Online Rehab VS In-Person Physiotherapy: What really works for shoulder pain in 2025

Tim Stevenson
Oct 3
4 min read

Shoulder pain is one of the most common musculoskeletal complaints — but what’s the best way to treat it? Should you book an in-person physiotherapy appointment, or can online rehabilitation (tele-rehab) be just as effective?

A 2025 systematic review and meta-analysis of eight randomised controlled trials found that remote rehabilitation can improve pain management and functional recovery for people with non-surgical shoulder conditions.

That’s big news, but does it mean you can skip the clinic altogether?

Let’s break down the science, the pros and cons of each approach, and how to decide which option is right for you.

What Is Online Rehabilitation (Tele-Rehab)?

Tele-rehabilitation uses digital tools; video calls, apps, and online platforms to deliver physiotherapy remotely.

This can include:

Live video coaching where a physio cues, progresses, or adapts your exercises in real-time.
Structured digital programmes providing progression, accountability, and motivation.
Gamification features like streaks, exercise trackers, and reminders to keep you on track.

In contrast, in-person physiotherapy involves face-to-face appointments, manual assessment, and hands-on treatment where appropriate.

What the Research Says About Online Rehab

The 2025 review showed that:

Doing something is better than nothing. That might sound very obvious, but you’d be surprised how many people do nothing and expect their shoulder to get better.
Tele-rehab works better than unsupervised home exercise. The percentage of people who don’t do the exercises prescribed can be as high as 70%. That's 7 out of 10 don’t do the thing that the person they paid to see told them to do to get better.
Coaching and accountability matter. Programmes with feedback, progression, and regular check-ins deliver better results.

Advantages of Online Rehab

✔️ Accessible anywhere – no travel or clinic visits needed.

✔️ Structured progression – many online platforms build in exercise progression and feedback.

✔️ Accountability and motivation – reminders, check-ins, and gamification type “streaks” keep clients/patients engaged.

✔️ Evidence-based – research shows measurable improvements in pain and function for non-surgical shoulder issues.

When In-Person Physio May Be Better

While online rehab works for many, there are times when in-person care is essential.

An accurate assessment and diagnosis is step one in setting you on the right rehab pathway. As part of this process we need to screen for a number of medical red flags that might mean a referral to a different healthcare or medical department needs to be made.

Whilst some assessments can be done remotely, others need to be done in person, for example any condition or issue presenting neurological symptoms. We don’t want to mess about with this so we’ll always suggest an in-person assessment by a physiotherapist in these situations.

There are also times when in-person manual rehabilitation techniques might be the most appropriate strategy. You don’t need manual therapy to resolve a lot of shoulder problems, we hardly use it at all, but there is a place and time for hands on mobilisation and facilitation.

We also need to consider the psycho-social benefits of human to human connection. Practitioners will always beat digital interfaces when it comes to understanding, communicating and planning for the impact of factors such as emotional duress, stress, work, lack of sleep and the general pressure of adulting! These things can have huge implications on the success of a rehab programme.

We should finally mention tech-literacy as a potential barrier and the fact that some people just don’t like using their phone and apps in this way. It’s a personal preference and that’s all good, we should just find a different way to stack all that positive stuff that I spoke about earlier into the rehab ecosystem.

The Best Approach? Integration

Rather than choosing only online or only in-person rehab, a hybrid approach often works best.

We still need appropriate initial screening and diagnosis. I have no doubt that in time AI will play a role in this but right now we want a human making a decision and clearing anything which could be more sinister.

For our remote coached rehab programmes we have an initial screening questionnaire and a live zoom consultation call. This gives us the opportunity to make sure we are the right fit for the client. We have the opportunity here to redirect them to someone else or for a face-to-face session with us if that is most appropriate.

If we get the green light, we will assess either in-person or remotely and then deliver the rehab programme using an elegant online system which allows weekly communication, programme progression and accountability.

This model combines the convenience of online rehab with the reassurance and accuracy of in-person care.

Key Takeaways

Online rehab for shoulder pain works. Research supports its effectiveness when properly supervised.
Not everyone is a candidate. In-person care is essential for red flags, complex cases, or when manual therapy is required.
Accountability and progression are key. A one-page PDF of exercises is rarely enough for lasting results.
Hybrid models may be the future. The best outcomes often come from combining digital and in-person support.