Education is key — this isn’t your father’s physical or rehabilitation therapy
Chiropractic physical rehabilitation therapy is big. Regardless of your practice style, incorporating chiropractic physical rehabilitation (rehab) therapy into your practice has big returns for your patients and your bottom line, regardless of your practice style.
Whether it is low- or high-tech, properly applied rehab improves outcomes, patient satisfaction, referrals and is an additional service your office can provide. However, the main reason chiropractic rehab is big is because of the exceptional outcomes it achieves.
How chiropractic rehabilitation therapy is different
Chiropractic rehabilitation therapy is not physical therapy, personal training, group training, myofascial release or athletic/performance training. These disciplines are beneficial and address faulty movement patterns and muscular imbalances between tight and weak muscles (length-tension relationships) and expect joint mechanics to normalize along the way.
Chiropractic rehab is different: We treat and assess the entire body, adjust the hypomobile joints (local as well as within the entire kinetic chain), and then address the soft tissue imbalances, faulty movement patterns and altered muscular length-tension relationships to enhance the effects of chiropractic manipulative therapy (CMT).
Finally, we discuss lifestyle and nutrition to fully restore homeostasis. This approach is the reason chiropractic rehab is big in creating superior outcomes.
Begin with the basics
NFL Hall of Fame coach Vince Lombardi started every season by holding up a football and announcing to the team, “Gentlemen, this is a football.”
Therefore, regardless of if you have no experience with rehab or are in an interdisciplinary facility with the newest rehab equipment, let’s start with the basics and build your practice to where you feel comfortable.
- Sharpen your spinal and extremity adjusting This is essential in correcting kinetic chain imbalances. Also, as patients recognize your office is big in rehab, they will expect you to treat more than just the spine.
- Have a go-to soft tissue plan Be ready to address soft tissue issues with manual, instrument-assisted or even high-tech modalities — be proficient in at least one.
- Start in your current treatment Elastic resistance bands, physioball, balance discs and a foam roller can all be used effectively in your current treatment rooms with excellent results for the acute, sub-acute and corrective phases of care. There is no need for a dedicated rehab suite to go big in rehab.
- Learn low-back and neck exercises for mobility, stability and These will be the most common conditions that will arrive in your office.
Building on the foundation
Thoughtful rehab is a process that incorporates CMT, soft tissue work, active and passive exercises, taping/bracing, nutrition and lifestyle advice. Exercise principles need to address both the local stabilizer muscles as well as the global prime movers.
Exercises must also address mobility and symmetry between left and right as well as front and back. Anyone can look up exercises on the internet; however, as a chiropractic rehab provider you need to know which exercises are appropriate and correct technique. Improper technique is simply not acceptable for optimal results.
- Take courses and get hands-on experience in exercise prescriptions for spinal and extremity Start with the most common extremities: shoulder, knee and hip. Consider starting a study group with other local colleagues to sharpen your skills.
- Be prepared to address the Top 3 common postural distortions of tech neck (forward head posture), lower crossed distortion (hyperlordosis with anterior pelvic tilt), and pronation.
- Apply all exercises in proper alignment and strong Use postural correction as the transition from treating the patient’s “pain” to a corrective “non-pain” model of care.
- Learn to assess and correct faulty movement
- Video your patient’s exercises on their own phone — video exercise software programs are also available.
- Create a professional referral base for patients when they get to return to sport and higher levels of activity. This phase of rehab is time-consuming and requires more extensive equipment and space. Patients still remain under care for adjustments, soft tissue work and oversight. This is a triple win: The patient, the local gym and your office all benefit at this stage of rehab.
Growing to the next level
Active care takes time and it may affect your appointment scheduling. Be prepared to add “rehab slots” to your appointment book for patients to learn and review exercise prescriptions.
As your rehabilitation therapy practice grows and your patients tell others you “do more than just give adjustments and heat,” the decision needs to be made on expansion. You may need additional space at this time and/or additional providers.
- Moving to an open-concept adjusting room can make the space for your rehab suite right in front of This will enable you to adjust patients while observing other patients performing active care. Caveat: If you are billing insurance carriers for exercise therapy, you need to have one-on-one patient contact. However, it does not have to be continuous, so you can intersperse exercise instruction between adjustments.
