PT and the Pandemic: Physical Therapy at Home

The coronavirus pandemic has changed how healthcare is practiced and delivered, and physical therapy is no exception. Learn how you can get your PT done safely and effectively in your own home.

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The year 2020 has been a challenge when it comes to anything that takes people out of the house. In-person medical care is harder than ever to get (thanks, Covid-19!), making it especially rough if you need physical therapy or rehabilitative chiropractic care. The pandemic, quarantine, social distancing, and the general guidelines advising against being too close to other people for too long can combine to keep you out of your healthcare provider’s office.

Home physical therapyPhysical therapists and their clients are making home-based PT work.

Physical therapists are coming up with ways to work within current guidelines. Patient health is the first priority, both in terms in physical therapy plans and Covid-19 safety concerns. Physical therapy at home is often the answer—physical therapy treatment that doesn’t require an office visit so that patients can keep improving while reducing coronavirus risks.

Coronavirus and Chronic Pain

“Everyone is hurting!” says Theresa Marko, doctor of physical therapy, board-certified clinical specialist in orthopedics in New York City and SpineUniverse Editorial Board member. “It is not only Zoom fatigue, it is literally the back fatigue everyone is feeling from sitting in these chairs so long and the decreased activity levels. Not only are we sitting more–desk chair, eating food chair, Netflix and chill chair–but people aren't going places due to Covid-19 so they are not walking as much as they used to.”

Kristen Nelson, DC, a chiropractor based in Deltona, FL, agrees. She and her husband Ben, also a DC, are evidence-based practitioners with a focus on rehabilitative and physical therapy. “We are actually noticing an increase in spine pain patients with the current situation,” says Kristen Nelson. “Safety precautions are a priority to stop the spread of Covid-19 and it’s important that anyone who has been in a high-risk exposure situation or had any symptoms of illness, stay home during this time.”

Telehealth: It’s Not Just for MDs

Initial and continuing appointments can be done remotely with telehealth video calls. The calls have the added advantage seeing a patient’s home and available space. “There is a lot we can see through the computer,” explains Dr. Marko. “I [recently] did a telehealth session with a patient with back pain to assess her desk set up. In the end, I gave her recommendations to move her screen, get a new keyboard, and a new chair.”

Telemedicine aids patient education as well. “We go over the exercises on screen, many times with myself demonstrating and then I can assess the patient’s movements and give them verbal cueing to correct any faults,” Dr. Marko continues. “We can check in periodically to review these exercises and to progress them to even harder, more challenging exercises.”

House Calls 2020-Style

At-home in-person appointments are also an option. This is ideal when it comes to manual therapy, during which a doctor or chiropractor takes a literal hands-on approach.

“We offer a mobile option for our patients. This allows us to bring our equipment to homes or businesses, which has been very popular during this time,” says Nelson. “Many patients still need the addition of manual therapies to fully recover. This is especially important in the first several weeks after an injury or onset of pain. Manual therapy may include treatment such as chiropractic spinal manipulation, trigger point therapy, muscle release techniques and neuromuscular reeducation.”

Home PT house callDoes your physical therapist make house calls?

But what about patient compliance? Regular in-person office visits allow therapists to track progress. At-home treatment plans make it easy for patients to cheat a bit on their treatment plan, so doctors and therapists must be a little more vigilant.

According to Dr. Marko, simple explanations and reasons are the best path to compliance, especially for younger patients. “I have a 7-year-old patient who hates to exercise. Yet, she hurt her knee. I asked her what she wanted to do this summer and she said paddle boarding. There we have it–her desire. So I remind her of this desire every time we exercise and when I tell her to do her exercises.”

Holistic Health and What Hasn’t Changed

Understanding the patient’s emotional and mental state is also vital, reminds Nelson. “The pandemic has caused many people to experience isolation which can be detrimental to mental and physical health, she says. “This isolation is especially problematic for people experiencing pain from an injury which is why it’s good to keep a close doctor patient relationship during this time. For patients who are not being seen in person, we like to do weekly check-ins to answer any questions that may come up as well as making any necessary changes in the treatment plans.”

As before the pandemic, communication is key. Patients who understand why physical therapy treatment is needed patients who will work to improve. That’s not new, and patient buy-in is as important with virtual visits as it is important.

“People need to know why you are telling them to do an exercise,” notes Dr. Marko. “If they don't know why it will feel stupid and boring. When you explain to them the why, which muscles, and how this exercise will improve their function, they tend to buy in more because they understand now why it's so important.”

 

Updated on: 08/31/20
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Work from Home Advice for People with Back Pain
Theresa Marko, DPT
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