Post-rehab programs present limitless opportunities for practice owners and Pilates instructors alike.

by Dawn-Marie Ickes, MPT, PMA-CPT

Integrative Wellness is an emerging niche where healthcare dollars are being spent by the billions. Physical therapy practices are creating new models for rehabilitation and whole body health, which reach beyond the short-term outcomes of working within a four- to six-visit limit for rehabilitation. As we see a shift in accessibility of high-quality healthcare and corrective exercise instruction for everybody, there exist opportunities for personal trainers, yoga teachers, and Pilates instructors to work with rehabilitation professionals to grow and utilize their background, expertise, and commitment to wellness to bridge a gap between rehabilitation and wellness. Practices are utilizing high-quality movement educators to support post-rehabilitation transition, medical fitness, and wellness programming. This focus toward improving overall client health not only creates better outcomes by innately driving client compliance and independence, but it also creates options for increasing revenue.

Integrating Pilates equipment and programming into a physical therapy practice is a simple cost-effective way to diversify a practice and introduce the concept of the physical therapist as a wellness practitioner and preventative health expert.

Recognizing the Potential for Pilates in a Practice
One very important consideration is the location of the practice—this could be the difference between success and failure. The socio-economic target market, current client base, and competition are necessary to consider in your needs assessment. The determination of whether clients will pay for services not covered by insurance is imperative, and, if so, how much are they willing to pay. Creative programming can create opportunities for any demographic as long as there are metrics established early on to test the market, and analyze spending habits, budgets, and perceptions of value around health and wellness.

What percentage is insurance? Cash pay? Talking to clients and finding out how they spend their time and energy can provide vital information. Considering the demographics of the practice’s clients, pricing, programming, unique services, and how the practice will brand its approach to teaching Pilates all come into play. Highlighting a rehabilitative specialty with an integrative wellness approach to treating “the whole person” is one example. Others include injury prevention programming designed to target local athletes and/or performing artists, offering postural assessment clinics, or health lectures.

Pilates as a method is a great choice for those working in rehabilitation, for post-rehabilitation, and then as a transition to fitness and sports specific training. It has proven benefits for every population from pediatric to geriatric, from orthopedic to neurological and everything in between. Having the direct link between a PT practice and post-rehabilitation/fitness programming is simple, smart, and sound.

Equipment and Space—The sky is not the limit!
Once a practice has decided to add Pilates, the next step is identifying what equipment options the current clinic footprint will support.

The Reformer is the most universal piece of Pilates equipment and presents minimal risk for the development of cash-pay programming. Practice owners can start small, determining how best to incorporate Pilates programming into their clinic setting, and develop an overall plan for the business. They also can make the commitment to educate their current PT staff while mapping out the longer term plan for more equipment and the expansion of the practice’s offerings.

Smaller equipment such as the Wunda Chair and Pilates Springboard provide a wide range of options for private and class programming without taking up a lot of space. The footprint of the Wunda Chair’s versatile offspring, the EXO Chair, is roughly the same size as a water cooler and offers resistance options not previously offered from its predecessors. The option of functional resistance bands creates seated and standing options incorporating upper and lower extremity strengthening while challenging proprioception, deep abdominal work, and postural awareness all at the same time. Its smaller profile, lighter weight, and stacking options support its use in private and small group settings.

The Springboard represents low cost with high return. A facility can be outfitted with six Springboards for roughly the same investment as one large piece of equipment, and it occupies zero floor space. This piece is highly versatile and offers the ability to instruct private sessions, semi private, and group equipment classes. In locations where traditional exercise classes are offered, the Springboard can add a new dimension to space utilization by introducing the equipment classes without the large start-up costs.

The concept of starting small, while the larger plan is being mapped out, is an excellent way to introduce Pilates programming to the existing client base, and build excitement and enthusiasm around the wellness programming to come. Small yet specific programming can be very profitable with reduced risk.

Pilates programming also can create a profit center that supports healthcare providers who are exploring ways to differentiate themselves and create a competitive practice, and individuals who do not have coverage for their rehabilitation needs and cannot afford cash-based physical therapy. In a traditional physical therapy setting, patients are discharged with a home exercise program with the goal of their compliance keeping them healthy and pain free. By integrating Pilates into the practice model, the client can be retained in the business, be supported in the move toward independence, and have a place to check in sooner rather than later if they begin to notice a change in function. Clients can access highly specialized corrective exercise instruction in order to maintain their functional strength for their activities of daily living. As a business, the practice can target/access a new and expanded client population. Direct Access has created greater ease for clients to move back and forth between the two areas within this hybrid business model.

