Adding a rehabilitation area to your chiropractic office is a low-cost investment that can provide growth and prosperity

Is your practice in need of a little rejuvenation? Does basic chiropractic no longer challenge you or your business? Bring new energy and growth to your practice by adding a rehabilitation area. The service will not only prolong your contact with your patients, it may also attract new clients who are looking for help beyond basic chiropractics.

According to our Roundtable panelists, establishing a rehabilitation area does not necessarily require a building permit or deep pockets. Through simple steps and some creativity, most practices should be able to accommodate for this service with minimal hassle and funds.

Sheila Hurtt is director of Clinical Health Services Inc, a rehabilitation product company based in Tampa, Florida.

Mark A. King, DC, is a contributor in association with Orthopedic Physical Therapy Products (OPTP), based in Minneapolis. King runs a four-physician clinic with an emphasis on optimizing functional performance for the athlete and nonathlete. He is the current president of the Motion Palpation Institute (MPI) and has been teaching for MPI since 1994. He is on the post-graduate faculty for the Chiropractic Colleges at Northwestern Health Science University and National University of Health Sciences.

John P. Boren, MD, is president and CEO of the Lordex Spine Institute in Houston. He is also the developer of the Lordex Decompression Unit.

Why is it important for chiropractors to offer rehabilitation as an adjunct service?
Hurtt: We have a couple of clients who have very successful and inviting practices that only offer adjustments. However, I think the majority of chiropractors would be more successful, profitable, and marketable if they offered basic rehabilitation services. Plus, rehabilitation services are usually performed without the presence of the chiropractor, which means less work for you!

King: There are quite a number of patients who are simply not going to improve with chiropractic adjustments alone. There is a need to balance adjustments with stabilization/rehabilitation. Dr Stuart McGill, a well-known spine researcher, has stated that the best chiropractic practices “mobilize and stabilize” in combination for a more comprehensive treatment protocol.

Boren: In the research and development of medical devices, machines, and methods to manage mechanical spine pathology, I have arrived at the conclusion that exercise is not an option; it is a necessity.

What are some costs involved in setting up a rehabilitation area in chiropractic practices?
Hurtt: The costs can vary from simple gym balls and elastic bands (low-cost and effective products) all the way to adding additional space in your practice for a Nautilus®-style gym and employing a therapist. I would recommend starting with just the basics and working your way into larger equipment and staff.

King: The DC will need a small amount of space to set up a low-tech rehabilitation area with a minimum of 100 square feet. It can certainly go up from there, depending on how extensive the practice is and its use of rehabilitation. The equipment needed can also vary quite a bit. A small, low-tech rehabilitation section of a chiropractic office can be outfitted for very little money with some Swiss balls, balance boards, weights, or resistive bands. DCs can perform the rehabilitation, or they can hire physical therapists or exercise specialists. Many offices actually train a CA to do the rehabilitation for them, which frees up the DC to perform examinations and adjustments.

Boren: A specialty area in a DC office is as important as an operating room for a surgeon. The attention paid to aesthetics and presentation is all part of perceived value. The doctors should not fail to address the environment that surrounds the equipment.

How can chiropractors promote their practices with a rehabilitation niche?
Hurtt: You can promote this service to all of your referral sources such as patients, athletes, and attorneys.

King: Many people are athletes, and many other people think they are athletes. So making the rehabilitation component geared toward athletes, post-accident injury patients, or workers’ compensation patients are easy. Just utilizing the rehabilitation area as clinically indicated for your patients will make that part of your practice better known. Any marketing of your practice can include the fact that you do rehabilitation.

Boren: Promotion or lead generation is something a doctor should work on. Marketing, advertising, and public relations are three distinct ways to generate leads and should be sharply separated in planning promotion activity. Never rely on one format or media to sustain patient awareness and new patient flow. You should plan and coordinate marketing activities along with timed advertising.

How can DCs build a successful secondary profit center with rehabilitation products?
Hurtt: I believe that the rehabilitation services are the most profitable secondary profit center; you are making money on your therapist’s time. However, there are some great prepackaged rehabilitation products available for specific injuries. They can be of great benefit to your patients as a means to do therapy on their own time as well as an additional source of revenue.

King: The rehabilitation center is like any other component of the practice. If the patients are properly handled, costs are kept down and people get better. Therefore, your practice will naturally grow.

What patient-education tools and products do you recommend for a DC rehabilitation program?
Hurtt: There are several companies that offer effective educational tools and products.

King: One can use charts and pamphlets available from many sources to help educate their patients on proper rehabilitation and exercise.

Boren: A media presentation room that provides DVD educational material is a must for new patients. Using DVD or video tools to explain the purpose of a prescribed protocol simply can’t be beat.

What rehabilitation product or equipment do you recommend, and why?
Hurtt: I would recommend starting with the basics, such as Thera band and Synergy. They are relatively inexpensive and are patient friendly.

King: In our office I like to utilize equipment from OPTP as they have high-quality equipment at great prices. We use the Swiss balls, wobble boards, weights, patient-education booklets, and tapes.

What are the new technological advances that DCs should know about?
Hurtt: Lasers seem to be the new buzz, and they seem to do a great job increasing rehabilitation time.

King: Research is ever growing and expanding. If a DC is reading the current literature regularly, he or she will be kept abreast of new advances in the rehabilitation arena. There are cutting-edge classes available out there, and literature is constantly updating and changing.

Boren: By producing outcomes that are not technician-dependent, DCs have a technological advantage that separates them from the confusion of low back pain management as evidenced in medicine today. The joy of restoring strength and stability and producing decompression by way of a procedure that is technologically proven, is satisfying, to say the least. The increased income makes the process even more satisfying.

Tell us a success story about one of your clients.
Hurtt: We have a client that began as an employee of three different chiropractic clinics. Two years ago, he decided to start his own practice, which grew from a 1,000-sq-ft office offering rehabilitation programs to a 4,000-sq-ft facility. The newly expanded facility offers a fully equipped chiropractic/rehabilitation environment to all its patients.

King: One of our patients came in with low back pain. With the use of adjustments and rehabilitation, her low back pain improved. However as a secondary benefit, her urinary stress incontinence improved. She had been having incontinence since the birth of her second child; and with the use of transverse abdominis and pelvic floor recruitment rehabilitation, both areas improved significantly.

Boren: Many of our doctors used to spend their day lamenting over how it “used to be” back in the 1970s and 1980s. Others have sung the blues about the changes in workers’ comp, managed care, and tort reform. Fortunately, our company’s philosophy has always been “outcome equals income.” This has resulted in the majority of our clients transforming their practice into a new, exuberant, and fun business. They are totally focused on “outcomes,” while reaping the rewards of skyrocketing incomes.

Any last words of advice?
Hurtt: I would recommend starting off slow and simple; make sure the rehabilitation services are a benefit to your current practice.

King: Today’s DCs need to have a rehabilitation area from a clinical standpoint, or they need to have easy referral ability and access to a rehabilitation center for those patients who need it. Adjustments, proper nutrition, a positive mental attitude, and exercise/rehabilitation are all vital components for the modern chiropractic office. My advice would be to get current with the year 2005 and add low-tech rehabilitation to your office. It is inexpensive and clinically very helpful, and it serves as an excellent profit center for your clinic.

Boren: The field of lumbar spine decompression therapy has grown in the past 10 years to a point where it is a requirement as much as a competitive option. Doctors should be aware that a higher price does not mean quality. Remember that you are buying more than the equipment; therefore, integrity, knowledge, and support are extremely important. CP

Julie Z. Lee is a contributing writer for Chiropractic Products.