Ask Mike Reinold Show

Integrating Strength and Conditioning into a Physical Therapy Business

On this episode of the #AskMikeReinold show we talk about adding strength and conditioning to a physical therapy practice. There are good ways, and suboptimal ways, to do this. Learn from our experience growing Champion over the last 6+ years. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 229: Integrating Strength and Conditioning into a Physical Therapy Business

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Show Notes



Transcript

Student:
So we have Maddie from Canada, “Hi everyone, I love your show. I just wanted to ask how you guys manage to successfully integrate strength training and physiotherapy services into your business model. We were looking to add in strength and conditioning coaches to our physiotherapy clinic, but are concerned about when does one profession really take over and the other become less involved in the patient’s care, as the two professions crossover significantly. Any thoughts and advice on this would be greatly appreciated.”

Mike Reinold:
Can we all give Ray a quick round of applause right there for that? That was –

Lenny Macrina:
Good, really good.

Mike Reinold:
Welcome to the show, Ray. Yeah, you know what, that’s actually a great question and I think it’s becoming more and more relevant as people are looking … I don’t know if businesses are looking to increase their ancillary services or their bottom lines. I don’t know if that’s the true case. I know the way we did it at Champion was we wanted to build a nice integrated model, and we kind of thought what’s best for people first and then kind of figured out how to make it a business. We didn’t do it just to make money. So I would say that’s one thing physical therapy clinics do wrong a little bit, is they just want to add strength and conditioning just to make money. So it’s not a well thought out plan.

Mike Reinold:
So how about I’ll start with this; I’ll kind of start and say about how we structured it and why we did it that way. And then maybe we can talk a little bit about how that interaction goes. So maybe we can hear from a therapist or two that kind of talks about how they’ve handed people off, and then maybe we can talk from Diwesh’s perspective as kind of our director of strength and conditioning. Did I just give you a raise? Was that a proper promotion? So you’re the director of fitness. We should change your title to director of strength and conditioning. I don’t like –

Diwesh Poudyal:
I think officially fitness manager is my title.

Mike Reinold:
Okay. Well we’ll work on that. You see, it’s services first, business second. That’s not our thing, but I think you’re better than that. So I’ll start with this and say how did we build it? What was the model behind what we did? The first thing we thought of is what is best for the person? What is best for the client, the patient to get them where we wanted? And we totally thought that traditional physical therapy was kind of missing the boat on some of the advanced stuff. So we thought to ourselves, well, we need a gym, we need real equipment, we need those types of things. Now at this point in time, a lot of physical therapy clinics will screw up. They’ll either hire a tech or maybe just a personal trainer that they just want to push around and delegate stuff to. What we did is we said no, we want to start a strength and conditioning facility as well.

Mike Reinold:
And it’s not us micromanaging that, but what we did is we hired a team of strength coaches that were really good at their job and really understood it, and we just came up with a vision and let them run with it. And I think that’s the real key here, is a lot of PTs wanted to micromanage the strength and conditioning department and make it very rehabby, and then I think what happens is people don’t want to work out in your gym, because they see it as a rehab kind of gym. So it depends on what you want to do. For us, we wanted to have something where we could holistically work on everybody throughout the spectrum, and that was the best way of structuring it. So our goal is that there’s a lot of collaboration. People join the gym, they’ll have some issues, come to physical therapy, our physical therapy clients can then join the gym, and then we’ll get a nice holistic thing. So that’s kind of how we did it. Len, did I miss anything from the structure standpoint before we get into the how we operate together thing?

Lenny Macrina:
No, I think that was good. I think, as you said, it’s good to be a strength coach or a personal trainer that’s running the show, not the PTs trying to do it, because we’re really good strength coaches, most of us. There are tremendous PTs that are good strength coaches and we’ve got a few on staff, actually. So you need to have the right people, and that’s why in our initial model, we had strength coaches that would run the show. We just kind of helped guide it a little, but –

Mike Reinold:
Wow, that’s a first for Lenny. Lenny just had a pure dropout. Wow. Okay, sweet. All right. Perfect.

Dave Tilley:
I think he just ripped the cord out of the wall.

Mike Reinold:
I know, right? That’s a weird one. That’s not a Zoom glitch. Let me just –

Dave Tilley:
I love the freeze frame, that’s great.

Mike Reinold:
I think we can officially call that Lenny pulled a Jonah and just froze.

Lenny Macrina:
I’m back.

Mike Reinold:
All right, great. Good thoughts, Len. I like it. So I want to hear from … how about Dan Pope? Because Dan Pope was actually a strength and conditioning coach that actually worked as a strength and conditioning coach prior to becoming a physical therapist. How do you see this model working for people from both of those perspectives? What have been some pearls for you that you think people can benefit from? Dan you’re muted.

Dan Pope:
The wheels are falling off this episode.

Mike Reinold:
We are … wow, worst podcast ever. So worst podcast ever, and Ray read the question. Coincidence? I’m not sure, but … so Pope, from your perspective as an ex … not that you’re ever an ex, but as somebody that was purely a strength coach at some point in time, how do you see this going best?

Dan Pope:
Yeah, so for me, I came in as a strength conditioning coach into physical therapy and then my very specific flavor of physical therapy really is strength and conditioning. And for me, it was actually a lot of letting go of my responsibilities as a strength and conditioning coach and trusting some of the other coaches that we do have. So I try to get people involved in the strength and conditioning side as soon as possible, because I feel like that’s a big part of their rehabilitation. I think we’re very, very lucky with our strength and conditioning coaches here at Champion because they understand pain and injuries and we just work together so much that it’s not really that challenging to do.

