Post Rehab Tip #13 - What documents do I need for insurance reimbursement?

When seeking insurance reimbursement for post rehab services contact the client’s insurance claims adjuster. You will need the following documents when you make the contact:

a. Signed post rehab referral for the client's physician
b. Post Rehab Program Goals (functionally-based)
c. Post Rehab Program Design (include duration, frequency & number of sessions)
d. Post Rehab Assessment

Securing insurance reimbursement for post rehab services requires more than having these documents on hand. How to negotiate the insurance reimbursement maze is reviewed in detail in our "Insurance Reimbursement for Post Rehab Professionals" workshop. Dealing with insurance carriers is becoming part of the daily life for post rehab professionals. This and other streams of post rehab income are reviewed in our podcast titled "Multiple Streams of Post Rehab Income". Follow this link to listen in our how to develop multiple streams of income in your post rehab practice - Multiple Streams.


Dr Mike

Post Rehab Tips #12 - Levels of Assistance

Sometimes you will receive a referral to work with a client that requires assistance with balance, transfers and ambulation. You must be aware of the three levels of assistance. The levels of assistance are:

a. Maximal Assistance
b. Moderate Assistance
c. Minimal Assistance

Click on the link below to listen to the definition of each level and how impact on the post rehab program.


Dr Mike

Post Rehab Tip #11 - The step-by-step medical history interview

A thorough medical history must be completed on each post rehab client. Verbally ask the client each question on the med history form. Direct interaction with the client allows for a much more accurate medical history appraisal and avoids the possibility of a medical condition slipping through the cracks. The medical condition missed in the medical history may result in the client exacerbating an old condition or causing a new injury. The most important aspect of the medical history is to listen. Your client will tell you every medical concern they have but you must listen closely for the subtle meanings within the medical history interview. The importance and approach to taking a medical history is reviewed in our Medical Exercise Specialist and Essentials of Post Rehab Fitness workshops.


Dr Mike

Post Rehab Tip #10 - Overall Leg Strength in Post Rehab Fitness

"Overall Leg Strength" is a concept to be considered when working with clients referred with lower extremity disorders such as total knee or hip replacement and ACL rupture. Overall leg strengthening simply means strengthening the muscles of the lower extremity to lift 2-3 x bodyweight. This is important for climbing stairs, stepping off curbs and getting out of a chair. The lower extremity must be able to control and support the client's bodyweight. Closed chain exercises such as the lateral step up, leg press (both bilateral and unilateral) and wall squats improve overall leg strength. Overall leg strength is vitally important to the clients functional capacity and level of independence.


Dr Mike

Post Rehab Tip #9 - Understanding Bone Spurs or Osteophytes

Bone spurs are known as osteophytes. Osteophytes occur as a result of osteoarthritic changes. Rheumatoid arthritis (RA) does not cause osteophytes. RA usually polishes the end of long bones. When the physician looks at an x-ray, an indicator of osteoarthritis is the presence of bone spurs along the margins of the joint. Osteophytes are a normal occurrence with osteoarthritis.


Dr Mike

Post Rehab Tip #8 - The Use of the Thomas Test

The post rehab and/or corrective exercise assessment of the lower extremity commonly includes the the Thomas test. The Thomas test is often illustrated and demonstated incorrectly with the pelvis positioned far back on the surface supporting the client. The test should be performed with the ischial tubs placed on the edge of the surface supporting the client but the tubs are fully supported. The error in placement of the pelvis will cause inaccurate test findings. Please watch my demonstration of the Thomas test by clicking the link below.




Dr Mike

Post Rehab Tip 7 - The Components of Function

Medical Exercise Specialists and Post Rehab Conditioning Specialist are bombarded with information on "functional training" programs. It's important to understand the components of function and how exercise will impact on the overall functional capacity of the post rehab client. Functional improvement is the most important aspect of rehabilitation. The components to function include:

If any or all of the components of function improve with exercise, then the client's overall functional capacity will improve. Remember, its all about "function" with the post rehab client. Click the link below to listen to this post rehab tip.

