Rehabilitation Business

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Taking Preventative Medicine to the Store

Storefront health clinics, patient engagement, and community outreach are all touted as great new innovations in healthcare. Well, today we found a great example that includes all three and was established over 3 decades ago yet continues to engage patients today. And it takes place somewhere you might not expect: a shoe store.

Over 30 years ago Dr. William Warnekros, a podiatrist from Seattle, approached running store Super Jock N Jill founder Laurel James with the idea that he have “office hours” in the store every Thursday night where he would answer questions and do screenings. Dr. Warnekros believed that by doing this he could provide a community service, practice preventative medicine, and also create referrals to his clinic. At the time, running had not gained the popularity it has now, so there was limited information for runners on how to prevent injury.

Events at Super Jock N Jill

Events at Super Jock N Jill

The relationship between the podatrist and the store proved to be symbiotic, where staff became more educated in biomechanics from Dr. Warnekros and he learned about the different types of running shoes on the market. Together, they were practicing preventative medicine by making sure runners received the best advice and the right shoe for their style. Dr. Warnekros recalls that at the time the most common injuries he saw through the store  were plantar facitis, achilles issues, tendonitis, ingrown toenails, stress fractures.

In addition to these  “Medical Nights” at the store, Dr. Warnekros also visited community centers every Saturday to lecture on preventing running and athletic injuries. When I asked Dr. Warnekros why he did all this, he said that “outreach and community service helped me generate the type of patients I wanted to see, rather than relying only on referrals.” Sometimes we forget how simple community engagement can be, and while social media enables us to reach the world, often the best way to reach the community is face-to-face.

The Injury Wall at Super Jock N Jill

The Injury Wall at Super Jock N Jill

Since its inception, the Medical Nights program has proven so popular it’s been expanded to two nights per week, and features podiatrists, sports medicine doctors, physical therapists, and massage practionners from over 25 local clinics on a rotating schedule.

Rim Veitas from University of Washington Medicine at Super Jock N Jill

Rim Veitas from University of Washington Medicine at Super Jock N Jill

On the night I attended, Rim Veitas, a physical therapist from the University of Washington’s Roosevelt Exercise Training Center Clinic was the attending healthcare professional. He had a treatment table set up, conveniently near Super Jock n Jill’s selection of injury aids.

I was surprised to see that Rim spent between 15 and 20 minutes with each client. When I asked him about it, he said that he did it because he loved treating people. (Sadly, he said he especially loved treating people when he didn’t have to fill out all the insurance or Medicare paperwork after.) Rim wasn’t sure that the University of Washington received a lot of new clients from participating in the Medical Night program, so for him it really was a labor of love and community outreach. I suspect that other clinics that might not be as well-known as the University of Washington see a lot of referrals from this program, and that for them it’s both goodwill and good business, just like Dr. Warnekros’ original intention.

In addition to interviewing Dr. Warnekros, Rim, and the Super Jock N Jill staff about the Medical Nights program, I decided to participate. I have tight hamstrings. I come by them naturally as a short person, and running tightens them further. I thought that might be the reason that after longer runs I had a clicking in my achilles. Rim did a few assessments, and pointed out that I had unusually tight ankle joints. He gave me some exercises and said if I did them, I could become a faster runner. (I assume they will also improve my Downward Dog.) I’ll try it!

If you’re in Seattle and want to know more about your running style or if you’ve been struggling with an injury, definitely stop by Super Jock N Jill Medical Nights. You might get some tips or establish a long-term relationship with a new healthcare provider. If you’re not in Seattle, take a look for events in your area or maybe start one yourself!

Posted in: Exercise Physiology, Rehabilitation Business

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The Outcomes That Matter to Patients

As an industry, healthcare spends a lot of time measuring and reporting outcomes. Taking a consumer based approach would also consider the outcomes that matter to patients. This table from Harvard Business Review’s “The Strategy to Fix Healthcare” offers a patient-centered approach with the example of the patient’s view of a successful hip replacement.
The Outcomes That Matter To Patients

Posted in: Healthcare Disruption, Healthcare motivation, Rehabilitation Business

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Getting the Most Out of Your Golf Game

Ah golf. I love this game. It can be such a frustrating sport, but nothing can beat the feeling of a well struck ball or the sound of the ball hitting the green. I don’t get out nearly as often I would like, but when I do I fully enjoy what the sport provides: a solid four hours of time with good friends out in the beautiful outdoors. When I can find the time to squeeze in a round I want nothing to get in the way. So when I heard that Sitka Wellness was putting on a Golf Workshop to learn how to get the most out of your game and prevent injuries, I grabbed a friend and we went to go and check it out.

Sitka Wellness is a full-service physiotherapy and wellness clinic located in the heart of downtown Vancouver. Along with physiotherapy services, Sitka offers group Yoga and Pilates classes as well as Personal Training. The instructors work closely with the therapists to tailor programs to each individual’s needs. What we love most about Sitka, besides their integrated approach to health, is that they put on monthly community workshops that anyone can attend. They range from managing chronic pain to training for your first 10k. Anne attended a workshop on minimalist running last month.

images (1)Jason Lee, Registered Physiotherapist and TPI Certified Golf Fitness Professional started off the workshop by discussing some of the basic functional movements required to perform a golf swing such as squats, pelvic tilts and trunk rotations. Jason used the example of balancing on one leg. If you weren’t able to perform this simple movement, then you wouldn’t be able to follow through correctly by finishing with all your weight on your front leg. Flexibility, strength, coordination, balance and endurance are all important factors in maximizing your performance. A physical therapist can help you break down your movements and determine where you might need to focus your energy and improve.


