Is this the physio of the future?

Jane McGuire
·6-min read
Photo credit: Aliaksandra Ivanova / EyeEm - Getty Images
Photo credit: Aliaksandra Ivanova / EyeEm - Getty Images

From Runner's World

Let me start by saying that I was sceptical about the idea of a virtual physio. How could a physio fix a problem without being in the room with me? Halfway through lockdown, I picked up a niggle. Some physios were still open, but travelling on the London underground felt a little scary, so I explored the growing number of online options.

After a virtual half marathon, I experienced pain along the inner edge of my foot that got more painful after longer or more intense runs. It didn’t stop me running, but getting out there was no longer the stress- and pain-free activity it had been up to that point during the pandemic. I turned to Matt Bergin and Mark Buckingham, who had recently launched their online physio platform, the Performance Team, for some help.

The gait analysis

Before my first virtual session with Matt, he did a thorough gait analysis. I was asked to send in a number of videos of myself running, as well as photos of the tread on my favourite Hoka running shoes. On our first Zoom call, along with my running coach, Matt talked me through my gait analysis, showing me just how much my left ankle collapsed as I ran, due to what he thought might be a weakness in my tibialis posterior muscle (lower leg), or restriction in the ankle joint. He noted that my hip flexors looked tight in the videos and that my left (non-dominant) side seemed weaker. It wasn’t pretty, but it explained the pain in my left foot.

When asked about the importance of the gait analysis following treatment, Matt said, ‘Far too often, runners don’t seek help until the inevitable – they get hurt and are told to rest. On top of this, physios are often guilty of just looking at the sore bit and failing to look at the reasons why it has become sore in the first place.

‘Virtual gait analysis allows us to observe how your body moves, and not just your legs. How does your leg swing through? Where does your foot land? How does your foot absorb the impact? How does the arm swing? Are you rotating through the upper back? Through our knowledge and understanding of running biomechanics, all these points allow us to build a picture as to the areas of your body that may be susceptible to overload and are more likely to develop injury if left untreated.’

The treatment

Matt asked me to apply pressure to different parts of the foot, as well as getting me to perform various exercises on the left leg, such as a single-leg calf raise and a squat. This all felt pretty similar to a normal physio session – it was just taking place in my living room rather than in a fancy studio in London. Matt soon noticed I was experiencing pain in the tendons in my ankle and showed me how to massage the area with a wooden spoon. An hour later, I logged off with a series of exercises and massages to do, as well as a One Drive full of recordings and videos from the session.

Over the next few weeks, Matt checked in by email. I sent back concerns and questions when the impatient runner in me couldn’t understand why my foot wasn’t settling as fast as I had anticipated; Matt patiently replied and arranged a follow-up Zoom call. The level of care was excellent; after two sessions, the pain was gone and the wooden spoon became a cooking utensil once more. As well as being pain-free, I’m aware of the weaknesses in my left ankle and I’m armed with a series of exercises to strengthen it and run stronger.

Photo credit: Willie B. Thomas - Getty Images
Photo credit: Willie B. Thomas - Getty Images

What do the physios say?

Of course, there are massive benefits of seeing a respected professional via Zoom – the appointments are often cheaper, you don’t have to travel or fit in physio sessions around work and there’s often not the same waiting list to contend with. But what’s it like on the other side of the table? ‘Virtual physio was not entirely novel’ explains Mark Buckingham. ‘With a number of patients and runners training abroad or at university here or the United States, we had been providing remote physio from time to time. Clearly, the advent of Covid-19 and access to good enough internet and Zoom has made this more possible.’

Matt adds: ‘With lockdown forcing people to take to the “virtual” way of life pretty quickly, it was more a matter of having our patients and runners on board with the concept. A lot were, understandably, hesitant to begin with. However, once they gave it a chance, most were impressed by how much we could actually do, and some things actually proved more effective remotely than in the clinic itself.’

According to Matt and Mark, the challenges of diagnosing patients without seeing them face to face are outweighed by the benefits of runners being able to have their coach at the appointment with them. The experience of the physio also comes into play when you take things online, as Mark explains: ‘There is a huge amount we learn from the history of how the issue presents. We are also able to see movement patterns well over video and many of the tests for strength, length and stability can be performed well. With instruction, the patient can carefully palpate around the sore areas and, seeing this, we know which bits are sore.’ Both Matt and Mark have years of experience under their belts, treating everyone from elite athletes to first time runners - they know their stuff.

Speaking to Matt and Mark, I’m reminded that physio is far more than single-leg squats and wooden spoons – they also have a doctor on board, Dr John Rogers, who is able to coordinate injections, surgical interventions and post-surgery management remotely as a Sports Medicine Consultant. The team can also refer patients for MRI scans or Ultrasound scans if necessary. ‘We have been able to deal with acute injuries such as sprained ankles and muscle strains, but we have also been able to deal with those more complex long-term issues through video gait analysis and even change running-gait patterns to resolve these issues’, Matt explains.

For me, one of the biggest shocks was realising how I run and why I got injured, something Mark calls the ‘eureka moment’. ‘Many runners have never seen themselves running and are often shocked at how they look’ he says. ‘Your running gait should be analysed just as closely as a tennis coach scrutinises a forehand or a golf coach your swing, regardless of whether you can hit the ball or not.’

While seeing a physio at home is still novel, I wonder whether it will be so in years to come, as we all get smarter in this virtual world. For me, virtual physio was a positive surprise – I saw an expert from the comfort of my own home, I didn’t have to wait weeks for an appointment and, unlike the Zoom quizzes I've sat through, the sessions were informative and to the point.

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