Benefits of Creating an Additional Profit Center
1. Patients have somewhere to go after discharge
2. Opportunities for cross-marketing within the business
3. Encourages independence and autonomy
4. Options for community outreach
5. Utilize multitasking equipment for post-rehabilitation and fitness
6. Job creation

Patients are referred to the physical therapy department and are seen for all types of rehabilitation needs. They are introduced to the Pilates post-rehab services at day one, where the seed is planted.

An introduction into what Pilates is prior to discharge can be established early on in the rehabilitation process by simply integrating one or two Pilates exercises into the treatment plan based on areas of need. The introduction of equipment into patients’ current treatment plans exposes them to the benefits of Pilates early on in the rehabilitation process and the experience can make the idea of practicing Pilates less intimidating.

Within this framework, discussing programming options for a “post-rehabilitation transition” package for discharging clients can be offered at a discounted rate. “Specialty population” Reformer classes, such as Belly Bump Basics, Balance For Life, or Healthy Hips & Spines guided by a physical therapist or specialty trained Pilates instructor, can increase participation as well by providing specially designed programs aimed at targeting the challenges each of these groups may face. The client is then able to complete the course of treatment with the idea they will see a Pilates instructor for post-rehabilitation corrective exercise progressing to pure fitness—all within the same facility. The physical therapist and Pilates instructor are able to communicate and fully assist each client as they move through the process.

Establishing a reasonable time commitment when transitioning the client is one key element of success. If the client is accustomed to coming 3 days per week, their Pilates instructor will be able to work with them to establish a realistic frequency and affordability when scheduling their post-rehabilitation fitness service(s). If they have a difficult time making it to more than one appointment per week, suggesting unattainable and unrealistic time commitments can result in a poor transition and compliance. The cost can be structured to provide high-quality corrective instruction, which is less than the co-pays paid while receiving insurance-based physical therapy.

Scenario 1: One private and two Mat classes a week (cost for client is $90 per week).
Scenario 2: Two equipment classes and one Mat class per week (cost is $60 per week).
Scenario 3: One equipment class and two Mat classes per week (cost is $52.50 per week).
Scenario 4: Monthly membership of $40 per month and choose one class or a private session per week (cost is anywhere from $25 to $80 per week).
Scenario 5: Two Mat classes per week at $15/class.

Identifying the Opportunity Potential
A conservative way to estimate the potential of adding this type of programming is to review your current client base and identify what percentage of discharged clients return within 18 months, and/or send a friend or family member, and calculate what 40% of that number would be if they stayed within your practice and participated in any of the five scenarios above for 6, 12, and 18 months.

If the programming and services are outlined clearly and offer simple options for the transition from physical therapy to post-rehab fitness, clients will gravitate toward staying committed to a more functional, healthy lifestyle.

Clearly outlining the costs of services and client options for combining services to meet their short and longer term needs keeps expectations very clear. For example, if a client needs 30 minutes of physical therapy for a quick tune-up, as well as a private Pilates session, and takes one class each week, they are able to identify the costs associated with each of those services and plan accordingly. The option for combining services based on what is necessary and important for the client’s overall health and well-being further supports the practice’s team approach and genuine commitment to a client centric environment.

Connect, Share, and Care
When clients experience success, the human tendency to share their positive experience is the single best form of referrals and marketing a practice director or owner could ever hope for.
Offering post-rehabilitation programs is an untapped opportunity for practice owners and Pilates teachers to create increased revenue, community outreach, job stability, and a service that will help people of all ages throughout their lifetime. Physical therapists hold the key to creating a continuum of healthcare. With healthcare changing at rapid speeds, clients need options, and affordable ones within their reach. RM

Dawn-Marie Ickes, MPT, PMA-CPT, holds a BS in Biology from Loyola Marymount University and a Master’s degree in Physical Therapy from Mount St Mary’s College. She is the owner of Evolve Integrative Wellness Physical Therapy & Pilates, specializing in corrective exercise for sports performance, integrative wellness, and dance medicine. She is adjunct faculty for California State University, Northridge, and Mount St Mary’s College DPT programs. For more information, visit or email [email protected].