The Reverse Spine Angle. The number one cause of lower back pain in golf.

Jason then walked us through these simple recommendations for avoiding injury.

1. Improving physical conditioning before the season starts

2. Warm up before you play, minimum 15 minutes

3. Using a push cart instead of carrying your clubs

4. Engage your core before your swing

5. Rotate through the hips instead of lateral sliding during your backswing

6. Avoid excessive extension as you finish your swing



Using the foam roller in this position can help open up tight chest muscles caused by sitting at a desk all day.

Tip #4  really stood out for me. I know engaging my core is one of my weaknesses and this is where Irene Lugsdin (a Pilates instructor at Sitka) came to the rescue. Pilates is an approach to exercise that focuses on the deep stabilizing muscles of the body or the core. Irene took us through some simple exercises that would help strengthen and lengthen the spine and that would facilitate the flexibility and mobility needed to enhance our golf swings. Irene described Pilates as breath with movement and so we focused on how your breath could help you engage your core but also infuse your swing with a fluid tempo. She also explained that golf is an asymmetrical sport while Pilates is all about symmetry and balance hence the reason these two activities are an excellent combination.

I really enjoyed the workshop. Jason and Irene were both very knowledgeable and engaging speakers. It was great to be able to breakdown the golf swing and really think about the mechanics and the movements/muscles required.  My friend Carla, who came along and who is an avid golfer, was surprised to see the Physiotherapist and Pilates instructor working together. She had never imagined such collaboration between the two practices, but after attending the workshop she thought that it made absolute sense.

Sitka offers comprehensive golf swing assessments where a physiotherapist will look for any dysfunctional movement patterns that could be limiting your performance. The 1 hour golf screen includes a walk through your injury history, a series of functional movement tests as well as a swing characteristic analysis using 2D video.  Once the assessment is complete, the PT can then work with you on an exercise program focused on improving any physical deficiencies that need to addressed. They will even work with and communicate with any golf instructors or personal trainers you might be working with outside the clinic.

We have noticed that many physical therapy clinics offer screening services for golf  and other sports such as Running, Tennis, Softball/Baseball and Cycling.  Working with a Physical Therapist is an excellent way to learn how to take care of and get the most out of your body no matter what you want to do.  I know that I am excited to take my new tips and tricks to golf course. I might even have a chance at beating Carla!

Posted in: Exercise Physiology, Rehabilitation Business

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The 1/2 Marathon Fun Run


Race registration

This past weekend we participated in the ANCPT 1/2 Marathon “Fun Run” and BBQ in Seattle. This is an annual race put on by Sarah Anderson and Noal Cattone for their physical therapy clients. Sarah and Noal were our earliest early adopters at Wellpepper and we were happy when they invited us to the event. (We did try to explain that “fun run” usually means 5K but Noal and Sarah are also ultra-marathoners so I guess 13.1 miles is fun compared to 50 miles.)

The Urban Trail 1/2 Marathon Fun Run Route

The Urban Trail 1/2 Marathon Fun Run Route

The event was billed as an “urban trail run” and the course wound its way from park to forest to ravine throughout Seattle. It was well marked and had volunteer aid stations. We did get lost a couple of times but that was part of the fun. With the exception of the Wellpepper representation, all the participants were former or current clients of Noal and Sarah. One runner asked us what our injuries were. Luckily we don’t really have any yet.

After the run there was a rooftop barbecue with fun prizes, like for the oldest participant and the best cadence. The race awards were handed out onsite and the winning time was something like 1 hour 35 minutes by a very tall and lean guy. At the barbecue, many of the participants knew each other from previous races or events that Noal and Sarah have put on, and everyone was extremely friendly. (We even received an offer of startup advice from a veteran entrepreneur who is one of their clients.) We were also really happy to talk with end-users who loved how Wellpepper helped them remember to do their exercises. How many physical therapy clinics can say they’ve built this type of community around their practices?

Rocking some swag at the BBQ

Rocking some swag at the BBQ

We write a lot on this blog about physical therapy marketing. Sarah and Noal are naturals. Yes, they fully admit their website could use some love. However, they are experts in client engagement. Their business is 100% based on referrals from clients and they are always booked for months. Their clients will run 13.1 miles for them, and want to hang out with them on a sunny Saturday afternoon. They had been looking for a solution like Wellpepper to engage their clients between visits long before we met them (from a referral from another client who loves them). They have provided us with amazing feedback to help us build out the product.

Oh, and it turns out that a 1/2 marathon can be fun. We had an amazing time on route and after, and weren’t even sore after. That’s how good Sarah and Noal are.

Sarah Anderson and Noal Cattone

Noal Cattone and Sarah Anderson


Posted in: Rehabilitation Business

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How To Become a Minimalist Runner

Last week I attended a free seminar at Sitka Physio & Wellness in Vancouver, BC, about how to avoid runner’s injuries with a focus on the mechanics of minimalist running. We also blogged about offering seminars like this as a best practice.

Physical Therapist Elisabeth Mclatchie

Physical Therapist Elisabeth Mclatchie. Source Sitka Physio & Wellness

The seminar by physical therapist Elizabeth McLatchie, started with an overview of why people get injured: repeated mechanical stress to tissues. She then talked about how the main goal of minimalist running and the new minimalist or barefoot shoes is to change the mechanics to avoid injury.  I’ve read a lot about minimalist shoes and have talked to a few runners about them, but this clinic really helped me understand what they are trying to accomplish and why: more efficient movement, and encouraging a mid-foot strike rather than a heel strike, with the long-term goal of avoiding injury.

