Finding Your Niche


One physical therapy practice gets creative with its aquatic programming.

Veronica Paquette, PT, ATRIC, PRC

Running a physical therapy practice is similar to running any kind of a business: You need to find (or make) a niche. What that niche consists of is up to you and your team, but it has to stand out among the other options patients and physicians have.

Years ago, our Vermont practice needed to increase not only the number of patients we wanted to see, but also our options for treating those patients. Though we use land-based methods, we realized that being able to offer a complementary type of therapy treatment would be advantageous for both our patients, as well as our business. After careful planning, we determined that adding aquatic programming to our physical therapy techniques was the innovation we needed to round out our abilities and offerings.

Why Choose Aquatics?

Aquatic therapy has been around for a while, but it is come a long way since physical therapists worked with patients in standard pools. Today’s warm-water therapy pools, equipped with treadmill floor and resistance jets, afford advances that truly make an enormous impact on the therapeutic exercises patients can do, how soon they can do them, how much they can expect to achieve, and even how quickly they heal after surgeries. Best of all, aquatics can be used as either an introduction to land-based physical therapy or, in some cases, in lieu of it. Even people who are wheelchair-bound can move their bodies in a water-based environment, allowing them to gain strength and build cardiovascular endurance. When immersed up to their chest, they are able to move more freely. This makes it versatile, and means the physical therapists can use innovation in patient treatment.

What Types of Exercises Can Patients Do in the Water?

One of the biggest surprises for many patients is that they are able to tolerate more activity with the support of a special warm-water therapy pool. Once their fears are minimized (some fear falling, but overcome that once they realize they can hold onto the side of the pool or handrails, as well as the physical therapist in the pool with them), they find they have a wealth of options. Typically, due to the support the water provides, patients find that their pain levels are much less in the water, and they are therefore able to move more freely, and with less compensatory strategies. This, in turn, helps to expedite their progress.

Exercises include, but are not limited to, leg abduction/adduction, arm “push-pull” activities, knee extension/flexion, shoulder external/internal rotation and lateral arm raises. Using a snorkel and mask allows for prone work to enable greater shoulder range of motion and ability to work on scapular stabilization activities. We may also have patients float supine with a cervical collar and buoyant belt to complete additional scapular stabilization activities, or just to promote relaxation of those overactive upper trap muscles.

Peripheral devices for added resistance or stretching include gloves with webs, dumbbells, aqua fins, buoyant cuffs and hand paddles. The use of resistance jets add challenges to balance and stability. With the treadmill floor, we can introduce gait exercises such as walking sideways (e.g., grapevine step), walking backwards, walking in general, jogging, or even running!

Therapy sessions typically end by focusing the warm water resistance jets using a special hose. We can gently massage muscles and scar tissue, and patients often comment that this becomes their favorite “cool down.”

Generate Additional Revenue with Pool Memberships

To help recoup the costs associated with having an aquatic therapy pool, our facility has instituted a practice membership. The membership is offered to prior clients, and cannot be purchased by the public. Membership allows clients to schedule blocks of time when our team is not working with physical therapy patients and the pool would therefore be unoccupied. The underwater treadmill in the pool is sometimes running continuously for 12 hours, which means we leave no time wasted. We reap passive income by being open-minded and giving our former patients the ability to continue to work in the pool during the open pool time. Although some people also use cooler pools at their health clubs, they report that our therapy pool is cleaner and more comfortable. Plus, their constant presence is a good reminder to current patients that they can continue to make incredible strides even after their work with us is technically finished.

Entrepreneurial Decisions, Financially-Advantageous Results

Creativity is necessary for every entrepreneur, including physical therapy practice owners. While patient care must always remain at top-of-mind, adding value through aquatics is one way to ensure that treatment methods are wide-ranging and multiple types of patients can benefit from the practice’s offerings.

In the beginning, it requires time to educate people, including your own team members, about the opportunities afforded aquatic therapy. However, once everyone understands the potential that a therapy pool can promote a new era of providing health care and enjoying new revenue streams can begin.

Veronica Paquette, PT, ATRIC, PRC, is the owner of Essex Aquatic & Rehab Center. She can be reached at

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