Incorporating Pilates as a standard treatment option pushed this physical therapy practice to a new level of success.

Cristina Gabor, PT, has turned a personal passion into a living, breathing physical therapy entity. Gabor, owner of two Southern California physical therapy facilities, began taking Pilates classes 6 years ago strictly as a means of self-improvement. There was no ulterior business plan, no reason to believe that an exercise class routinely offered around the world would forever change her approach to physical therapy—just a desire by a respected physical therapist (PT) to present a pleasant physical image to her patients.

“Physical therapists preach fitness, flexibility, physical strength, and endurance, and I believe that comes from example first,” notes Gabor, a native of St Petersburg, Russia. “I also believe you have to try different activities offered out there to intelligently answer questions from your patients.”

As it turned out, Gabor herself posed the most important question. What she discovered, thoroughly by accident, is that incorporating basic Pilates movements into her standard physical therapy practice was an idea whose time had come.

“I couldn’t help thinking that, after doing some of the exercises, ‘Hmmm, I could do this form on my shoulder patients.’ Then, when I did something else, I would say, ‘My God, this would be awesome for my knee people.’ As I went on, I found a way to take many of the Pilates movements and make them part of my rehabilitation. That’s how it all started.”

Laying the Foundation

Giddy with infinite possibilities, Gabor rushed back to her Culver City, Calif, facility, gathered her staff, and announced that Pilates would become a part of the Orthosport Physical Therapy regimen. While studying under famed guru Siri Darma at Life Art Pilates in Beverly Hills, Calif, Gabor “gently” began introducing Pilates to Orthosport’s rank and file. Soon, Gabor made Pilates training mandatory for anyone working at her 4,000-square-foot Culver City, or 2,000-square-foot Hermosa Beach, Calif, facilities. Orthosport also provides physical therapy services at the Beverly Hills Country Club.

“I basically told our 24-person staff, ‘If you do not know how to do this skill, you cannot work at Orthosport,’ ” she recalls. Much to her surprise, the employees showed no resistance. In fact, they embraced the directive.

“My employees were so excited. They were so happy because it’s an additional skill they can learn,” explains Gabor, who immigrated to America in 1985. “It made everybody feel more excited about their job. It provided more variety, more things to do with the patient, and the patients loved it.”

The clerical and front office staffs also were included in the novel approach. Part of marketing the new program, Gabor suggests, was ensuring that those responsible for making initial contact with prospective patients could explain the benefits of Pilates.

“If the staff has to answer questions, I want to make sure they know what we have to offer,” notes Gabor. “I also want them to feel as though they have firsthand experience. They’ll say, ‘I’m not an expert, and I’m not a PT, but I know we offer Pilates. I’ve tried it, and I love it.’ ”

Gabor admits that many physical therapy clinics offer Pilates as an adjunct pursuit not directly connected to the facility. What makes Orthosport’s approach unique is that every patient—except those suffering from hand injuries—is offered Pilates as part of their regular rehabilitation program.

“I found out that my patients who absolutely loved the hands-on massage very often traded it for Pilates sessions because they just loved the one-on-one workout,” says Gabor, whose facility sees about 50 patients per day, 90% of which receive Pilates treatments. She invested an initial $3,000 for a Reformer, enlisted the services of a licensed Pilates teacher, and made it mandatory for all seven of her full-time PTs to learn Pilates inside and out. All told, the cost of implementing the Pilates program included $15,000 for a full range of Pilates equipment and another $3,000–$4,000 for staff training.

 “We have very high standards in everything we do,” explains Gabor. “That’s the best way to maintain quality. When we teach Pilates, we always tell our clients, our patients, that we are not licensed Pilates instructors. We do tell them we’re licensed PTs and have enough knowledge where we can offer them enough Pilates to make them stronger.”

If patients want to achieve a different level of Pilates mastery, or if their goals go beyond what Orthosport’s PTs have to offer, they are referred to licensed instructors. It’s an exciting win-win situation for everyone, maintains Gabor.

