By Michael J. Mulrenan, PT, and Mike Severo, PT

By now, therapists and practice owners should all be aware that outcomes, patient satisfaction, and cost-effectiveness are overall measuring sticks for the future of physical therapy practices, but these tenets should also become part of strategic decision-making when it comes to capital investments, such as exercise equipment.

It seems that every year, fancy and oftentimes costly technological advances touted to help therapy clinics survive in the current healthcare market are introduced. Much of the new technology and equipment is quite good and trendy, if not particularly innovative. The reality, however, is that solutions for maintaining optimum patient outcomes and high levels of employee satisfaction come in a range of sizes and prices—including resistance equipment.


All the recent literature across multiple diagnoses suggests that exercise and movement continue to be the best methods to recover from an orthopedic issue. The challenge to the physical therapy practice owner or manager, however, is determining how to choose the right combination of exercise equipment that best serves the needs of patients while not breaking the bank.

At ProEx Physical Therapy, headquartered in Portsmouth, New Hampshire, the prevailing philosophy is to keep it simple, so much so that the facility continues to utilize one of the original simple machines: the good ‘ole reliable pulley, to perform much of the practice’s exercise rehab. Before, during, or even after a pulley routine, the practice often has patients performing what the therapists refer to as “global” exercise using a variety of cardio exercise equipment. In combination, these pieces of equipment can achieve remarkable outcomes in a cost-effective manner.

A pulley system offers many advantages of single-use pieces of equipment or a set. Some of the most important features include cost/space ratio, versatility, ease of use, support from the latest literature, and transferability to a home program.


It is dangerous to think of cost-effectiveness as providing less treatment. The value equation to the payor is the relationship between the number of visits relative to the outcomes achieved. As providers we must consider the revenue we can generate as compared to the cost of providing service. Naturally, labor cost is a practice’s greatest expense, but it is important to not ignore the impact of occupancy and equipment cost when calculating the bottom line.

Research the amount of space the equipment that is being considered for purchase will require, being sure to include any benches and non-usable “pathway” space. Also, sketch out how this will fit in a clinic’s current space or a new space. Cost out the square footage based on what the going rate is in the local market. An extra 200 square feet of space could cost $4,000 to $7,000 more per year. The pulley system we use through Cardon Rehabilitation, headquartered in Burlington, Ontario, Canada, takes up approximately 200 square feet when fully utilized by patients. This system can have as many as six patients working at the same time on different types of exercises, creating a very efficient use of space. We start our global equipment with a treadmill, bicycle, and elliptical, and find that variety is best.

[sidebar float=”right” width=”250″]Product Resources

The following companies offer products for resistance training, health, fitness, and therapy:



AKT Medical


Brookdale Medical Specialties Ltd




Cardon Rehabilitation


Hausmann Industries Inc


Spirit Medical





To maximize profitability, most of a clinic’s space should be revenue generating. A versatile piece of equipment is one that can be used for a wide range of diagnoses, body types, and patient populations. For example, the use of a versatile pulley system allows our practice to maximize its space in revenue-producing ways. Versatility itself can be broken down into subsets such as the following:

Can be used with multiple diagnoses or body parts. In combination with the associated benches provided by Cardon Rehabilitation, one single pulley stack can be used to treat every region of the body. In combination with a complete “module,” the number of exercises are only limited by one’s imagination. A module would consist of four single pulleys, a lateral pull-down, and a slant board that can be varied in height and angle.

Can be adjusted to accommodate any Range of Motion (ROM) A large component to how this practice treats as an organization is to “deload” a body part to find the pain-free range of motion for patients. Therapists then progress to a high volume of exercise in that pain-free range during early stages of recovery. For postsurgical cases, it is also important to restrict a specific motion or ROM. The pulley system used in the practice allows for variations and restrictions in ROM.

Can be adjusted to accommodate small increments of resistance or change in resistance in addition to heavy resistance training. In particular, during the tissue-healing phase of recovery and/or when patients are getting over their fear of movement, it is important to begin with a very light load and then increase the load in small increments. With industrial exercise equipment, this is often difficult to accomplish as the increments are too far apart, the result being either the inability to challenge the tissue (if the load is too light) or overtaxing the tissue (if the load is too high), thereby not making good use of the time spent in rehab.

Can be utilized to simulate functional tasks. This is important, since it is our clinical and professional responsibility to eventually get patients doing functional tasks that simulate the tasks, job, or sports they most commonly perform. The latest literature suggests that task-specific activity or exercise with high volume and low load leads to better outcomes. In addition, functional improvement is what the payor is more frequently asking for and what outcome tools measure. Again, the pulley system can allow therapists to mimic most function tasks, including but not limited to reaching overhead, picking objects up from the ground, squatting, kneel-to-stand, pushing, and pulling. The pulley system also allows combined movements that other single-use pieces of equipment cannot simulate. For sport-specific exercise, with a few basic attachments and sometimes none at all, a therapist can simulate swinging anything from a bat to a tennis racquet at nearly any height.


High volume-low load exercises are proving to be well-supported by the literature from many different aspects, including tissue healing, motor control, and graded exposure in chronic pain. The effects of global or cardiovascular exercise are well-known, and recent indications that it assists in pain modulation makes cardiovascular equipment all the more valuable clinically. For practices considering the purchase of cardiovascular equipment, there are several manufacturers that offer a variety of this type of gear at several levels of technology and designed for the physical therapy market. One example is the Eccentron eccentric resistance trainer from BTE, headquartered in Hanover, Md. Spirit Medical Systems Group, based in Jonesboro, Ark, likewise offers several products for cardiovascular exercise, including the MU100 Upright Lower Body Ergometer, MT200 Bi-direction Treadmill, and other recumbent bikes and steppers.

For the global equipment large pieces of equipment can be intimidating and may feed into pain behavior, particularly for a non-exerciser. Patients will be more likely to want to keep using equipment if it is safe and easy to manage with minimal assistance. Physical therapists know that compliance with home exercise is often poor, yet this critical element is vital for patients to “own” their recovery. We find it easy to replicate the pulley exercise performed in the clinic by utilizing either latex exercise bands or exercise tubing, such as the Thera-band line offered by The Hygienic Corporation, Akron, Ohio. Whether for graded exposure, function, endurance, strength, or ROM, patients can immediately see the exercises performed with the Thera-band are near exactly what they have been performing with the pulleys in the clinic. It is not a new movement pattern, only a different one. Another source for therapy bands and tubing is the Fit-lastic product line from Warminster, Pa-based Stretchwell. The Stretch Ranger range of motion pulley is also available from Stretchwell.

In summary, when considering exercise equipment purchases, keep it simple. Consider combining a state-of-the-art pulley system with a variety of cardio equipment for a space-efficient, cost-effective, evidence-based start to achieving successful outcomes, happy patients, and protected profit margins. PTP

Michael J. Mulrenan, PT, is chief executive officer and president of ProEx Physical Therapy. He earned a master of science degree in physical therapy from Boston University. Mike Severo, PT, is chief operating officer of ProEx Physical Therapy and has over 25 years experience as a clinician, administrator, and educator. Severo holds a bachelor of arts in exercise physiology from California State University, Fresno, a masters degree in physical therapy from Boston University and completed a 2-year fellowship program in orthopedic manual therapy. Severo is on the faculty of the Boston University Fellowship in Orthopaedic Manual Physical Therapy program and a member of the MA APTA Education Committee. For more information, contact [email protected].