- Hire another professional to oversee your rehab. Depending on your state’s laws and scope of practice, it could be an ATC, licensed chiropractic assistant, PT, PTA, RN, DC, OT, personal trainer, exercise physiologist or massage Again, be sure to check with your local licensing board on the requirements.
- Consider higher-tech machines to add to your menu of services. These offer services you can prescribe but do not have to oversee directly. Many of these novel therapies do not have CPT codes and are a cash service, which helps cash flow.
Growing into the interdisciplinary model
The interdisciplinary model for rehab is effective and profitable; however, it can change the focus of treatment.
Often the intake physician is a DC and they schedule the patient for the appropriate care with the other providers in the office. This offloads the DC greatly; however, it is important the team has weekly clinical rounds to assure the patient is progressing as well as maintaining their treatment schedule.
Remember, the hallmark of success in chiropractic rehab is the whole-body approach we use with a foundation of the chiropractic adjustment. Multi-disciplinary clinics can fall into a reductionistic model.
- Conduct weekly clinical rounds with the entire team to ensure patient response and compliance.
- As the DC on the team, be aware of the active care being provided. Understand the exercise prescriptions the other providers are incorporating.
- Be mindful that there is a difference between “churning” the patient and comprehensive care — patients know the difference.
- Monthly re-exams and progress reports are integral to compliance.
- The patient can always begin a postural correction program once they are pain-free.
Chiropractic rehab is big
Expanding rehab in your practice is supported by research and patient demand. Numerous studies indicate a multi-modal approach to musculoskeletal pain that incorporates active care is the current paradigm.
In addition, patients are looking for active care solutions and desire to be independent. They appreciate the knowledge of a provider who can counsel them to attain their health goals and embrace technology that demonstrates postural and muscle imbalances, faulty movement patterns and physical limitations.
Finally, as mentioned above, active care is a reimbursable code for insurance carriers.
- Make sure patients are scheduled for a mini report of findings to review the results of any movement, postural or kinetic Simply emailing the results is not enough.
- When billing for active care, be sure to bill and code Active care can be billed under several allowable codes, both individual and group. Take a course or speak with a coding/billing specialist to ensure compliance.
- Perhaps the easiest code to document for one-on-one active care is 97110, Therapeutic The code 97110 is billed based on the outcome of the intended procedure, not the procedure itself. Therefore, if the goal is to increase range of motion (ROM), any technique (other than CMT) designed to increase ROM to that region can be applied.
- Depending on your state’s scope of practice and laws, patients may be able to pay directly for a personal trainer in your office to oversee their rehab. Since this is not billed to the insurance, it is direct pay.
Chiropractic rehabilitation therapy adds an exciting dimension to your practice. For doctors interested in adding rehab to their practice, start with the steps outlined above. You can use low tech in your current treatment rooms and address the conditions that currently present to your office.
Develop your rehab assessment and exercise skills and then decide if you want to take it to the next level. For doctors looking to expand, you can keep it “chiro-centric” or grow into an interdisciplinary model. Both models allow for appropriately coded reimbursement from insurance carriers. However, active care and non-billable high-tech machines can be direct-pay cash services, too.
Aligning chiropractic rehab
Chiropractic rehab is effective because it is different than generic rehab. It is a corrective procedure that centers around the adjustment and the patient’s individual goals.
Our approach is to first restore joint motion to hypomobile areas (CMT), then proceed to restore soft tissue compliance before strengthening weak muscles and correcting faulty movement patterns. Performing strengthening exercises before joint mechanics and soft tissue compliance are restored simply reinforces the underlying pathomechanics.
Finally, reinforce strong posture and proper joint alignment with every exercise to improve outcomes and to transition the patient to postural correction, beyond pain control. Incorporating chiropractic rehab into your practice from low-tech to multi-disciplinary and high-tech will have big rewards for your patients and your practice.
NOTE: Check your state laws and regulations on billing for active care and follow appropriate documentation guidelines before incorporating the steps outlined in this article.
DONALD C. DEFABIO, DC, DACRB, DACBSP, DABCO, teaches Relevant Rehab with virtual and hands-on seminars throughout the US. His e-book, “The Six Keys to In Office Rehab,” is available free on his website, DeFabioDifference.com; exercise protocols can be found on his YouTube channel, which has over 32,000 subscribers. He can be reached at DeFabioChiropractic@gmail.com to schedule him as a speaker or register for his workshops.