Challenges with Traditional Shoes

Challenges with Traditional Shoes

When a runner heel strikes, his or her center of gravity is off, resulting in more force on the body and more energy spent. Heel striking also affects cadence (how quickly you can move from one foot to another) because you are spending more time transferring weight across the foot, rather than touching down and lifting off. While minimalist shoes attempt to change the way people run, people can be trained to run differently in any type of shoe. 90% of runners will heel strike in traditional shoes. Unfortunately there’s a group of about 10% of runners that will heel strike regardless of shoe.  Heel striking and overuse are key causes of injuries, and over 80% of runners will be injured during their running careers.

As an example, we were shown video of a runner who regularly runs 50K races running in shoes, barefoot, and at different cadences. Running barefoot (on a treadmill) helped her to increase her cadence to 180 beats with minimal effort. For more effective running, runners should strive to be light on their feet and run at a 180 cadence. (Note that this may take some working up to: recommendations for switching to a minimalist style and shoes suggest 9-12 months for the full transition.)

Elisabeth recommended a phased approach to switching to a minimalist style, and for those wanting to try barefoot shoes, to phase in the change over 9-12 months. She also stressed that you don’t necessarily need to move to minimalist shoes to change running styles, and that there are many types of shoes. Minimalist doesn’t equal no support and no padding, it just means less rise in the heel of the shoe. For those who had further questions, she recommended talking to either an expert at a dedicated running store or a physical therapist, who could also perform a gait analysis. Elizabeth finished off the talk by demonstrating some ABCD drills, which are recommended ‘active stretch’ warm-ups for runners and talked about the lack of consensus on stretching in general.

The most important takeaways from the talk were about how to avoid overuse injuries:

  • Avoid repeated mechanical stress: you can do this by varying terrain, speed, intensity, and distance
  • Improve efficiency: change your running style to mid-foot strike from heel strike
  • Find your cadence: running at 180 cadence and being light on feet will minimize reaction force from the ground and therefore energy loss.

Elizabeth was an engaging and enthusiastic speaker who truly cared about imparting her knowledge. Her passion for her profession shone through in the presentation.

For more on the topic of ‘barefoot’ or minimalist running:

Posted in: Exercise Physiology, Rehabilitation Business

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Five Best Practices For Community Outreach for Physical Therapy Clinics

In our recent study, we found that 96% of physical therapy clinics offer additional services beyond physical therapy. The most popular were the following:

Popular Services

One clinic owner we spoke to said that his business didn’t become profitable until he started offering additional services. While this is definitely not true for everyone, we’ve seen a promising trend with physical therapists talking about how they can help manage the whole health of the individual, and this includes offering additional services. When we saw a post on Twitter advertising a minimalist running clinic at Sitka Physio & Wellness in Vancouver, BC, we thought we’d check it out, both for our own education, we’re all runners at Wellpepper and love learning how to improve, and of course for the blog.

Sitka Physio & Wellness

Sitka Physio & Wellness Reception

Sitka Physio & Wellness is located in the Fairmont Hotel Vancouver, which isn’t a typical location for a rehab center, but makes perfect sense for a wellness clinic, where hotel patrons and local business people might stop in. The clinic itself is beautiful: clean and airy, it definitely connotes health and wellness. We were positively greeted as soon as we came in. We’ve visited our fair share of clinics since starting Wellpepper, and this is definitely one you’d want to visit even if you weren’t injured.

The seminar itself, by physical therapist Elizabeth McLatchie, focused on basic education minimalist running. It was so full of great information that we’ve covered the content in a separate blog post. Many of the attendees were already familiar with Sitka Physio & Wellness from their weekly running club that Elizabeth mentioned. (Interestingly, and reflecting the demographics of runners, the audience was predominantly female.)

Selection of minimalist shoes

Selection of minimalist shoes

I talked to both Elizabeth and clinic owner Helen Ries after the session and learned that they offer these type of community outreach classes monthly. Elizabeth said that the physios all volunteer to do the sessions and she had to wait 8 months to get on the calendar because their were so many other sessions booked. She said she loves sharing her knowledge and would definitely volunteer to do more sessions. Upcoming sessions include Pilates for pelvic floor control and golf swing analysis.

Some of the best practices we noted in the session:

  1. Elizabeth did a great job of providing examples and breaking down more complex concepts into something we could understand.
  2. The session was focused on preventing injuries, which changes the conversation that someone might have with their physical therapist, and enables the clinic to emphasize their wellness services.
  3. She engaged with the broader running community. The clinic featured shoes from local businesses that focus on the running community. This provides a potential symbiotic relationship: if a runner is looking for new shoes because of an injury or issue the store could refer this person back to Sitka, and of course, Sitka referred to these stores, as experts in shoe fitting.
  4. The session targeted an audience that needed to engage with physical therapy. Over 80% of serious runners will face injury at some point. Why not establish a relationship with them before they “need” you?
  5. Suggestions of how to further engage with your physical therapist, for example, for a gait analysis were presented within the context of the overall session. Elizabeth also recommended that if people were interested in what type of shoes might work for their running style that they consult their physical therapist. Both of these services furthered the idea that physical therapists are there to help you stay well, not just for episodic treatment.

Offering sessions like this are a great way to market your clinic and services, first you get people into the clinic, second you help educate them on the importance of proper movement, and third you can educate them on other services you might be able to offer them. We’d love to see more clinics offering these types of services, and you can bet that we’ll be back for more sessions at Sitka Physio and Wellness. Jacquie needs to fix her golf swing. 😉

Posted in: Exercise Physiology, Rehabilitation Business

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How To Score Big With Your Next Big (Physical Therapy) Marketing Idea

“You guys need to spend more money on a PR campaign” said speaker Adele Cehrs, CEO of Epic PR Group, addressing a crowd of physical therapy business owners at the American Physical Therapy Association conference in Salt Lake City last week. The Public Relations veteran pulled no punches when encouraging the audience to think differently about how they market themselves.

