Why Hybrid MSK Care Beats Digital-Only Solutions
Over the past decade, digital MSK platforms have stepped in to tackle one of the biggest cost drivers for U.S. employers: musculoskeletal care. The idea is simple — give employees a digital-first option for PT and related services to improve access and cut costs.
And on paper, it makes sense. We know that early access to conservative MSK care lowers costs and improves outcomes. But there’s a difference between having an option and people actually using it. People need to have access.
Patients run into barriers all the time. Long wait lists. Limited appointment hours. High out-of-pocket costs. When care gets delayed, back and neck pain don’t just go away — they become chronic and harder to treat. Even motivated patients struggle to navigate a complex healthcare system. They might need a referral before starting PT, or get conflicting advice from the urgent care they visited over the weekend.
Digital MSK platforms have helped by working directly with employers, reducing some of those barriers and making conservative care more affordable. And for the employees who use them, the results are encouraging.
But here’s the catch: most employees never engage in the first place. Utilization is the Achilles’ heel of digital-only care. Utilization often hovers in the 2–4% range, even when companies run aggressive campaigns to promote the benefit. And even when people sign up, many drop off before completing treatment.
In other words, the promise of digital MSK is real — but its reach is limited.
The Adherence Problem
Sticking with treatment has always been one of the toughest challenges in musculoskeletal care. A recent PHTI report found that digital MSK platforms retain about 70–80% of patients at 12 weeks. That sounds promising — but it only reflects people who chose virtual care in the first place. What about everyone else?
Plenty of patients never opt in. In fact, a survey by Assurance found that 44% of people believe telemedicine is less effective than in-person visits. If you start out skeptical, you’re less likely to stay engaged. And skepticism is just one piece of the adherence puzzle.
A new study on MSK care laid out the rest: patients stick with treatment when they see real progress, enjoy the process, feel supported, and have flexible options. They drop off when care feels like a hassle — in the form of rigid schedules, boring programs, low confidence, or no one checking in.
This is where digital-only care often struggles. It’s hard to meet all those needs through an app alone.
A hybrid approach solves that gap. By blending in-person visits with digital tools, patients get the best of both worlds: local, hands-on care when they need it and flexible, at-home support to keep them moving forward. It’s a model built around real people, not just technology.
The Case for a Hybrid Approach
Internal Factors: Beliefs and Confidence
Adherence often starts in the mind. Patients who believe in their recovery and feel confident performing exercises are far more likely to stick with treatment. Traditional in-clinic education helps, but visits are spread out and only offer one mode of communication.
Digital platforms fill that gap. Videos, infographics, and FAQs can address misconceptions like kinesiophobia (fear of movement). Real-time feedback from apps or telehealth check-ins boosts confidence, helping patients feel capable of managing their plan at home or in the gym.
Hybrid models go one step further. By combining in-person visits with digital follow-ups, they reduce the fear of being left on their own. Providers can gradually taper clinic visits while still offering support through chat or virtual check-ins — keeping patients motivated and connected to their plan of care.
External Factors: Time, Flexibility, Environment, and Support
Time is one of the biggest obstacles in MSK care. Digital programs make it easier for patients to fit treatment into real life, with flexible timetables and reminders that compete with busy schedules.
Support matters too. Virtual communities, peer groups, or group chats help counteract the isolation some patients feel. Remote monitoring tools allow clinicians to adapt care to the patient’s environment — making it more personal and sustainable.
In-person care still plays a vital role. Nothing replaces the trust and connection of face-to-face visits, or the hands-on treatments that only therapists can provide. After all, physical therapy is meant to be physical.
But digital platforms complement that experience with multimedia resources, step-by-step modules, and interactive exercise tools that make the process engaging instead of monotonous. Apps can even adjust exercise progression automatically, giving patients instant feedback and a tangible sense of progress.
Putting It All Together
The future of musculoskeletal care won’t be digital or in-person. It must be both. Digital tools reduce barriers of cost, convenience, and access, while in-person care brings the human connection, local familiarity, and clinical expertise that technology simply cannot replace.
When combined, hybrid models create care experiences that are more flexible, engaging, and sustainable. That combination directly translates into higher adherence rates and better outcomes.
If the goal is better results at lower cost, then meeting patients where they are—both online and in the clinic—isn’t just a good option. It’s the only one.
At Second Door, we’re helping PT practices and employers bring this hybrid model to life. The path forward is clear: better adherence, lower costs, stronger outcomes — all through hybrid, local-first MSK care. Whether you’re a PT group ready to grow beyond insurance or an employer looking to control rising claims, the next step is the same: let’s talk.
