Hands On Hands Off: Manual Therapy & Orthopedic Physical Therapy (AAOMPT)

Physical therapy has been knocking on the primary care door for decades. But according to Chris Bise, the profession now has to answer a harder question: are we prepared to deliver what we are proposing? In this episode, host Nick Rainey talks with Chris Bise about the future of primary care physical therapy and the infrastructure needed to support it. Their conversation moves beyond first-contact access and into the realities of team-based care, payment models, outcomes measurement, coding, workforce readiness, and advocacy. Chris explains why primary care PT should not be understood only as “seeing the patient first.” Instead, it is about managing musculoskeletal conditions over time, knowing when to treat, when to co-manage, and when to refer. He also discusses why behavioral health may offer a useful roadmap for physical therapy’s integration into primary care. The conversation also explores why current payment structures often fail to recognize the cognitive and management work physical therapists perform, why outcomes data must become part of PT culture, and how emerging models such as ACOs, CMMI demonstrations, and value-based care may create new opportunities for the profession. This episode is a practical and strategic look at what comes next if physical therapy wants to become a true primary care partner in musculoskeletal health. Key Takeaways: Primary care PT is not just first-contact care. It is the management of musculoskeletal conditions over time. Physical therapists need to be integrated into team-based care, not merely co-located near primary care providers. Current billing systems often recognize PT treatment but not the cognitive work of assessment, management, and ongoing decision-making. Behavioral health’s integration into primary care may offer a model for how PT can move forward. Outcomes measurement is essential if PT wants to prove value in primary care and value-based care models. Emerging CMS and CMMI models may create opportunities for PTs to demonstrate cost savings and improved care. The profession needs infrastructure, education, advocacy, and payment reform to match its vision.

In this episode, Antigone Vesci, PT, DPT, ATC, SCS, FAAOMPT speaks with Filip Maric, PT, PhD and Emma Swardh, PT, PhD, as they introduce the field of environmental physiotherapy and invite clinicians to think beyond the walls of the clinic. Rather than limiting sustainability to recycling, energy use, or clinic operations, environmental physiotherapy asks a deeper question: What do health, environment, society, and physical therapy have to do with each other? The conversation explores how environmental factors influence patient care, including heat waves, air pollution, unsafe walking routes, access to movement spaces, health behavior, physical activity, and adherence. Philip and Emma also discuss the role of physical therapy in sustainable healthcare, including prevention, health promotion, lower-footprint care, and avoiding unnecessary or low-value interventions. For clinicians, the takeaway is practical: start asking better questions about the patient’s environment. Where are they moving? What has changed around them? Is their environment helping or limiting their recovery? This episode offers a timely and thought-provoking look at how physical therapy can contribute to human health, planetary health, and more complete clinical reasoning. Key Takeaways: Environmental physiotherapy is broader than clinic sustainability. The patient’s environment can influence movement, adherence, pain, access, and recovery. Physical therapy may be a lower-footprint healthcare option compared with more resource-intensive pathways. Prevention, health promotion, and avoiding unnecessary care are part of sustainable healthcare. Clinicians can start immediately by asking more curious questions about where and how patients move. Physical activity can support human health and planetary health, but context matters. Links and contacts: Filip Maric (PT, PhD), Associate Professor in Physiotherapy, Healthcare Innovation and Sustainability at UiT The Arctic University of Norway. Founder and Executive Chair of the Environmental Physiotherapy Association. https://en.uit.no/ansatte/person?p_document_id=706687 Emma Swärdh (PT, PhD), Assistant Senior Lecturer at Karolinska Institutet, Stockholm, Sweden and member of the Environmental Physiotherapy Association executive committee. https://ki.se/en/people/emma-swardh#about-me Environmental Physiotherapy Association website: https://environmentalphysio.com/. The one-stop shop for all things environmental physiotherapy. Including all the latest research publications, resources for education and clinical practice, information on past, ongoing and upcoming events, and a regular blog covering the breadth of environmental physiotherapy. The website will also lead you to those of other key organisations in the field like the Planetary Health Alliance, the Sustainable Development Solutions Network, and many more. Publications of note: Conceptual Maric, F., & Nicholls, D. (2019). A call for a new environmental physiotherapy - An editorial. Physiotherapy Theory and Practice, 35(10), 905–907. https://doi.org/10.1080/09593985.2019.1632006 Maric, F., Plaisant, M., & Richter, R. (2025). Advancing the deliberate implementation of the concept of sustainability and its alternatives in physical therapy research, practice, and education. Physiotherapy Theory and Practice, 41(6), 1239–1253. https://doi.org/10.1080/09593985.2024.2395486 Swärdh, E., & Hagströmer, M. (2026). What if physiotherapists reimagined physical activity as relational and planetary health-enhancing? – Editorial. European Journal of Physiotherapy, 28(1), 1–4. https://doi.org/10.1080/21679169.2026.2610151 Clinically oriented Maric, F., Groven, K.S., Banerjee, S. & Dahl-Michelsen, T. (2021). Essentials for sustainable physiotherapy: Introducing environmental reasoning into physiotherapy clinical decision-making. Fysioterapeuten, 88(4), 54 – 58. https://fysioterapeuten.no/fagfellevurdert-sustainable-physiotherapy/essentials-for-sustainable-physiotherapy-introducing-environmental-reasoning-into-physiotherapy-clinical-decision-making/1317 Toner, A., Lewis, J. S., Stanhope, J., & Maric, F. (2021). Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. Physical Therapy Reviews, 26(3), 159–167. https://doi.org/10.1080/10833196.2021.1876598 Swärdh, E., & Maric, F. (2024). From Knowledge to Action: Fostering Advocacy Skills for Planetary Health in Physical Therapy. Physical Therapy, 104(11). https://doi.org/10.1093/ptj/pzae130 Struthers, N. A., Zecevic, A. A., Stanhope, J., Breed, M. F., Gittings, L., Gunz, A., Wagenfeld, A., Birmingham, T., Kothari, A., & Maric, F. (2026). An international and interdisciplinary framework for nature prescribing in healthcare: A modified Delphi study. PLOS Global Public Health, 6(4), e0006361. https://doi.org/10.1371/journal.pgph.0006361 PT education Barna, S., Maric, F., Simons, J., Kumar, S., & Blankestijn, P. J. (2020). Education for the Anthropocene: Planetary health, sustainable health care, and the health workforce. Medical Teacher, 42(10), 1091–1096. https://doi.org/10.1080/0142159x.2020.1798914 Maric, F., Chance-Larsen, K., Chevan, J., Jameson, S., Nicholls, D., Opsommer, E., Perveen, W., Richter, R., Stanhope, J., Stone, O., Strimpakos, N., Vieira, A., Williams, M., Zuber, S., & Söderlund, A. (2021). A progress report on planetary health, environmental and sustainability education in physiotherapy – Editorial. European Journal of Physiotherapy, 23(4), 201–202. https://doi.org/10.1080/21679169.2021.1932981 Swärdh, E., Brodin, N., Palstam, A., & Pettersson, A. (2024). High consciousness—low application: sustainable development and sustainable healthcare in undergraduate physiotherapy education in Sweden. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1509997 Swärdh, E., Palstam, A., Pettersson, A., & Brodin, N. (2026). Sustainable development in physiotherapy education: why, what, how. Perspectives of educators in Sweden. European Journal of Physiotherapy, 1–17. https://doi.org/10.1080/21679169.2026.2693304