Adele Cehrs, CEO, Epic PR Group, source: EPIC PR

“Consumers don’t understand ‘musculo-skeletal’. They know something went pop.” At this point one of the audience members said that a ‘pop’ isn’t an indication of a problem. Adele pointed out that consumers don’t know this, and it’s about speaking their language.

Adele’s PR firm represents the Private Practice section of the APTA, whose members own some of the 57,000 independent physical therapy clinics in the United States. She told the audience that she has a really hard time finding clinic owners willing to speak to the press when she has a story, and was extremely surprised that people weren’t coming forward to take advantage of this membership benefit of the Private Practice Section of APTA.

When she wasn’t encouraging the audience to be more proactive with marketing and understanding what their potential customers care about, Adele led the group through a number of exercises to develop creative solutions to real-world marketing challenges. She started by dividing the audience into groups of 3, and requiring that each person spin a wheel to determine what role or ‘hat’ they would represent in the group. The roles consisted of common archetypes in either in business and group work, and each person was responsible for approaching the problem from the perspective of that person. In our group we had a future visionary, a bean counter, and an analyst. The role of the visionary was to evaluate the ideas had sticking power in the long run. The bean counter was responsible for ROI, and the analyst was to question the viability of the solution. I was the analyst in our group, which is my natural behavior, so it wasn’t much of a stretch. The idea of this role playing is actually to see things from another perspective, so I didn’t have that benefit. However, not actually being a physical therapy clinic owner did enable me to stretch my viewpoint significantly.

In our small groups we worked on two business problems, the first was to determine how to capitalize on new research that showed 33% better performance from patients that didn’t receive overly positive encouragement (“you’ve got this”) from their physical therapists. With my analyst hat on, I questioned whether everyone liked the same type of motivation and also wanted to see the actual study. Our group decided that some groups, for example, seniors might actually like friendly encouragement, so our recommendation was to screen patients and match them with the type of physical therapist who would be most compatible for their personality. Another group recommended using the patients phones or clinic iPads and filming them, and said that when patients are engaged everyone wins. (At Wellpepper we concur, but also think you can go further in extending your reach outside the clinic and also warn you to make sure your mobile patient communications are HIPAA-compliant.)

Another exercise involved ways to increase the number of clients at the clinic. Solutions to this included examining where most referrals came from and trying to duplicate this with another segment of users. Other ideas included offering free screenings or volunteering to provide services for a local team. Adele pushed people to go further, both in sharing the data around why physical therapy works and sharing patient stories for additional human interest.

Adele also mentioned that people trust their own data more than yours, which is why her company offers an online quiz to access your PR readiness. She explained that when people see their own PR readiness, it’s a much more powerful change agent than her firm telling them what their gaps are. She asked the group to consider how to apply this theory to marketing physical therapy. Our group decided that an online falls quiz might be helpful for attracting the attention of people whose parents were aging and at risk. Adult children and caregivers could do it together, and it would be an opportunity to educate on how physical therapy can aid in falls prevention.

We didn’t actually get to finish all the content in the 90-minute session because of the interactive nature of the talk and the great stories told by Adele. If you’re a member of APTA’s Private Practice section, we recommend joining her newsletter for additional tips and PR opportunities, and if you’re not a member, having a resource like this available to you might be reason to consider joining.

Posted in: Rehabilitation Business

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Innovative Care Models for Prevention, Health Promotion, Fitness and Disease Management

Standing room only at the APTA 2013 Conference

Standing room only at the APTA 2013 Conference

It was a packed house for an excellent session on Innovative Care models at the American Physical Therapy association annual conference in Salt Lake City last week. Any of the 5 presenters could have held their own for the entire session. Together, they provided a powerhouse of enthusiasm, ideas, and motivation to change healthcare practice.

A common theme across all the presenters was that the time is now right for the types of innovative programs they were espousing. Many commented on how they are seeing a lot more acceptance of new ideas and new models of care than when they first embarked on this path. Another common theme was that the data doesn’t lie. Healthcare is in crisis due to the declining health of the American public. Our favorite quote of the session was from Mike Eisenhart from Pro-activity who said “Chronic disease is simply the accumulation of years of bad behavior.” Sad but true that most chronic disease in the United States is entirely preventable. Each presenter showed saddening statistics that supported this view.

Karen Kemmis kicked off the session by reviewing the triple aim of healthcare reform developed by the Institute for Healthcare Improvement:

Triple Aim for Healthcare Improvement

Triple Aim for Healthcare Improvement

She also described changes that are making new care models possible including:

  • Integrated care models, like Accountable Care Organizations
  • Expansion in coverage
  • Changing payment mechanisms
  • Outcome and quality based payments
  • Program integrity

Next up was Jennifer Gamboa, founder and President of Body Dynamics, Inc – a multi-disciplinary physical therapy and wellness center in Falls Church, Virginia. Dr. Gamboa outlined their consistent and unique approach to treating clients, where each healthcare professional applies the same rigorous screening process to access overall health and wellness. This approach recognized that clients choose their treatments, for example, many lower back-pain patients see a registered massage therapist first although they might be better helped by a physical therapist. Rather than bemoaning the lack of consumer awareness, Body Dynamics works with the consumer to access overall health and willingness to change regardless of how they found the clinic. It was a refreshing approach that creates a health team that includes a physical therapist, nutritionist, massage therapist, personal trainer, and counselor, and screens patients based on their movement quality, disease risk factors, fitness, and willingness to change. Body Dynamics is incubating the process now, so Dr Gamboa was not able to share outcomes or recommend how others might use her methodology yet but this is definitely a development to watch.

