How can a PT treat via telehealth?

Importance of a proper diagnosis

How can you even treat me via telehealth? This is becoming the age old question as I continue to race down the path of telehealth treatments. Some patients have been forced into telehealth because businesses are shut down, and others are just self-opting into it. Word of mouth from people across the country travels fast. Once you hear a solid recommendation from your friend, family member, coach, or physician you can’t help but reach out. You run through all the skeptical thoughts before hand and think this is worthless, but yet the call happens anyways. There is something that intrigues you to believe in the recommendation you received because you are so close to that person you can’t help but trust them. But still, how can it be?

Can you find the right fit?

Telemedicine is becoming a large entity in the medical field now that COVID hit. But what people don’t know is that telemedicine has been around for years! Yes, it can be skeptical. Yes, it can fail like many other treatments. However, it can also pass with flying colors. Think of it this way. Have you ever been treated for an injury in the past? By a physical therapist,chiropractor, MD? Like anything in life, there are always going to be great practitioners and horrible practitioners. This is were patient advocacy comes in to play. Regardless of knowing the right questions to ask, you should know as an individual whether or not your practitioner is a good fit for you. Do they listen? Are they asking you the right questions? And most of all, are you seeing changes and getting BETTER?! If the answer is no to any of these questions then maybe you need to move on and find a new practitioner. The “old”way of treating patients has passed by years ago. The days doctors used to make house calls seems archaic at this point.

What are your goals? Are you communicating with your PT to meet your goals?

Medicine as we know it is a quick 10 or so minutes with someone and then a hodgepodge treatment begins. Did those 10 minutes give that person enough time to listen to you to find out the cause of your issue? Or are they trying to treat your symptoms instead of the cause? BINGO! Symptom treatment is one of the most common errors made from any practitioner. It involves treating the site of pain directly whether with medication, strengthening exercises, etc. Most of the time this method fails miserably, involving a multitude of visits, hundreds of dollars wasted on co-payments, time lost not being able to enjoy the activity that got you injured in the first place, and did I mention FRUSTRATION??? After months of visits and what feels like hundreds of exercises later, you are at best slightly better.There could be nothing more wrong with this picture. Yet, I continue to see iton a daily basis. People ask me why I am different, or why I think I can get them better in a handful of visits when someone else couldn’t. My answer is, “Itake the time to listen to you. I figure out the proper diagnosis which involves finding the cause of your issue. The cause is usually no where near the pain site, and sometimes not even on the same extremity of the pain. I take a full hour to figure out the diagnosis, and then start treatment to work on pain management as well as mobility and flexibility of the structures we are working on.” With traditional physical therapy most clinics have 30 minute visits and at best 60 minute evaluations. This structured environment is still very fast paced for the clinicians where they are forced to diagnose, answer questions, write their note for the insurance company, and then get you started on a program. By the time they get part of their assessment written down half of that 30 min is already over. With added questions your time is up. The stress of forcing everything on to paper strains a PT into focusing on the insurance guidelines versus paying attention to what you are saying. This delays a proper diagnosis and eventual delays your healing. On average most clinics take 10 visits or more to treat a patient that comes into the office. If surgery is involved this can take many more visits and months upon end. With a solid foundation, proper understanding of what is required of you as a patient in and out of the clinic, this timeline can be drastically reduced to an average of 3 visits. With telehealth the requirements are the same. People ask if the lack of hands on work effects their healing time. With a PT that is listening and progressing you forward appropriately they will educate you on how to properly utilize equipment at home like a foam roller or broomstick to manipulate your joints. They will also show you how to self-massage areas in need of flexibility. Understanding and knowing why you are doing certain movements and exercises will help you to perform them consistently to see changes occur. Not understanding why a certain exercise is being used will cause poor body mechanics and technique leading to you performing the exercise slightly wrong, which in turn is not allowing you to make positive gains. Even the slightest change in body position can change what the exercise is doing and make it worthless. Telehealth allows the PT to watch everything you are doing to make small adaptive changes to make your treatment worth your time. Physical therapy is making its way back to the old way of practice and patient-centric appointments with house calls!

Understanding the tools to help fix yourself is an important concept
Follow through on your home program is cruicial to seeing improvements and meeting your goals

Understanding why and how your body works the way it does is critical for you to progress through an individualized program for healing. Telehealth can allow you to do this in the comfort of your own home. Remember, it is not about being in person for us to touch or feel different areas. It is about your ability to describe your limitations and symptoms to a well-educated physical therapist. If done well, your therapist will be able to correctly diagnose you and prescribe a home program individualized to you. Changes should be seen within a 24 hour period, with lasting changes after a week. The plan of care with exercises should be changed every 1-2 weeks based on symptom management, in order to progress you further along. Treatment sessions typically do not need to be more than 1x week, with email check ins as needed to answer questions. 1x week visits allow you to be more independent in your care, it holds you responsible for completing your home program without having someone repeat the same exercises and sessions time after time. Follow up visits should only be utilized for a progression of treatment, and a review of the previous program only if there are questions. There should be no need to watch the same exercises at the next visit as you should have progressed with them during the week prior. This type of progression should allow for an average of 3 visits before being pain free with discharge and a self management program to prevent injury in the future. There are always outliers with more chronic issues taking longer to heal. Stop wasting money and time on multiple visits a week for months on end. Find a PT that will listen and show you the tools to get you back on track.

Don't let a mole hill become a mountain.
Why wait to be pain free?

Take a look at one of Dr. Kim’s patients from Pennsylvania who started out skeptical via telemedicine and ended up pain free after just 3 visits.