Dan Pope:
But generally speaking, when I’m working with a strength and conditioning coach, I want to get them out into that setting, I will do a few sessions, maybe a couple of weeks to make sure that pain problems aren’t too high to get an idea of how their pain is progressing over the course of time so I can give some expectations for the coach, I can show them which movements they should probably push and which ones to stay away from, what to expect as we progress along. And then what happens is that we start off with more physical therapy and we convert a little bit of strength and conditioning, but it doesn’t mean that your physical therapy is over. We’re still doing some physical therapy. Maybe we’re doing less physical therapy with the course of time as that person’s pain goes down, down, down.

Mike Reinold:
Right, which I love in terms of a healthcare perspective and even a financial perspective is you’re weaning them down off when they need your skilled physical therapy less and less and they need more just TherEx type stuff or actually strength and conditioning. It’s that transitional phase. So I think Dan just outlined a good thing. It’s not physical therapy and strength and conditioning. There’s a big overlap in the middle that the person probably goes through a spectrum and does them all. So they go through it a little bit. So Diwesh, from your perspective as the strength coach in the facility, what do you like about the model? How do you see this being beneficial to somebody? But then more importantly, what advice could you give probably the physical therapy crowd that are interested in doing this, in finding somebody like you and collaborating with somebody like you so this goes well?

Diwesh Poudyal:
Yeah, I think just kind of building off of what Dan said, because I think he kind of put that perfectly. I think a lot of people like to think that it’s one or the other, where in fact it’s just like a really good harmony of them both, and it’s always just adding a little bit more of the one that the client or the athlete needs and then giving them a little bit less of the other one, or vice versa. So it’s always this add and subtract instead of this only addition or only subtraction. And then to answer the second part of your question, I think the biggest advice that I would give is, again, find a coach that you truly respect and trust and let them kind of take lead on strength and conditioning instead of, like you said, Mike, early on, kind micromanage what’s happening in the facility and saying all right, here’s my principals as far as rehab and training goes. I want you to do stuff this way. And just kind of let the coach be the coach and trust in them that they understand strength and conditioning principles and they can take someone who’s in late-stage rehab and get them back to performance.

Mike Reinold:
I like that, and I think a lot it’s going to go into either having relationships with good professionals or maybe even a really good interview process to make sure you’re on the same wavelength, to make sure you’re the same type of training. Us at Champion, I don’t want to call us functional. I don’t think that’s quite it, but we kind of call it more performance-based, where we work with people that want to optimize themselves or enhance their performance. So since we share that vision across both service lines, then you can see the synergy. It’s actually pretty cool from that perspective. So yeah, I think that’s super helpful. Maybe one more. How about Mike Scaduto, question for you. So I think you’re a good example of people that we transitioned to the gym.

Mike Reinold:
You probably do this, I don’t want to say more than others, but when you’re working with a golfer that’s healthy, they come to you for an assessment and oftentimes you find some things that might not be pain, but maybe there’s some things that physical therapy services, some manual therapy might be beneficial, but then you also collaborate with the strength coaches to build performance for them. Maybe just from your perspective on that, where it’s not maybe the injured person, but maybe the healthy person that needs some physical therapy too. I know that kind of sounds like an oxymoron to some people, but I think that’s another way of thinking. It’s not just how does rehab go to strength and conditioning, but how does somebody coming in for performance also need … how do we determine they need manual therapy and stuff like that?

Mike Scaduto:
Yeah, absolutely, and I think it starts with the assessment. So from my perspective as a physical therapist who also kind of does some performance-based therapy, it starts with my assessment and if we determine that the person has maybe a mobility restriction that we think may respond well to manual therapy in the short term, I think that can kind of boost their home exercise program that we’re giving them and set them up for success out in the gym, and then once we see some positive changes, if they’re responding well to manual therapy, then again, like Diwesh said, we kind of wean that down, we start increasing their loading a little bit to kind of take their performance to the next level. So I think we use manual therapy to maybe jumpstart that process or hopefully accelerate that process to see how they’re responding to manual therapy, and then our goal is ultimately to maximize their performance.

Mike Scaduto:
So we have to determine in our assessment where we’re going to spend most of our time. Is that on strength, power, mobility, and stability and stuff like that. So I think the two definitely go together. Part of my goal is to use my skills to get them out into the gym as quickly as possible and to collaborate with the coach. And I think from the client perspective, when they see a strength coach and a physical therapist talking together, I think that’s really powerful and we’re working towards their goals and I think they really buy into that process. So I think it makes the whole process go smoothly, but then they also … if they do have nagging aches and pains, they feel a little bit of comfort knowing that they can always check in with the physical therapist. Even though our strength coaches are tremendous at handling minor bumps along the road in terms of some minor pain or aches, I think having a physical therapist on their team and in their medical team is really impactful for that person.

Mike Reinold:
Awesome. Well said, Mike, I like it. Awesome. So hopefully that helps. I mean hopefully that helps kind of a little bit with your perspective and not just business structure, because I think it has to start with the right perspective. A lot of people maybe either do it for the wrong reason or maybe they have the wrong vision, but I think the vision that we created at Champion was part of why the structure was successful and I think that’s kind of an important part. So hopefully that helps. I think that’d be some great advice from everybody on how you can potentially structure something similar to us at Champion. So again, thank you very much. If you have questions like that, head to the website, mikereinold.com, click on the podcast link, fill out the form. Please head to iTunes, Spotify, wherever you listen to this podcast. Rate and review us so we can keep getting the word out. The more, the better. Thanks so much. See you on the next episode.