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

AAOMPT
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The Hands On Hands Off Podcast from the American Academy of Orthopaedic Manual Physical Therapists explores the debate at the heart of modern rehab: How much treatment should be hands-on… and how much should empower patients to move independently? Through conversations with leaders in manual therapy, orthopedic physical therapy, pain science, and rehabilitation, we break down: • clinical reasoning • manual therapy techniques • patient education • exercise-based care • evidence vs tradition in PT If you’re a physical therapist, manual therapist, DPT student, or rehabilitation professional, this show will challenge assumptions and sharpen your practice.

  1. 5d ago

    Dr. Thomas Ibounig on Incidental Rotator Cuff Abnormalities and Shoulder MRI

    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.

    Dr. Thomas Ibounig on Incidental Rotator Cuff Abnormalities and Shoulder MRI

  2. Aug 14

    Tim Fearon on Exercise, Manual Therapy, and Patient Responsibility

    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.

    Tim Fearon on Exercise, Manual Therapy, and Patient Responsibility

  3. Aug 7

    Should PTs Be the First Provider for Musculoskeletal Pain?

    In this episode, host Dr. Nick Rainey is joined by Dr. Bremen Abuhl and Dr. Dallas Ehrmantraut to discuss their 2025 Physical Therapy Journal article, “First Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of RCTs.” The conversation explores whether physical therapists should serve as the first point of contact for patients with musculoskeletal disorders and how first contact PT compares with usual primary care. Dr. Abuhl and Dr. Ehrmantraut discuss their findings, including reduced imaging utilization, reduced prescription medication utilization, and similar clinical outcomes for pain, disability, and health-related quality of life. They also unpack the terminology around direct access, first contact PT, and primary care PT, and explain why direct triage models may offer a more efficient pathway for patients. The episode also addresses real-world implementation barriers, including reimbursement models, state scope-of-practice variation, imaging privileges, medication prescribing, stakeholder buy-in, and the need for PTs to step confidently into first contact roles. Key TakeawaysFirst contact PT is not the same as direct access. Direct access means patients can choose PT without referral. First contact PT means the PT is the first provider evaluating the patient for that episode of care.The study found lower healthcare utilization. First contact PT was associated with 45% less imaging and 71% less prescription medication utilization compared with usual primary care.Clinical outcomes were similar. Pain, disability, and health-related quality of life outcomes were statistically similar between first contact PT and usual primary care.Less imaging is not automatically the goal. The more important question is appropriate utilization: avoiding both overuse and underuse.Implementation is a system problem. Scope of practice, reimbursement, stakeholder buy-in, state law, and health system workflows all influence whether first contact PT can work.Direct triage may be the stronger model. Compared with warm handoffs, direct triage allows patients with appropriate MSK presentations to start with PT as the first provider.PTs need to be ready for real-world first contact care. That includes identifying red flags, determining urgency, ordering or recommending imaging when appropriate, and referring to the right provider when needed.  Chapters: 00:00 — Welcome and guest introductions 01:17 — Dr. Bremen Abuhl’s path into first contact PT research 03:13 — Dr. Dallas Ehrmantraut’s clinical spark for the topic 06:16 — Overview of the PTJ systematic review and meta-analysis 09:52 — Direct access vs first contact PT vs primary care PT 13:15 — Global evidence and limited U.S.-based RCTs 16:24 — Imaging findings and appropriate utilization 20:37 — Medication utilization findings 23:27 — Clinical outcomes: pain, disability, and quality of life 25:20 — Study limitations and downstream utilization 27:13 — Why longer-term outcomes matter 31:15 — Risk of bias and crossover between groups 33:36 — U.S. system barriers to first contact PT 36:37 — Reimbursement, payer models, and stakeholder concerns 40:45 — Direct triage vs warm handoff models 44:15 — Scope of practice and state-level barriers 46:08 — Real-world safety, red flags, and PT decision-making 48:01 — Call to action for physical therapists 50:06 — Closing thoughts

    Should PTs Be the First Provider for Musculoskeletal Pain?

  4. Aug 6

    Jess Ellis on the Reality of Pro Sports PT, Clinical Honesty, and Pragmatic Practice

    In this episode, Seth sits down with Jess Ellis, fellowship-trained physical therapist, former NBA health and performance leader, founder of Rehab Code, and consultant for professional athletes. Jess shares his career path from early burnout in high-volume physical therapy to mentorship with Tim Fearon, fellowship training, EXOS, the Portland Trail Blazers, the New York Knicks, and his current work in mentorship, consulting, and concierge care. The conversation explores the realities of working in professional sports, including the pressure of return-to-play decisions, reduced clinical autonomy, team politics, athlete relationships, and the lifestyle tradeoffs that come with elite sport. Jess also discusses his PhD work on athlete buy-in with wearable technology and force plate testing, raising important questions about trust, data, ethics, and shared decision-making. This episode also gets into the deeper professional questions many PTs face: Are you actually getting better? Are you pursuing mastery or professional FOMO? Are you being clinically honest with yourself and your patients? And are you relying on theory, or producing meaningful change? A sharp, candid conversation for clinicians interested in OMPT, sports rehab, mentorship, career development, and pragmatic clinical reasoning. Chapters:  00:00 — Welcome and Jess Ellis intro 01:34 — Burnout, mentorship, and fellowship training 03:00 — EXOS, NBA roles, and Rehab Code 06:23 — Career growth and owning your opportunities 09:11 — OMPT in pro sports 11:01 — Imaging, structure, and pathomechanics 12:55 — Why fellowship changed Jess’s reasoning 14:54 — The reality of working in pro sports 17:01 — Return-to-play pressure 18:08 — Leadership, politics, and athlete trust 20:10 — Lifers, burnout, and leaving sport 23:43 — Athlete data, wearables, and Jess’s PhD 27:50 — Clinical bias and shared decision-making 30:00 — Pain science communication problems 31:43 — Mentorship and PT career paths 34:15 — Professional FOMO vs mastery 35:54 — Clinical honesty and getting better 37:47 — Pragmatism, listening, and results 40:11 — Where to find Jess Ellis