Jennifer was followed by Margaret O’Neil from Drexel University, who talked about health promotion strategies for children and their caregivers. Dr. O’Neil stressed the importance of motivational interviewing to support behavior change. Motivational interviewing includes expressing empathy, supporting self-efficicacy, accepting resistance, and avoiding argumentation. Open questions and active listening are tools in motivational interviewing. The point of the process is to determine where someone is in their willingness to change, and therefore, the type of intervention that is appropriate. Interventions might need to be psychological before physical. As well, the entire family needs to be involved and parents need to model healthy eating and activity. Dr. O’Neil mentioned that parents often believe that being overweight is inevitable, using the excuse “we’re just a big-boned family.”

Next up was Mike Eisenhart from Pro-Activity, who was the most provocative  and tweetable (hashtag #apta2013) of the group. He graduated as a physical therapist and immediately stopped calling himself one because he was told that physical therapists could only treat problems not help prevent them. Instead, Mike built a business around wellness and prevention, specifically in the workplace and now helps to manage the health of over 20,000 people. Pro-Activity provides health assessments and helps employees manage change, resulting in lower insurance costs for employers. Mike is really happy that he’s starting to see other physical therapists take proactive roles in health and wellness.

The final presenter was Cheryl Resnik who quipped that you should find out how funny the other presenters are before agreeing to a panel. She didn’t need to worry, as the story of the USC Fit Families program was extremely compelling. The program, which provides exercise programs and a free physical therapy clinic to low-income families, is located near USC campus in a neighborhood known for a gang with ties to the Mexican mafia and that is a “food desert”. A food desert is defined as an area where it is not possible to buy fresh food. Fast food is often the only or definitely the cheapest option. Resnik recounts needing to buy a scale that measured up to 1,000 pounds to weigh some of her participants, who were mostly teenagers! Fit Families provides individualized and group exercise programs, nutrition counselling, and assessments. It’s funded by grants and volunteer physical therapy students from USC. Students become so engaged in the program they often continue volunteering after they’ve received their credits.

This was one of the best sessions we attended at American Physical Therapy Conference in Salt Lake City. It was amazing to see so many people focused on prevention and wellness both in for-profit and not-for-profit scenarios. At the end of the session, Margaret O’Neil asked the audience how many were inspired to try their own programs, and a number of people who reported previously being discouraged said they were ready to give it a go. We can’t wait!

Posted in: Healthcare Disruption, Healthcare motivation, Managing Chronic Disease, Rehabilitation Business

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Encouraging Exercise for Injury Prevention

Washington Physical Therapy Conference Spring 2013Last weekend Wellpepper attended two conferences, the Washington Physical Therapy Association Conference in Spokane, Washington and the Physical Therapy Association of British Columbia Annual General Meeting in Vancouver, BC. It was amazing to introduce Wellpepper to so many new faces and to hear feedback. We were too busy at both conferences to take advantage of the information and other activities however, we did manage to attend one talk  “Recreational and Elite Athletes:  Can we really prevent injuries?”  by Rick Celebrini. Dr Celebrini is the head of sports medicine and science for the Vancouver Whitecaps MLS team, and former physiotherapist for the Canadian Olympic Ski Team. He became interested in physiotherapy after breaking his food during his teen years as a high-level soccer player.

Dr Celebrini started his talk with some statistics about injuries. Injuries cost the MLS $7M in 2012. Considering that MLS players are not the highest paid professional athletes, you can only imagine what this might be in other sports. He also shared that sport and recreational injuries can cause osteoarthritis later in life. Then he focused on one of the most common sport injuries: ACL tear. The ACL tear will take an athlete out of commission for 8-12 months and is estimated to cost the US healthcare system $2B a year. Women are 4-6 times more likely to have an ACL tear and have a greater risk of osteoarthritis. The major cause of ACL tear is changing direction. 70% of injuries are non-contact, that is they are incurred by the athlete him or her self by changing direction or landing incorrectly: if the knee is close to extension, and the foot moves outside the center mass, this becomes a perfect situation for an ACL tear. This situation of imbalance can result from extrinsic or intrinsic factors. Extrinsic factors are things like weather, footwear, equipment. Intrinsic factors are related to things about the person: How does the person move? Is the person tired? What is their mood? When Dr. Celebrini had his injuries, he remembers that he was tired and felt he shouldn’t have been playing. These types of factors change on a daily basis.

It turns out however, that a study in 1986 proved how to prevent ACL tears. In particular changing how deceleration happens and making rounded turns instead of sharp changes of direction are two key factors. However, in all this time, there has been no change in the number of ACL injuries. The reason for this: human nature. He cited a study where physical therapists were brought in to help professional athletes with preventative techniques and exercises for ACL. As soon as the PTs left, and the coaches and players were on their own, only 50% had compliance with the program. Physiotherapy Association of British Columbia

Dr. Celebrini believes that we don’t need to do any more research into how to prevent ACL tears. What he’d like to see is the translation of the research into a practical application for people. That is, focusing on how to motivate them to change their behaviors for the better. He thinks there’s a gap between academic research and practical application. Even the Whitecaps, who rely on their bodies being healthy and functional for their careers, don’t do their preventative exercises.

Dr. Celebrini had some suggestions for this:

  • How do you fit preventative exercises into the schedule? He gave the example that the Whitecaps players would not want to spend 30 minutes pre-game doing preventative exercises, they would want to be warming up for key skills they’d need in the game.  Can you include exercises in the warm-up without detracting from other exercises they need to do? 
  • What is the player’s motivation? Can you tap into their desire to have a long career?
  • How do you make it sport specific? Can the exercises be adapted to have relevance to the specific sports?
  • Make sure that the decision makers are bought off. In the study he mentioned, the coaches weren’t on board and didn’t continue the program after the physical therapists left.

