Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing instead A VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out." Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field. What we cover: Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary careWhere tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually doHow the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectoryWhy social media arguments about exercise intensity and volume miss the point, and what behavior change should look like instead Plus three threads that emerged outside the five-things framework: The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expectWhat top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuseThe phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change" Dr. Cook shares some uncomfortable numbers that we need to face to address. -75% of PT referrals never initiate, -30% drop off after the first visit, -and MSK patient outcomes have actually gotten worse over the last two decades Plus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in. Chapters 00:00 Introduction to Dr. Chad Cook 02:56 The Identity Crisis in Physical Therapy 05:47 The Role of Physical Therapists in Primary Care 08:33 The Precision Paradox in Treatment 10:51 The Emotional Aspect of Diagnosis 13:29 The Transition to Self-Management 15:41 The Impact of Digital Health Solutions 18:20 The Future of Physical Therapy 28:45 Navigating Uncertainty in Healthcare 30:45 The Digital Transformation of Health Systems 32:08 The Role of AI in Patient Care 36:51 Understanding Patient Recovery Trajectories 39:36 The Importance of Prognosis in Therapy 46:04 Redefining Exercise and Patient Engagement 50:48 The Power of Touch in Therapy 55:22 Negotiating Behavioral Change in Healthcare 59:09 The Future of Physical Therapy Find the full transcript here. Related: Episode 30 with Dr. Trevor Lentz About our Guest: Dr. Chad Cook is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries. Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: Many Paths to Recovery: The Case for Treatment Pluralism. About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession. Hosts: Alex Bendersky and Dana Strauss Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid." Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list. Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.
