I’ve seen the future: the world cup tournament is being played on the moon, and Sepp Blatter has had himself cryogenically frozen until his reputation for corruption blows over and he can return as head of FIFA.
No, of course that’s nonsense. But I have recently come across something that I really do believe will become a part of the future. Something that I think may change the way many of us manage injuries.
I give you two words: online physiotherapy.
If you’re anything like me and you’ve got your trusty skeptics hat on, you’ll be seriously suspicious about how that might work. Luckily, I’ve already given it a try using JimJam, one of the new wave of online physiotherapists.
And without giving the game away, I think it’s rather good!
I booked an appointment* with Paul Bryce, Clinical Director for online physio service JimJam, to check out exactly what it involves.
Using an online physiotherapy system – the practicalities
Using their own website, you’ll book an appointment with JimJam, fill in a few details about yourself as well as the injury you’re suffering with, then you make payment and you’re ready for your first appointment. It’s all very straightforward, and I found the process very easy to follow.
Appointment availability is also pretty good at the moment, you can get seen fairly quickly (something that can’t always be said of my local physio).
When your appointment is due, you should log in a little early in order to make sure that your video technology works. You can attend your appointment in the comfort of your own home or office using your computer, tablet or smartphone – as long as it has video and microphone. No need to go to any special efforts for it, but probably best that you’ve changed out of your SpongeBob pajamas.
The initial consultation lasts around 20 minutes, and it’s all recorded, for your reference. In fact, I conducted my whole interview with Paul over the video link too.
How does an online physiotherapy appointment work?
Essentially it works the same as any normal physio appointment would. It starts by the Physio, in my case Paul, introducing himself and asking me a couple of data protection questions to establish who I am and my relevant contact details.
Then the fun begins. You get to start telling the physio about your injury, and the problems you’re experiencing. In the words of Paul: “You would tell me when you first felt it. Was it a specific injury, say when you were reaching for something and hear a pop, or is it something that flares up with playing and settles down with rest? What eases it? We try to identify particular patterns, how it behaves throughout the day. Is it there all the time?”
Don’t worry, the physio guides you all through this. By asking these sort of questions and exploring the behavior of your symptoms, what aggravates or eases them, it starts to provide the physio with an indication of the nature of your problem.
Obviously you’re going to want to make yourself seem like a hero when you’re describing your symptoms, but don’t overdo it on the stories – there’s a time limit on the appointment.
Practical tests – part of the online physiotherapy toolkit
After some initial chat, you might be asked to do a few tests to further explore the issue. “For example, in the case of an Achilles injury, I might ask you to stand up and do a heel raise and see if you can tolerate that,” says Paul. “And if you can tolerate that I might just ask you to do it on one leg, and then do it on one with a bent knee. We are selectively stressing different structures, which will describe your symptoms and allow us to respond to that.”
With all of that done, the physio will arrive at a working diagnosis. They’ll explain it to you and tell you what you can expect, including how long that might keep you off the football field.
Treatment and rehabilitation – how you can see which exercises you need to do (and how to do them)?
Once you’ve understood the issue, attention will turn to discussing how it can best be managed, and what can be done for rehabilitation.
When it comes to giving you exercises to work on, you’re obviously not in the same room as the physio, so they probably won’t watch you doing the exercises they give you. Instead, that’s taken care by sending you a personalised exercise plan after the call: “the rehabilitation advice that we send to people is in a package that is in an online video where you see the person doing the exercise correctly. It has a voiceover that tells you what they’re doing and why they’re doing it,” says Paul.
If more follow-up appointments are needed, you’ll be advised of this and they can be booked. Otherwise, like with any physio, the rest is up to you. You’re in charge of getting the exercises done and managing your own road to recovery.
Is Online Physiotherapy Safe?
Firstly, it’s worth pointing out that if you’re using a legitimate online physiotherapy service like JimJam, you’ll only be seeing trained, qualified clinical professionals. Self-certified witch-doctor types are exclusively for other, shadier, corners of the internet.
In the case of the physio that saw me, Paul has sixteen years of clinical experience under his belt as well as experience working in professional sport. He knows what he’s talking about, as should the other JimJam physios who all work in real clinics across the UK.
You’re talking to professional people who are trained to diagnose your case and also look for what they call ‘red flags’. For instance, they’ll always ask about history of cancer or tumors, or whether there is any acute bleeding, for example.
Such complications are quite rare, but nevertheless, if they’re identified by your online physio you’ll be advised to go and see the relevant people, such as your GP, or the hospital.
If the physio can’t deal with your case, or there are complications spotted, they’ll refer you on to others.
The point is, an online physio has the same duty of care as any other and has no interest in jeopardising your health. If they identify that they can’t adequately manage your problem, or other professionals should become involved, they will refer you on and can liaise with those healthcare professionals.
Can online physio really be effective? Don’t you need to be hands-on?
For me, the big question mark that I had with all of this is whether the whole premise of online physiotherapy actually makes any sense. I had the idea that it was more of a hands-on discipline.