Finally he stressed the need for the research to include implementation. Researchers should collaborate with athletes, sports psychologists, and coaches, to translate the research into practice. At Wellpepper we’re working with physical therapists, behavior researchers, and patients to try to solve these challenges in getting people to do what’s good for them, so we were really happy to hear this message!


Posted in: Exercise Physiology, Rehabilitation Business

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Integrating Wellpepper Into Your Practice

At Wellpepper we’re focused on motivating behavior change and encouraging people to do their exercises and get better. We’ve learned that we are also asking you, the professionals to change your behavior. While we’ve developed Wellpepper to be extremely easy to learn and use, integrating any new technology into your practice requires some change.

A few things to think about as you are adopting Wellpepper:

    Wellpepper Clinic

    Wellpepper Clinic

  • Some clients may be better candidates than others for using Wellpepper. You might want to find out in advance who has an iPhone, iPad, or iPod touch and make sure they bring it to their first session. You could do this when confirming appointments.
  • Try it out first and practice recording videos and assigning exercises. Also check out what the client will see so you can answer any questions they may have. It’s easy to use, but you want to be a pro when you’re using it in practice.
  • Get help. We know you don’t have a lot of time with your clients. We recommend you set up their program before they even install. When you invite a client to use Wellpepper, their exercises will be waiting for them when they download the app and login. Maybe have your receptionist help the client download and login to Wellpepper before they leave your clinic. It will give them a chance to build a greater connection with the client and offer an increased level of service.
  • Determine your “SLA”. An SLA is a service level agreement: what is your commitment to your clients for their Wellpepper results? Will you look at them daily? Weekly? At the beginning of their next session? It’s your business, and it’s up to you but you need to set expectations with your clients.
  • Integrate Wellpepper into your sessions. At the point when you are getting clients to practice their exercises, just start recording them. Avoid the temptation to reach for pen and paper and your clients will thank you.
  • Create special programs or offerings that incorporate using Wellpepper, for example, get ready for tennis or golf season. Wellpepper can be used as part of the program as a lightweight communication tool for patients, to show them the exercises, and to hold clients accountable to reaching their goals.
  • Remember your iPad. This may seem obvious, but at the start it sometimes takes time to get used to remembering a new tool. Remember when you got your first cell phone? Did you always have it with you like you do now?

Our blog posts on choosing the right clients to use Wellpepper and best practices for recording video can also help you get started. We promise though, that once you make the change it will be as easy as drawing stick figures.

We design Wellpepper by testing and getting feedback from our users. Our development process enables us to continually improve and innovate.  If there’s anything you’d like to see us add to make Wellpepper even easier for you to adopt, we’d love to hear about it.


Posted in: Rehabilitation Business, Using Wellpepper

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The Value of Physical Therapy

We’ve participated in quite a few #solvePT tweetchats, and a recurring theme is the need for the physical therapy profession to better market the profession both to consumers and within healthcare as a whole. What’s interesting is that within our experience, everyone we know has seen a physical therapist at one point or another, and seen benefit. Of course, we are active ourselves and so are our friends. We also fall into that category of people who want to remain fit and active as we age.

Once, people did not see a doctor until they could barely get around. “Now patients will say: ‘I can’t exercise. I can’t ride my stationary bike or regular bike or go for walks of one or two or three miles,’ ” said Dr. Mark W. Pagnano, an orthopedist at the Mayo Clinic in Minnesota. NY Times

However, keeping in mind that everyone is not like us, we thought we’d explore the concept of the value of physical therapy and exercise in a few blog posts. Recently, we met with an MD who on the one hand was a huge proponent of preventative medicine, and on the other hand was a bit dismissive of physical therapy. However, he swore by his personal trainer so he definitely sees the value of exercise.

Search for “the value of physical therapy” and the fifth result is:

It may be stated with little fear of contradiction that there is no field of therapeutics less understood and less frequently employed by internists than physical therapy. There are several reasons that account for this unfortunate state of affairs which has its inception in our medical schools.

It’s from 1941, so hopefully sentiments have changed a bit, but the fact that it’s in the top search results is a bit disturbing. A much better resource has been developed by the Canadian Physiotherapy Association, where they outline the types of conditions and interventions where physical therapy can help.

Here’s the list, with links to evidence on how physical therapy can help in each one of these cases.

Tracking exercises in Wellpepper

Tracking exercises in Wellpepper

If you’re like us, accidents and sports injuries are the first areas that come to mind. However, where physical therapy can really shine is in preventative treatments for things like falls and low back pain. Did you know that low back pain causes almost as many work absences as the common cold? Management of chronic disease is also an area where physical therapy can add value. Diseases like arthritis, multiple sclerosis, and Parkinson’s can all be managed through regular movement and exercise. Keeping people moving is key to keeping them from getting worse. We’re working with researchers using Wellpepper for Parkinson’s management and we are hoping the findings can be applied more broadly to chronic disease management.

Recovery from disease is another area, stroke, heart disease, and cancer all need physical therapy to help regain quality of life. The first two are obvious. Healthcare professionals are just starting to realize the toll that cancer treatments take, and are prescribing physical therapy as part of a recovery program. Often people are so weakened that they need help to get muscles back to where they were.

In our experience, people who have been helped by exercise prescription understand the value. The challenge seems to be not enough people know about the possibilities. Direct access, which enables people to see a physical therapist without a doctor’s referral, can help this tremendously. However, in order for people and the profession to see the benefits of direct access, there needs to be more awareness of when it could help.

