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June, 2010

Exercise Your Options In Outfitting Your Office For Rehab Care

By Jeffrey Tucker, DC, DACRB

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

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.

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