Dr Mike

Post Rehab Tip #6 - Utilization of Heart Rate Monitors

Use heart rate monitors with ALL clients. Even clients with musculoskeletal disorders should use heart rate monitors. Many clients do not exercise at the appropriate intensity levels. Working in the target zones ensures the improvement of cardiovascular efficiency and the avoidance of extremely high exercise intensity. Though heart rate monitors may not work for clients on certain medications, primarily beta-blockers, the majority of clients will benefit from their utilization. Listen to this post rehab tip by clicking on the link below.

Dr Mike

Post Rehab Tip #5 - Wolfe's Law

Wolfe’s Law is the very basis of post rehab and strength training. Wolfe postulated that if we stress connective tissue it will become stronger. Strengthen training actually makes bone, muscle, tendons, ligaments, muscle and even cartilage stronger. Even connective tissue has limits. This limit is known as the "physiologic threshold". The physiologic limit or threshold is the amount of force the tissue may absorb before damage occurs. Tissue damage occurs when the force exceeds the limit. Sprains, strains and ruptures are examples of exceeding the physiologic limit or threshold. Wolfe's Law is fundamental in understanding the injury process and post rehab program progression guidelines. Click the link below to listen to this post rehab tip.


Dr Mike

Post Rehab Tip #4 - Post Rehab Red Flags

When we implemented our Medical Exercise Specialist workshop and certification program, we realized it was important the post rehab professional be able to identify the inappropriate client. We established the "Post Rehab Red Flags" to give post rehab professionals hard fast signs they could easily see to identify that inappropriate client. The post rehab red flags are noted below:

a. Numbness/tingling
b. Radiating pain
c. Swelling
d. Nite pain
e. Loss of range of motion
f. Loss of function
g. Chest pain/shortness of breath
h. Open Wounds
i. Abnormal vital signs

Clients demonstrating any red flags should be referred to a medical professional. The client's exercise program may require modification based on your discussion with the medical professional. Recognizing these red flags will help you avoid exacerbating existing conditions or possibly injurying an apparently healthy client. Follow the link below to listen to this post rehab tip.

Dr Mike

Post Rehab Tip #3 - Post Rehab Scope of Practice

The scope of practice for the post rehab professional includes the following functions:

a. Fitness Assessment
b. Strength Training
c. Cardiovascular Training
d. Flexibility Training
e. Functional Conditioning
f. Aquatic Exercise
g. Spinal Stabilization Training
h. Diabetic/Hypertensive Training
i. Weight Reduction Programming

There should be no attempt to offer your services in lieu of physical therapy, chiropractic or any services provided by a licensed medical practitioner. The terms “therapy” and “therapeutic” should not be used. These terms convey that licensed therapists are providing the services. Remember, clients are easily confused and may misunderstand the terms "therapy" and "therapeutic". Clarify and avoiding such confusion by clearly defining your role and scope of practice in all of your brochures and marketing materials will enhance your image and standing the medical professionals in your community. Follow the link below to listen to this tip.

Dr Mike

Post Rehab Tip #2 - Pain Levels

Avoid exercise when the client reports pain levels above 5 on a 1-10 scale. Pain levels above 5 indicate possible tissue damage. Follow the link below to listen to this post rehab tip.

Post Rehab Tip #1

When developing the post rehab program for the spondylolethesis client avoid excessive lumbar extension (beyond neutral) and strengthening of back extensors with movement beyond spinal neutral or past zero degrees. Emphasize strengthening of the abdominals and maintaining slight trunk flexion. Any extensor strengthening must be done while positioned in slight trunk flexion and should not allow the client movement past neutral spine into excessive extension. Follow the link below to listen to Dr Mike's discussion of this post rehab tip. Visit us again in 3-4 days for another post rehab tip.

Click here to listen to Post Rehab Tip #1