• Jason Oswell

Why Online Physio will be the new normal for many



Let me first clarify that I am not advocating online physio only by any means. Throughout my footy career, face- to-face consultation has always been the normal and I will definitely still be seeing patients in person. However, the point I will make, is that due to the current lockdown, we were almost forced into online physiotherapy and for many, it’s here to stay.

Physio is changing beliefs

Within the physiotherapy world there is a great emphasis for providing ‘evidence-based practice’. Now more than ever, with the NHS experiencing huge waiting lists, it is essential to stick to what is actually proven, rather than make it up as we go. This may sound obvious, but you would be surprised. Have you ever had ultrasound treatment on an ankle sprain? It has been the ‘go to’ for years, but has no evidence to say it improves healing time (1). How’s about massage for a muscle strain? Or using ice to reduce inflammation? There is very little evidence to suggest that these conventional forms of physiotherapy even work (2). Don’t get me wrong, the power of psychology is huge and if somebody has used these strategies all their life then continuing will do no harm. The short-term relief that massage gives and the additional 1% it may give a player before a sporting event may definitely be worthwhile in some cases. Ice can have a pain numbing effect to help you through a few hours of the day. But if you have an injury and you want to accelerate your healing and you want to reduce the chance of re-injury, then none of these are essential.

So, what do physios actually do if they don’t give massages? Good question. Before training to be a physio I tended to think physiotherapy was all about the hands-on therapy and electrotherapy. Ice was always my first instinct following an injury. Exercises and rehab were always an after- thought. However, exercise rehabilitation, alongside guidance and support, is physiotherapy. Targeted exercise not only helps rehabilitate an injury back to normal/ better function, but it can also help prevent the injury in the first place (3)(4). Physios are in a great position to help you understand what is going on with your body, what to expect during the recovery process and how best to maximise recovery.

How can you even assess me though? The majority of information gathered to diagnose your injury comes through the ‘subjective’ assessment, whereby the physio will put the diagnosis puzzle together by asking you questions about your injury. Hands on special tests during assessment often lack clarity in clinic in general (5), and physios are more and more looking at functional movements that elicit pain or show weaknesses rather than trying to twist your arm into a position to bring on your pain. Assessment over video call can be reliable when compared to face-to-face contact, with the exception of a few techniques such as orthopaedic tests (6). In reality physios should know if something serious has happened and they can send you for further investigation if necessary. So, if we can assess an injury over online video call and we can support, guide and provide structured exercise rehabilitation, could online physio be the way people choose to have physio?

But Online Physio? Really? Let’s face it, online physiotherapy will not be for everybody. Many enjoy the familiarity and connection they have going into their local practice. Some will want that additional hands on therapy that they may feel gives them an added edge going into their rehabilitation. But if you can get the same results from the comfort of your own living room, then it may be more appealing to many. Often patients walk into a physio clinic a little apprehensive about what ‘pain’ they might be put through, whether it be an elbow in the back or a twisting of the knee. Having physio from your own home reduces those anxieties. Another benefit about online is that both parties know what to expect. ‘The physio just gave me an exercise sheet’ is a phrase that many will have heard when coming out of a clinic. Well in all fairness exercise maybe the correct recipe, but a standardized sheet doesn’t cut it. With online physiotherapy, you should expect specific, tailored rehabilitation for your individual needs. Finally, online physiotherapy has the capacity to give you more support and guidance than conventional physio. The world is more connected and instead of ‘see you in 3 weeks’, you can be led through your rehab via social media and email. Like I said, it may not be for everybody. But for those who want to save time, be in the comfort of their own home/gym and are prepared to commit to exercise rehabilitation with dedicated support, it maybe for you.

References:

  1. Van Den Bekerom MPJ, Van Der Windt DAWM, Ter Riet G, Van Der Heijden GJ, Bouter LM. Therapeutic ultrasound for acute ankle sprains. Eur J Phys Rehabil Med. 2012. doi:10.1002/14651858.cd001250.pub2

  2. Tiidus PM. Alternative treatments for muscle injury: massage, cryotherapy, and hyperbaric oxygen. Curr Rev Musculoskelet Med. 2015. doi:10.1007/s12178-015-9261-3

  3. Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. J Sport Heal Sci. 2017. doi:10.1016/j.jshs.2017.04.001

  4. Ribeiro-Alvares JB, Marques VB, Vaz MA, Baroni BM. Four weeks of nordic hamstring exercise reduce muscle injury risk factors in young adults. J Strength Cond Res. 2018. doi:10.1519/JSC.0000000000001975

  5. Apeldoorn AT, Den Arend MC, Schuitemaker R, et al. Interrater agreement and reliability of clinical tests for assessment of patients with shoulder pain in primary care. Physiother Theory Pract. 2019. doi:10.1080/09593985.2019.1587801

  6. Mani S, Sharma S, Omar B, Paungmali A, Joseph L. Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review. J Telemed Telecare. 2017. doi:10.1177/1357633X16642369



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jason@sportsphysiotherapyonline.co.uk

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