Sure, you can establish a clinical relationship with your physio just as well over a video call as you can in person. But I’ve been to physio appointments in the past and I recall that they’ve been hands-on in both the diagnosis and the treatment of my problems. No online physio can do that.
What Paul is keen to point out, however, is that actually the merits of having ‘hands on’ treatment tend to get overplayed. According to him “manual therapy [such as sports massage] might help you feel nice in the short term, but there is limited evidence it helps with recovery.”
In fact, Paul explains that the National Institute for Clinical Excellence (“NICE”) have just released their guidelines for management of lower back pain, which is by far the most common musculoskeletal problem there is, and as he puts it “at front and center of the management is active rehabilitation. Manual therapy is there as an adjunct, at best, to active rehabilitation.”
Active rehabilitation basically means doing exercises to strengthen and align the affected area. Rather than just lying on a treatment table, which is more like manual therapy.
By its very nature, online physiotherapy can’t provide manual therapy, like sports massage. Perhaps, however, that forces it to be more efficient – to cut out the temporary relief and focus instead on the activities you can do to aid your recovery.
As Paul puts it: “Our system will never be the same as being in the same room as a clinician, but it’s certainly more convenient, and more cost effective. We can do a lot of the same stuff and actually, we remove the ‘passive treatment’, which can be detrimental to recovery. This removes the thought that ‘we are fixing you’ and instead helps the patient see that actually it’s you who needs to fix yourself, and that you’re in control of what happens to you.”
For a lot of people, their image of physiotherapy is more hands-on, like this.
How much does online physiotherapy cost (and is it worth it)?
One of the biggest benefits to online physiotherapy is clearly the convenience. You’re not travelling far out of your way, missing work to attend physio appointments. JimJam fits round your schedule.
But there’s a second BIG draw here, and that’s the cost. It’s currently only £19.99 for an initial appointment of between 20-30 minutes. Follow-up appointments are priced similarly.
In my book £19.99 for a physio appointment is a screaming bargain. There’s no physio in this country (UK) who would see you in person for that price. In fact, if you want a 30-minute appointment in person then you’re looking at £40 at the very least, possibly paying well over £100 if you’re trying to see a physio in London, where I’m based.
With an online service you’re getting all the same access to the knowledge and experience of a physio, but at a much reduced cost.
As Paul says, “the cost effectiveness along with the convenience makes it an absolute no-brainer. In addition, it doesn’t have problems with waiting lists, which in some areas can be from 10-12 weeks.”
When should I go and see a physio instead of a doctor? And when should I just let things heal without seeing either?
We’ve already covered this in a previous article: should I see a physio, but I was interested to get Paul’s take on it too.
According to him “it depends how it is affecting you functionally. If you’ve got an ankle problem, for example, and after the game you are thinking that’s a little bit sore but I can walk, there’s no swelling, no bruising, I can function I can get my shoes on I can drive my car. this is maybe something you might be thinking ‘I might just try and manage this myself’.
“If it is affecting you functionally and it is a musculoskeletal problem I would see a physiotherapist before I would see a GP. GP’s are general Practitioners as the name says. Musculoskeletal physiotherapy is a small area of physiotherapy, never mind medicine as a whole.”
“The sooner that you do the correct things for those sort of Injuries the better. As we’ve already said it’s not about what’s done to you it’s about what you do to help yourself. You want to ensure that you are doing the absolutely correct things, not only to progress your rehabilitation to get you back on the pitch or whatever it may be, but to also make sure that you’re not making things worse.”
If you’ve got an injury, you want to make sure that you’re doing the right things for it to heal – a physio can advise you on this.
The overall verdict – hit or miss?
I’ll be honest, I was extremely skeptical on hearing about online physiotherapy. But I’ve been forced to reassess my views.
For me, it’s about whether it’s worth the money, and in my book it’s a yes. If you’re short on time, or money, or particularly if you’re short on both of those, then this is a compelling alternative that you should look at.
Ultimately, would I be prepared to pay the £19.99 fee out of my own money for this service? Yes, yes I would. Where I am based, a physio appointment would easily cost three times the price JimJam are charging, and then I’d also have the inconvenience of having to go out of my way to visit the physio practice. Don’t get me wrong, I’m not saying those sorts of physios don’t have a place, but for the cost and convenience, I’m certainly willing to give this online model some more goes.
I’m on board with this new model, but I’d be really interested to know what you think. Do you think that you’d want to see an online physio, or is it still the in-person appointment you’d favor. Have you used online physiotherapy, what was your experience? Let’s get some chat going below.
*Note that in order to provide a review of the JimJam system, 5-a-side.com was provided with a free consultation (although to be quite honest, we weren’t really suffering badly with an injury at that point). However, the article is intended to be a true and honest assessment of the service JimJam offers, and other online physios are also available. None of the above article is intended to constitute medical advice – please seek the professional view of your own doctor or physiotherapist. Finally, 5-a-side.com does not have any ongoing relationship or receive any fees from JimJam.