Posted in: Exercise Physiology, Managing Chronic Disease, Rehabilitation Business

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Marketing Physical Therapy

At Wellpepper, we’ve been surprised about the amount of effort physical therapists need to do to promote their services and profession. We’ve had great personal experiences with physical therapy ranging from sports injury recovery, chronic illness recovery and management, and pediatric developmental support. To us, it was a bit of a no-brainer that physical therapy works. The more time we spend with the community though, we realize there’s a lot more work to do. On that note, we’d like to highlight some great marketing of the profession that we’ve seen.

One of the most impressive is the award-winning campaign “Moving for Life” from the British Columbia Association of Physical Therapists. Here’s the television spot that was launched in 2011.

The campaign works for two reasons, it connects the general public to the profession and to what physical therapists can do for them, and it introduces physical therapists as professionals and people. The Facebook portion of the campaign shows physical therapists out enjoying all the wondrous nature that British Columbia has to offer, while providing tips for staying safe and fit during physical activity.

Why I Became a Physio

Why I Became a Physio from Physical Therapy Association of BC

We know that physical therapist are happy in their profession, but this campaign takes it one step further by introducing reasons why people are inspired to be physical therapists.

One caveat, of course, is that people in BC have direct access to physical therapists, so the customer for therapy is the consumer, not a doctor who is providing referrals. The campaign would probably look very different if it were aimed at convincing doctors to send therapy referrals. Also, with the abundance of nature and the resource-based economy, BC has a very active population who tend to be more familiar with the benefits of physical therapy and want to get back to work and play faster.

What great examples have you seen? What do you wish your local association was doing for you?

Posted in: Healthcare Social Media, Rehabilitation Business, Uncategorized

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Functional Screening as a lead generation tool

UBC BodyWorks Centre

UBC BodyWorks Centre

This past week the Bodyworks Fitness Center at the University of British Columbia School of Kinesology had an open house. They offered free functional movement screenings (FMS) and Titlest Performance Institute (TPI) screenings for golfers.

A few of us signed up for the 20 minute screens and walked away with a scoring sheet of results. The TPI was probably more useful as it specicially targeted golf and was pretty clear where the individual would need to improve to positively affect golf swing. The FMS was interesting in that it highlighted core stability issues that a person might not be aware of, however, the session could have been improved if the screener had engaged us in a few questions about our sports and exercise goals. Otherwise, it was hard to make the leap from the screening results to potential areas for improvement. It was nice to find out that an old shoulder issue has healed and is back to a full range of motion.

Titlest Functional Movement Screen

Titlest Functional Movement Screen

The real value to the center in providing these free screenings in getting the person to sign up for a program based on improving their weak areas. The open house also featured free access to the fitness center, talks on wellness, and tours. All of these activities were designed to raise awareness and hopefully gain new clients, especially before they become injured.

Our curiosity and love of the word “free” got us in the door, which is definitely a good first step. Did we join? No, and that’s because the location isn’t convenient, which is something for single clinic practitioners to consider. Unless you’re the local expert in a particular type of treatment or injury, your market is largely your local community.

Titlest Functional Movement Screen

Titlest Functional Movement Screen

We weren’t really the target market:  the Kinesiology student who showed us around mentioned that the target was mostly professors, students, and seniors who lived in the area. Apparently people won’t walk more than a block to a coffee shop, which is why in Seattle and Vancouver there’s one on every corner. We wonder if anyone’s figured out how far they would walk or drive to a clinic or a fitness center.




Posted in: Rehabilitation Business

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Just-In-Time Management Principles for Physical Therapy

Disruptive technologies and business models, paired with changing consumer expectations, will change healthcare.

In keeping with our theme of lean healthcare, today’s topic is a recap of the American Physical Therapy Conference CSM 2013 is a session called “Doing Today’s Work Today: How To Reduce Inefficiencies in Physical Therapy Service Delivery Through the Application of ‘Just In Time’ Management Principles.” Yes, the title was quite a mouthful, but the session was well organized, clear, and straightforward. Presenters Todd E. Davenport, Nicholas J. Ferlatte, Ivan Matsui, Carol Jo Tichenor, were all from Kaiser Permanente. Since Kaiser Permanente is a managed care consortium, they are able to experiment with programs and collaboration between disciplines all within the umbrella of their organization.

Starting with a recap of lean management principles applied to healthcare, presenters focused on case studies and learning from three programs at Kaiser, all designed to increase client satisfaction and decrease waste.

Roving physical therapists program

This program had physical therapists ‘on-call’ to be brought in if a consulting MD needed support. The therapist could quickly access the situation, make a prescription, and then decide whether the patient needed a referral. If the patient needed a referral to a physical therapist, they might have to wait 30 minutes to see that physical therapist rather than a few weeks. The results of the program were significantly happier patients, and a dramatic reduction in the wrong physical therapy prescription. Given that patients were seen sooner, there could also be assumed to be better recovery times as well.

While this program turned out to be the best for patients, some considerations needed to be taken on how to manage the physical therapist’s productivity. Kaiser’s structure of being a full-service managed care organization enabled this scenario, but it’s definitely worth considering how to bridge this gap with integrated care.


Telehealth is expected to grow 55% in 2013 and reach 1.8M patients. This is partially driven by Medicare’s penalties on readmission, but also as Kaiser Permante learned, by consumer preference. Patients liked the video check-in because it meant they didn’t have to leave work or battle traffic for their appointments. There was also a strong personal connection having the appointment at their convenience and location rather than a clinic. However, one extremely important reason they liked the Kaiser program was that it was free. This is a consideration that’s not possible for many clinics. However, we have seen changes in billing codes in most states that allow for telemedicine.

