All the Equipment: Rise of the Machines

“Hey Dr. Q I just want to talk to you and see where your facility” 

“well we’re mobile right now so we come out to your house or we take you to your gym to do your therapy “ 

“What about all the machines that my doctor says I need to move my knee?”

“Well honestly whatever could be done at a clinic can also be done at your home and if we need to use heavier weights than my kettlebells I have access to multiple gyms.” 

“Well my doctor said I needed these machines to move it and I just don’t see how this can be done in my home because there’s nothing here. The clinic has machines to do my therapy I don’t get s**** here.” 

“Well, honestly the only machine that you need to get better is connected to you. Our bodies need the appropriate loading and stress to the injured structures to heal. The equipment is just an extra tool in the toolbox. Most of the equipment that you use in the clinic I have in my trunk right now.”

 “ NO! My doctor says I need to use the equipment and he’s adamant that I use equipment so I’m just gonna go to this place.“ 

I’ve had this conversation so many times where somebody starts off inquiring about my services but when they find out that I’m mobile they have a hard time picturing how we’re gonna do therapy without the fancy treadmill and other machines with LED lights and sounds. It gets frustrating because it seems like I can convince people I don’t have any relationship to the benefits of in-home outpatient therapy more easily than I can’t people that I have known sometimes for 10+ years. Other times it’s the doctor who is so adamant that they need to use equipment that they go to another place first even though they want to come here. Sometimes, quiet is kept, and the MD if they are so adamant about going to a specific place has a relationship with the said clinic and tries to push patients to that clinic even though in the state of Virginia and many other states the client can go to whatever clinic they so choose.

Photo by Dmitriy Ganin on

 What’s funny, to me, is that I’ve worked in multiple PT clinics and managed most of them. I was responsible for ordering all this fancy equipment. Invariably the equipment either collected dust or was used to allow the Therapist to catch up on notes.. I remember looking at the sale guide for different types of zero-gravity treadmills. Those things on the cheap end were as expensive as a new car meaning we would have to see more clients to cover that expense. I have a few friends who are therapists and they say that the Lexus of treadmills gets driven less than a Hummer during a price hike on gasoline.

Back in North Carolina, a vendor came to my clinic trying to sell me on a shockwave/ laser machine. The gist of the machine was that it sent “ shockwaves” down into your muscles to break up scar tissue to promote healing. The demo was great. It was fun to use after about two weeks that they became a coat hanger, a $10,000 coat hanger. That fancy machine was used on exactly 2 people for three visits each for a clinic that saw close to 100 clients a week. It did feel good on my knee but by the time I finished doing squats at the gym, my knee was hurting again.  

 I understand seeing the fancy equipment and wanting to go there because it looks like the place to be. In 2009, I fell into the trap of a gym that had new weight machines, the shiny cardio equipment.  I was spending over $50 a month for membership. The thing was the gym was at least 20 minutes away from my job without traffic and since I lived 45 minutes from work. Let’s just say going home from the gym was the worst, especially after leg day. After a while it didn’t matter how fancy the cable machines were or how new the grips on the pull-up bars were. Getting there was just inconvenient. I was paying $50 a month in gym fees and did more working out at the house with my free weights.

Photo by Andres Ayrton on

When you go to P.T. clinic you expect to see treadmills, Nusteps, and UBE’s of many colors. Most do not realize that in a lot of those clinics you’re with an overworked physical therapist who’s treating three other people at the same time they’re treating you. Sure, being on the Nustep or the arm bike/treadmill will help to increase mobility but it also allows the P.T. to at least partially finish the note from the four patients an hour before. At times it’s not even a PT or PTA you’re working with so why not just pay $10 to use the same equipment at Planet Fitness especially if you’re on them for 20-30 minutes.

I’m going to give you a trade secret: you can go to Walmart and get a little pedal bike for $30-$50 and use it the same way you use the arm bike or the recumbent bike. Oh and that $2000 treadmill that the PT clinic has, which has to be fixed frequently, just go for a walk. Unless you’re training to return to sports or going to a PT specifically for running, no one is going to turn the treadmill speed past 2.0 mph and most people walk that speed. 

There’s one more piece of fancy equipment in most PT clinics, the electrical stimulation device. You know the device that they plug up to you turn it on and you feel a little electrical current down your body and everyone disappears on you for 15-20 minutes. I love this machine, it is great at relieving temporary pain so I’m not going to bash it. I show people how to use one all the time then I have them go on Amazon or Wally World and purchase one for the price of their copay most times and now they have that temporary pain relief for the life of the machine.

 I guess what I’m getting at is that the fancy equipment is only as good as the person, and the reason for you being put on that machine. Also, that fancy piece of equipment can be replicated by something you have at home unless you’re having to lift/move serious weight. I was always told that the sign of a good therapist was the one that can use the human body and simple objects that are present as the basis for the exercise program. That if I had to rely on machines and give everyone the same exercises no matter how the patient presented I was nothing more than a tech. That most patients don’t have fancy machines at home. That the art of therapy was looking at the patient, the n=1, and using what was available to get the job done.

5 months later 

“Dr. Q how are you doing” “I’m good how’s everything going how did your therapy go”

“well all they did was put me on a bike and kinda left me alone to do the same for exercise all the time I really couldn’t do it at home”

“Well, how’s your knee feeling?” 

“Well, it hurts when I go up my stairs because my stairs weren’t quite the same size as theirs when I try to clean my tub it hurts.”

“I’m sorry to hear that.”

“Are you able to fit me in your schedule”


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