Expanding Your Offerings

How do you open the door to more clients at your rehab and physical therapy clinic? Try offering performance enhancement services—and watch both your patients and your staff flourish.

By John Honcharuk

John Honcharuk, ATC, CSCS, is Director of Sports Enhancement Programs and Manager at the St. Charles, Ill., facility for Athletico, Inc.

Training & Conditioning, 14.8, November 2004, http://www.momentummedia.com/articles/tc/tc1408/offerings.htm

Three years ago, a couple of adult distance runners who’d been rehab patients at my Chicago-based company, Athletico, asked for a favor. They approached our president, Mark Kaufman, about using one of our clinics to stretch before a big race and to ice down afterward. Since they were already clients of our rehabilitation and physical therapy services, Mark, wanting to provide good customer service, said yes.

But Mark soon realized there was potential far greater than a one-time favor. He saw hundreds of athletes, with a fairly high level of commitment to their sport, in need of sport-specific training once their rehab programs ended. Knowing that many of them would turn to "fitness" coaches for help, it occurred to Mark that we have the certified expertise these customers were seeking and, furthermore, we have actual experience with real athletes on real teams.

Many of our therapy and rehab patients are active athletes at various levels, so why not try to capture them as training clients as well? Many of our employees have experience working with competitive athletes, so why not tap their expertise in this area?

So that’s exactly what we did. Now, sport training and performance enhancement are significant parts of Athletico’s business. Some locations in our company’s network of clinics produce definable profits from these services, and all of them generate referral business to our rehab and therapy lines. Performance enhancement is fully integrated into our menu of services, contributing to and benefiting from our therapy and rehab offerings for individuals, teams, and organizations, as well as our outreach athletic training in area high schools and colleges.

Overall, the idea of expanding our rehab clinic to include performance enhancement services has worked extremely well. I don’t claim to have all the answers about how to set up a performance enhancement program, and it remains a work in progress, but here’s how we did it.

Who Are Our Customers?
Company-wide, the majority of our sport training and performance-enhancement clients are high school athletes who want to improve and who know that the equipment, space, and expertise their schools offer isn’t enough. Some come with teammates, some come with friends, and some come alone. And a handful of high school coaches have essentially turned over their strength and conditioning programs to us so they can clear one thing from their already-full plates.

The rest of our performance-enhancement clients are adult athletes. Many are marathoners, cyclists, or triathletes, for example, who are accountants during the week because they need to earn a living.

In either case, we’ve made customers for life out of many of these clients. If their first encounter with our company is as an athlete seeking improvement, they quickly see that if they ever need rehabilitation or physical therapy, it’s available from someone they already know. In reverse, we’ve had many traditional clients sign up for sport training after learning about it during their physical therapy visits.

Matching Staff to Ambitions
One of the first things we did at Athletico to make our idea work was to figure out if our current staff would be able to offer performance enhancement services. There are approximately 400 different certifications available for personal training, strength, or speed coaches. But to provide the best services, we felt we needed staff who could function within the therapy environment and also had experience and certification in strength and conditioning.

Why not just use athletic trainers and physical therapists with an interest in performance enhancement? Today’s coaches and athletes know an experienced strength coach when they see one, and they can spot someone who is a novice in the weightroom. We felt that we would be getting off on the wrong foot if we didn’t have experienced specialists in strength and conditioning. We felt that our new clients might question our dedication to the performance enhancement side of our clinic and might also question our overall effectiveness as a rehab clinic.

So why not just use strength and conditioning coaches? We felt that this staff also needed some rehab background to fit in our clinic. There are many strength and conditioning or performance specialists who would thrive in a collegiate athletic department but might flounder in our setting because they lack an adequate background in designing and conducting medically-based rehabilitation programs. We believed this might reflect poorly on our facility as a whole.

We decided the ideal person for the job is a certified athletic trainer who has spent a good deal of time in weightrooms working with athletes—the type of person who has a rehab background but knows that the athletes are going after the coveted "300-pound bench press" T-shirt. Athletic trainers with the CSCS or NASM-PES certification would be an especially good fit.

To assemble a corps of practitioners, we created a list of all employees containing information such as certifications, the sports and hobbies participated in, and the languages spoken. From there, we found a base of current employees who could work this new side of the clinic.

We also imported some new expertise. When Mark launched the plan, he first gathered three people: Alex McKinney, PT, CSCS, who had completed many marathons and triathlons and had begun conducting lectures in endurance-sport training; Phil Pfieffer, hired from one of Chicago’s largest and reportedly most profitable traditional health clubs; and myself—the kind of athletic trainer who hangs around weightrooms. We had to call in others to help, but this group provided an excellent starting combination of experiences and certifications that helped launch our new services.

In interviewing our current and potential new staff members, we looked at much more than credentials. We wanted staff members who could take a unified approach to care. In other words, we sought the ATC/CSCS/NASM-PES who could actively assist in patient care when indicated, which allows for cross promotion of services and the ability to create a unified staff. The idea is to work synergistically as a unit to provide the athlete a complete experience.

