Based on his own exercise regimen, J. Kenneth Bowman, DC, increases his patient base by recommending rehabilitative and conditioning programs

In the early days of a now 3-decade-old Northern Virginia practice, J. Kenneth Bowman, DC, noticed with dismay that a high number of patients experienced injury recurrence. He attributed the problem partly to the failure of patients to follow through with treatment. Yet, those who did comply also had recurrences. Then, Bowman’s consternation gave way to a solution—to recommend a program of rehabilitative and conditioning exercise for most of his patients.

This program made all the difference. Injury recurrence rates decreased, while follow-through rose dramatically. "Whenever I was able to convince a patient to start exercising," says Bowman, "he or she would almost always take a much more active role in therapy, would be much more inclined to follow through with therapy, and would have far fewer recurrences of injury."

Spread the Word
Importantly, too, this same patient would also be more prone to refer family and friends to Bowman, a solo practitioner in the District of Columbia suburb of Vienna. "The satisfaction my patients experienced increased," he says, "which led them to want to tell others about me."

J. Kenneth Bowman, DC, in his Vienna, Va, office.

Today, Bowman’s case files bulge with documented good outcomes for patients who have followed his exercise advice. Take, for instance, a patient named Joan, who was 50 at the time she sought Bowman’s care 15 years ago, suffering osteoporosis. "Joan had a small frame and a family predisposition to osteoporosis on top of that," Bowman recounts. "When I first saw her, she was already rapidly losing bone mass, which was the source of the back pain she had been experiencing."

Joan responded well to chiropractic adjustments. Bowman next suggested she start a rehabilitative exercise program consisting at first of walking, followed later by swimming, and then weightlifting. "Her bone density has since greatly increased," Bowman says. "She’s really buff-looking, too and doing things she never dreamed she would be able to, like traveling extensively around the world."

Off and Running
The idea to recommend rehabilitative and conditioning exercises as an adjunct to the types of chiropractic-oriented stretching routines conventionally prescribed during treatment popped into Bowman’s head soon after he took up running in the mid-1970s. "I was seeing a lot of benefits to running, so I thought, why not advise my patients to try it themselves, or maybe some other form of aerobic exercise suited to their interests and capabilities," he says.

Bowman explains he never puts patients on a rehabilitative and conditioning exercise program right off the bat. Step one is to correct the cause of injury, a process that entails a period of refrain from physical activity in order to give the body time to heal. "Not until the patient is functioning in a more normal fashion do I start talking about rehabilitative exercises," says Bowman. "But once the patient arrives at that point, the sooner he or she gets started with rehabilitative exercise, the faster the patient sees response."

Bowman adjusts patient Kathleen R. Walsh.

Bowman likes patients to initially engage in exercises that feature not only stretching, but also strengthening motions. "Once the patient is tolerating those, we’ll go to a more aggressive flexion control and strengthening program," he says. "Along with this, we’ll seek to introduce some type of aerobic program. Later, after the patient is tolerating this, we’ll talk about increasing the aggressiveness of the aerobics to something that will bring the heart rate up for 20 to 30 minutes, three or four times weekly. Lastly, we’ll vary the aerobic program and then initiate resistance training or strengthening, unless the patient is under high school age and not already involved in athletics."

Mostly, Bowman steers patients toward outdoor exercise. However, he also urges them either to enroll at an indoor health club or, if they have the space at home, equip a spare room, basement, or garage with aerobic exercise gear and, if possible, weights. "Being able to workout inside is important because, here in Northern Virginia, the winters are cold enough and the summers smoggy enough to discourage people from exercising at all if their routine is conducted entirely outside," he says.

For many patients, exercise—breathing hard and breaking a sweat—is something totally alien, to be avoided like the plague. Yet, Bowman is often able to convince them to engage in it. "I continually talk to them about the value of aerobic exercise and resistance training," he reveals. "The first words out of my mouth will be, ‘How are your exercises going?’ I just keep at them, keep reinforcing this idea that they need to start exercising. Sometimes it takes years to get through to them that this is something they very much need to do.

"But half the battle is getting them to take that first step. Once they do something—light walking, even—they start to feel better. And, generally speaking, once you get them feeling even a little better, it’s easier to take them to the next step, then the step after that, and so on. Before you or they know it, they’re faithfully adhering to a good, solid exercise program."

Interestingly, few patients who decline Bowman’s repeated entreaties to start an exercise program object enough to want to take their business elsewhere. Says Bowman: "Human inclination might be to say, ‘Hey, every time I come in here Dr. Bowman talks to me about exercise and that’s something I’m not interested in, so I’m not going to be his patient anymore, and then I won’t have to put up with it.’ But that’s not what usually happens. Instead, it registers that I’m encouraging them to exercise because I really do care about them and want them to be well and fit. People want to be treated by a doctor who they know is sincerely interested in them. That’s what they find here. That’s a big factor in why they stick around. They really don’t feel anyone here is haranguing them about exercise."

