Online Physiotherapy Safety Screening

Is Online Physiotherapy Right for You?​

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Please Read This Page in Full Before Booking

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Online physiotherapy is a safe and effective option for many common musculoskeletal conditions. However, it is not appropriate for everyone. This page exists to protect your safety. Please read it carefully and honestly before proceeding.

 

Important notice: Booking forms and enquiries may not be reviewed until the day of your appointment. You are responsible for reading this page in full and ensuring that none of the conditions listed below apply to you before booking. By proceeding with a booking, you are confirming that you have done so.

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This service is provided by a HCPC-registered and CSP-member physiotherapist holding appropriate professional indemnity insurance.

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Your personal data is handled in accordance with UK GDPR. Please refer to the Privacy Policy on this website before booking.

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Patient Declaration

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By completing a booking, you are confirming all of the following:

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1. I have read this page in full and understood its contents

2. I accept that online assessment is inherently less comprehensive than in-person assessment, and that certain clinical findings may not be detectable remotely

3. I accept that a definitive diagnosis may not always be possible online and that I may be referred for in-person assessment

4. I understand that hands-on treatment cannot be provided online

5. I confirm that none of the red flag symptoms or exclusion criteria listed on this page apply to me at the time of booking

6. I understand that if my symptoms change at any time — before, during, or between sessions — I must follow the safety guidance on this page immediately and not wait for my next appointment

7. I understand that my physiotherapist may determine at any point during my treatment that in-person care is more appropriate, and I agree to act on that recommendation

8. I accept that it is my responsibility to ensure a stable internet connection for my session, and that the full session fee is payable if a session cannot proceed due to inadequate connection quality on my end

9. I confirm I have read and understood the Privacy Policy on this website and consent to my personal data being processed for the purposes of my care

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If you cannot honestly confirm all of the above, do not proceed with a booking.

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Section 1: Understanding the Limitations of Online Physiotherapy

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Before booking, you must understand what online physiotherapy can and cannot provide. Proceeding with a booking confirms that you have read, understood, and accepted the following limitations.

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Assessment is less accurate online than in person

Your physiotherapist cannot physically examine you during a remote session. They cannot palpate, feel tissue quality, perform hands-on clinical tests, or detect certain findings that would be identifiable through direct examination. Some assessments that are straightforward in person are significantly limited or impossible to conduct remotely.

Diagnosis may be less certain

Because a complete physical examination cannot be performed, your physiotherapist may not always be able to reach a definitive diagnosis online. In some cases, you may be referred for in-person assessment to progress your care. You accept this as a known limitation of remote care.

Hands-on treatment cannot be provided

Manual therapy, joint mobilisation, soft tissue techniques, and other hands-on treatments cannot be delivered remotely. Online sessions focus on movement assessment, education, advice, and guided exercise rehabilitation.

Your safety depends on your accurate and honest reporting.

Your physiotherapist will rely entirely on what you report and what can be observed on screen. It is essential that you describe your symptoms fully and accurately. If you are unsure whether something is relevant, mention it.

Technical quality affects assessment accuracy

Connection speed, camera angle, lighting, and screen size all affect what your physiotherapist can see and assess. Your physiotherapist may ask you to adjust your position or setup. If a safe and adequate assessment cannot be completed remotely, you will be advised to attend in person.

Consent is ongoing

Your agreement to online physiotherapy is not a one-off event. If your condition changes, if new symptoms develop, or if your physiotherapist advises that in-person care is needed at any point during your treatment, you agree to act on that advice promptly.

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Section 2: Video Platform and Technical Requirements

Consultations are conducted via Zoom or Cliniko Video — both are secure, clinician-appropriate video platforms suitable for remote clinical consultations.

Please ensure the following before your appointment:

• You are in a private, quiet location where you can speak freely and move safely

• Your device (phone, tablet, or computer) has a working camera and microphone

• You have a stable internet connection sufficient to support a video call throughout the session

Internet connection — patient responsibility:

It is your responsibility to ensure that your internet connection is of adequate quality to support a video consultation. If your session cannot proceed, or is significantly disrupted, due to a poor internet connection on your end, the full session fee remains payable. Please test your connection in advance of your appointment. If you have any concerns about your connection quality, please reschedule to a time or location where a stable connection is available.

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Section 3: Who Is Not Suitable for Online Physiotherapy

Online physiotherapy is not appropriate in the following circumstances, regardless of the nature of your condition.

