Cash-based programs offer a new window of opportunity for physical therapists and patients

By Christine Romani-Ruby, PT, MPT, ATC, PMA(R) CPT

There is no doubt aging bodies will need maintenance and a specific exercise plan to remain active and healthy. The plans will have to take into account chronic conditions such as multiple sclerosis, spinal stenosis, osteoporosis, arthritis, and other limitations brought on by aging, such as conditions that affect balance, vision, and sensation. If left to a traditional exercise program, many of these clients would be destined to pain and failure. Therefore, a need is growing for an exercise program that focuses on functional goals, uses props and equipment for support and instruction, and essentially does no harm to existing conditions.

Physical therapists have the unique skills and tools to meet this demand, and in this role they will change focus from relieving pain to creating activity that does not increase pain, from increasing strength and range of motion to maintaining strength and range of motion, from short-term goals related to basic functions to long-term goals related to life goals and overall wellness. These services will be cash-based and must be creatively affordable and marketable. This service could be provided in a stand-alone facility or added to a traditional physical therapy practice.

YURBack: A Program for Chronic Conditions

PHI Pilates, Pittsburgh, has created such a stand-alone program called YURBack. This program is directed to clients who have chronic back conditions such as spinal stenosis, sacro-iliac dysfunction, pelvic floor dysfunction, rheumatoid arthritis, osteoporosis, or osteoarthritis, and who have completed physical therapy. The concept of the program is simple: “Get a great workout that won’t increase your back pain.”

Clients who join the program begin with an evaluation by a physical therapist for a fee of $100. In that evaluation, the client’s history is discussed to assure he or she is actually in the postrehabilitation phase, and that any possibility for differential diagnosis is ruled out. Then, a postural and movement assessment follows to determine if the client can progress into the class setting. At the completion of the evaluation, the physical therapist determines whether the client will need private sessions or can go directly into the class environment. With the YURBack program, this is generally determined by the ability to hold a stable spine position.

If the client still requires either specific spine flexion or extension to decrease pain symptoms, then that person will be limited to private sessions ($65 to $80 per visit) and a home program guided by a 30-minute DVD that uses small props such as a foam roller, ball, or resistance band that can be used at home. Foam rollers and balls are available from companies such as OPTP, based in Minneapolis, and SPRI Products Inc, Libertyville, Ill. A number of companies, including the Warminster, Pa-based Stretchwell Inc, and Akron, Ohio-based The Hygenic Corporation, also offer resistance bands for fitness.

Either a physical therapist or a physical therapist assistant instructs the private sessions with the overlying goal of the maintenance of a stable spine during exercise. When the client achieves this goal, he or she is progressed to the class setting. Some clients are able to go directly from the evaluation into the class setting because they have the ability to stabilize to avoid an increase in pain.

The YURBack classes cost $27 each and are instructed by a physical therapist or physical therapist assistant. They consist of a 50-minute workout that maintains the client’s spine in a stable neutral position. The class size is limited to seven participants, and the instructor does not perform the exercises with the clients. The instructor is actively cueing and teaching proper movement as well as answering any questions about discomfort. Exercises are geared to challenge the core and produce normal, healthy movement patterns with the use of the Pilates Reformer, Pilates tower, TRX straps, and smaller props such as the Pilates ring, overball, resistance bands, foam rollers, Pilates spine correctors, and Airex balance and kneeling pads, which are available from the Magister Corporation, Chattanooga, Tenn.

TRX straps are available from Fitness Anywhere LLC, headquartered in San Francisco, while companies such as Balanced Body, Sacramento, Calif, and Peak Pilates, Venice, Calif, distribute the Pilates Reformer and tower. Peak Pilates and Balanced Body also offers smaller accessories for Pilates, including Pilates rings. The class is led at a slower pace with a great deal of instruction about the purpose and benefit of each exercise, as well as the appropriate work or discomfort level that should be felt by the client.

Positive Feedback

Most program referrals are gained from PHI Pilates’ own clients, but traffic from other referral sources such as nearby physical therapy clinics and orthopedic physicians/surgeons is increasing. The clinic has not done any advertising, and currently conducts five postrehabilitation classes per week. Clients have offered considerable positive feedback, and the most attractive feature appears to be the time spent with—and education provided by—a physical therapist.

As one client says, “I always feel better when the teacher (a physical therapist) reassures me that a discomfort I am feeling is just workout pain and not my back pain.” Others are most impressed by the educational component. “The exercises all have goals to healthy movement, and the teacher (a physical therapist) educates me throughout the whole class.”

Guiding Clients to Wellness

Other positive features have been the camaraderie that has developed among clients. The classes are like a small support group where clients share their accomplishments and histories. It can be observed that clients are actually more willing to try new movements as a group, especially if it involves a new prop such as a ball or ring for guidance. It seems to offer them a new confidence and excitement for exercise. Email is also used to keep in touch with each client after class to reassure them discomfort is normal, or advise when it is not.

Clients appreciate knowing they can ask questions and receive advice. Many of the small worries clients express are those such as, “Should I go for a walk?” and, “Can I wear heels to my daughter’s wedding?” They worry that any movement they do will reinjure their backs and increase their levels of pain.

A New Healthcare Opportunity

As a physical therapist, providing postrehabilitation classes has grounded my cash-based practice, and education continues to be my most valuable asset. I can provide a needed service at a reasonable price that continues to grow in referrals. The variety of conditions keeps me actively challenged as a physical therapist to continually create new choreography for healthy movement patterns while keeping clients from positions that may increase their pain. PTP

Christine Romani-Ruby, PT, MPT, ATC, PMA(R) CPT, is a licensed physical therapist who owns PHI Pilates, a cash-based private practice in Pittsburgh. She is an international presenter and the founder of the PHI Pilates teacher trainings and YURBack program, as well an associate professor in the Department of Exercise Science and Sport Studies at California University of Pennsylvania. For more information, contact [email protected].