In this episode, Seth Peterson talks with Josh Funk, founder of Rehab 2 Perform, about private practice ownership, business growth, staffing, reimbursement, clinical education, and the future of physical therapy. Josh shares how his own rehab experience at Ohio State inspired him to build a more active, performance-oriented community rehab model. He explains how early entrepreneurial experiments, side hustles, personal training, coaching, and customer service roles helped prepare him to launch Rehab 2 Perform just three years after PT school. The conversation covers practical resources for clinicians interested in business, including SBDC, SCORE, local accelerators, and the Goldman Sachs 10,000 Small Businesses program. Josh also discusses what it takes to grow from one clinic to 17, how to understand payer value and internal economy, and why practice owners need to treat staff recruitment with the same strategic attention they give patient acquisition. Josh also describes how residency programs can serve as attraction magnets, career accelerators, and company-wide education engines. The episode closes with a forward-looking conversation about healthspan, diagnostics, wellness screening, and why physical therapists should become more proactive in risk stratification and prevention-oriented care. Key TakeawaysGreat business ideas often come from bad personal experiences. Josh’s own contrast between high-level rehab at Ohio State and community-based care helped spark the Rehab 2 Perform concept. Microdose entrepreneurship before you cut the cord. Josh emphasizes side hustles, coaching, training, and customer service as low-risk ways to build business skills before opening a practice. Free business mentorship exists. Use it. SBDC, SCORE, local accelerators, and Goldman Sachs 10,000 Small Businesses helped Josh build business literacy without draining early-stage cash. Practice owners must understand reimbursement. Josh argues that owners need to understand payer value, administrative burden, MPPR, billing differences, cash services, and the internal economy of the practice. Staff acquisition needs a funnel. Many practices have a patient marketing funnel, but no talent funnel. Josh sees this as a major missed opportunity. Residency can raise the floor across a company. A residency program does not only benefit the resident. It creates a pourover effect that can improve the whole clinical ecosystem. Build a process-dependent company, not a people-dependent company. High achievers may leave. The owner’s job is to operationalize their genius so the organization keeps growing. PT needs to move into healthspan and diagnostics. Josh believes the public is ready for proactive screening, risk stratification, wellness, and physical capability conversations. Find Josh and Rehab 2 Perform: https://rehab2perform.com/ https://www.instagram.com/drjoshfunk/

