This New York DC finds success with Pilates, which helps to hold adjustments longer and increases patient compliance

Howard S. Sichel, DC, might just possess the perfect practice—lifetime patients, most paying cash, but needing adjustments far less frequently than ever (and involving low-force technique at that); attractive offices at prestige addresses in Manhattan, Chicago, and Los Angeles; periodic overseas travel.

Sichel says he owes this in no small measure to a deceased therapist and inventor from pre–World War I Germany. What Sichel has done is integrate within his practice the classical exercise system, devised in about 1910 by Joseph Pilates, who experimented with bedsprings and floor mats as a way to rehabilitate injured soldiers, and recognized today as the hottest body strengthening-and-conditioning methodology.

“Pilates is so popular because it works,” Sichel enthuses. “The exercises strengthen the core musculature to take the pressure off the lower back. It reduces pain, improves performance; it’s the most unbelievable spinal rehabilitative exercise system ever developed.

“And it works 100 times better if it’s performed in conjunction with visits to a chiropractor.”

Healing Power
Something else that works 100 times better is the chiropractic treatment itself.

“Pilates exercise causes adjustments to hold longer and that gives compensatory weaknesses a real chance to heal,” Sichel explains. “With Pilates, I see changes in people that are the most dramatic of any. It doesn’t matter whether they’re 20 years old or 80; the expectations might be different for different ages, but the results are almost invariably dramatic.”

As Sichel sees it, Pilates in the right circumstances contributes more to the actual healing of chronic weaknesses over massage therapy and even physical therapy as adjunctive interventions.

“Physical therapy is great for enabling people to get functional after traumatic injury, but physical therapy and massage therapy, those are things somebody must do for the patient,” he argues. “Pilates, by contrast, is something the patient learns to do for himself or herself. And that’s part of what makes Pilates so excellent for patients—it gets them taking an active role in their care. Unless that happens, they never get well. You can give them the greatest adjustment in the world, but unless they do something to help hold that change in their body structure, no real healing will occur.”

Sichel, president of Manhattan-based Sichel Chiropractic & Power Pilates™, is reasonably certain he was the first American chiropractor to combine adjusting with Pilates exercise, having been a Pilates advocate since 1982. He remembers how colleagues cautioned him back then that his practice would suffer were patients to get better, faster, because of the incorporation of Pilates in their care.

“Their concerns were unfounded,” Sichel says. “I knew that I would be flooded with new patients if I could develop a reputation for having to adjust each person less—in an acute phase and then provide just monthly maintenance afterward instead of having to adjust 40 to 60 times a year. And that’s exactly what happened.

“Giving patients the tools to actually heal their weaknesses reduces the necessity of constant chiropractic care and enables the chiropractor to have a much greater impact on a person’s health and recovery.”

The Power Pilates staff (L–R): Carrie Clark, Power Pilates teacher trainer; Jeff Elsass, senior teacher; Howard S. Sichel, DC, owner and president; Erin Hurlburt, senior teacher; Susan Moran-Perich, co-owner and dIrector; Kathleen Smith, senior teacher; and Dana Leigh, senior teacher trainer.

Pilates Makes a Practice
It was because so many of Sichel’s patients required such intensive and prolonged adjusting that he first turned to Pilates.

“I had been in solo private practice only a year and was confident in my ability to correctly diagnose patients and get them out of pain, but I began to grow frustrated over the need for patients to keep coming back in for very similar weaknesses,” he recalls. “No matter how many times I got on the floor and taught them what to do physically, it just wasn’t enough.”

Propitiously, it happened that among Sichel’s patients were quite a few professional dancers. One of them, an older woman with an astonishingly toned body, revealed to Sichel the secret of how she kept herself in such youthful shape—Pilates. “I had noticed that the corrections I achieved with her always seemed to hold longer, and it occurred to me that perhaps her Pilates regimen had something to do with it.”

Curious to know more about Pilates, Sichel paid a visit to the leading Manhattan studio where the exercise regimen was taught. There he met the teacher, Roomana Kryzanowska and, in the course of discussions and demonstrations, Sichel realized how invaluable Pilates exercise could be to chiropractic patients from all walks of life. Not long afterward, Sichel began sending limited numbers of his patients to the studio for Pilates sessions.

Three years later, Sichel decided to undertake formal training in classical Pilates, making it an official adjunctive therapy in his practice by 1987. The Pilates studio to which Sichel had been intermittently referring moved right next door; so conveniently accessible now was the studio that he began referring his entire practice there.

Patient success stories quickly piled up thanks to the Pilates adjunctive. Sichel even has one of his own. “In 1997, I was involved in a serious accident that resulted, 10 days later, in a rupture of my disc at L5-S1,” he tells. “After the searing pain subsided, my Achilles reflex was gone, leaving me with a bad case of drop foot because a 2.5–cm piece of disc had wrapped around the S1 nerve route. Slowly, my calf was atrophying.”

Back surgery helped partially restore the reflex, enough that Sichel felt able to return to practice. But, after 7 months of subjecting his body to the strains involved in administering adjustments day in and day out, the problem recurred. Sichel’s surgeon told him to lay off work for at least a year to heal. Reluctantly, Sichel assented and found a colleague to whom he could temporarily hand over his practice.

