April/May 2000

Private Practice: Nurturing a New Technique

By Greg Thompson

By inventing a new therapy technique, Shirley A. Kleiman, PT, OCS, has boosted the financial bottom line of her private practice with increased patient referrals and more cash patients.

Necessity helped inspire the idea for biomechanical correction technique (BCT), but Shirley A. Kleiman, PT, OCS, nurtured and coaxed it to life. For the patients of Kleiman’s private practice, Spine and Sport Biomechanical Rehabilitation Center, Grand Rapids, Mich, her BCT has shifted the focus of healing away from symptoms to a restoration of functional symmetrical movement.

BCT is based on the concept that a change in joint position affects movement and function. While the theoretical basis for the technique is not new, Kleiman’s innovation springs from her function- oriented approach and practical application of biomechanics to active exercise.

“In most traditional physical therapy, the patient is questioned about his symptoms and asked to rate his pain. What I tell patients is that when you get rid of pain, it does not necessarily mean you are out of the woods,” Kleiman says. “What you want in terms of function is to get rid of the entire negative movement pattern, then you have prevention. When I talk about restoring function, I mean that every joint has its optimum position to move in so there is no restriction and no compensatory pattern in any other part of the body.”

BCT transforms manual therapy into therapeutic exercise to restore biomechanics and resolve structural dysfunction and symptoms. A therapeutic regimen of corrective exercises is developed for each individual depending on his or her pattern of dysfunction. Kleiman’s results are achieved without manual manipulation, mobilization, or other passive interventions. When Kleiman started her own private physical therapy practice a decade ago, she used traditional techniques with good results. Back then, she had plenty of patients, but not enough time. “As the only one at my practice who was skilled in manual therapy techniques, I felt the burden to cure everyone,” Kleiman says.

In addition to time constraints, she began to see limitations in traditional symptom-based methods. Using her clinical experience and skills as a manual therapist, Kleiman developed BCT as a better way to treat patients and boost results. The first biomechanical correction technique evolved from the need to help a patient that could not maintain sacral (pelvic) positioning. In spite of strengthening exercises, pain returned hours after treatment and progressed as activity level increased. Kleiman was concerned that the patient was strengthening his joints in a less than optimal place of function. By adapting her hands-on correction to an exercise, Kleiman cultivated the beginnings of the technique that would flower into her full-time mission. As BCT blossomed, better outcomes and positive word of mouth translated to a healthier bottom line and a steady flow of referrals.

TeamWork Pays Off

In contrast to the competitive approach of many practices, Kleiman freely refers patients to massage therapists, fitness trainers, exercise physiologists, and other allied health care professionals. About half of all new patient referrals are patient-initiated (no marketing is needed), while the other half comes from physicians and allied professionals. “Physical therapy practices are trying to hold on to patients and offer everything. By doing that, they actually limit themselves and end up in competition with allied fields,” she says. “I probably get more referrals from these types of professionals because I work with them as a team and routinely send patients back into their world. That philosophy has been a tremendous asset and the patient appreciates it.”

About a third of the patients at Spine and Sport are health maintenance organization (HMO) members who opt out of their plan and elect to pay cash (Spine and Sport is not part of any managed care system). Remaining payment comes from a diverse group of private insurance, Medicare, and workers’ compensation insurance.

Patient Education

Kleiman teaches patients the basics of BCT so they can help themselves if future problems should arise. “If the mechanism or the injury should change, patients have the basic tools to correct the problem,” Kleiman says. “The same principles of biomechanics apply to every joint. You just go through and clean house. You identify the joints that are involved and identify the pattern of dysfunction, then apply that knowledge to fix yourself.”

Patients are instructed in individualized exercises that progress through a four-phase program of correction, stabilization, strengthening, and stretching. They perform unilateral check-tests comparing gross arcs of movement to identify involved joints and the symptoms that may arise from their dysfunction.

Kleiman explains that it is not necessary for patients to understand the scientific reasons behind their improved function, only that they correctly apply what they have learned. “It is almost like an algorithm,” she says, “where you can start at one point and work your way through. By the time you get done, you know exactly what pattern you are in. And there is an exercise that correlates to each pattern.”

BCT is based on the principles of clinical human anatomy, physics, and geometry and does require a degree of precision. Initial patient evaluations take about an hour depending on the extent of joint and soft tissue compromise. For the physical therapists who work for Kleiman, BCT has been easy to learn and apply.

With a staff of seven at her single-clinic, 2,000-square-foot operation, Kleiman no longer feels a need to do everything herself. “Before BCT, patients came to my clinic for me. Now they come for my technique,” she says. “If I am not there, patients will still get my tools.”

Kleiman has not yet released BCT to her peers. “This has been pretty hush-hush because I am a firm believer in research,” she says. “I do not want the technique to come out, then have to prove it. I want it to be proven and then come out.” Beyond expanding her practice, Kleiman hopes to make a lasting contribution to the practice of physical therapy. Like neurodevelopment treatment and McKenzie’s mechanical diagnosis and therapy, she dreams that BCT will one day be a treatment option for all licensed physical therapists.

During the past 4 years, Kleiman has partnered with her alma mater, Grand Valley State University, Grand Rapids, to do clinical research and validate her technique. Her current research is a comparison of BCT techniques to standard McKenzie protocols for low back pain. “I validate BCT every day in my office, and my patients are my living proof,” she says. “But the critics out there are the researchers and they want proof. I want to come out and say, ‘Here is the proof.’ ”

Kleiman will get a chance to present her proof this December at the American Back Society’s annual meeting in Vancouver, British Columbia. “My whole focus is that I want to give back to my profession a specialty above and beyond what a patient can get from a physician, massage therapist, exercise physiologist, or trainer—and that is the scientific aspect of exercise,” she says. “This is my life’s work and I want to teach the world.”

LOOKING FOR EXPERT ADVICE? Experts here are available to answer all your questions! Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER Interactive Media  Archives  · July 2009  · June 2009  · April 2009  · March 2009  · January/February 2009  · December 2008  · November 2008  · October 2008  · August/September 2008  · Fall 2008 Product Directory  · All Archives  Newsletter  · Rehab Today  · Monthly Top Ten   Podcast Series  · Trends in Practice Management Software  · CSM Podcast  · Long-Term Rehabilitation   Webcasts  · Solutions in Long-Term Rehabilitation Resources Classifieds Calendar Consumer Resources Media Kit Advertiser Index EAB Reprints Submit an Article