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When and how is telemedicine appropriate for physical therapy sessions?

From March 2020 to the current day, I've learned when and how telemedicine can work with the physical therapy profession with respect to treating patients. At first, I was skeptical. I mean, hands-on care is so integral to what I do everyday for my patients. How could I possibly do that virtually?

The truth is: I cannot. So, while I do believe telemedicine is appropriate for physical therapy sessions, I also believe at some point in your care the provider should get their hands on you. It helps with assessment, treatment, and appropriate movement mechanics.

So, when is telemedicine appropriate for physical therapy? In my opinion, there's three answers to that. Immediately after injury, assessing workspace environment and exercise progression.

Immediately after injury

Speaking to a physical therapist right after you roll your ankle, throw your back out, twist your knee, pull your shoulder or whatever is so helpful to know what first steps you can take to speed up your recovery. This point actually comes from a recent experience. I was playing tennis and I felt something pull in my back and then I also pulled my calf. Now, I was very sore the next day but I was able to do all the appropriate and correct things to make sure my injuries didn't get worse and to make sure I healed quickly. Within 2 days, I would've never remembered that I pulled them in the first place. I thought to myself, "This happens all the time to my patients." This always leads to my next thought or comment, "I wish I could have talked to you RIGHT AWAY so I could have helped!" Frequently, physical therapists will be able to ask enough questions about your mechanism of injury and current symptoms to give you advice on positions to be in, light exercises to help, icing, heat, etc that will help speed your recovery and reduce worsening the injury. I am always wishing I could see patients in the first 24 hours of their injury, but the schedule doesn't always allow for that. The likelihood of us getting to do a last minute telemedicine visit within 24 hours of your injury is very very high.

Assessing workspace environment

I cannot believe some of the workspace setups I see in people's homes when we do telemedicine. It is so nice to have the patient be able to set up the phone in such a way that I can see how they are sitting at their desk and evaluate if their screen is too high, too low, too much left, too much right, or if their mouse is too far away or their keyboard is too low. I can tell if their feet are on the ground or if they are sloping backwards in their chair. Now that work remotely and work from home is more acceptable - having a physical therapist assess your ergonomics can be hugely beneficial in reducing strain and injury.

Exercise progression

I like to do exercise progression both in-person and virtually. Virtually is nice because I can see the space that you are utilizing and often see furniture and set up differently than you are. Physical therapists can be VERY crafty with household supplies. For example, a patient of mine needed to do hamstring work and didn't have a ball that I would have liked so instead we used their rolling office chair! Another patient needed to find a place to mount a band in their workout space and we were able to concoct a system with their pool table. That same patient needed a "wand" and we were able to use their pool sticks. I do also love in-person progression so I can give hands on feedback, but in moments where we cannot do in-person sessions, virtual exercise progression is 100% appropriate.

Overall, I think that number 1, immediately after injury, is the MOST BENEFICIAL telemedicine visit. If the population knew that they could have access to a musculoskeletal and movement expert within 24 hours after a musculoskeletal injury, their recoveries would be so much smoother and so much faster. So, next time you think you've pulled something or twisted something or heard a pop, don't wait until you "can get in." CALL PHYSICAL THERAPY and see if you can get a telemedicine visit within 24 hours!!! I promise it'll be worth it!

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