Musculoskeletal (MSK) care still has a long way to go when it comes to keeping up with treatment recommendations. Treatment options are still way behind in what comes to what the CDC advises, for instance. Surgery and prolonged drug treatment are the go-to options to address chronic back and joint pain, and that’s partly due to the fact that conventional physical therapy cannot solve the problem.

MSK treatments: a quick recap

Musculoskeletal care is essentially being addressed in two ways: via surgery or through a more or less continued use of opioids and other pain medication.

The costs of surgery are, as it should be apparent, very high (both by economic and by quality of life standards). Of course they would be completely justifiable if these interventions had a high likelihood of success. Alas, this is not the case.

Back in 2007, the New England Journal of Medicine had already published a study that randomly assigned sciatica patients to either surgery or conservative treatment. A year after, the study found no difference in pain or perceived recovery for either treatment. As for spine surgery, the rate of failure is so high that there is even a syndrome named after it: Failed Back Surgery Syndrome (FBSS), which according to recent medical literature affects 20 to 40% of all patients submitted to back surgery. This being said, according to The Bone and Joint Initiative’s study “The Burden of Musculoskeletal Diseases in the United States”, roughly 12.000 procedures are still performed every year to treat musculoskeletal disease (MSD).

As for opioids, they just don't work.

Crooked: a harsh history of back pain

Crooked, the book where New York Times bestseller Cathryn Jakobson Ramin exposes the problem with the entire back treatment industry, painstakingly explains the never ending cycle of pain many musculoskeletal patients have to endure: “In 2004, Chris Livingston, (...) stood up after a couple of hours of pounding nails into a subfloor and heard a loud pop. (...) his primary care doctor sent him to a physical therapy clinic, one that was conveniently in-network with his health care plan. ‘I didn’t have to pay much for it (...) and that was important. (...) I was looking for convenience and price.’ After the facility’s head therapist did a quick evaluation, a young assistant took charge of his care. (...) ‘I’d say that I had pain and tingling down my leg’, Livingston said, ‘and she’d tell me to stop for the day.’

After several weeks of no progress, the head PT told Livingston that he’d used up his sessions, and should see a spine surgeon.

He followed this advice. After a couple of unsuccessful lumbar discectomies, the surgeon sent him to a pain management doctor. Under the influence of strong opioids, he couldn’t find the motivation to get back to work. ‘I let the business go, and the house, too,’ he said. ‘The pain was too great, and I couldn’t handle it, and to be honest, the drugs made me really not care.’”

Jakobson Ramin’s book is filled with gruesome stories about opioids, surgery and conventional physical therapy. But above all, Crooked is a book about a patient’s struggle with pain and the twisted path she underwent to find a solution for it. It’s a story we’ve heard many times but one very worth your reading. Or watch the webinar with Jakobson Ramin.

The problem with conventional physical therapy

Therapeutic exercise is, as we pointed out, the CDC’s recommended treatment to tackle musculoskeletal disorders.

The problem with traditional physical therapy, as we can see from Crooked ’s example, is first of all its cost: good physical therapists are costly, many are not in-network with health care plans, and even if they are, out-of-pocket expenses are prohibitive for the vast majority of Americans.

The second problem is how cumbersome physical therapy is: going to a clinic every day for weeks or months is not exactly doable for many patients.

And clinics have yet another problem: you are dependent on the attention of a very scarce resource: physical therapists. Not only that, a PT’s quality can range from the assistant that dealt with Mr. Livingston to the highly trained Doctor of Physical Therapy (DPT) who eventually helped Cathryn Jakobson Ramin (which, by the way, was not covered by insurance and cost around $125/session).

Why Sword just works

Let us quote Cathryn Jakobson Ramin again: “Everyone who goes to PT is assigned home exercises, but very few people do them. For an exercise to work, you not only have to do it but must do it correctly. For the patient left to his own devices, that’s unlikely. As the late Karel Lewit, who led the Prague School of Rehabilitation, was famous for saying: ‘The capacity of the patient to alter his prescribed exercises knows no bounds’.” This is the exact point we’re solving at Sword, along with the cumbersomeness of the entire back-and-forth to clinics.

To encourage participants to perform the exercises correctly, Sword's Digital Therapist evaluates the participant's motion with clinical precision and provides detailed feedback on how to perform better.

Alongside our human DPTs, who assess, orient, and prescribe sessions to every participant and are available whenever they need them, we have created a digital physical therapy solution that solves everything that is wrong with conventional physical therapy. And because contrary to what happens at a clinic, our DPTs are not overbooked with hour-long sessions, we can provide more cost-effectively and better care, reducing the number of surgeries by up to 50%, medication intake by 33%, and pain by 74% (in only 8 weeks) But perhaps the most prominent feature about Sword is something a participant of ours once pointed out: “The best thing about Sword is the ability to perform physical therapy in our pajamas.”