In this episode, host Leda McDaniel speaks with Dr. Thomas Ibounig, shoulder and elbow surgeon at Helsinki University Hospital and researcher with the Finnish Centre for Evidence-Based Orthopaedics. Dr. Ibounig discusses his 2026 JAMA study, “Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging.” The conversation explores how common rotator cuff abnormalities are on MRI, including in asymptomatic individuals, and what that means for clinicians interpreting imaging findings in patients with shoulder pain. The study used a representative Finnish population sample, bilateral 3 Tesla MRI imaging, shoulder surgeon clinical examination, and extensive questionnaire data to examine the relationship between imaging findings, symptoms, clinical tests, and broader patient factors. Dr. Ibounig explains why MRI findings and isolated clinical tests may not identify the source of pain as reliably as clinicians often assume. He also discusses why terminology matters when explaining imaging to patients, how structural findings can become over-medicalized, and why future research needs to look beyond anatomy toward psychological, occupational, metabolic, and longitudinal contributors to shoulder pain. This episode is especially relevant for orthopedic manual physical therapists, surgeons, sports clinicians, educators, and anyone helping patients make sense of shoulder MRI findings. Link to referenced study: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844659 Key Takeaways MRI abnormalities are extremely common after age 40. Dr. Ibounig reports that nearly every shoulder over 40 in the study showed some abnormality on MRI. Abnormal does not always mean pathological. Findings such as tendinopathy, partial-thickness tears, and even some full-thickness tears may be part of aging rather than the clear source of symptoms. Symptoms and imaging do not map cleanly. Full-thickness rotator cuff tears were more common in symptomatic shoulders, but many findings were also present in asymptomatic shoulders. Clinical tests may not add as much certainty as clinicians hope. Even a thorough clinical exam did not clearly improve the ability to distinguish symptomatic from asymptomatic rotator cuff findings. Language matters. Telling a patient their shoulder is “torn” or “broken” can create fear, even when the finding may be common for their age. Shoulder pain needs a broader explanatory model. Dr. Ibounig emphasizes that future research should explore pain mechanisms beyond structure, including psychological, metabolic, occupational, and longitudinal factors. Clinical humility is essential. One of the episode’s strongest messages is that experience often brings less certainty, not more.

In this episode, Seth speaks with Tim Fearon, a respected leader in orthopedic manual physical therapy, about the role of exercise in manual therapy practice. Tim reflects on retirement, mentorship, and the clinical evolution that led him to place exercise and patient responsibility at the center of care. He shares how early mentorship shaped his manual therapy skills, but how recurring patient problems forced him to ask a harder question: if symptoms improve but the problem returns, did we really fix anything? The conversation explores Tim’s shift toward active participation, PNF principles, the Maitland model, reassessment, and exercise as a reasoned clinical intervention rather than a generic home program. Tim also challenges clinicians to stop treating exercise as the less important part of care, stop overdosing patients with too many exercises, and stop outsourcing the very thing that helps patients take ownership of their recovery. The episode also looks toward the future of physical therapy, including remote therapeutic monitoring, exercise apps, online programs, and why skilled clinicians who can integrate passive care, active care, and patient psychology will continue to matter. Key TakeawaysManual therapy alone may not create lasting change. Tim describes realizing that he could improve symptoms manually, but patients sometimes returned with the same problem because the underlying functional capacity had not changed. Exercise should be reasoned like manual therapy. Tim emphasizes using reassessment after active interventions just as clinicians do after passive techniques. Patient psychology matters. The best exercise is not just biomechanically appropriate. It has to match the person’s behavior, motivation, tolerance, and readiness. Do not overdose the home program. Tim warns that giving too many exercises can reduce adherence and cause patients to abandon even the most important pieces. Exercise should not be treated as lower-value care. Handing exercise off too casually can signal to the patient that it is less important than the manual treatment. The patient must own part of the outcome. Tim repeatedly returns to personal responsibility: patients need to experience that what they do can change their symptoms and function. Generic exercise apps will help some people, but not everyone. Tim sees value for people in the middle of the bell curve, but warns that more complex patients still need skilled clinical reasoning. Skilled PTs integrate passive and active care. Tim is not dismissing manual therapy. He argues that passive care and active management work best when they are both delivered with skill and intention.