The Ultimate Guide to Online Physical Therapy
Physical therapists are leading experts in how the human body moves. We see patients who need help with a range of musculoskeletal issues, from short to long-term.
And it’s likely you’ll see one of us in your lifetime (if you haven’t already). There are around 265,000 physical therapists in the USA alone, completing around 300 million physical therapy sessions per year.
Physical therapy has been practiced for around 100 years now and is changing with the times.
The last 10-15 years have seen the birth of online physical therapy. And the number of therapists offering online appointments continues to rise.
But what exactly is it?
+ Contents (click to view/hide)
1. What is Online Physical Therapy?
1.2 Why is Physical Therapy Important?
1.3 What is Online Physical Therapy?
2. What to Expect From Online Physical Therapy
2.1 How can I get safe and effective treatment if I'm not seen in person?
2.2 What do I need to consider before starting Online Physical Therapy?
2.3 How long will it take me to feel better with Online Physical Therapy?
2.4 What should I expect from my first Online Physical Therapy appointment?
2.5 What will I actually need to do in Online Physical Therapy?
2.6 What can I do to help make my treatment successful?
2.7 What are the downsides to Online Physical Therapy?
2.8 Can I pay for Online Physical Therapy with a copay?
3. What Makes a Good Online Physical Therapist?
3.1 What should I look for when choosing an Online Physical Therapist?
3.2 How often will I see a therapist?
3.3 Will I see the same therapist every time?
3.4 How do I keep in touch with my therapist?
4. What About These Alternatives to Online Physical Therapy?
4.1 There is a physical therapy clinic near me. Should I go there instead?
4.2 How is Online Physical Therapy different from following exercise routines on Youtube?
4.3 My doctor said I will probably need surgery Should I still try Online Physical Therapy?
4.4 I'm on pain medication so I don't need to do physical therapy, right?
What is Online Physical Therapy?
What is Physical Therapy?
The Federation of State Boards of Physical Therapy (FSBPT) says physical therapy is ‘identifying the highest functional potential of the individual client and striving to reach that goal through a variety of means’.
In other words, physical therapy helps you move your body to the very best of your personal ability in a clinically safe way.
Photo by Joyce McCown on Unsplash
Why is Physical Therapy Important?
Physical therapy helps you:
reduce and end pain
recover from injury
avoid surgery
improve your mobility
It also saves you money. Research shows that physical therapy treatment means fewer days off work AND fewer visits to the doctor’s office for musculoskeletal pain.
MDs do a vital job. But it is widely known that their knowledge of musculoskeletal conditions is inadequate.
Undergraduates receive minimal osteopathic training. And many are not up-to-date with the latest osteopathic best practices.
You’ll probably get an imaging referral from your MD (such as ultrasound or MRI). You could also get an opioid-based pain medication prescription.
What’s wrong with this?
Imaging Can Delay Your Recovery
Physical therapy reduces recovery time. It’s never too late to see a physical therapist but the sooner you do, the better.
If you choose to see your physician first, you’ll wait for your appointment with them.
Wait to have your imaging done. Wait for a diagnosis. Wait for a prognosis. Wait for a treatment plan.
Meanwhile, you could have started your recovery journey already in physical therapy.
Direct access (going straight to a physical therapist first) prevents the injury from getting worse.
A minor injury, like a sprain or strain, left waiting (or worse: waiting and on RICE treatment) can easily turn chronic.
And, sometimes, your imaging results give an inaccurate picture of the cause of your symptoms. They may even have nothing at all to do with how you physically feel.
Research shows that many people with no lower back pain symptoms still show tears, and bulging and protruding discs on their MRI results.
You Could Get Prescription Pain Medication Long-Term
Your physician could prescribe you pain medication, either alongside or as your only treatment.
78% of Americans prefer drug-free treatments. But, worryingly, musculoskeletal patients who are prescribed opioids are highly likely to end up taking them long-term.
And here’s the kicker: your MD will probably finish up referring you for physical therapy anyway.
What is Online Physical Therapy?
Online-based physical therapy has various names:
online physical therapy
virtual physical therapy
telehealth physical therapy
but they all work in the same way.
Online physical therapy is a full physical therapy service. It consisting of consultations, appointments, treatment plans, demonstrations, and movement assessments.
We deliver it via the magic of video calls and other online-based communication methods (that we all became so familiar with in 2020!).
Online physical therapy fits around your existing commitments easily.