Was it difficult to find such people? No! For those of us who are athletic trainers and certified strength and conditioning or performance enhancement specialists, expanding into these services has enabled us to provide more value to our clients and the company while doing more interesting, satisfying work. In this way, we have the best of both worlds: the relatively sane hours of clinic-based employment and the close involvement with competitive athletes. We enjoy the profession more than ever before.

Space Considerations
Next, a clinic needs to consider if it has the proper set up to accomplish this endeavor. This is not as straightforward as it may seem, and the answers may not be obvious. First, you’ll need to research legal and insurance issues. If your facility is rented, the lease could contain a restriction that will not allow the space to be used as a health and fitness facility. If your company owns the facility, it may be necessary to consult local zoning or other land-use rules that could affect your plans.

If the site can legally be used as you envision, ask whether you have the appropriate insurance. Health club insurance policies are different than physical therapy policies. You don’t want to expose yourself to any unneeded liability.

Second, figure out if you have adequate space and the right types of equipment. However, before being overwhelmed by potential space limitations, know that your facility may be more useable than you first think.

The staff members working on performance enhancement love it when we get our own space so we can get really sport specific. But working in small spaces actually can create excellent results because they force us to get creative.

Particularly in speed-training and agility circles, everyone seems to think you need 100 yards of open space to run athletes and create obstacle course-like drills. But when forced to train clients in a small space, we find we have to think deeper about the sport’s real demands. You can have a basketball team do 40-yard dashes, but how often do they need to run 40 yards on a basketball court? That would put them in the bleachers. Likewise, do football linemen really need 30-second gassers?

Instead, we use our ability to conduct evaluations and train energy systems and movement patterns to make up for a lack of space. As athletic trainers, we break out the goniometer and measure joint angles. We tell a young athlete or his or her coach, "This kid can touch his toes but has horrible hamstring flexibility, which tells me he has a hypermobile back and stiff hamstrings. We’ll keep the athlete on the training table and have him stretch. That’ll make him faster because it will increase his stride length."

Some locations offer access to fields or an indoor running track, but at most sites, being forced to make do with clinic-scale space means we are innovative in our program design. We’re able to give athletes workouts that are good by both their standards and ours. They’re sweating, huffing, and puffing when they leave, but they’ve worked on what their bodies and sports really need.

Space shortcomings can also be handled (or at least mitigated) through careful and creative scheduling. One of the objectives is to avoid conflicts. You don’t want to mix groups of young, boisterous, active athletes with older patients who might object to the noise and balls being tossed around. We’ll usually schedule teams near our closing hours. The teams can arrive, do their warm-up and stretching, then hit the now-empty gym for their sport-specific work as rehab patients are leaving—but not before this group has been exposed to the idea that, once they’ve recovered, they can find performance enhancement services right here.

More difficult, sometimes, is balancing revenue and space usage. Since rehabilitative physical therapy patients provide more revenue, generally speaking, many facility managers are reluctant to schedule a performance enhancement session over a rehab visit. The solution is to recognize that some sport work uses no more space than rehab therapy. For example, a runner needing stability exercises and myofascial release work for flexibility can be booked in limited spaces that leave room for other therapy visits.

Setting The Price Tag
Perhaps the hardest task when beginning a new kind of service is putting a value on it. Most of us are used to working as the unsung hero behind the scenes. Thus, when it suddenly comes time to venture into the open marketplace and establish prices for what we do, we’re content to figuratively kick the sand and say something like, "Fifty bucks isn’t going to offend you, is it?"

Ours is a knowledge-based commodity, not a product with easy-to-define costs and value. We soon learned, however, that when athletes understand the tremendous knowledge and skill that we have to offer, they’re willing to pay for it.

To start, we used a volume discount idea and offered 24 sessions for $1,100. A large number of athletes signed up, but the accounting department threw cold water on our plans, pointing out that this rate translated to $5 an hour for our time. We sold relatively few six- and 12-session packages because athletes saw the value of the larger bundle before we did. We’ve since eliminated the 24-session package and are considering raising the prices on our six- and 12-session deals. Ultimately, our price breaks down to $50-$60 a session per client, varying slightly by location.

An unexpected twist on pricing is that when we raised the rate, clients seemed to value their visits more. Our cancellations and no-shows dropped precipitously after we increased our prices—which means we’re now making better use of our human and physical resources.

Cross-Pollination
Getting the word out about the new services is another challenge. We changed our company’s logo to better reflect the broader array of services we offer, but the main method of promotion is simple word of mouth and client retention. And that means making sure clients see the value of the synergistic approach.

In an effective combination rehab-performance enhancement setting, clients know that the person putting them through their workout is also a person they can consult if they hurt their rotator cuff. They know they’ll get good advice from someone who knows not only their pathology but also can be in communication with their physician.

If a high school athlete who’s come back from an ACL injury is told by his coach to do leg extensions, we can step back and say, "Remember when I told you the only exercise you won’t be able to do again is leg extensions? Can you tell your coach that? Or should I talk to him?" This is the kind of integrated relationship that can pay off for everyone—clients, athletes, and practitioners alike.