From Running Director Heidi Caldwell.

Being injured is always difficult. Being injured during a pandemic introduces a whole new set of challenges, from how to stay sane and recover while working from home to how to stay safe while getting the medical treatment you need. Navigating these additional obstacles on the road to recovery has its downsides, but there are also some unforeseen benefits to tackling a recovery plan under these circumstances. One such perk: remote physical therapy.

Remote physical therapy, also referred to as “telehealth PT”, is exactly what it sounds like - having your physical therapy appointment virtually via zoom or some other video conferencing platform. At first it may sound odd, or near illogical - the whole point of physical therapy is to receive in-person assessment and hands-on treatment from a provider looking at your unique issue, right? Yes, but it turns out there is a lot that can be accomplished through the computer too. The effectiveness of remote PT does depend on the injury itself; certain issues require regular manual work or manipulation while others are more focused in strength and mobility exercise progressions. In my experience, a hybrid plan with both formats has proven to be ideal. 

As I began planning treatment for a recent shoulder injury, I felt strongly about working with a physical therapist I know and I trust. Treatment from a shoulder dislocation can be controversial, with some providers pushing for surgery and others preferring a more conservative, PT-first approach. In both approaches, it is a long slow recovery process, and I wasn’t willing to tack on weeks to my recovery spent finding a new local PT that I liked. So I reached out to my hometown PT who I have worked through various injuries with since college. His practice is a 90 minute drive from Craftsbury; not a sustainable commute for regular visits. But thanks to telehealth, the distance is not an obstacle to continued care. After seeing him in-person for the first few visits, we were able to transition seamlessly to weekly telehealth visits. Our plan is to continue with weekly telehealth appointments over the next three months, with one in-person visit each month to ensure my recovery is headed in the right direction. I’ve been pleasantly surprised by how much we can accomplish in these virtual appointments, and have been grateful to continue getting quality treatment during the pandemic.

I spoke with my physcal therapist Eric Ellingson, partner at the BE Fit Physical Therapy practice in the Upper Valley, about their transition to more telehealth appointments. Here he answers a few questions and offers great insight into how PTs are continuing to offer quality care remotely.

As a physical therapist leading telehealth appointments, what have you found to be the biggest pros/cons to this style of treatment?

Pros: Allows anyone to get PT anywhere, anytime. Great accessibility. Better continuity of care, being able to stay with the same PT even if you have to travel or be out of the area; you can still work with the same PT who knows your case. Also allows people to still access care and work on their pain or injury even if they are in isolation/quarantine. Some insurance plans have even waived copays or other patient costs for telehealth vs in person visits. 

Cons: You do miss out on the hands-on portion of physical therapy. We often consider PT to be three critical things: 1) education about the injury and how to handle it, 2) individualized exercise programs, and 3) hands on manual therapy where needed. Obviously, one of those three elements cannot be done via telemedicine. Technology should be smooth, but can also be a challenge at times (work issues, people who are not as tech savvy, etc). Evaluation is actually harder than treatment - we do sometimes depend on our hands for testing and assessment, but we are getting better at testing these things in other creative ways.  

What do you find people are most hesitant about when considering remote PT?

I think most people hesitate about telehealth because they think primarily of the hands on pet of PT, and underestimate the value of the educational and exercise portions (which you still get from telemedicine), particularly if they have not had PT before. A lot of people have also put PT off rather than doing telemedicine, thinking that the pandemic would not last this long. 

Is there anything that has been surprisingly great or even better about telehealth appointments?

It has been helpful sometimes to see people in their home environments, setting up and doing the exercises there with their specific modifications as needed, rather than in the clinic with our ideal setup.  Saves some people the travel to the office too, when that is a challenge like right after surgery, or needing a ride there.  

What role do you think telehealth will play in your practice post-pandemic? Will you continue to offer telehealth appointments?

We will definitely keep it available for patients who cannot travel to the clinic for other reasons like travel, surgery, etc. 

Any final thoughts to make a plug for remote PT?

For people who hesitate because they want the hands on part of PT… why wait to get pain relief? “Something is better than nothing” - there are some limitations to what can be done via telehealth, but it is better than struggling on your own! We can provide valuable advice about how to manage the injury, and get you going on an exercise program to address the underlying factors.  

There is much to be gained from remote PT. I heartily recommend you give it a try if you are struggling through an injury or dealing with some nagging aches and pains. To sum it all up: 

Pros:

• No travel needed. Save money (and the planet) on gas, and save time! 

• No risk of exposure. 

• PT sees you practice exercises in your at-home environment.

• Support your favorite PT practice!

• Low or no co-pay. Many insurance companies are waiving co-pay fees for telehealth appointments during the pandemic. Be sure to check with your insurance before making the appointment, but this seems to be the standard offer across insurance companies. 

Cons:

• Dealing with finicky technology.

• No manual therapy.

• Initial evaluation is difficult without hands-on tests. 

• Can be challenging to see the “full picture” of how the body is moving on screen. 

• Not a viable option for every injury.