You have a range of appointment times to choose from and you can speak to your PT more often than you can in a clinic.
It has been around for a fair few years (Flex With Doctor Jay was here well before the world was slam-dunked into pandemic!).
But it’s becoming more common. More therapists had to make adjustments to the way they work in the wake of COVID-19, so many switched to provide online therapy.
Photo by Sam Burriss on Unsplash
Which conditions can I get treatment for with Online Physical Therapy?
Online physical therapy can treat acute and chronic orthopedic conditions. That means you can get help for injury, pain, or discomfort in your:
joints
muscles
ligaments
tendons
nerves
Which orthopedic conditions can Online Physical Therapy not treat?
You cannot have virtual treatment if you:
have paralysis
need physical help to walk (including crutches)
have had surgery within the last three months
This should be standard practice among all physical therapists.
If you are in one of the categories above and offered virtual therapy, do not accept treatment. It would be dangerous.
What To Expect From Online Physical Therapy
How can I get safe and effective treatment if I’m not seen in person?
Many people think physical therapy means physical touch. They can't see how treatment works without it.
Physical therapists are experts in how the body moves. PTs know what the best movement should look like for your unique body.
We know which of your body parts need to do the work to achieve that. And we only need to see you move to assess that. That’s why you don’t need touch for treatment.
People have become used to instant gratification. In all areas of our lives, we ‘want it now!’: entertainment, food, travel. And we have the same attitude when it comes to pain: ‘take it away, NOW’.
We want to take something, wear something, or have something done to our bodies to get rid of the pain immediately.
Manual physical therapy (where a PT makes physical, manual adjustments to your body with their own hands) has its place. But a good physical therapist doesn’t rely on it alone.
Any treatment you have should empower you with:
the right level of education on how your body moves
what your pain is telling you
how to reduce or end pain yourself
That’s exactly what online physical therapy does.
What do I need to consider before starting online physical therapy?
Your ability to move alone
If you need help to move, online physical therapy is not right for you.
Whether you have left enough recovery time after a recent surgery
Leave around three months recovery time after recent surgery before starting online physical therapy.
Your finances
Online physical therapy is a specialist health service provided by experts.
But the depth of knowledge and experience varies between PTs. If you want the most effective, long-lasting results you will need an experienced PT.
You should expect to pay a premium for the most highly skilled practitioners. When it comes to your mobility, you want the best:
quality
safety
ethics
care
Personalized programs can cost anywhere between $1000 - $5000. So it’s a good idea to think about how you will finance your treatment in advance.
Whether the physical therapist is right for you
You need a PT who believes strength training is the key to resolving chronic issues.
You also want to avoid being given a pdf list of a handful of exercises. This shows that the PT only provides cookie-cutter routines instead of personalized programs.
You’d basically be one step away from following a YouTube exercise routine.
How long will it take me to feel better with Online Physical Therapy?
Annoyingly, it depends.
A physical therapist needs to consider what stage of healing your injury is at, how long you have been dealing with pain, and how active (or not) you have been in that time.
But the best physical therapists know that this is only a very small part of the story.
There is much to consider outside of your physical body that has an impact on pain:
past experiences with other medical practitioners
influences from society
your living conditions
how you cope with stress
your belief system
your economic and financial status
and more.
This is why it is crucial that physical therapists treat the person and not just the pain.
Have you ever had treatment at a clinic before and your pain returned after the treatment ended?
That’s because your care team only focussed on your pain and not its root causes.
What should I expect from my first online physical therapy appointment?
The PT should ask A LOT of questions
Your physical therapist must understand your lifestyle, not just which body part is hurting.
If your PT dives into assessing your movement straight away, it’s a red flag. You’re about to end up with that cookie-cutter pdf you need to avoid.
Understanding your wider lifestyle uncovers root causes and habits to address. And addressing root causes keeps you out of pain long-term.
The PT should ask about your availability and access to equipment
Let’s say you can only work out for 20 minutes, three times a week, at home. But your PT gives you a plan of 5 x 60-minute gym workouts a week.
Is this the kind of lifestyle change we’ve been talking about? Absolutely not. It’s as bad as getting the cookie-cutter pdf.
Yes, you want a PT to help you figure out which of your habits need course-correcting. But you still want your program to fit into your life, around your existing commitments.
This is why your physical therapist should ask about your workout availability and whether you have access to a gym.
If you want long-term pain freedom, you need a long-term plan that you can actually stick to.
