Trusting the internet for medical advice has always been a crapshoot. A runny nose paired with a vivid imagination can quickly metastasize to a terminal prognosis from a number of sources, and often you don’t know the qualifications and motivations of social media advice-givers. But 27.5 million Americans don’t have health insurance, and even those with health care can find the out-of-pocket costs of physical therapy to be an insurmountable barrier. Sometimes it feels there’s nowhere else to go, really, but online.
When I was a marketing manager at a small San Francisco startup, I used my employer-provided insurance to splurge on a $30,000 shoulder surgery and complete roughly 10 months of physical therapy after a freak indoor skydiving accident. My surgeon recommended a number of physical therapy offices and I found one two blocks away from my company’s office in the financial district of San Francisco. Twice a week, I’d slip out at lunchtime to do my 3-pound bicep curls, hand bicycling, and other perspective-setting exercises. As my strength and mobility progressed, so did the intensity of my therapy sessions. But when I made the switch to full-time freelancing, a PT visit with a $20 co-pay turned into a $200-plus luxury I could no longer afford. Informed by notes from my surgeon and PT visits, I turned to a more cost-effective option: the internet.
My physical therapy became a curated Instagram feed of self-guided routines to do at the gym. I’d search tags like #labrum and #slaptear. I came across physical therapists with tens — sometimes hundreds — of thousands of followers. I could tell I wasn’t the only one doing internet-based rehab.
There’s the well-known disclaimer that you should not substitute the internet for professional medical advice. But just as the Q-tip box says “do not insert directly into the ear canal,” that is exactly what some people will do.
Leilani Noguera, a 16-year-old junior at Clear Lake High School in Houston, Texas, is also a digital PT devotee. In the beginning of 2019, she was practicing basketball at the Y when she fell and heard several pops in her knee. She tore her meniscus in three places, as well as her ACL. Under her father’s health insurance, Noguera was covered for 20 physical therapy appointments, some of which she used prior to her surgery in February of this year.
When her dad’s health insurance denied additional physical therapy sessions, Noguera and her father looked on YouTube for ACL rehabilitation videos. Now nine months post-surgery, Noguera searches for rehab videos with terms like “ACL rehab 9 months post ACL surgery” to find routines relevant for her. She’s found one doctor, Matthew Boes, whose YouTube videos she particularly likes.
There’s the well-known disclaimer that you should not substitute the internet for professional medical advice. But just as the Q-tip box says “do not insert directly into the ear canal,” that is exactly what some people will do. Often because there is no obvious alternative. Going online for physical therapy sessions is frequently not a choice between the doctor and the internet. More often, it’s a choice between the internet and nothing.
Online resources for physical therapy are abundant, but you have to know where to look. The usual suspects for fitness information are not always helpful. For example, the r/fitness subreddit, an exercise forum with 7.5 million members, is strict about keeping physical therapy advice and solicitation off their platform. (It’s in violation of rule #5.) Another subreddit, r/physicaltherapy (which has a smaller audience at slightly under 21,000 subscribers) has a similar policy. A moderator for the subreddit told Elemental that several posts soliciting physical therapy advice are removed from the subreddit every day, “as no professional therapist would prescribe exercises to an individual he/she had not evaluated in person.”
Other channels are much more friendly for those searching for help. On Instagram and YouTube, many professional physical therapists have built giant followings.
“I love that people try to find answers themselves and try things out,” says Mike Reinold, a physical therapist and athletic trainer. Based in Boston, Massachusetts, Reinold is currently a senior medical adviser for the Chicago White Sox and co-founded Champion Physical Therapy and Performance. But people must know they will not always be successful, he adds, citing something he calls the “corrective exercise bell curve.”
“Twenty percent of the time you’ll nail it, but 20% of the time you may make things worse… The other 60% of [the time people] just spin their wheels because they are working on the wrong things,” he says.
But because Reinold and his staff receive so many requests from people looking for help, they’ve created online versions of the programs they offer in person. “The goal isn’t necessarily to get them to see us, but to try the program and see how much it helps,” he says.
“It’s better than nothing, but any person needs to do their due diligence and deep research.”
Sure, the online PT route is not the same as in-person physical therapy consultations. Seeing an expert means they can offer real-time adjustments, correcting form and posture before bad exercise habits have a chance to form grooves. “The benefit of going and working with a physical therapist is that you get that personalized evaluation and attention that can look for the different muscle imbalances that you might not realize you have,” says Dr. Elizabeth Barchi, a sports medicine specialist at NYU Langone Health.
But Barchi acknowledges that a lot of people don’t have access to this kind of care. So she recommends physical therapy resources online that can help bridge gaps. “For some of the simpler problems, if access is a real limit for that person, then some of these online routes could really be quite helpful.” Two free online resources she recommends include HEP2go, a free website for referencing physical therapy exercises, and Ask Doctor Jo, another PT YouTube series.
“More and more often, health care professionals, especially in the therapy field, are getting roadblocked by insurance caps, limited visits, and very high co-pays for patients,” says Doctor Jo. (Despite her very large online footprint, she does not reveal her full name.) “Sometimes there is just not enough time to give all the instruction a patient truly needs. My information is not designed to make people stop going to their doctor or therapist or to replace information they have given them, it’s just to help along the way… Some people simply don’t have the means to go to a physical therapist in person.”
Tala Khalaf, a physical therapist at Stanford Health Care, sees people with chronic and complex spine injuries, and she’s hesitant to endorse any “cookie-cutter” type of treatment that is available online. “I see the other argument that sometimes it’s hard for people in that situation where [they lack access to health care.] It’s better than nothing, but any person needs to do their due diligence and deep research,” she says.
Using online therapy videos as supplemental support between in-person PT visits may be the best bet for people who can swing it. “If you’re waiting anyways you might as well try something,” says Khalaf.
Noguera, the high school athlete, was just cleared to play basketball by her doctor earlier this week. She’ll return to the court on December 10. In the meantime, she’s sharing her progress on Twitter, because “nobody knows how hard this is and nobody ever sees the behind the scenes,” she says. “I wanted to help anyone that is going through this.”