What online physiotherapy can do for a runner, and what it cannot

We are an online clinic writing about whether online clinics work, so read this the way you would read a restaurant reviewing itself. The useful parts are the bits where we tell you not to use us.

What the trials actually show

The closest thing to a musculoskeletal-specific answer comes from osteoarthritis, where the comparison is against usual care rather than against a matched in-person dose.

Those are real but modest effects, and the honest framing is not that online is better. It is that the delivery format turned out to matter less than anyone expected once the content was the same.

Where this stops applying to you: none of this research was done on runners. The populations are older, more sedentary and dealing with different problems. Anyone citing telerehab trials as proof that online running rehab works, including us, is extrapolating.

Where face to face still wins

The equivalence is not universal, and the clearest counterexample is worth knowing.

A deconditioned patient recovering from a serious illness is not a runner with a sore Achilles. But it makes the point that "telehealth works" is too coarse a claim to build a decision on.

The task decides, not the format

This is the part we would want a friend to know.

Transfers wellNeeds a room

History and reasoning

Transfers wellThe most valuable hour in rehab is a conversation, and it loses nothing.

Needs a roomNothing.

Watching you move

Transfers wellSquats, hops, calf raises, single-leg work, filmed and reviewed frame by frame.

Needs a roomSubtle joint-specific tests where the examiner's hands are the instrument.

Strength testing

Transfers wellRepetitions to failure, height, distance, symmetry between sides.

Needs a roomAnything needing a dynamometer or a fixed resistance you do not own.

Load management

Transfers wellYour training file is already digital. This part is arguably better remotely.

Needs a roomNothing.

Treatment

Transfers wellLoading programmes, progression, education, the decisions between sessions.

Needs a roomHands-on techniques, injections, and anything requiring equipment.

Diagnosis

Transfers wellMost running overuse injuries, from history and a handful of tests.

Needs a roomUnclear pictures, suspected referred pain, anything needing imaging or bloods.

The thing runners have that other patients do not

Almost every other patient arrives with a story about their activity. A runner arrives with a file.

Weekly volume, pace, elevation, heart rate, how the sessions were spaced, what changed in the four weeks before it started hurting. That record exists whether or not anyone asked for it, and it is exactly the information an injury history is trying and usually failing to reconstruct from memory. The running injury literature puts large effects in training characteristics as well as in health, lifestyle and biomechanics⁴, and the training half of that is already written down.

What makes it work when it works

The qualitative research on telehealth for people with chronic pain is useful here, because it asks what patients actually valued and what got in the way rather than whether the numbers moved.

Autonomy and fitting care into your own life are the parts people value, and they are also the parts that fail when a service is designed badly. The adherence finding from the trials matters for the same reason: it was similar to in-person care¹, which is not what most people predict.

When to go and see someone in person

None of those are reasons to avoid online care permanently. They are reasons for a different first step, and most of them are settled in one in-person appointment before remote work can pick up again.