Photo by Alexandra Tran on Unsplash
The PT should assess your movement
Your PT will ask you to move in various ways for them to assess your range of motion and prescribe the correct exercises.
They should explain their observations to you at the end of your movement assessment, and which exercises work on which issues.
The PT should get your agreement on a plan of treatment
If your PT says you need to do X for three weeks, Y for the next two, and call them on Z days only...congratulations, you’re back in Cookie-Cutter Land.
Technically, it is you who is going to be performing your treatment. So you and your PT must plan your treatment together.
What will I actually need to do in online physical therapy?
Expect to:
Do some form of daily exercise
Physical therapy means doing some form of exercise so that you can move better.
Remember instant gratification? Yes, it is possible to see some amazing results quickly. But your aim should be to stay out of falling into the same problems again in the future.
To do that, you need to build strength in the right areas. And to do that you need to complete some exercises, every day.
Plan for the future with equipment at home
You want to stay out of pain long-term. So you’ll need a plan for after your program has ended.
Bodyweight exercises (where you don’t use any equipment) are better than no exercise. But to strengthen your body, you need to put it under a bit of controlled stress every so often.
That’s where equipment comes in. Your local gym is likely stocked with plenty.
But you’ll want to have a selection of different weights, resistance bands, and more at home. Then you can take care of your mobility at any time.
Your PT will recommend equipment that is right for you and your long-term goals.
Push through some pain
Society has an unhelpful relationship with pain. People think (and are often told), “I am in pain so I can’t exercise”. Or, “I can’t do exercise because last time it flared my pain”.
If you feel pain, you panic. You try to get as far away as possible at the very first sign of it. But when you do that, you allow the problems the pain is signaling to fully set in. And that causes even bigger problems later on.
Pain is simply a signal that something needs a course correction. Sometimes that means exercising through some pain because it will actually help reduce it quicker.
If you notice some pain when exercising, your physical therapist can explain what’s going on inside your body. They'll also tell you what to look out for to check whether it is improving.
Get no pampering
Don’t worry. Your physical therapist won’t be an army sergeant about your exercise. And they absolutely expect you to fall off the wagon with your plan occasionally.
We’ve all been there!
But don’t expect to hear us say, 'rest up and binge a series of Netflix with a gallon of Ben & Jerry’s'. Or fake self-care, in other words.
Instead, they will remind you why you started this journey, where it’s headed, and encourage you to get back into the driver’s seat. And they’ll give you as much support and guidance to do that as you need.
Book appointments with your therapist (and turn up for them)
You catch up with your physical therapist so that they can check on your progress and discuss any adjustments to your plan.
With in-person physical therapy, you have to choose from the few appointments they have available at any given time (and usually during your work hours).
With online physical therapy, you choose appointments perfectly suited to your schedule.
You’ll see your PT frequently at first, at least once a week. Then less often later on in your program.
If you don’t book your appointments (or if you book them and don’t turn up) neither you nor your physical therapist knows whether you are on track with your exercise program or whether your discomfort is improving.
It wastes everyone’s time, and your money and future health. Make a commitment to your physical therapy partnership at the beginning of your journey.
Have access to a camera
You have several calls with your online physical therapist. They will assess your movement, demonstrate exercises, and show you how to use equipment.
You can also track your journey by taking progress photos or recording yourself performing exercises.
Feeling better in your body is great. But it’s amazing to see with your own eyes how much more freely you can move. Your phone, tablet, or laptop cameras are fine for this.
Photo by Daniel Thomas on Unsplash
What can I do to help make my treatment successful?
Find a physical therapist you feel safe with
Research shows that a huge indicator of a successful course of physical therapy is not exercises, education, or manual therapy. It’s the therapeutic alliance.
A therapeutic alliance is the relationship between patient and therapist. To build a strong therapeutic alliance with your online physical therapist you need:
To feel you can trust them
To believe they are doing everything in their power to help you get results
To feel they respect you
To feel safe with them
If your physical therapist is not a good match for you, speak to the company’s customer relationship management to see what they can change.
If things stay the same (or if the company has no customer relationship management), find another company.
A good way to judge a company’s therapeutic alliance ethos before approaching them is to check out what their previous clients are saying.
Be prepared for lifestyle change
Physical therapy is all about taking an active approach. You need to do the work!
This might mean saying goodbye to parts of your life that need to change for you to stay healthy.
