Making it in rehab and post-rehab personal training

Working with rehab and post-rehab clients is a very challenging and rewarding experience. My physical therapy patients began telling me 10 years ago there was a big need for more qualified personal trainers with my background and education. I knew at this point my future would involve integrating my physical therapy knowledge with fitness for the foreseeable future.
As I began my fitness career in 1998, my initial unique selling proposition was indeed my degree in physical therapy and sports medicine experience. Clients with rotator cuff injuries, arthritis, lower back pain and ACL injuries began seeking me out to guide them back to play or instruct them what to do or, more importantly, what not to do in the gym.
I quickly realized many trainers were not able to provide the detailed instruction I could based upon individual injuries, surgeries or specific medical conditions. Herein is the opportunity for trainers in this emerging market.
Acquiring Needed Skills
While having a health-related degree in physical therapy, athletic training or kinesiology is a big plus, it is certainly not a prerequisite to be successful. To be competent and attract this special population, trainers need to possess specific knowledge about the population they elect to work with. They should have a sound understanding of specific medical conditions (i.e. arthritis, tendonitis, fractures, total joint replacements, herniated disc, etc.) and know how these conditions affect tissue healing and stress response.
Personally, I believe trainers must understand anatomy and biomechanics to effectively analyze human movement and select appropriate exercises for clients transitioning from rehab. Understanding the real "why" behind each exercise is absolutely critical to success. Exercise must be prescribed and dosed accordingly to avoid re-injury and correct imbalances. Training must be directed at restoring function as opposed to just building strength or focusing on weight loss.
Based on my experience, clients do extensive research on their condition, and trainers will not be able to fool them or gain their trust if they are not truly knowledgeable about their problem. It is always best to refer them to a third party if uncomfortable training them. Therefore, fitness professionals need to gain experience with each type of condition. When starting out, it is best to align yourself with an established medical professional who can help direct the training and consult with you as questions arise. Make sure this person is an expert in the type of clientele you are attempting to attract in your business, as they will add instant credibility to your business and become a referral source over time.
Establishing a Strong Referral Network
Ideally, you want your business to be referral-only. The fastest way to accomplish this is by gaining trust and respect amongst the medical community you work and live in. Nothing carries more weight than the recommendation of a physician. When physicians are sending you direct referrals, the cost of your services is never an objection; however, landing a referring physician will take time, especially if you haven't had any direct experience with them. It is generally best to first identify the type of client you are passionate about working with and then seek out physical therapy clinics or hospitals who service this target market. See the sidebar on the following page for a quick how-to on attracting referral sources.
Gaining Physician Support
Why is it important to meet the physicians? The answer is simple: They are at the top of the food chain. They hold all the power, and their recommendation gives you instant credibility as an expert. Keep in mind that developing physician ties takes time, clear communication and appropriate follow-through. Physicians are extremely busy, so it is best to contact them only when absolutely necessary. Such times include patient inquiries, medical questions and saying "thank you." They will not hesitate to contact you if they have a problem or if they want something.
The most effective method of securing physician approval is getting to know their nurse. Developing a good rapport with the nurse will provide an easy line of communication with the doctor and ensure that he or she receives your messages. Once you have established a sound relationship, your clients will have more trust in your services and will pay more for them. When working with physicians, remember to allow them to guide you in decision making. Once they trust you, they will naturally give you more autonomy and decision-making power without getting their input beforehand.
Building a Profitable Business
Once you have established some consistent referral sources and clearly identified your niche in the public's eye, begin centering your business on this client population. You want to let people know how you are different in order to attract the clients dealing with injuries in your area. The following action steps will help trainers just starting out maximize their opportunity in the market:
Develop an advisory board with a physician/chiropractor, physical therapist and massage therapist as members.

Study current research and relevant literature on common conditions you work with.
Spend a few hours per week shadowing a doctor or therapist to build knowledge and cultivate reciprocal referral relationships.

Send out letters to key physicians in the area promoting your fitness programs with a sample report you will send them upon evaluating their clients. Place flyers and brochures at local medical offices.
Document case studies of successful outcomes to position yourself as the "go-to" expert in your geographic area.

Volunteer to speak in the community, and write relevant articles to post on your website or blog.
Acquire additional certifications specific to your population base.
Looking ahead, trainers interested in this market can easily grow and sustain a solid income by capitalizing on limited insurance reimbursement. Athletes and baby boomers alike today are in need of more specialized training to return to activity or simply maintain an active lifestyle free from injury because insurance offers limited visits or does not cover rehab at all. Proper positioning will place you first in line for these referrals.
As your reputation and expertise grows, you will be able to command higher training fees and begin hiring other trainers to work under you as well. The most important thing to remember is not crossing the boundary between trainer and medical professional. Never attempt to diagnose and treat medical problems but instead assist the referring partners in completing the recovery process. Maintaining this positive working relationship will keep you in business for many years to come.
Steps to Successfully Market to a New Referral Source
  1. Contact the clinic director or office manager. Speak with the director or office manager about arranging an in-service on post-rehabilitation fitness training. However, always check ahead of time to see if this facility already offers such a service. If so, don't waste your time trying to gain their business. If not, schedule an in-service, and bring food. Make sure to ask what they like to eat. Providing lunch for the staff is always a popular way to get your foot in the door.
  2. Meet the therapists who actually treat the patients. They are the key players in gaining referrals. Inquire about the types of patients they see and their philosophies on exercise. Discuss how they handle home exercise programs for their patients following discharge from therapy. Be sure to ask how they feel you could compliment their after-care procedures. Most therapists like to direct all aspects of patient care, so it is instrumental that your approach is collaborative and non-threatening.
  3. Clearly define your role in the continuum of care. Assure therapists you will call with questions, support their efforts and keep them informed about patients they send you. Once you begin to generate referrals and produce satisfied clients, they will not hesitate to recommend you. At this time, you should begin leveraging these ties to meet their referring physicians.
Brian Schiff, PT, CSCS ( is a licensed physical therapist, respected author and fitness professional. He became a Certified Strength and Conditioning Specialist (CSCS) in 1998. In 2000, he opened his own personal training and sport specific conditioning facility, Fitness Edge, in Dublin, Ohio. Brian has presented at several professional conferences and seminars on injury prevention and sport-specific training.