What specialisations should you choose for your physical therapy practice?

Two practice owners on the choices they made.

A physical therapy practice almost always offers multiple specialisations. The 'major' specialisations, with which therapists are listed in the register, act as a starting point. The 'minor' specialisations are any other additions or expansions, such as medical taping, dry needling or forms of physical therapy such as shockwave and TECAR.

If you're looking to start or expand a practice, the many options can be overwhelming. After all, which specialisations should you choose now? And does it depend entirely on your own preferences or do external factors also come into play?

We spoke to Bert from Kinekabinet Vrijders in Belgium and Imke from a Dutch partnership, two seasoned practice owners, about their approach. What specialisations did they choose and why? What do they wish they had done differently in retrospect? And what tips do they have for you as a practice owner who is just starting out or looking to expand?

What specialisations does your practice offer?

Bert: "The major specialisations we offer are manual therapy and oedema therapy. Patients can also come to us for movement counselling, myofascial therapy, dry needling, shockwave, medical training therapy, TECAR therapy, Bobath and other specific neurological rehabilitation techniques, vestibular rehabilitation therapy, sensed movement, fasciatherapy, hydrotherapy and taping and bandaging techniques."

Imke: "In the practice our specialisations are manual therapy, paediatric (pelvic) physical therapy and oedema physical therapy. We also have a lot of more minor specialisations, namely dry needling, medical taping, ultrasound, Mulligan Concept, plagiocephalometry, fitting compression stockings, shockwave, ultrasound, 4xT method, exercise programmes for COPD and claudication patients, physical fitness, (pregnancy) pilates and fitkids."

Did you consciously choose these specialisations?

Imke: "I took over an existing manual therapy practice with another therapist. That's where oedema physiotherapy came in, because it was in high demand. We also added paediatric physiotherapy because of my partner's specialisation. All of the smaller expansions that followed after that fit with what we already had. We think that consistency is very important."

Bert: "I wasn't particularly happy with my practice's success rate so I made a conscious decision at one stage to do significant continuing education and self-education. In retrospect, I would have preferred to master certain techniques earlier in my career. One example is myofascial therapy. It is often not considered when diagnosing musculoskeletal problems, even though it can explain many of the patient's symptoms."

What physical therapy do you offer and why?

Bert: "I offer shockwave, TECAR, electro- and cryotherapy. Sometimes we use only exercise therapy in treatment, but certain conditions require physical therapy because the tissue effects generated by it can improve the condition. This offers a responsible way to increase the load."

Imke: "We use ultrasound, shockwave and diagnostic ultrasound. We do not use ultrasound as a therapy in itself, but only as a support as part of other treatments. Shockwave is used as a stand-alone treatment and it has achieved good results. Ultrasound is a good addition in terms of diagnostics and thus to the treatment we provide."


What specialisation would you still like to add?

Bert: "I would like to further hone exercise therapy, for example with blood-flow restriction (BFR) and flywheel training. Both approaches have a good scientific grounding. I have already experimented with them in athletes with good results, so I would like to learn more about them so we can start applying them to other patient groups. With BFR, I like the idea that it allows weaker people to also engage in good strength building thanks to the smaller number of repetitions and the less intense effort involved."

Imke: "Pelvic physiotherapy would be a great addition because of its links to oedema physiotherapy, paediatric physiotherapy and to our elderly target group due to incontinence problems. Hand therapy would also be a good fit for our practice as it is regularly in demand. An oncology and psychosomatic therapist would also fit well in our team. In turn, fascia therapy and negative pressure therapy are a great complement to scar therapy. Finally, a collaboration with an orofacial therapist may be of interest because of the dental hygienist on our multidisciplinary team, although it would be less compatible with our own practice. So quite a long wish list but the pelvic physiotherapy would be the top priority."


Of the specialisations you already offer, which one would you recommend to fellow practice owners?

Imke: "Manual therapy is an important part within physiotherapy, you can't really do without it as a practice in today's society. Other specialisations depend on where your affinity lies. For example, if oedema or paediatric physiotherapy interests you, that's a great addition, but it dramatically changes your target audience. I also find things like dry needling, scar therapy, Mulligan Concept and nerve stretching techniques to be useful additions. Little things that add some more depth, and that can go in many directions. My tip: try to delve deeper and not get stuck in the basics."

TIP IMKE: "Try to delve deeper and not get stuck in the basics."

Bert: "I absolutely recommend shockwave, because it changes your view of many musculoskeletal complaints. Shockwave combined with myofascial techniques and manual therapy has been a great success with us."


Does the location of your practice play a role in your choices for specialisations? For example, are there specialisations that you have or don't have because of the location?

Bert: "My practice is located in a village and that certainly determines my choice of specialisations. For example, I don't have an orofascial physiotherapist in the team. In my opinion, that specialisation fits better in a larger city because of the wider range of patients. The specialisations available from colleagues in the area also play a role. For example, there is a pulmonologist in the village who regularly refers patients for respiratory therapy. This is definitely an important specialisation to have in house, especially with the increase in patients with lung diseases. Furthermore, we don't offer paediatric physical therapy because several practices in the area already offer it. That's also true of pelvic physiotherapy, but because the number of practices offering pelvic physiotherapy is still modest, this specialisation is still worth considering."

Imke: "Our location close to a centre doesn't really play a role for us; all age groups are represented about equally in our practice. On the other hand, the competition in the local area is important in our choices. For example, we have some good sports physiotherapists in the area. Sports physical therapy doesn't fit our target market and who we are anyway, but even if it did, because of the competition in the area, it wouldn't be wise to expand in that direction."

If you could go back and start your practice all over again with the knowledge you have now, what would you do differently?

Bert: "At the time, I was self-employed from day one, but it would have been better if I had quietly matured for a few years under the supervision of an experienced therapist."

Imke: "We started with a core of three therapists and then slowly expanded the practice. Sometimes we have taken risks that have worked out well, other times we may have missed an opportunity such as hiring a new colleague or expanding with a particular specialisation. But all in all, I am satisfied with our approach."

Do you have any other tips for budding practice owners?

Bert: "Before you jump in, think carefully: where do you want to be located, who lives nearby, and what specialisations are already available in the area? The practice's location and easy accessibility to it are essential. Also make sure the treatment rooms and reception area are decorated appropriately and are inviting. You don't get a second chance to make a first impression. Not only the colour choice and reception are important, but also, for example, the way you answer the phone. Privacy is crucial, make sure the treatment rooms are designed so patients can say something to you in confidence. Furthermore, for your patient base, as a physical therapist it helps to join a sports or social club. Last but not least, invest in good ergonomic equipment because you have to work with it every day."

TIP BERT: "Make sure you have good ergonomic equipment because you have to work with it every day."

Imke: "Make sure you are good at what you do and don't try to do it all at once. Choose specialisations you really enjoy, where your heart lies. From there, look at what you are missing and how you can complement it. The truer you stay to yourself, the stronger you are. That makes you a good practitioner and practice owner."

Learn from your predecessors' experience

We hope reading Bert and Imke's experiences and excellent tips have been inspiring. Have you figured out your next steps? If you're still not sure or have questions, be sure to talk to experienced practice owners and tap into their expertise. Chances are they will have other tips for you. If you have specific questions about the usefulness and application of physical therapy, such as: electrotherapy, shockwave, electrolysis, TECAR or cryotherapy, please contact us without obligation.