Tracy Halmos, MPT, ATC, CSCS, has been a physical therapist for nine years and co-founded Individualized PT, Morgan Hill, CA, with her husband, Zsolt, about six years ago. But Halmos has also found time for innovation amid her busy schedule as a private practice owner, wife and mother. Always seeking new ways to help her patients achieve the best possible outcomes, she invented The BackStrap, a patent-pending therapy device appropriate for a variety of conditions. ADVANCE recently spoke to Halmos about her inspiration for The BackStrap, its uses and potential impact on the profession.

ADVANCE: When did you invent The BackStrap?

Halmos: About two years ago. I had been toying with the idea to develop something for patients to release their soft tissue at home. Then in December 2006 I was watching "The Oprah Winfrey Show" and she said they were teaming up with QVC for a contest asking viewers to come up with the next big idea. I got so excited and thought that was my opportunity to move forward.

Between December 2006 and March 2007, I developed a prototype and knew what I wanted to do. The product wasn't finished but I at least had something to go down to QVC and show them. "Oprah" representatives were there and videotaped the whole thing. I got really good feedback from them but didn't win so they never called me back. Still I thought that I needed to continue developing the product. So over the past two years I've been modifying my invention to the point that it's now something I truly want to introduce to Oprah if given another opportunity.

ADVANCE: Is there a QVC branch office near your clinic?

Halmos: Morgan Hill is located just south of San Jose and the nearest QVC office is in Los Angeles, so that's where I went. There were also tryouts in Philadelphia and Chicago.

ADVANCE: How did you create a prototype?

Halmos: It was an interesting process. My idea was to develop something that patients can do at home similar to what I did with them in treatment. I've had a successful practice conducting manual therapy with a lot of sustained hold and pressure, finding restrictions and releasing them out - basically a combination of joint and soft-tissue mobilization. And then of course assigning home exercise programs.

So for the duration of an appointment, I'm really trying to release restrictions. Then I thought, what's the next step? I wanted patients to have something to do at home, so I was cutting up foam rollers and using tennis balls, but they just couldn't get in there the way I wanted and didn't suit all patients.

I came to the conclusion that a ball offers the best shape to provide release because it will hit the spot no matter where you lay on it. But the size of the ball made a difference. So I decided I needed balls of different sizes and densities, offering varying levels of firmness. For example, most people can't lie down on a hard ball on the floor.

I thought I needed something that was tennis ball size but very soft. Then a harder ball for people who have more muscle tissue, a bigger one for larger muscle groups and a small one for the feet and hands. I was really trying to create a kit that all patients, from senior citizens to athletes, could use to find a ball that suited their needs, from firm to soft.

And then thermal balls came into the picture because I found some I liked online. So I talked with the developer and we just incorporated that into our kit since they were the appropriate sizes. Balls you can heat or freeze have been a great adjunct to my practice itself. So I truly feel like we offer the whole package as far as choices for people.

Then there is the strap, which I knew early on was a unique tool. It secures all the balls in the kit and also has Velcro on each end so you can fasten it to a chair or around your waist. In addition, patients can pull it over their shoulder to release the top of the shoulder and first rib. You can easily adjust it over the body anywhere so that those with shoulder or back problems don't have to twist awkwardly to get a ball in the correct place. You can use it against a wall, on the floor or in a chair. It just provides versatility that a ball alone doesn't.

Initially the strap was designed simply to hold the balls in place but some patients had difficulty mobilizing the first rib and releasing the top of their shoulder. I could get in there with my thumb and fingers or they could lie on the floor and press into that area with a ball and stick, but that's not for everybody. So I added extra reinforcement to part of the strap. That way, they don't have to pull down very hard on it to get a really nice force into the top of the shoulder. They can also do it in coordination with breathing exercises to release the first rib and top of the shoulder. I've had great success with that exercise. Just the comfort of gravity pulling down on the strap.

One of my philosophies of release is getting patients to relax into my holds. So when I teach them to release themselves over these balls and the strap, I tell them to let go. I don't want them to pull on the strap or force anything, but rather easily get into position to provide the release. Letting their body sink into it will bring more success as far as relieving soft tissue, easing pain and encouraging correct joint movement.

Now in my clinic we give everybody The BackStrap when they come in and let them use it over the course of therapy. If they decide they want to keep it after their therapy has been completed, we bill them. If they don't, they can return it. But either way, during the course of therapy I know they're using a tool that will help me mobilize and treat them.

ADVANCE: What material is the strap made of?

Halmos: It's very strong nylon about two and a half inches thick, which is wider and a little harder than a traditional yoga strap. That nylon strap is also tripled over in the area that's reinforced and there are heavily stitched elastic and spandex components forming pockets that hold the balls. Another nice feature about the strap is you can use it like a yoga strap, doing hamstring stretches by pulling the legs over your head. You can also execute other movements with assistance from the strap because it's easy to put your feet into the loops where you place your hands.

ADVANCE: How long is the strap?

Halmos: About three-and-a-half feet. The idea was it should be long enough to fit around most people. However, patients generally don't secure it around themselves so now I teach them to just fasten the strap around a chair. Because it's easier for patients to get up and move around. Then they can sit down and have it there for lumbar support, which is great. So fastening it around your waist is a nice option but you don't need to.