Although Bowman brands himself a chiropractic generalist, more than 90% of his caseload involves treatment of musculoskeletal problems, notably repetitive-motion injuries. "The single greatest cause of injury I see is the result of a sedentary life- and work-style," he says. "That’s a reflection of the fact that, in my market, everyone works in offices and, in many of those offices, the ergonomics are quite poor."

The Personal Touch
He treats them at his Vienna office, a 1,200-square-foot space he owns in a low-rise building that caters to professionals and health care providers. The facility—decorated to look more like a home than a clinic—has four treatment rooms and a conventional assortment of diagnostic tools. Therapy equipment includes electric stimulators, hydrocolators, cold packs, and ultrasound.

Shipp treats Walsh with ultrasound therapy.

"I’ve outfitted each room with the same sets of equipment to prevent workflow bottlenecks from developing," Bowman shares. "If you have just one piece of a particular type of equipment, you end up with patients having to wait around for it to become available. That doesn’t happen if you’ve got that same piece of equipment in each room."

Bowman also maintains a small inventory of nutritional supplements. "Nutrition counseling is part of the package of care I offer—I see it as an essential part of getting a patient safely and successfully into exercise and to producing a better response to the workout," he explains. "I’ve found that the best way to introduce a patient to a supplement I’ve recommended is to have a supply of that product on-hand. If I make the recommendation and tell the patient to go to a retail outlet to obtain the product, chances are that he or she will put off doing so for a long while and may in fact never get around to buying it."

Assisting Bowman is a staff that includes two chiropractic assistants, an office manager, and his wife, Christine. "Christine has been with me for 25 years," he says. "She’s qualified to do any task in this office, with the exception of adjusting patients."

As for marketing, Bowman concentrates on encouraging referrals. A favorite technique is to write personal notes of appreciation to those who send in their family and friends. "People like when you acknowledge their kindness," he says. "By taking the time and making the effort to write a thank-you letter to them, they’re then more inclined to give me additional referrals." Further, when patients reach the point that they are responding well to treatment, Bowman issues a letter inviting them to tell relatives, coworkers, acquaintances, and intimates about chiropractic—what it is and how it helped.

Naturally, not every marketing technique works for Bowman. He recalls the fiasco that resulted when he made use of an address list supplied by one particular direct-response consulting firm. Bowman mailed a discount coupon for his services to people who were new to the area—at least they were new according to that address list. It turned out, though, that many who received the coupon had been living in the area for some time and were in fact already patients of other chiropractors. It was embarrassing, but, fortunately, Bowman was on good terms with those other practitioners, so everyone saw the incident for the honest mistake it was.

Under New Management
Bowman has enjoyed a relatively trouble-free practice since first opening his practice in 1970. That, no doubt, derives from his good fortune in being able to latch onto a terrific mentor—his father.

"My dad was a great chiropractor, the same as his own father was," Bowman beams. "Because of that, I inherited a lot of insight about the business of chiropractic before I even got started in practice. And it helped that I spent the first couple of years as a chiropractor working alongside my dad, who was very successful."

But one thing Bowman’s father could not prepare him for was the advent of managed care, a largely unknown system when the elder Bowman was in practice. "If I had to name the biggest single problem I’ve encountered, it would have to be dealing with managed care," Bowman confides. "Seven years ago, managed care was just beginning to make big inroads in this market. In response, I joined virtually every managed-care organization my patients belonged to, which were quite a few. Before long, I was generating tons of referrals from PPOs. But then I awoke one day to discover I had a practice that was almost entirely dependent on managed care.

Thompson and Lambert discuss a future appointment and nutritional supplements with a patient.

"That’s when I learned how disastrous it actually was. Not only was it very difficult to get paid, but my patients were not responding well to treatment since there were PPO-imposed guidelines as to what I could and couldn’t do as a care provider. They were trying to dictate care. For me, that just didn’t work."

Bowman promptly quit all of the PPOs he had joined. That move hurt him at first, but he quickly recovered. Today, 40% of Bowman’s patients pay cash for his services, while 35% rely on indemnity insurance, and another 15% on Medicare. Workers’ compensation and personal injury claims make up the remaining 10%.

Always confident he would be a successful chiropractor, Bowman, in his first years of practice, had visions of early retirement—even had a spot in the Florida Keys picked out. But a funny thing happened on the way to that golden life—Bowman realized that his work as a chiropractor was proving to be much too enjoyable to give up prematurely. Or ever, for that matter. "I’ve since accumulated the means to retire early if I should desire," he says. "That’s not my plan, though. What I want to do now is work as long as I possibly can. Seeing patients get well, seeing them become strong and fit is extremely satisfying. I just don’t know that I could give this up."

About the Author
Rich Smith is a contributing writer for Chiropractic Products.