Feeble to Fit Part 2: Tips on physical therapy over video

A computer on a video call, a foam roller, an exercise band, and a kettlebell. All on a yoga mat.
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Editor’s note: This is Part 2 of a series about my experience with physical therapy to fix chronic knee pain and problematic shoulders

 

Introduction

Except for two in-person sessions, all my physical therapy for my knee and shoulders has been over video chat. This worked surprisingly well, but it did require me and my physical therapist, Lev, to find creative ways of doing what’s normally a hands-on activity.

I this post, I share the tips we figured out along the way to make our sessions more productive.

The value of a hands-on assessment

All physical therapy programs begin with an assessment session.

The purpose of an assessment session is so the physical therapist can understand you and the issue that brought you to them. Then they create a plan for how they can help you get better.

During an assessment, a physical therapist will guide you through various motions, exercises and stretches. They will ask you questions about your past activity levels, any pain you feel, the (possible) cause of the issue, and what your goals are for physical therapy. They will put their hands on you as you do certain movements so they can feel how your muscles, joints, ligaments, tendons and other body parts are moving.

Assessments are difficult to do over video.

For one, the physical therapist is limited to just one sense, sight, and what you’re able to tell them. On top of that, they’re viewing you on a small screen in 2D instead of life-sized in 3D.

For another, both you and the physical therapist have to be excellent communicators. This is hard for the physical therapist because they have to spell out every little thing they need you to do. They can’t move your leg for you; they have to tell you exactly how they need you to move your leg.

It’s further complicated because you, as the patient, aren’t usually experienced with talking about discomfort in precise detail. If all you can say is that your knee hurts, that doesn’t give the physical therapist much to go on. You need to be specific, for example by saying “When I’m midway through a squat, the outside part of my left knee feels a sharp pain that goes away when I reach the bottom of the squat”.

Despite the inherent challenges, Lev and I had no option but to do the assessment session over video. I live in California and he lives on Long Island.

The assessment session went well-enough and I began seeing immediate improvement in my knee pain in subsequent sessions. However, I was grateful that two months later I was able to take a detour to see Lev while visiting family on the east coast. He used half of our first in-person session to redo the assessment, which dramatically improved his understanding of my knee pain. After that, we made even faster progress.

If you can do an in-person assessment session – even if it’s after you’ve begun working with a physical therapist – that will help all aspects of your recovery.

What I learned about making video PT sessions more effective

Some things are basic and obvious, others more subtle. Some things apply to just video PT sessions and others to in-person sessions as well.

Take notes between sessions

It’s tough to remember how you felt five days ago. It’s tougher to succinctly describe how you felt each day for the past week. When did you feel discomfort? Were there any issues doing the prescribed exercises? Did you have to skip any exercise sessions?

Take notes and bring them to the video PT session. It doesn’t have to be fancy – I just use a post-it note that I scribble notes on through the week. When Lev and I begin a session I have all the information he needs to know about how it’s been going since the last time.

Prepare your space ahead of time

When you go to a physical therapist in person, they have everything set up already. When you’re at home, you need to get whatever you need prepared ahead of time so you don’t waste time on the call.

Maybe you need to move a piece of furniture so you have space to move. Or maybe you need to get a yoga mat out, or get weights out of the closet.

You definitely need to get your computer/tablet/phone set up for the video call. If you normally do video calls, you know what to do. If not, this means opening the video chat app, finding the link to the call, making sure your device has enough battery, getting headphones if you’re going to use them.

You also need to make sure your device is at the right height for the sorts of exercises you’ll need to do during the call. Will you be standing most of the time? In a chair? On the ground? Make sure the camera can show your entire body in whatever positions you need to get into for the PT session.

Physical therapists should provide a simple checklist to patients before they have their first call. How much space do they need? Will you need to see their entire body at one time or just part of it? Will they need a chair, countertop, or other household items? Many things can be improvised during the call, but getting enough space or having a piece of furniture available wastes a lot of otherwise useful time.