ADVANCE: What are the balls made of?

Halmos: For the two hard balls, one is foam and one is rubber. The others are air-filled to a certain density when we get them. Then we pump them up or let air out according to our needs, to make sure they're the right density. For example, I like to squish down the smaller blue-colored balls to about three-fourths their size. The larger orange balls are pretty firm so you can't squeeze them as much.

However, with the deluxe kit we now include a pump. Any air-filled ball will lose air eventually so it's nice to have that because you can keep a ball well inflated or modify the inflation. If somebody likes the size of the blue ball but wants it to be firmer, air can always be added. That provides so many more choices for density or firmness.

ADVANCE: How many balls come with the strap in each kit?

Halmos: In the basic kit, there are six. In the deluxe kit, there are nine, including two orange, two blue, two red, one green and two thermal balls. The green ball is small - just a little bigger than a super ball. My main purpose for it is working the bottom of the foot in cases of plantar fasciitis. But I've found a lot of patients use it for the top of the shoulder too. They like that little ball to get in there and it works very well. Basically I tell people to try different things. It's fun to see what they come up with. That's part of the learning process.

But we have developed another product called the Release-It Kit, which is probably going to be one of our biggest sellers. We might even discontinue the basic kit. With the Release-It Kit, you can see the balls and strap because they're packaged in a clear bag. We've just reached an agreement with [a local back store chain] about carrying it. And at approximately $50 we've developed it to be a better price point.

That kit will only have two orange balls, two blue, one green and the strap. It is very functional since you can do pretty much everything, but doesn't have the thermal balls or hard red ball. People can still go online to order those if they want. I'm just trying to meet everybody's needs.

ADVANCE: At what point did you introduce The BackStrap to patients in your clinic?

Halmos: By October 2007. I basically offer it to patients no matter their diagnosis, although of course I make sure it would be safe. I don't use it over fractures but pretty much any other kind of back, neck or shoulder problem is appropriate, if you need to release soft tissue. I've tried it with seniors and pediatric patients.

The exercises are one of the main things I've emphasized during the development of this product. I hadn't devised them all yet in 2007 when I invented it - they have basically come to fruition over the past couple years, including more aggressive exercises. Those include lying on the floor with the soft balls under your back, which I wouldn't have a senior or somebody with osteoporosis do. But I would encourage them to sit in a chair against the ball. The bottom line is there are wonderful ways to modify the exercises for everybody.

ADVANCE: How did you choose a manufacturer to mass produce the product?

Halmos: It's all about who you know. At the time I was inventing this, my mother-in-law made the prototype for me. She has a seamstress background and was able to do a hard-core sewing job. Then one of my patients knew somebody whose company did manufacturing in China. So I contacted him about making my first set of straps. It's actually the same group we currently use, but we're getting to the point that we'll need to order more.

Since that time we've learned of other companies through the Internet because I had difficulty finding balls that were not subject to the middle man in the United States. So I ended up going online directly to the source in China. It's so amazing to find people that way. They spoke English, I was able to tell them what I was looking for and they started sending me ball prototypes that I could feel to see if they were the right match.

I finally got the balls I wanted and then we hired a graphic designer to make the logo, which we printed on the strap and balls. We went through probably three different manufacturers to get all the balls in the current kit and hope eventually to have them manufactured by one company.

ADVANCE: What are your other future goals for The BackStrap?

Halmos: I've attended the IDEA conference, which is a big fitness convention with aerobics, yoga and fitness people. I've also gone to a PT conference in California and local running events. I even went to a physician conference for industrial medicine. At every venue, people thought it was a great product. But I had the best time at the PT conference because I was able to show other therapists what The BackStrap does. And they understood how useful it can be. They really liked my exercises or the strap itself because it held the different balls. It was just peers coming together and I thought that was great.

So I think it would be ideal for other PTs to use this product. Right now it's being sold to the general public online and by a fitness catalog, and will be soon by the local back store chain. But when PTs see this device, they just love it. Unfortunately, I haven't gotten it out there to therapists very well yet. I'm having success in my office but it's hard to treat patients, help run the practice, raise my kids and also promote The BackStrap. If it became a common modality in PT practices, then patients would see the value firsthand and maybe think of it as a great gift idea.

Now that I've reached an agreement with the store chain, I just want to get endorsed by a couple other [retailers] and then I will mail a letter to Oprah. In fact, I've already written it. I want to tell her I've had success, thank her for the opportunity and see if I can get on the show. So there's hope for the future but my main focus is still treating patients. It's been a great tool that I can do a lot with, allowing me to work longer and saving my hands. Patients can also use it at home, letting me play the role of coach.

Some insurance entities, like workers' compensation, already cover The BackStrap, which is nice and provides some validity. But as far as I know, none of the private insurances do. So in those cases we tell patients they can use their flex plan, if they have an allotment of money to put toward medical devices. It's so interesting because with a product like this that can do so many things, I've learned to keep it simple in my brochures about potential uses. Just because it can be overwhelming for people. What ball do I use? What exercises should I do? I know all the things it can do but if you look at the Website (www.thebackstrap.com), I'm still trying to focus that message.

Brian W. Ferrie is managing editor of ADVANCE and can be reached at bferrie@advanceweb.com