You have experienced a recent trauma or significant injury

If your symptoms arose following a fall, road traffic accident, sporting collision, or any significant physical impact, you must be assessed in person before booking online physiotherapy. This applies even if you feel your injury is minor. An in-person assessment is necessary to exclude fractures or structural damage that cannot be safely assessed remotely.

You rely on a walking aid or mobility device

If you currently use crutches, a walking frame, or a wheelchair as your primary means of getting around, online physiotherapy is not appropriate for you at this stage. Your assessment and treatment requires in-person care.

Your condition requires hands-on assessment or treatment

Some presentations cannot be safely or adequately assessed or treated without physical examination. If this applies to you, in-person care is required.

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Section 4: Emergency Symptoms — Call 999 or Go to A&E Immediately

If you are experiencing any of the following, do not book an appointment. Do not wait. Seek emergency care immediately. These symptoms can indicate life-threatening or permanently disabling conditions.

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Cauda Equina Syndrome — Spinal Nerve Emergency

Cauda equina syndrome is a serious condition involving compression of the nerves at the base of the spine. It requires emergency assessment and often emergency surgery. Outcomes are significantly better the sooner it is treated.

Go to A&E immediately if you have back or leg pain alongside any of the following:

• Numbness, tingling, or altered sensation in your inner thighs, groin, buttocks, perineum, or genital area — sometimes described as "saddle numbness"

• Any change in your bladder function — difficulty starting to urinate, reduced sensation when urinating, inability to fully empty your bladder, or leaking urine without intending to

• Any change in your bowel function — difficulty controlling your bowels, loss of sensation when passing a stool, or faecal incontinence

• Any change in sexual function or altered sensation in the genital area

• Pain shooting down both legs simultaneously

• New or rapidly worsening weakness, heaviness, or loss of control in one or both legs

Do not wait to see if things improve. If you are in any doubt, go to A&E.

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Cervical Artery Dysfunction or Stroke — Neck and Brain Blood Supply

These symptoms may indicate reduced blood flow to the brain and require immediate emergency assessment. They must never be assessed or managed remotely.

Call 999 or go to A&E immediately if you have neck pain or headache with any of the following:

The 5 Ds:

• Dizziness — sudden, severe, or unexplained unsteadiness

• Diplopia — double vision or sudden loss of part of your visual field

• Dysarthria — slurred speech, difficulty speaking, or difficulty finding words

• Dysphagia — difficulty swallowing, or a sudden unexplained change in your voice

• Drop attacks — suddenly falling without losing consciousness

The 3 Ns:

• Nystagmus — involuntary, uncontrolled flickering of the eyes

• Nausea or vomiting alongside any of the symptoms above

• Numbness — particularly around the mouth, face, or nose

Also seek emergency care immediately for:

• A sudden, severe headache unlike any you have experienced before — particularly after a neck injury, sporting impact, or unusual physical exertion

• Any facial drooping, sudden arm weakness, or difficulty speaking — use the FAST test: Face drooping, Arm weakness, Speech difficulty, Time to call 999

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Rapidly Worsening Neurological Symptoms

Call 999 or go to A&E immediately if you develop:

• Rapidly worsening weakness, heaviness, or clumsiness in your arms or legs

• Sudden inability to walk normally or loss of balance

• Loss of coordination or fine motor control in your hands

• Spreading stiffness or tightness through your limbs

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Section 5: Do Not Book Online — Seek Face-to-Face Medical Assessment First

The following situations require in-person medical or physiotherapy assessment before online physiotherapy is appropriate. Contact your GP the same day, or call 111 for guidance.

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Recent Trauma or Significant Injury

If your symptoms arose following a fall, road traffic accident, sports collision, or any significant physical impact, you must be assessed in person first — both medically and physiotherapeutically. Online physiotherapy cannot safely exclude fractures, ligament ruptures, or structural damage. Do not book online physiotherapy until you have been assessed face-to-face.

This applies particularly if:

• You are unable to bear your full weight normally through the affected limb

• You have significant bruising, swelling, or deformity following an injury

• You are a postmenopausal woman who has sustained any fall — even a minor one. Reduced bone density means fractures can occur with surprisingly little force, and must be excluded before any physiotherapy begins

• You have a known diagnosis of osteoporosis and have experienced new or sudden onset pain following any activity or impact

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Possible Fracture

Seek face-to-face assessment before booking if you have:

• Pain that is significantly worsened by movement or bearing weight following any trauma

• Localised tenderness over the spine, hip, wrist, or limb following a fall or impact

• Known osteoporosis with new or suddenly worsening spinal, hip, or limb pain — even in the absence of obvious injury

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Possible Serious Spinal Pathology

The following can indicate serious underlying spinal conditions requiring medical investigation before physiotherapy begins.

