Functional Fit


Finding success for your practice.

By Joan Arieta, RPT, DPT

What makes a successful practice? Why does one clinic attract new business and stay busy, while another, in the same market, with seemingly equal space and resources, struggles?

Alhambra Valley Physical Therapy is a small, outpatient neurological and orthopedic family practice clinic with the therapeutic goals of pain relief and restoration of proper biomechanics, movement, and function through evidence-based practice. We have been practicing physical therapy in California’s San Francisco Bay Area—the hub of high-tech innovation—for almost 30 years. We have made it through the Dot-com Bubble, state health care reform, housing booms and busts, and the financial crisis of this decade. Hundreds of health care providers have come and gone through the years in this challenging business climate.

We have learned through experience—and all of the market’s ups, downs, and somersaults—that to see their clinics thrive, private practice owners must find a functional fit in their specific business climate—a way to serve a target niche in their own, unique way.

We have done this through our aquatic therapy program.

We are a full-service physical therapy clinic with many modalities. Yet, as our website attests, we specialize in and are devoted to aquatics. We feature a state-of-the-art therapy pool with underwater treadmill, resistance jets, and massage capabilities. Our aquatics program is at the forefront of all we do.

In developing a marketplace niche—whatever that may be—it is important for every private practice owner to remember three key actions leading toward business success: attract attention, gain trust, and offer an indispensable “product.”

Attract attention

We love the properties of water in treating patients. The buoyant force of water can eliminate from 20 percent to 100 percent of an individual’s body weight.1 This fact, in conjunction with the therapeutic characteristics of warm water, allows for a substantial decrease in joint compression and pain. We knew this modality could be a huge benefit for orthopedic surgeons and their patients in assisting patients through the healing process. But how could we effectively communicate the benefits of our offerings to others—especially those who refer patients to physical therapy?

When we first invested in our pool 13 years ago, we sent out a hundred letters to orthopedic surgeons, inviting them to after-hour events at our practice to demonstrate our new aquatic capabilities. This produced zero leads. We learned our lesson.

Through trial and error, we realized the best approach to attract attention from the right people was to set up appointments and personally visit potential referral sources and patients. This took time and energy, but was invaluable in helping us attract attention and develop important relationships.

For example, in our area, there is a large health system consisting of two hospitals and a large handful of rehab clinics. As a small independent clinic, we knew we could not compete with them head-to-head, but realized that we could provide a service to their clients that they did not have—aquatic therapy.

We met with doctors and explained to them the capabilities of our underwater treadmill and resistance therapy jets and the effect these tools could have on a segment of their patient population. We discussed the benefit the aquatic environment would be to patients with limited weight-bearing abilities who, in the water, could be treated “crutch-free,” and therefore steer clear of developing any of the bad habits and flawed gait patterns that come with the overuse of upper extremities while patients try to unload the legs. The doctors liked the idea of the water and so did their patients.

Gain trust

Today, our pool is used continuously. But this took time. Our aquatic program grew methodically, through word-of-mouth by patients, doctors, and other members of the community. We built trust with people by constantly delivering the best care through the most technologically advanced equipment and therapists specially trained in aquatics. Our practice grew as our patients experienced many successful functional outcomes.

After many years of collaboration with us, the big health care system still refers in-house when possible, but they call on us when aquatic therapy is needed. We stay in the loop and, as a result, our practice—and our pool—stays tremendously busy.

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Offer an indispensAble product

In the pool room, we utilize four video cameras—two above the water’s surface, two below the water—and a flat screen monitor. Above and beyond the healthy aquatic environment, this camera system offers patients and therapists something incredibly useful: immediate feedback for the patient and enhanced diagnostic capabilities for the therapist.

Many times, patients do not realize what they are really doing with their bodies until they see themselves on camera. Our therapists cue patients to look at the various cameras. They can make “real time” adjustments. Also, when a patient sees themself on the monitor, walking or running after an absence of such activity, they are able to conceive the reality of experiencing these functional outcomes again on land.

Unique opportunities exist in every market. Private practice owners must thoroughly and deliberately assess how they can potentially serve a niche, then go about grabbing some positive attention, gaining community trust, and delighting individuals with skills and offerings. When this is done effectively, their business can thrive even in the most challenging marketplace.


1. Cole A, Becker B. Comprehensive Aquatic Therapy. Waltham, MA: Butterworth-Heinemann; 2003.

Joan Arieta, RPT, DPT, founded Alhambra Valley Physical Therapy in 1986. AVPT is a small, outpatient neurological and orthopedic family practice clinic in Pleasant Hill, California, specializing in aquatics and offering patients evaluation and treatment for a variety of musculoskeletal and neuromuscular system dysfunctions. Prior to founding AVPT, Joan served in the U.S. Army medical centers in the Musculoskeletal screening, Orthopedic, and Neurologic rehab units. She graduated from the University of California with a bachelor of arts in physiology (honors), from Baylor University as a doctor of physical therapy, and is certified with APTA as a clinical physical therapist. She can be reached at

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