The first generation of virtual physical therapy startups sold access. The startups gaining ground now are selling a specific clinical model, not just a video call.
"We do physical therapy over video" stopped being a differentiated pitch once every major player in the category could say the same thing. Investors and health system buyers evaluating MSK startups now are asking a sharper question, and it is not about convenience anymore.
Integrated care teams, not a single point of contact
A newer group of musculoskeletal care startups, distinct from the category's earlier convenience first entrants, are building around integrated clinical models, physical therapy paired with prescriptions, imaging, lab ordering, and health coaching under one care team, rather than a single point of contact for exercises alone. That is a materially heavier operational build than the first generation of MSK apps required.
The question these startups are answering is a specific one: what happens when a patient's pain does not resolve with exercises alone, and does this platform actually have an answer, or does it hand the patient back to a fragmented system it was originally supposed to replace. The first generation of MSK apps rarely had a good answer to that question, since their entire model assumed exercises alone would be sufficient for most patients.
A market that has already priced in the easy version
Roughly half of US adults report musculoskeletal pain or injury at some point, making it one of the largest and most expensive categories in healthcare, and one where the "just add video" version of digital health has already been tried and priced in by both investors and buyers.
This is a category, similar to Hinge Health's move into HingeSelect covered elsewhere in this issue, where the largest and most established players are the ones investing in physical infrastructure and integrated clinical teams, not retreating from them. That is a signal about where the category's ceiling actually sits, well above what a purely virtual, video-only model can realistically reach on its own.
The startups building integrated clinical teams are effectively betting that MSK care needed the same depth telehealth eventually needed everywhere else, a real care team behind the interface, not just the interface itself.
Downstream cost data is the real proof point
Watch which MSK startups can prove their integrated model actually reduces downstream costs, imaging, injections, and surgery referrals in particular, compared to the earlier generation of video only competitors. That data point, not funding size, is what will separate the category's next winners from companies repeating a pitch the market has already stopped rewarding.
Also worth tracking is whether any of these second wave startups follow Hinge Health's lead into building or curating physical provider networks of their own, since that would confirm the pattern is becoming a category standard rather than one company's individual strategy.