Possible spinal tumour or malignancy — see your GP urgently if you have:

• Any history of cancer alongside new or worsening back or neck pain

• Back or neck pain that is constant and unrelenting, and not relieved by rest or any change in position

• Severe night pain that wakes you from sleep and is getting progressively worse

• Unexplained weight loss alongside back or neck pain

• General malaise or feeling persistently unwell in a way that does not fit a straightforward musculoskeletal injury

Possible spinal infection — see your GP urgently if you have:

• Back pain accompanied by a fever

• Back pain following a recent significant infection (urinary tract infection, dental abscess, recent surgery)

• Back pain and you are immunocompromised or taking immunosuppressant medication

Possible inflammatory arthritis — see your GP if you have:

• Back pain that has persisted for more than three months

• Morning stiffness lasting more than 30 minutes that improves with movement

• Marked night pain eased by getting up and moving around

• Onset of back pain before the age of 45

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Neck Red Flags

See your GP before booking online physiotherapy if your neck pain is associated with:

• A history of significant trauma to the neck — whiplash, fall, road traffic accident, or sporting impact. In-person assessment is required before any remote care

• A previous history of cancer

• Unexplained weight loss

• Constant, worsening pain at night

• Fever

• Long-term steroid use or immunosuppression

• Age over 50 with sudden onset severe neck pain without a clear mechanical cause

• Progressive arm weakness or difficulty with hand grip alongside neck pain

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Hip and Lower Limb Pain with Weight Bearing Concerns

Seek face-to-face assessment before booking if you have:

• Pain preventing you from bearing your full weight normally through your leg

• Groin or hip pain following a fall in a postmenopausal woman — hip fractures can present this way following low-impact trauma

• A swollen, hot, or red joint alongside a fever — this may indicate a joint infection, which is a medical emergency requiring immediate care

• One leg appearing shorter or externally rotated following a fall

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Unrelenting or Unexplained Pain

Do not book if your pain:

• Is constant, severe, and entirely unaffected by movement, rest, or position — this pattern is not typical of a mechanical injury

• Is getting progressively and rapidly worse without a clear musculoskeletal cause

• Is accompanied by systemic symptoms such as fever, unexplained weight loss, night sweats, or profound fatigue

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Section 6: What Online Physiotherapy Is Well Suited For

In line with NHS England guidance, online physiotherapy is appropriate for people who do not require in-person physical examination and whose presentation is not complex, acutely unstable, or structurally uncertain.

Conditions well suited to online physiotherapy include:

• Mechanical neck, back, and radicular pain — discrete episodes without red flags

• Simple mechanical back pain and sciatica without neurological emergency features

• Shoulder, elbow, wrist, knee, and hip pain of a mechanical or degenerative nature

• Carpal tunnel syndrome, tendon conditions, and muscle injuries without acute trauma

• Mild to moderate osteoarthritis of the knee or hip

• Chronic pain management and exercise-based rehabilitation

• Postural assessment and ergonomic advice

• Monitoring and progression of an established rehabilitation programme

• General musculoskeletal health and exercise guidance for postmenopausal women, including osteoporosis-related strength and conditioning

Online physiotherapy is not a substitute for hands-on manual therapy. Some conditions will require in-person attendance during the course of treatment and your physiotherapist will advise you if this is the case.

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Section 7: A Note for Postmenopausal Women

Postmenopausal women are at increased risk of reduced bone density and fragility fractures. If you have experienced any fall or low-impact injury and have developed new pain — particularly in your spine, hip, or wrist — please seek face-to-face medical assessment before booking. The vast majority of musculoskeletal presentations in this group are entirely appropriate for online physiotherapy. This guidance is simply to ensure that any structural injury is excluded first.

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Section 8: If Your Symptoms Change at Any Point

This section applies before your first appointment, between sessions, and during the course of your treatment.

If at any point — before booking, before your appointment, between sessions, or during a session — you develop any of the symptoms described in this document, you must act immediately. Do not wait for your next physiotherapy appointment.

• Symptoms from Section 4 (emergency symptoms) — call 999 or go to A&E immediately

• Symptoms from Section 5 (red flag or serious pathology symptoms) — contact your GP the same day or call 111

• If your condition has significantly changed since you last attended — inform your physiotherapist at the start of your next session before proceeding with any exercises or treatment

Your physiotherapist cannot monitor your condition between sessions. The responsibility to seek appropriate help if your symptoms change rests with you. This page tells you exactly what to do.

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