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Virtual PT: What works and what doesn’t?

COVID-19 has sped up a trend that’s been coming for quite some time – people and clinicians are getting more comfortable with telehealth, which is good news for employers and plans looking to reduce costs without compromising on outcomes.

 

When I tell people that I work for a digital musculoskeletal (MSK) therapy provider, I’m met with a combination of curiosity and skepticism, especially from my clinician friends. The most common response is something along the lines of “that sounds cool, but virtual PT can’t possibly work as well as in-person PT.”

 

I’m proud to tell them it does. In fact, SWORD’s solution has been clinically-proven to outperform gold standard PT programs (three one-hour in person sessions per week) by 30%. Plus, with SWORD, members report 70% less pain, and are 64% less likely to consider surgery and 36% less likely to take medication.

 

But not all virtual MSK solutions will work as well.

 

There are three main pillars that have to be met in order to deliver high quality MSK care virtually:

  • Programs must be tailored to the member’s needs and adequately supervised;
  • Results only happen if the members actually do their exercises, and do them correctly;
  • Education and behavioural coaching are essential to achieving lasting changes.

Here are three questions to ask if you’re considering a digital MSK solution:

Is the program designed and supervised by a licensed PT?

It might sound obvious, but virtual MSK programs need a real physical therapist managing care in order to get the best results.

 

We have years of clinical training in diagnosing and treating musculoskeletal conditions. We understand underlying patterns to diagnose referred pain or other conditions as early as possible, and we monitor every patient’s progress to make sure they’re getting the best treatment possible.

 

At SWORD, members only ever interact with a physical therapist who is there every step of the way, from diagnosis to recovery.

Does the member and the PT both get feedback on performance and progress?

Feedback on how the body is moving is critical for effective PT.

 

We can’t do our jobs properly unless we understand exactly how someone is moving and their subjective experience of the session (Was it painful? Was it difficult? How are they feeling?).

 

In the clinic, the PT is able to see how their patient’s body is moving with their own eyes. We’re trained to identify movement patterns that are causing issues or indicative of problems and adjust our patient’s form accordingly.

 

When they go home from the clinic, patients often leave with instructions on a piece of paper. Those paper instructions may not even make it out of a purse, and even when they are followed, we have no idea if the person is performing exercises correctly. This means the recovery process can be slow.

 

At SWORD, we use wearable inertial motion sensors that are even more precise than the human eye. They give the member real-time feedback on how they’re doing. If a member performs an exercise incorrectly, our Digital Therapist will correct their form. This feedback not only helps members learn new movement patterns, but it also helps them stay accountable and stick with their program.

 

These sensors also give the PT live feedback on exactly how a member is performing every stretch and bend, and we use that feedback to evolve their program and catch any red flags that come up through the course of their treatment.

 

Since joining SWORD, I’ve been amazed at how much information I’m getting about how my members are performing. I can progress their programs with more certainty, and have seen members start feeling better quickly.

 

There are many solutions out there that use video to guide people through exercise programs. While they may be good for helping people see how to do an exercise, they don’t tell you if you are doing them correctly, and the clinician on the other end is flying blind. Just like that piece of paper from the clinic, they aren’t going to get you the results you need, especially for serious chronic or post-surgical issues.

Does the program combine education and coaching?

I became a PT after I experienced the benefits of great physical therapy first-hand.

 

I had just injured my knee running the Chicago Marathon. I love to run, and this injury was devastating. My PT helped me get back on track – not just by prescribing me an exercise program, but by helping me understand why I got injured in the first place, giving me the tools to prevent it in the future, and making me believe that I had it in me to make a full recovery.

 

I’m grateful to this day for her guidance and support – and she has inspired me to become the PT I am today.

 

Great physical therapy is more than just an exercise program – because pain is complex and healing involves both body and mind.

 

Physical therapists are trained to incorporate pain education into their treatments, helping patients understand that hurt does not equal harm, their bodies are strong and adaptable, and that they do not need fixing – they are the most important factor in their own rehabilitation.

 

The words we use to empower our patients are critical. Discussing pain from a less-trained perspective can result in increased fear, decreased belief in one’s ability to heal, and avoidance of activities – all of which can contribute to the persistence and aggravation of pain.