Make sure you can quickly join the call

Figure out what app your physical therapist will use for the video call and, if possible, download that ahead of time and make sure it works on your computer/tablet/phone. If you don’t usually do video calls, call a friend or family member using that app as a test.

Make sure you know how to access the video call link. If it’s buried in your email, you’ll waste precious time looking for how to dial in when you could be working with your physical therapist.

Maximize video quality

The pandemic taught everyone how to improve the quality of their video calls. More light is the biggest improvement you can easily make – put the light behind the camera focused on you. Make sure not to have lights behind you that are pointed at the camera.

There are some PT-specific tips though, too:

  • To improve the physical therapist’s ability to see your movements, wear clothes that are contrasting colors. For example, if you wear black leggings, wear a light-colored shirt. The same goes for physical therapists who want to demonstrate movements to their patients.
  • If you have a dark floor – which many gyms and physical therapy offices do – try to avoid black clothes if you need to go on video. Again, this is about improving contrast so the physical therapist can more easily see detail in your movements.
  • It’s best if you can move your computer/tablet/phone during the call to change angles. A laptop is pretty easy since it doesn’t need a stand and the lid makes it easy to change angles.

Agree on a common pain scale

A common reason people go to physical therapy is to reduce chronic pain or heal from an acute injury.

It’s vital that you and your physical therapist are speaking the same language when it comes to pain. With Lev, I’ve used a common-sense variation on the PEG Pain Screening Tool.

Pain scales can be tricky because most people don’t have experience distinguishing between degrees of discomfort. What is a 6 vs. a 3? I don’t know.

There are a couple suggestions I would make based on personal experience. First, in physical therapy the pain scale biases low. That’s the direction you want to head in, and at the upper levels physical therapy is neither possible nor relevant. I model 10 out of 10 pain as pain so bad you’re fading in and out of consciousness; 9 out of 10 as screaming incoherently and struggling to communicate with anyone trying to help you. Physical therapy isn’t possible at these pain levels, so if you find yourself telling your physical therapist you’re in 9 out of 10 pain, you need to adjust your scale. Again, this is my personal take on the pain scale – not medical advice.

You should take notes on how much pain you feel and what causes that pain between sessions. This will give you a more reliable and detailed record to share with the physical therapist than just relying on your memory. Additionally, you can track whether things are improving or not in a more objective way than just how you feel during once-a-week sessions.

Warm up beforehand

In order to make the most of your time during physical therapy, you should try to warm up beforehand. Ask your physical therapist what you should do – it will probably depend on your injury or what you’re working on.

Be creative with what you’ve got

Physical therapists can accomplish a lot with a very limited amount of equipment. You’d be amazed at what experienced practitioners can do with some stretchy bands, a yoga ball, and very light weights.

That said, doing a video physical therapy session means that they won’t have access to a lot of supporting “equipment”. For example, it’s common to hook a band onto something for pulling exercises. Or, you might need to be able to slide up and down against a wall – which means you’ll need a wall that’s within view of the camera. Or, you might need to slide your hands on the floor. Easy enough to do in a gym that has equipment for this, but at home you might need dish towels and a smooth surface like a laminate, tile or hardwood floor.

Both patients and physical therapists will have to get creative with how they do exercises. In a future post, I’ll describe some of the solutions I came up with.

In sum

Video physical therapy can be remarkably effective. To make the most of your sessions, follow these simple guidelines:

  • Prepare ahead of time: tech, lighting, space, and warm-up
  • Get on the same page with your physical therapist about how you describe pain (i.e. what scale you use)
  • Take notes between sessions and, if helpful, during calls
  • Be as specific as you can when describing your discomfort to your physical therapist: where on your body, in what positions, and how bad is the discomfort?

Good luck with your physical therapy and share any other tips you’ve got in the comments section below!

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