While waiting for his back to mend, Sichel stayed in New York and engaged in Pilates exercise daily. He also used the time during his recuperative sabbatical to oversee the transformation of a portion of his office into a Pilates exercise studio (shortly thereafter he opened a second facility, a combination chiropractic office and workout space in another part of Manhattan), where he trained chiropractors and others to be Pilates teachers.

Since that time, Sichel has had to be adjusted at least once a month. But he also performs a Pilates routine two to three times a week between adjustment visits. “I’m my own best advertising for Pilates,” he says.

Today, in addition to the practice offices, Sichel, through the auspices of his Power Pilates company, now owns six Pilates studios across Manhattan, plus two more in Chicago and one in California. He also has formed teacher training affiliations with 15 independent Pilates studios in locations coast-to-coast.

Says Sichel, “In our owned as well as affiliated Pilates studios, we develop relationships with chiropractors in the neighborhoods where those studios are located and make referrals to them. Those chiropractors, in turn, refer to the studios. “Pilates has got to be the greatest inter-referral source out there.”

Meanwhile, Pilates studio operators who are not affiliated with Power Pilates seek out Sichel for instruction in anatomy and kinesiology and teaching certifications so that the exercise routines they impart to their patrons will be more effective. “When we provide training to Pilates teachers, we also instruct them in formalized guidelines to help them and their studio staffs identify clients who are candidates for referral to a Pilates-knowledgeable chiropractor,” Sichel notes.

Try This at Home
As an exercise system, Pilates primarily involves mat work. Because beginners often have trouble performing the precise movements required in order for the exercises to be effective, machines were devised to help them develop the needed muscle strength and control.

Sichel’s facilities are outfitted with both mats and machines. He also supplies his patients with 15- and 30-minute-a-day Pilates routines they can perform at home.

Those at-home workouts form the basis of a collection of Pilates videos now being produced by Power Pilates. Sichel says pain-management specialists and the chief of orthopedic surgery at a major New York City hospital have endorsed them, as has the chairman of the physical therapy department at one of New York’s leading universities.

The videos, which separately feature beginning, intermediate, and post-natal Pilates exercise routines, will be sold through chiropractors. “Each video carries a suggested retail price of $19.95, but chiropractors are able to obtain them at the wholesale price of under $10,” says Sichel, adding that doctors also will receive a kit of marketing support materials that include eye-catching displays and point-of-purchase materials to help build demand among patients. “One of the reasons for the videos is to put Pilates information in the hands of chiropractors, who haven’t in the past had enough information about Pilates to really be able to tell their patients about it, let alone begin offering it to them.

“The other reason for the videos is to help chiropractors increase their practice revenues. In this era of managed care, one of the most important things a chiropractor can do is develop adjunctive therapies. In my opinion, you can do no better in that regard than Pilates.

In addition to selling videos, Sichel’s organization certifies Pilates instructors worldwide. “We’re now the largest teacher-training organization in classical Pilates,” he says.

The certification program, which Sichel cocreated, emphasizes injury protocol and covers anatomy, physiology, kinesiological applications for Pilates work, and philosophy. “Our latest offering,” he says, “is a weekend-long certification process in which we train chiropractic assistants and massage therapists to teach a very basic, in-office mat program for patients.”

More Power to Patients
Although Sichel’s enterprise goes by the moniker Power Pilates, he assures it is not called that because his brand of the Pilates exercise system is any more strenuous than the others. Rather, the name is meant to call to mind the healing power that Pilates promises to deliver.

Sichel assists client Theresa Castaldo in the first seated exercise in the classical beginner system to ensure proper core connection and release of the lumbar muscular compression. Flat back with awareness of opposition upwards and down thorugh the sit bones is critical.

And, while Power Pilates is enjoying enviable growth, Sichel has not made the company his sole focus. He continues to practice chiropractic. “Currently, my practice averages 40 to 75 new patients a month, counting new Pilates clients as well,” he says.

In terms of income, the practice has shifted from insurance based to cash based.

“This has happened due to the involvement of the patients in their own health care as made possible by Pilates,” says Sichel. “They come here, expect to get better, and work at it, so they’re willing to pay for it.

“But we still take insurance—about 30% of the practice is PPO. Also, with Pilates being done in my offices as an adjunctive therapy, we can get reimbursed for it. There are a number of different codes we can use when submitting claims.”

Try as one might to convince him otherwise, there is no shaking Sichel of his conviction that the combination of classical Pilates with chiropractic care amounts to a winning match.

“It’s a truly brilliant and inspiring pairing, it really is” he says. “I’m going to continue offering it because it gives people a far greater ability to heal themselves in conjunction with their chiropractic visits. It’s all about teaching them how to move, how to exercise, how to strengthen their core musculature in order to support and take pressure off the spine, decompress the spine, make the spine long and supple, and improve posture.

“People look at chiropractic differently because of this. So do chiropractors, once they understand and appreciate how it can make their practice better.” CP

Rich Smith is a contributing writer for Chiropractic Products.

Sichel can be reached via the Web: www.powerpilates.com.