 

At SWORD, our PTs develop coaching programs that incorporate education as well as motivational techniques. These programs are specific to each member and are adjusted as they progress along their journey, so they don’t just get better, they stay better.

 

Want to learn more about SWORD? Fill out this form and someone will get in touch.


About the author: Megan Hill, PT, DPT

Megan Hill, Doctor of Physical Therapy, is a licensed physical therapist focused on musculoskeletal rehab and chronic pain management. She dropped her plans to go to law school for physical therapy after a knee injury from the Chicago Marathon left her in need of rehab, and she hasn’t looked back since. She’s on a mission to empower people to manage their health through exercise, education and coaching, rather than relying on passive approaches.

 

Megan earned a Doctor of Physical Therapy degree from the University of Illinois at Chicago (UIC). She also holds a Bachelor of Arts degree in psychology from Duke University and is a certified running coach.

 

Megan lives in Denver, Colorado, where she spends every spare second running, biking, hiking, sailing and stand up paddleboarding with her husband, Layton, and dog, Ollie.

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Ask a PT

Ask a PT: Why do I feel pain in my shoulder if it’s coming from my neck?

Have you ever felt pain in one area of the body, only to be told by a clinician that the real source of pain is somewhere else?

 

You’re not alone – this is quite common.

 

In fact, 12% of SWORD members end up getting a program for a different area of the body than the one they feel the pain in. It’s called ‘referred pain’ and it’s one of many things that physical therapists are trained to look out for.

Your brain on pain

Here’s why it happens: pain is complex and involves both the body and the mind.

 

Our body is like a giant antenna, capturing signals that travel to our brain. All the pain happens in our brain: the brain controls where and how much it hurts. So, pain is an experience that can be influenced by multiple factors.

Imagine stubbing your toe at the same moment as finding out that you won the lottery. It’s highly unlikely you’d feel the pain in your toe, as your brain would have more important things to focus on.

 

When you feel referred pain, it’s caused by signals from different parts of your body converging in the same place in your brain. You might have knee pain that’s actually caused by hip arthritis, or shoulder pain that’s actually stemming from an irritated nerve in your neck.

The danger of treating the symptom and not the cause

When you treat the area that the pain is referring to, rather than the true source, the best possible scenario is that nothing will happen – the pain simply won’t go away. Worst case, the original condition could get worse and you could end up considering medication, injections or surgery.

 

In about 1% of cases, pain isn’t caused by a musculoskeletal issue at all.

 

A wide range of disorders can manifest as physical pain – from anxiety, to neurological conditions, and even cancer. If this is misdiagnosed, someone may run an entire course of treatment for their pain without clinical supervision, only to find that they have a condition requiring a different kind of treatment altogether.

How physical therapists prevent misdiagnosis

Physical therapists like me are trained to find the real source of pain – a process that requires years of clinical training. We understand underlying patterns to detect referred pain or other conditions as early as possible, and can recommend you see a clinician if we think something else may be at play.

 

At SWORD Health, we’re proud that our members only ever interact clinically with a licensed Doctor of Physical Therapy.

 

In addition to making sure we’re treating the right condition, we continuously monitor how you’re performing, adjust your prescription as you progress, and motivate you every step of the way, ensuring you don’t just get better, you stay better.

 

Want to learn more about SWORD? Fill out this form and someone will get in touch.


About the author: Megan Hill, PT, DPT

Megan Hill, Doctor of Physical Therapy, is a licensed physical therapist focused on musculoskeletal rehab and chronic pain management. She dropped her plans to go to law school for physical therapy after a knee injury from the Chicago Marathon left her in need of rehab, and she hasn’t looked back since. She’s on a mission to empower people to manage their health through exercise, education and coaching, rather than relying on passive approaches.

 

Megan earned a Doctor of Physical Therapy degree from the University of Illinois at Chicago (UIC). She also holds a Bachelor of Arts degree in psychology from Duke University and is a certified running coach.

 

Megan lives in Denver, Colorado, where she spends every spare second running, biking, hiking, sailing and stand up paddleboarding with her husband, Layton, and dog, Ollie.