By the end of your program, you will have a deep understanding of why an active approach is key.
What are the downsides to online physical therapy?
You need to change
If your program doesn’t have any kind of lifestyle change requirement then it’s not good enough.
The changes you need to make may be as simple as doing some simple stretches at your desk every hour. Or as big as exercising for the first time in your life since school. But there is no way around change.
If just want an exercise plan without lifestyle change, you’re better off heading to YouTube. But bear in mind that you don’t get any pain rehabilitation this way.
You have to do the physical work without us
I explained earlier why an online physical therapist doesn’t need to see their client in person to help them.
But the other side of that coin is: we can’t physically help you to do the work either.
No one puts their hands on your body to give you a quick adjustment for instant relief (but, as I explained here, this is a good thing!).
Can I pay for online physical therapy with a copay?
It depends on the individual practice.
Flex With Doctor Jay doesn't accept copay.
Research, and our experience, show that people associate the value of the quality of care they receive with the price they paid for it and therefore put in similar levels of commitment.
For example, imagine you could either pay $50 a month at one gym but $50 a year at another.
Which would you believe has better quality equipment, more helpful staff, and a cleaner studio?
Which would you visit as much as you could to make sure you got the full value you paid?
Also, insurance-based physical therapy is known for churning through as many patients as possible. Each appointment equals a payment for them.
Additionally, you are limited to a completely arbitrary number of visits per year under your insurance terms, even if you need more.
This indicates a disastrously low quality of care. And you still need to go elsewhere for your issue, which will worsen in that time, all costing you more in the long run.
What Makes a Good Online Physical Therapist?
What should I look for when choosing an Online Physical Therapist?
A safe physical therapist
But, first of all, is your physical therapist legally allowed to treat you?
All practicing physical therapists should hold a current license to legally treat patients.
You can check out the PT you’re considering on your state’s website. The FSBPT has a handy page of quick links for license searches for every state.
A physical therapist who believes in strength training
Bodyweight exercises have their place.
They’re a great starting point, particularly for people who haven’t exercised in a while. But long-term, they can only really get you a little farther than the starting line.
You need strength and power to reach your pain-freedom goals. You can’t do that without strength and resistance training.
A physical therapist who doesn’t want you to come back
For the right reasons!
The ultimate goal of physical therapy is to reduce or eliminate pain and give you the tools and knowledge to stay out of that same discomfort long term.
If you have to keep returning to the same therapist for the same problem, after your original program has ended, your PT did not do their job.
That’s not to say you can’t return to your physical therapist if you want to.
Flex With Doctor Jay has many repeat clients who re-sign with us simply because they love working with us and don’t want to leave the Pain Free Tribe!
A physical therapist who understands their scope of practice
There are occasions when you may need to be referred elsewhere for treatment instead.
For example, if your therapist suspects that your pain may be organ-related, they should refer you straight away. They should not try to see if physical therapy can make any difference first.
Like I said earlier, an online physical therapist should never treat you if you are fresh out of surgery.
If you tell an online PT you had recent surgery and they still try to give you a program, run away immediately (to the best of your ability!).
A physical therapist who provides custom programs
I’ve talked about the cookie-cutter approach a few times in this article.
As a guide, if you can easily find the exercise routine they gave you Google or YouTube, please throw it in the trash and find a better therapist.
How often will I see a therapist?
Again, it depends.
For a general idea, your plan of care will last for a set duration (usually between 8-12 weeks).
You see your therapist at least once a week for the first 3-6 visits and then gradually less often for the rest.
Why is this?
During your therapy, your education, lifestyle, and mindset training should be thorough enough that you can begin to work through your plan with less guidance and then, eventually, on your own.
For whichever therapy you choose for your issue (including chiropractic, massage, acupuncture, etc), if you continue to need appointments at the same frequency throughout, it’s a good indicator that either:
The care plan is not adequate
They want you to stay in pain
If you stay in pain and have to keep returning, they get more of your money.
Will I see the same therapist every time?
You should see the same physical therapist every time.
You can’t build up a safe, trusting partnership with your therapist if they pass your notes between PTs like the broken telephone game.
Having a conversation is different from reading written therapy notes. Notes do not capture nuance, tone, and emotion.
If you see different physical therapists every time (which is common in clinics), the company has more patients than they can handle. This means a seriously diminished quality of care.
How do I keep in touch with my therapist?
Each practice has its own contact protocols.