Patients Preferred Communication Modes

Patients Preferred Communication Modes

The presenters also shared some best practices if you’re thinking of implementing video visits into your practice which we’ll dedicate a separate post to in the coming days.

To judge whether telehealth is effective, you need to consider two factors: clinical outcomes and patient satisfaction. If you’re going to try a telehealth pilot, think about how you will measure in advance.

Workplace occupational injury prevention

Workplace injuries are decreasing, while workplace injury costs are actually increasing. That is, fewer people are being injured but it’s costing more to treat those injuries. The main users are younger men who work as laborers, and women 50-60 who work as tradespeople. Similar to other sessions, this session promoted physical therapists as ambassadors of total health and wellness, and in this case occupational wellness.

Kaiser Permanente implemented an occupational wellness program in their own workplace in two high-injury departments: radiology and materials management. Starting with an ergonomic assessment, they then created programs that include pre-shift and at-home exercise programs, and stress and weight management. The result has been a steady decline in workplace injuries over the last 15 years, and a general increase in the importance of health and safety.

While this program was internal to Kaiser Permanente, corporate wellness programs are quite common with their focus on preventative healthcare. This could be an interesting area of focus for physical therapy organizations.

Finally, the panelists encouraged the audience to start thinking about and embracing new business models by saying “It’s okay to ask for money for services provided.”

Posted in: Lean Healthcare, Rehabilitation Business

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Whole Health and Wellness in Physical Therapy

Physical therapists are uniquely positioned to look at the whole health of the patient, however,  many are still just treating the injury. Health promotion needs to be a key evolution of the profession.

These were themes  in a few sessions at APTA CSM 2013 last week in San Diego, particularly in “How Can We Integrate Wellness Into Orthopedic Physical Therapy?” and “Challenging PTs to Thrive in a Changing Healthcare Environment.”

Both sessions challenged physical therapists to think about how to expand their impact by focusing on whole wellness of the person, whether that is trying to understand other lifestyle factors that may affect their health, or how to keep people active after their treatment.  When they only focus on the injury, physical therapists get the patient to a certain point of recovery and then discharge. The patients then don’t continue their exercises and are likely to re-injure. The idea of “patients for life” was introduced, not that we want patients to be injured for life, but that patients can continue to look to their physical therapist for prevention of injuries and support for their general well being.

Behavior change was cited as a key tool in helping patients manage their entire health. It’s not enough to get them to do their exercises, they may also have to change their behaviors if these are also impacting their recovery. For example, diet might need to change. Physical therapists are urged to look at one unhealthy behavior and figure out how to change it.

7 Forms of Wellness from University of California Riverside

7 Forms of Wellness from University of California Riverside

Understanding the full picture of wellness, will help understand the full patient. The  University of California Riverside defines these 7 forms of wellness as:

  • Social
  • Physical
  • Emotional
  • Spiritual
  • Environmental
  • Occupational
  • Intellectual

Identifying whether any of these, besides physical, are inhibiting the patient from recovery is key. For example, a patient might be missing social support, like a friend who could go for walks with them, which could slow or impair overall recovery.

Although both talks were similar in their recommendation that physical therapists become more involved in helping the patient modify their behavior to get better, neither offered practical tips on how to do this in a clinical setting. As well, they both admitted that although physical therapists were uniquely suited to do this they didn’t have the right training or tools.

At Wellpepper, we’d say this is consistent with our experience during our research on patient exercise compliance. Some of the physical therapists we talked to had well-defined strategies for getting patients to do their exercises, for example, don’t assign too many exercises or get the patient to choose the time, while others just prescribed and hoped. Helping patients modify their behavior for positive outcomes is a key tenant of what we’re trying to do at Wellpepper, so we’d love help physical therapists take a more active role in this.

Both sessions also encouraged the profession to have a voice in public health on health promotion and wellness. Doing this could make health promotion a more systematic part of physical therapy practice, and give physical therapists a seat at the table in the larger health reform conversation. We’re all in favor of this, and hope we can help.


Posted in: Healthcare Disruption, Rehabilitation Business

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Wellpepper is attending the American Physical Therapy Association 2013 Combined Sessions Meeting. We’re having a great time, although are quite exhausted with all of the amazing sessions and people to talk to. When we catch our breath, we’ll blog a bit more about what we found, but for now here are some brief impressions.

  • People are very friendly. We know that PTs are the 3rd happiest profession in the US (behind clergy and firefighters), but we’ve been really impressed with how friendly and helpful everyone is here.
  • Healthcare is at a crossroads. There are a number of sessions on Lean PT and using Toyota’s lean imagemanufacturing principles to improve clinic performance. One we attended was an interactive session that had us mapping out all the steps when someone cancels an appointment and looking for ways to improve. Kaiser Permanente led a session where they talked about the coming disruption in healthcare, stressing that it doesn’t matter what the billing codes say, patient expectations of service have increased and while budgets have decreased so figuring out better ways to deliver care is paramount.
  • Technology can change lives. We’ve seen some pretty amazing exoskeletal ‘machines’ that are enabling spinal cord injury patients to walk around the show floor. How’s that for a demo?
  • There’s a lot of talk about holistic health, health promotion, and seeing the whole patient. Physical therapists are uniquely suited to look at the broader picture and participate in prevention, because that’s what they already do.
  • Behavior change is key to improving outcomes, but it’s not necessarily something that PTs are trained in or good at. How can we help change this?

Those are just some high-level impressions, we’ll have more detail over the next few days. One day left to learn more!

Posted in: Rehabilitation Business

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