I’ve Been Dealing With Stubborn, WFH-Induced Back Pain for Years. Virtual Physical Therapy Finally Broke the Cycle

As a digital nomad, I’m a big fan of remote work. My body, on the other hand, is not; it misses the ergonomics of a proper work set-up. Since mid-2021, I’ve become one of the millions of Americans dealing with stubborn lower back pain. In my case, it’s almost certainly fueled by sitting cross-legged or in other poor positions, hunched like a gargoyle over my laptop for hours in chairs that are simply not designed for computer work.

Unfortunately, it’s had cascading repercussions on my knees and hips, eventually stopping me from being able to do some of the active, adventure-y things I love to do most while traveling, like hiking, running, and biking. As a former fitness editor and a certified personal trainer, I had a rough idea of what might be causing my back pain and how to fix it (hi, core stability exercises), but my attempts to self-treat weren’t making a dent.

At the end of 2023, I hit a breaking point and finally decided to seek help in the only way that felt sustainable as a nomad: virtually. I booked an intro call with Prehab PT, a physical therapy practice in Los Angeles that offers both in-person and digital treatment, and soon after committed to their one-on-one virtual program.

After six months of virtual physical therapy, I’m not back to 100 percent, but having a pro listen to me, program a personalized routine, and keep me accountable has gotten me to a point where I finally feel strong and capable again.

Virtual physical therapy certainly lacks some of the important benefits that IRL treatment offers—like hands-on care and someone there to supervise your every move—but it also comes with a much lower barrier to entry. You have the flexibility of healing on your own time, wherever you want, and likely while spending less than you would to see someone regularly in person.

It’s not for everyone, but for many people, virtual physical therapy could be the difference between ignoring an issue and finally getting help. How can you tell if it’s a fit for you? Here’s what to know.

How does virtual physical therapy work, exactly?

It’s going to be a little different depending on where and how you seek care. Some practices are digital-first, offering only virtual care, while others are brick-and-mortar locations that have digital PT capabilities, explains Drew Contreras, PT, DPT, vice president of strategic affairs at the American Physical Therapy Association, who heads the organization’s digital PT efforts.

Typically, you’ll start with a virtual history interview, where your therapist gets a sense of what your needs are and collects some data on how you’re moving, Dr. Contreras says. This could be via a video call, self-recorded video, or motion sensors that you attach to your body.

After the assessment, your therapist will typically deliver your program digitally, whether it’s through an app, a series of videos, or a written breakdown. They’ll likely be able to program moves using whatever equipment you have at your disposal, though in some instances, you may need to invest in equipment or get access to a gym.

In most cases, you’ll do the bulk of the work on your own (similar to how, even if you’re seeing a physical therapist in person, they’ll give you homework). Your clinician will monitor your performance over time via check-ins and workout tracking to determine the next steps, like progressing the therapy or working on a new area of concern.

In my case, I hopped on a video call with Dorian Saint-Danic, PT, DPT, physical therapist at Prehab Physical Therapy. He asked me questions about my back pain and ran me through a series of movement screens, taking note of what caused pain, what seemed to make it better, and where my abilities where at the time.

Then he gave me a digital program using Prehab’s extensive exercise library, where each move was presented with a video, step-by-step written instructions, rep and set guidance, and personalized tips from about how I should tweak each move for my specific needs. We scheduled quick check-in calls every two weeks, where I’d share updates and Dr. Saint-Danic would gauge my progress and offer new exercises to help with new pain points or progress my strength.

“Physical therapy tends to heal through movement, whether that’s strengthening exercises or mobility exercises. It’s about restoring your movement pattern so that you can be functional.” —Drew Contreras, PT, DPT

The benefits of virtual physical therapy

A June 2024 report by the Peterson Health Technology Institute (PHTI) shared that many people who would benefit from PT don’t pursue treatment because they believe that it’s too expensive, inconvenient, or inaccessible. Virtual PT can help knock down those barriers, though it has some limitations of its own (more on that in a bit).

1. Easier access to care

“I think the number one benefit is that it’s up to the patient to engage when it’s convenient for them,” Dr. Contreras says.

You can get care in the morning, evening, middle of the day, and without leaving the house or your workplace. Being able to see a therapist virtually also helps eliminate some of the major barriers to care, like proximity to the closest PT office, finding large chunks of uninterrupted time in your schedule, finding childcare, or getting transportation to a clinic.

It can also be drastically easier to get an appointment compared to trying to schedule one in person, especially considering there’s a shortage of physical therapists in the U.S., according to a September 2023 report by Definitive Healthcare.

2. Better prices

This is going to depend highly on the type and cadence of care you’re receiving, your insurance coverage, and whether you’re accessing it through some other sort of benefit, like one offered by your employer. If you go through your insurance, it’s very likely that the cost of virtual PT will be the same as an in-person visit, Dr. Contreras says.

However, it’s also very possible that virtual physical therapy ends up costing you less. Physical therapy can cost $20 to $60 per session with insurance, and $80 to $150 per session without insurance, according to Thervo, a platform for finding therapy services, and that can quickly add up.