With clinics, you often have to get through to reception, have them leave a message for your therapist, and wait for the PT to call or email you.
At Flex With Doctor Jay, you contact your PT on our dedicated app and get a quick response within an agreed timeframe. It’s just like text messaging.
Photo by Myriam Zilles on Unsplash
What About These Alternatives to Online Physical Therapy?
There is a physical therapy clinic near me. Should I go there instead?
If you want to.
But you must do your due diligence on everything you’ve read up to this point. Vet the company before signing up:
Do you get a dedicated PT or will you see more than one (broken telephone game)?
Can you contact your PT directly, whenever you need to? Or do you have to leave a message and wait for them to get back to you?
Do you get a custom, strength-based program? Or a basic, printed-out list of bodyweight movements?
Does their pricing represent high quality? Or high quantity?
Do they take any recent surgery you had into consideration before giving you a program?
Do they have a process in place for what to do if you’re not happy with your PT?
Do they have set-duration appointment times? Do you have time to go and see them in person? Do they have appointments that fit with your schedule?
How is online physical therapy different from following exercise routines on Youtube?
I’m all for everyone being more active. For some people, YouTube workouts are a good entry point. But they are not for solving musculoskeletal pain.
There’s a good reason every workout you see online has a “this is not medical advice. See your doctor before starting a new workout routine” disclaimer.
We have a saying in the world of physical therapy: assess, don’t guess. Without a physical therapy assessment, you gamble with your body.
You don’t know which movements are helping and which are making it worse.
Online workouts are:
Usually not created by doctors of physical therapy
Not based on an assessment of your body
Not tailored to your needs
If you are dealing with pain or discomfort, avoid YouTube workouts.
My doctor said I will probably need surgery. Should I still try online physical therapy?
As long as you have not already had surgery, seeing a physical therapist first is a great idea.
A good physical therapist can tell from your movement assessment and health history whether to refer you to an orthopedic doctor or surgeon.
Surgery is not a quick fix. It is a long, drawn-out process of treatment, recovery, and rehabilitation.
It doesn’t deal with the root causes of your pain, only the location of the pain signal itself. So your problems are likely to return anyway.
And it is somewhat of a gamble- surgery has only around a 50% long-term pain-relieving success rate.
Besides, in most cases of musculoskeletal surgery, you will be referred for physical therapy afterward anyway.
Why not try PT first and see if you can avoid surgery altogether?
As a guide, try physical therapy for at least three months. If there is no improvement at all, then seek a surgical consultation.
I’m on pain medication so I don’t need to do physical therapy, right?
Medication is the first intervention in most MD practices. It’s quick to prescribe, relatively cheap, and usually gives immediate relief of symptoms.
But, medication can have harmful side effects when prescribed long-term.
They can lower your pain threshold
Medication aims to keep you in a constant state of physical numbness.
This means it can distort your regular pain threshold and make you less tolerant to levels of pain you could have dealt with more easily before.
You become less able to tolerate movements, positions, and activities that put any stress on the body.
If you don’t put any physical stress on your body, it will take you longer to recover.
You can become dependant
The internet is awash with “Big Pharma” conspiracy theorists. I am definitely not one of them, so don’t @ me. :)
But there’s no getting away from it: medication is a trillion-dollar industry.
Even if you are referred to a PT, chiropractor, or any other pain relief service, you’re likely to get medication alongside it (not least, because of its money-making potential).
But pain medication can be highly addictive. America has a huge problem with prescription opioid overuse and overdose. It is better for you, in the long run, to avoid taking pain medication for something that physical therapy can solve more quickly.
It doesn’t address the root causes
Pain medication is a band-aid. It is put in place to assist healing but completely conceals what’s going on underneath.
Plus, medication is only dealing with a symptom of the problem, not the problem itself.
Like I mentioned earlier, pain is a signal that something needs changing. Deal with the root cause, and you reduce or eliminate the pain.
But if you only focus on getting rid of the pain signals with medication, the root cause remains. The pain signals continue.
Numbing those signals with medication leaves you no idea whether anything else you’re doing to address the root causes is making it better or worse.
There are countless options available today claiming to help with musculoskeletal pain.
But physical therapy remains the undeniable, superior first choice.
Approaching online physical therapy as soon as you can saves you time, money, and gets you to peak health much faster than other routes.
Ready to find out more about what online physical therapy can do for you?
Schedule a 15-minute strategy session with our pain-relief team to explore your options.