Game Changers


Finding your niche for the 21st century.

By Ian Kornbluth, PT, MPT and Tom Walters, PT, DPT, OCS, CSCS

In the 20th century, the profession of physical therapy was considered a niche within the health and wellness industry. Physical therapists were specially trained practitioners who differentiated themselves by simply possessing a unique skill set in the areas of physical examination, rehabilitation, and treatment. This was a good time to own a physical therapy practice—competition was minimal and insurance companies were paying top dollar for these premium niche services.

Today, the profession of physical therapy has gone mainstream. The previously unique specialty service is now available at your physician’s office, chiropractic center, school training facility, and local gym. Competition in the industry has grown fierce with physical therapist-owned practices taken over by corporations, hospitals, or physician groups. Additionally, other disciplines are steadily encroaching on physical therapy, including fitness trainers who are performing movement assessments and developing exercise programs for special medical populations.

Despite a growing demand for rehabilitation and wellness services, as the American population gets older, heavier, and more sedentary, most private practice owners are struggling to keep their doors open. They are contending with fierce competition combined with strict limitations on insurance coverage and dramatic cuts in insurance payment rates.


To generate the same revenue as yesteryear, some physical therapists have resorted to treating in volume. They double, triple, or even quadruple their patients during a treatment hour, while delegating skilled physical therapy services to less-qualified personnel, such as rehabilitation technicians or therapy aides. This high-volume, low-quality practice model is, unfortunately, causing irreparable damage to the profession. It lowers the customers’ perceived value of the services rendered, and it gives insurance companies even more ammunition to aggressively control utilization, limit coverage, and reduce payment for physical therapy services.

With Obamacare pushing the industry toward outcomes-based payment, this traditional practice model is quickly showing signs of insolvency. Many private practitioners are now searching for a sustainable model that is better suited in the 21st century. They are searching for ways to differentiate themselves in today’s competitive environment, gain new referral sources, and generate more income per customer while relying less on insurance payers.

Embracing some of the latest innovations in the industry, physical therapists can create a niche that separates and defines their practice for years to come. While learning something new takes a serious commitment of time, it has the potential to be a “game changer” for your practice. A unique skill can draw attention among people in the community and bring in new customers and referral sources. It can even bring in populations that were lost to your competitors. Combined with the right marketing strategy, a new service can provide a strong following and quickly become a very valuable asset to your business.

Those who decide to take the path less traveled should do so with a strategic plan. Find something unique that just a few others have in a geographical region and calculate the size of the market segment that would benefit from the service or tool. Additionally, you must dedicate enough time to learn the science and applications better than anyone else in the area. Becoming the “local expert” may develop cash-based options, dampening the impact felt of the declining trends in insurance reimbursement.

Numerous niche practice options are available to physical therapists. For instance, you can take advanced coursework to become certified in an alternative method of examination or treatment, such as neuromuscular rehabilitation, dry needling, or Selective Functional Movement Assessments. You can also focus on general areas of practice, such as orthopedics or women’s health, and become a board-certified specialist. Innovative tools, such as suspension exercise equipment, Pilates, and motion analysis cameras can add value to a practice with their modern and space-saving designs. Enhance your operations and reduce company overhead with the latest electronic business solutions. All of these options can set a practice apart from the competition by improving the customer experience with the latest science, tools, and systems available in the industry.


Suspension-based methods of examination and treatment help patients suffering from musculoskeletal pain, neurological conditions, physical impairments, or disabilities. Specially tailored exercises and neuromuscular re-education techniques administered in ropes and slings demand precise movement control, core strength, and muscle stability and coordination. Application of a “bungee” off-loading system helps facilitate proper form and control of each movement, while allowing the exercises to be pain-free and possible for people of all ages, conditions, and ability levels.

Video motion analysis software allows therapists to record and digitize motion to more precisely analyze movement from both quantitative and qualitative perspectives. In tasks that require increased speed, such as running, walking, and cycling, having the ability to record motion and slow down the rate of action is vitally important in identifying movement dysfunction. Additionally, motion analysis tools allow therapists to provide their patients with instant visual feedback and track changes in movement quality throughout therapy sessions. More advanced systems often allow therapists to capture real-time joint angles and coordinate with other tools such as force plates and pressure mapping treadmills.

The profession of physical therapy is ever-evolving to new areas of study and practice. Those who embrace innovation and foster professional growth are sure to prosper. Conversely, due to a fiercely competitive landscape, those who remain stagnant offering the same treatments of yesteryear are sure to be left behind. 

Ian Kornbluth Head Shot LR

Ian Kornbluth, PT, MPT, CNP, is a PPS member and a physical therapist, certified Redcord Neurac Provider, clinical instructor, and owner of a concierge practice called the Neurac Institute ( This state-of-the-art center for physical therapy and sports rehabilitation also serves as the U.S. Headquarters for Redcord training and mentorship. Ian is currently launching additional concierge clinics under the name Activcore ( He can be reached at

Tom Walters Head Shot LR

Tom Walters, PT, DPT, OCS, CSCS, is a board-certified orthopedic physical therapist, Redcord Neurac provider and instructor, adjunct kinesiology professor at Westmont College, and former traveling physical therapist with Cirque du Soleil’s Performance Medicine Department. Tom also co-owns a concierge physical therapy center that also serves as a biomechanical testing and movement lab called the ArthroKinetic Institute ( located in Santa Barbara, California. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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