on what is essentially a canvas painting of your injury or journey. Once you understand the WHY – why did this happen, why does it hurt, why has it not got better, why does that help – you will become more engaged in the recovery process.

6)  Plan for recovery

Together we devise a realistic plan to allow your body to get back to full function. Included in this will be a comprehensive rehab programme, outlined with videos and distinct instructions, repetitions and sets. You will come away from this feeling reassured and confident on what you can and cannot do, and what you can expect throughout your recovery.

7) Monitor response to rehab

Client-therapist feedback is pivotal to the process. By revealing which exercises were harder, or which tired you quicker, gives essential insight into how we will develop your next phase if rehab, if you require it.

The difference between online physio and a physical physiotherapy appointment is that we lack a hands-on treatment. This CAN be very valuable of course, but generally too much emphasis is placed on this by clients wanting to be fixed instead of getting stronger or fitter. Soft tissue release techniques or joint mobilisations can be reproduced at home yourself, granted that they may not be as effective as an expert administering them. Apart from this, there is no reason to say that we cannot perform physio consultation to extremely high standards. There is a growing body of literature to support the use of telehealth which I will review in my next post.

Online physio can be a daunting thing for a lot of people. Perhaps it clashes with peoples previously held image or preconceived sentiments of what physiotherapy actually is. But these are daunting times which require a paradigm shift regarding how we manage our health. The status quo has been uplifted and perhaps remains to be seen what the new ‘normal’ will be next month, or the following month, or in 6 months? Nonetheless time does not stop, and life continues. People continue to hurt and continue to reach out for help. We are a tribal society who work together. Despite the current situation, I am glad to have the experience and technology at my fingertips to be able to continue to effectively treat and help people.

For more information or for booking information please visit: www.onlinephysio.ie/bookings

All the best,

Liam

Chartered Physiotherapist

BSc, MISCP, CSCS