I think most doctors want to offer corrective, rehab exercise therapy in their practices. They just don't know what equipment is necessary or how to implement it. Once you have taken your patients through manipulation and mobilization, there are additional levels of health and fitness to take them through with exercise therapy. I know our patients want and expect us to be hands-on doctors. I also know from talking to practitioners from around the country, they think that doing rehab means hands-off. Nothing could be further from the truth. My in-office corrective exercise sessions are spent teaching very hands-on learning experiences with my clients. For more information on the various equipment and exercises I discuss in this article, please visit my Web site at www.drjeffreytucker.com.
There are numerous challenges I hear from doctors that keep them from getting started in providing rehab:
"I have space limitations." Space requirements are simple. Move your treatment table against a wall or turn it upright on its side. It's not about the size of the space. I just need enough room to see how clients move. I evaluate movement, looking for deficiencies or asymmetries.
"I don't know when to do the corrective exercises." My answer to that is "How long does it take you to demonstrate and teach one exercise at a time?" It is generally somewhere between two and five minutes! If you consistently teach your clients one to two exercises per session, then in five sessions they have command of five to 10 exercises.
"I don't have weight equipment." All I need are simple tools to help correct movement dysfunctions. I want to reprogram the bad patterns to function like a good pattern and then add symmetry of strength and stability. I know how many minutes I need to design a workout for clients. I know how to get clients to do this stuff at home. I understand the challenge you have providing passive care and modalities, and transitioning to being active.
"Why should I provide rehab in my office?" When I started providing rehab, I used it to differentiate myself. I wanted to offer weight loss programs. I also wanted to improve posture and help my back pain patients. Eventually, I was one of the first practitioners to offer small, group exercise classes with an emphasis on low back pain. Out of all of the office profit centers, exercise training has a very high revenue potential. Clients want one-on-one motivation. I sell higher quality lifestyle. It's not about fitness. Rather, the emphasis is placed on practical, functional everyday skills. It builds trust and gives me an opportunity to have better communication with clients. Rehab creates value, and it allows me to bond better with clients.
What Equipment Do You Need?
I am a big proponent of bodyweight exercise because it is the best overall type of exercise you can do to burn fat and sculpt your body. It is a hybrid between strength and interval training. Bodyweight training increases fitness, flexibility, stamina, strength and endurance. I can get my clients to a point where they can perform hard exercises like squats, one-legged squats, push ups, supine rows, chin ups and pull ups.
Other than bodyweight, strength-training modes include medicine balls, stretch cords and bands, dumbbells, kettlebells, sandbags, training ropes, free weights and machines. Yoga mats or larger exercise mats make being on the floor more comfortable and give the room the perception of being a work-out area. Foam rolling, one of my favorite low-tech devices, provides tissue self-massage that can be very beneficial for recovery and regeneration. A higher-tech device to help muscles feel better is a deep muscle stimulator. It is great for muscle soreness and knots.
Much more important than concerns about space requirements is the understanding of how to progress clients through functional movements. I know this can be a confusing task. You will need to learn the patterns that cause back troubles and learn functional approaches to movement-based exercise progressions. Having different pieces of equipment will enable you to develop new and different ways to perform functional movements.
[pb]In my examination, I look for compensations and substitutions in the squat test, lunge test, hurdle step, push-up test, active straight-leg test, arm-raise test, and many more. I have gotten good at observing movement patterns by having clients do squats or lunges before I even put my hands on them. This allows me to understand their patterns of movement and use the right equipment to help them properly compensate. One of my favorite assessment tools is the body-composition analysis device. It tells me body fat percentage, lean muscle mass, hydration, phase angle and more.
You can have a very successful exercise practice with resistance bands (especially the ones with handles), a barbell, dumbbells, kettlebells, a sturdy inclining exercise bench, a Swiss ball, a rocker or a wobble board, or a balance trainer. Other tools to purchase include: stacking step risers, which allows for adjustable heights to perform step ups. Bands and tubing offer unlimited options for rehab. These allow for adjusting intensity and speed of movement during resistance training. I especially like bands with handles because they provide smooth, consistent resistance. Gloves that attach to bands make working out with open palms possible and are great for PNF drills. Weighted sticks, also known as aerobic bars or body bars, are great for sit-ups, squats, lunges, presses and more. Stability balls help develop balance.
All rehab exercises can be done on the floor but if you have older and/or obese patients who can't easily get up and down off of the floor, you will need some type of adjustable workout bench. These could cost between $330 and $700. Something else to consider might be a multifunction exercise platform that can be used as a balance challenge, band-strength device and stability ball station.
Abdominal dollies and wheels are fun for clients to use instead of the old-fashioned sit ups on the floor. Mini bands loops are great for lateral walks, "monster walks," and other leg work and shoulder work. The cost of these loops is only a few dollars and these can be given to clients as a low-cost take home exercise device.
Balance boards help improve posture, body awareness, coordination, balance and strength of the stabilizer muscles. Balance training needs to be done at the beginning of a session so clients can come right into the rehab area and begin the session on an rocker board, wobble board or disc. Medicine balls come in various sizes. I have a 2-pound, 4-pound and an 8-pound medicine ball. These are used to practice overhead throws, chest passes, rotatory throws, chops and partner throws or tosses.
Whether you offer personal one-on-training or small group exercise classes, you will provide greater customer service with the proper equipment. In today's economy, we need to make our exercise training services more accessible to clients and know that we are creating a higher income for ourselves. We can make training more fun and challenging when we include people in groups to make it social and entertaining. In a group exercise class, each client pays less than they would for a private exercise session, but the total income per hour can be substantially higher. Group classes can target specific populations, like those with osteoporosis, bad backs, or weight loss. Most chiropractors that take rehab seriously can deliver results with the same effectiveness as a physical therapist.
The demand for rehab services has never been higher. I suggest you learn to incorporate individualized, one to two simple exercise progressions into a longer workout for clients to perform on their own at home. Stay dedicated to helping others change their lives.
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