“We are using the [Pilates] tool with every patient,” adds Gabor. “It’s a win for us because it’s exciting and it’s active, which we’re trying to promote versus getting a massage and just lying in the room. It’s exciting because patients like it and they can carry it on, and it’s exciting because it’s financially rewarding.”

A change in both the attitude and number of prospective patients was evident within 3 months of Orthosport instituting the Pilates regimen.

“People began calling and saying, ‘We know you offer Pilates. Can you tell us more about it?’ “ Gabor remembers. “When we told them that it would be part of their treatment, they would just come in immediately.”

Gabor has based the success of her Pilates program on what she terms “real and outgoing investment.” First, there’s the “real,” or initial, cost of outfitting the facilities with the latest Pilates equipment. Next comes the outgoing investment, which includes staff training. Gabor sent her physical therapy staff to prescreened Pilates studios to learn only classic training methods that would agree with the facilities’ philosophy of rehabilitation.

“You really have to invest in teaching your licensed PTs,” says Gabor. “They’re the ones who prescribe the exercises, and they’re the ones who can tweak certain things so they’re more applicable to the injured patient.” Aides and support staff also receive training in the safest way for patients to get on and off the Pilates machines. To ensure that all Orthosport personnel are working on the same page, the staff gets a Pilates “tune-up” every 3 months.

Marketing a Pilates Program

Gabor says she took a four-pronged approach to marketing the innovative program. The first step, getting the staff excited about Pilates, was much smoother than she expected. “Everybody was excited about it—the front office, the back office, the people who were doing the treatments,” Gabor recalls. “There was no resistance; in fact, they always wanted to know when the next class would be held.”

Each patient rehabbing at Orthosport was informed he was doing Pilates. A flyer and letter followed to all active patients and their physicians announcing the benefits of the exercise regimen. Then, Gabor invited some of the facilities’ best physician referral sources, and their wives and husbands, to take a class free of charge. “There’s no better marketing tool than treating your physician or a family member,” she admits.

And finally, Orthosport created a Web site and linked its facilities with major Pilates sites and equipment suppliers. “If people asked who they would recommend, we were on the list,” Gabor maintains.

Orthosport cleared another major roadblock when it standardized the way Pilates was used as a physical therapy tool.

“We had to make sure that everyone was doing the same thing,” Gabor relates. “Part of the problem when one PT versus another treats a patient is that they always come up with just a little different technique. In Pilates, we have to stay very, very uniform. We need to document what resistance we use, we need to document how many repetitions, we need to make sure we concentrate on the form. There are issues of consistency and documentation.”

There’s also the issue of billing. According to Gabor, medical insurance companies won’t automatically approve a Pilates session unless the PT can prove its worth in the rehabilitation process.

“If you just write ‘Pilates,’ insurance companies will say, ‘I’m not going to pay for play.’ We have to justify why using Pilates is important. If, for example, you have knee surgery, you really should do all your activities in a nonweight-bearing position. With Pilates, you lie down when you exercise. So you increase your strength and your range of motion without being on your knees. The documentation has to be appropriate as well.”

According to Gabor, what sets Orthosport apart from many other physical therapy clinics is its commitment to offering patients a complete rehabilitation package—at no extra charge.

“We’re different from other physical therapy clinics, because we made Pilates another piece of physical therapy equipment versus a side thing where patients have to come in and pay cash,” Gabor insists.

By taking the high road, she adds, patients are more apt to return later for private sessions. “The approach we took has paid off tremendously,” she notes. “People sometimes cannot pay out of pocket for one-on-one Pilates training, yet by being exposed to it and loving it, they are more likely to come back after their treatments are done to study privately.”

Even though she never formulated a formal business plan, Gabor’s passion has paid off both personally and professionally.

“This is something you must do to constantly stay ahead of the game,” she notes. “I felt using Pilates for my patients was already calculated and in my budget. When we started growing and we began seeing more patients, it just gave me the opportunity to buy better equipment. As a business owner, I believe that every 3 to 5 years you must reinvent yourself. Otherwise, you will be left behind.”

Instead, Gabor finds herself leading the physical therapy pack.

Dave Cater is a contributing writer for Physical Therapy Products.