I personally paid less than $300 a month (out-of-pocket) for Prehab’s program. It felt extremely affordable compared to some of my previous experiences with PT, where I shelled out thousands of dollars for in-person treatment (with insurance) over just a few months.

3. More consistent communication

How often have you wished you could just text your doctor? Your therapist won’t be that available with virtual PT, but one of the main advantages is that there are more frequent check-ins, Dr. Saint-Danic says.

Virtual PT often gives you the ability to chat with or email your therapist between sessions, so you can update them on your progress, pain levels, or any issues in real-time. And because it can be easier to get an appointment or do a quick check-in virtually, you’re likely to see them more, period.

“Virtual PT can offer a more detailed and continuous view of client progress, allowing us to better understand and manage their condition,” Dr. Saint-Danic says. “We can use the collected data to pinpoint triggers for flare-ups, signs of plateau, and factors that contribute to successful outcomes.”

The drawbacks of virtual physical therapy

1. No hands-on treatment or cueing

This is one of the few downsides of getting virtual care.

“Virtual PT is limited to auditory and visual cueing,” Dr. Saint-Danic says. So your therapist won’t be able to gently tap your back where you should be feeling the move, for example, or help guide you into a passive stretch. “This emphasizes the importance of coaching the how and the feel of exercises,” he says.

In the same vein, another drawback is the inability to provide manual therapy (e.g. massage), which can be effective in treating more acute or more irritable conditions, he says.

2. Less person-to-person connection

During rehabilitation and when you’re working with a physical therapist, there’s very much a patient-clinician alliance, Dr. Contreras explains. It can be created virtually, but it’s often stronger in person.

“That’s one thing we learned from the pandemic, which is that humans need contact with other humans,” he says. “It’s not that you can’t do that virtually, but there are some people that thrive better with in-person contact.”

3. Not everything can be treated virtually

“Not all diagnoses or conditions match well with virtual care,” Dr. Contreras says—but more on that below.

Who is virtual physical therapy a fit for?

“Three main demographics come to mind as a good fit for virtual PT,” Dr. Saint-Danic says.

First, are people who are actively working around pain and movement limitations (that is, people like me, who can go about their lives but aren’t moving optimally or pain-free).

Second, people with chronic, recurrent issues from activities and training (think: pickleball elbow, IT band syndrome).

And third, people who are in the mid-to-late phases of rehab for things like sports injuries and surgeries. As a general rule, the more straightforward a problem is, the better suited it is to virtual PT.

On the other hand, if you’re in the acute phase of injury (i.e., you just hurt yourself) or are experiencing more severe levels of discomfort, you may not do well with all aspects of virtual PT, Dr. Saint-Danic says.

If you’re dealing with a more complex issue (like rehabbing after surgery) or have tried and failed to treat pain with other methods, it may also be best to see someone in person, Dr. Contreras says.

“Virtual PT can offer a more detailed and continuous view of client progress, allowing us to better understand and manage their condition.” —Dorian Saint-Danic, PT, DPT

Is virtual physical therapy effective?

It definitely can be. “Both virtual and in-person PT are effective in managing pain and improving physical performance,” Dr. Saint-Danic says.

There isn’t yet a robust amount of evidence analyzing the outcomes of virtual PT, but what we do have is really promising. The aforementioned PHTI report analyzed all the existing research and found that, in many instances, virtual care is as effective as in-person care for musculoskeletal diagnoses (i.e. things like muscle strains and sprains), Dr. Contreras says. (For more complex problems, like stroke recovery or neurological issues, the data is less clear.)

Virtual PT patients also come away just as satisfied as in-person patients, according to a November 2020 study published in the HSS Journal¹. And because it’s easier to access, digital PT may help boost adherence, per an October 2022 study published in the Archives of Physiology², meaning patients are more likely to actually continue with their program and see their rehabilitation through.

What to know before trying virtual PT

First and foremost, it’s important to understand what’s expected of you as a patient when you commit to PT.

“Physical therapy tends to heal through movement, whether that’s strengthening exercises or mobility exercises. It’s about restoring your movement pattern so that you can be functional,” Dr. Contreras says.

Exercise is going to be part of the rehab process, and you need to be willing to do the work in order to see results.

When it comes to sharing your progress with your therapist, you need to be honest, Dr. Contreras says. Your clinician is going to know if you didn’t do your homework—and it’s not about disappointing your PT, it’s about getting what you want, which is to be pain-free. You should also learn to pay attention to what’s going on in your body, so you can share that valuable info with them.

“By repeatedly evaluating our programming, exercise acts as both the assessment and treatment,” Dr. Saint-Danic says. “The more feedback we have, the more individualized the process will be.”

Even before you start therapy, try to compile all the info you can about your issue and what makes it tick: How long ago did it start? Which movements hurt? What feels good? What seems to trigger flare-ups of pain? You’ll want to keep a log of all this and keep it going during your treatment, so your PT can tweak your programming as needed.

“Rehabilitation is complicated. If it was easy there would be no profession to help people through it,” Dr. Contreras says.

For the best chance at healing, go in ready to team up with your PT and do the work, even if it’s through the screen.