Physical Therapy is a Hands-On Profession that Uses Exercise - Not a Digital Exercise Platform that Uses AI Chatbots

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Welcome back to All Things #PhysicalTherapy! If you’ve followed my commentary on the digital musculoskeletal (MSK) space, you know how strongly I feel about differentiating “almost” physical therapy from what actually is. New digital platforms frequently claim to deliver “digital physical therapy,” yet they often omit key ingredients — namely, licensed physical therapists providing the vital hands-on, individualized care that defines our profession.

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Are Hinge Health & Sword Genuine Physical Therapy, or Just “Substitutes”?

In the language of Porter’s Five Forces, a “substitute” is any product or service that approximates another without delivering its true core value. Hinge Health and Sword Health position themselves as digital MSK therapy solutions, relying on wearable sensors, AI, remote coaching, and in some cases, a hard-to-discern mixture of chatbots and potential human PTs. But exercise alone — especially via an app — doesn’t replicate what physical therapy truly is: hands-on assessment, personalized manual interventions, and in-person, licensed expertise that extends well beyond following a generic exercise routine.

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Hinge Health’s S-1: Where Are the Physical Therapists?

If you look closely at Hinge Health’s S-1 filing, you’ll find plenty about digital care programs, wearable sensors, and health coaching. What’s missing is a clear emphasis on licensed physical therapists delivering in-person, hands-on therapy. For employers and investors, this underscores the key difference between genuine physical therapy and a digital approximation. Admittedly, Hinge doesn’t portray in their S-1 that they are providing physical therapy-just “digital exercise therapy” as though that is a new major in free Coursera course. Unfortunately, TPA’s are often conflating these two with self-employed insurers offering them an MSK point solution and spreading the word that they now have virtual physical therapy. We are not talking about the difference between natural vs. synthetic vitamins here and buyers need better full disclosure.

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Sword Health: Is It a Chatbot or a Real PT?

Sword Health sometimes states it employs physical therapists, yet — according to a recent patient experience posted on The Health Care Blog — it can be difficult to know whether you’re communicating with a licensed clinician or an AI-driven chatbot. For a patient in search of real-time assessment and manual therapy, that uncertainty can be substantial. If you can’t tell who or what is guiding your care, you have to question whether you’re receiving genuine physical therapy or simply a tech-based triage system.

Integration Into the Health System & the “n of 1” Experience

A patient perspective on The Health Care Blog brought up a critical point:

“The first is integration with the rest of the health system. You’d think that a service like Hinge or Sword would work best in some kind of integrated medical group that had some kind of capitated payment, and was able to sub out expensive human PT with cheap virtual PT and see a reduction in expensive surgery as a result. Right now, at least in my n of 1, there’s no way of telling what happened next to the patient post virtual PT program. Did I have surgery? Did I see a surgeon. What happened? No one knows. Presumably if I am an end-payer I would want to know, at least eventually.”

In many digital therapy models, there’s minimal visibility into the patient’s journey after completion of the remote program. Did they require additional interventions or eventually need surgery? Understanding these outcomes is crucial — especially for a payer or employer trying to evaluate the real-world impact and cost-effectiveness of such services.

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The Cost Question: Is $1,400 for Two Months of Virtual PT Worth It?

The same blog post also highlighted:

“The second is on price. Again this is n of 1, but it seems to me that $1,400 for 2 months of virtual PT is a hell of a lot. Assuming Hinge is roughly price competitive with Sword, how long before this gets knocked-off at a much lower cost–especially if you can replace the virtual therapists with AI. We’ve seen a similar cram down in cost in other areas of health AI, notably in ambient scribing. It’s hard for me to imagine that Hinge and Sword can keep this price level. And if they can’t, one can imagine that Wall Street might get grumpy.”

So, if the cost difference isn’t substantial — and sometimes can be more expensive — why not work with a true physical therapist, whether fully in-person or via a high-quality hybrid model that ensures hands-on expertise?

Hybrid Models Offer Real Value — Why Settle for Less?

The good news? Employers and payers don’t need to choose between purely digital or entirely in-person care. A true hybrid solution pairs in-person, hands-on physical therapy with remote monitoring, telehealth check-ins, and digital support. This approach ensures that clinical decisions remain firmly in the hands of licensed professionals, preserving the essence of genuine PT while leveraging the convenience of technology.

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The Investor Angle: Lessons from 23andMe’s Valuation Dive

Healthcare and technology investments can be volatile, and Hinge Health’s upcoming IPO invites comparisons to other once-hot digital health (or direct-to-consumer) companies like 23andMe. Their valuation trajectories highlight just how quickly fortunes can shift:

Hinge Health

• October 2021: Secured a $400 million Series E funding round at a $6.2 billion valuation.

• March 2025: Filed for its IPO in New York. Reported a 33.4% revenue increase (to $390.4 million for 2024) and a significant reduction in net losses (from $108.1 million to $11.9 million).

23andMe

• June 2021: Went public at around a $6 billion market cap.

• 2024: Valuation plunged to about 2% of its peak ($120 million).

• March 2025: Filed for Chapter 11 bankruptcy; co-founder Anne Wojcicki resigned as CEO but remains on the board. Her last offer valued the company at about $11 million.

These wild valuation swings serve as a warning: the health tech space is dynamic and can quickly reprice if revenue growth and profitability don’t match investor expectations. For Hinge Health — and others in the digital MSK world — the question is whether the “digital PT” model can truly deliver sustained value and cost savings, or if it’s just another fad vulnerable to a steep decline once investors demand real results.

Employers, Investors, and Patients: Choose Wisely

As employers and insurers seek to manage MSK-related costs, it’s important to distinguish between a service that truly offers physical therapy and one that merely approximates it. AI-powered chatbots and wearable sensors have their place, but they shouldn’t replace skilled manual techniques and real-time clinical decision-making.

Key Takeaways

1. Physical Therapy Involves Hands-On Expertise: Exercise-alone apps can’t replicate licensed PTs’ ability to perform manual therapy and tailor treatment in real time.

2. Porter’s Five Forces & Substitutes: Hinge Health and Sword approximate aspects of PT but may not deliver actual PT.

3. Integration & Outcomes Tracking Matter: If there’s no post-program follow-up, it’s impossible to see who truly benefits or if surgery was eventually needed.

4. Cost May Not Be a Differentiator: If digital solutions are pricey (or only slightly cheaper), the clinical value add becomes crucial.

5. Watch the Valuations: The rise and fall of 23andMe underscores how quickly the market can correct when expectations aren’t met. Hinge Health’s IPO will face similar scrutiny.

6. Hybrid Solutions Already Exist: Real clinics offer in-person therapy plus digital monitoring — ensuring that patients receive convenience and the professional skill set they deserve.

Ultimately, preserving the integrity of physical therapy is essential. Let’s utilize tech where it helps — remote monitoring, digital engagement, telehealth follow-ups — but let’s not reduce PT to a bunch of exercises delivered by AI.

larry

@physicaltherapy

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