    Jess Ellis on the Reality of Pro Sports PT, Clinical Honesty, and Pragmatic Practice

  5. Jul 7

    Mapping the OMPT Education Continuum with Dr. Matthew Smith

    In this episode, host Dr. Skip Gill welcomes Dr. Matthew Smith to discuss his Clinical Science in Manual Therapy Grant-funded study, “Mapping the Continuum: Enhancing Orthopedic Manual Physical Therapy Education Through Instruction and Training.” Dr. Smith shares how his own OMPT training shaped his interest in clinical reasoning, mentorship, and the way manual therapy is taught across different stages of professional development. He explains why his study looks at the continuum from entry-level DPT education through residency and fellowship, and how instruction changes depending on both the learner and the mentor. The conversation also explores the value of qualitative research, the complexity of analyzing interview data, early observations from the study, and the importance of near-peer instruction in helping students understand what advanced OMPT training can offer. For educators, mentors, fellows, residents, and clinicians interested in the future of orthopedic manual physical therapy, this episode offers a thoughtful look at how OMPT principles can be taught more clearly, consistently, and meaningfully across the profession. Key TakeawaysOMPT is more than technique execution. Dr. Smith emphasizes that his own training helped place clinical reasoning at the center of practice.The education continuum matters. DPT, residency, and fellowship training should not be conflated. Each level has different expectations, depth, and nuance.Qualitative research captures what surveys often miss. Dr. Smith’s interest is in the “why” and “how” behind clinician behavior, mentorship, and decision-making.Fellowship programs may vary in method but align in goals. Early observations suggest different programs use different teaching routes while aiming toward similar outcomes.Near-peer instruction may be powerful. Exposure to residents and fellows can help DPT students better understand advanced training pathways.Mentorship drives academic and research growth. Dr. Smith reinforces that being a strong clinician does not automatically make someone a strong educator or researcher.

    Mapping the OMPT Education Continuum with Dr. Matthew Smith

  6. Jun 26

    When Headache Starts in the Neck: Gwen Jull & Zhiqi Liang on Migraine, Cervicogenic Headache, and Clinical Reasoning

    Neck pain and headache often travel together. But as Gwen Jull and Zhiqi Liang explain in this episode, that does not automatically mean the cervical spine is driving the headache. In this AAOMPT and IFOMPT collaborative episode, hosts Amy McDevitt and Michael Boney explore the evolving science around cervicogenic headache, migraine-associated neck pain, sensitization, and clinical examination. Gwen Jull discusses the development and validation of physical criteria for cervicogenic headache, emphasizing the need for a cluster of comparable musculoskeletal signs involving joint, movement, and muscle impairments. Zhiqi Liang expands the conversation into migraine, reminding clinicians that neck pain can be part of a migraine presentation rather than proof of a cervical source. She challenges clinicians to rethink the meaning of symptom reproduction during upper cervical examination and to consider sensitivity, irritability, and migraine cycles when examining and treating these patients. Together, the guests make a compelling case for more careful clinical reasoning: listen to the patient’s story, examine without over-provoking symptoms, look for comparable signs, and match treatment to the impairments that are actually present. Big takeaway: The neck may matter — but clinicians need to prove it through the whole clinical picture. Timestamped Chapters00:00 — Welcome to Hands On, Hands Off 00:31 — Introducing the AAOMPT and IFOMPT collaboration 01:19 — Meet Gwen Jull and Zhiqi Liang 03:19 — Why headache and neck pain matter to manual physical therapists 03:40 — Major shifts in clinical thinking around cervicogenic headache 04:09 — Validated physical criteria for cervicogenic headache 05:37 — Joint, movement, and muscle signs 07:33 — The physiotherapist’s role in differential diagnosis 08:02 — How headache can refer pain into the neck 08:51 — Are cervicogenic headache and migraine distinct or a spectrum? 09:26 — Migraine as a primary neurological condition 11:33 — Sorting out mixed headache presentations 12:05 — Patient history clues: migraine vs cervicogenic headache 13:27 — Comparable signs and why intensity matters 14:51 — How much does pain location matter? 16:20 — Why no single feature is enough 17:17 — Neck pain in migraine may not be a neck problem 17:53 — Rethinking symptom reproduction during examination 19:22 — How to decide whether the neck is a driver 20:01 — Avoiding confirmation bias 21:27 — Why non-provocative examination matters 23:08 — Scapular dysfunction and other regional contributors 24:37 — Broadening beyond the diagnostic cluster 26:05 — Sensory-motor control, dizziness, and balance 28:41 — Local cervical findings and global systems 29:31 — Listening for migraine evolution over time 30:46 — Central sensitization and comparable physical findings 31:28 — PIVM vs PAVM assessment considerations 32:08 — Avoiding symptom provocation in migraine 33:04 — Migraine cycles and changing sensitivity 34:36 — Trial treatment and rigorous re-evaluation 35:41 — Individualized care beyond guidelines 36:19 — Who may benefit from a cervical-focused approach? 37:07 — Education, exercise, sleep, stress, and lifestyle strategies 39:02 — Let the physical exam guide treatment 39:46 — PTs as rehabilitation experts, not just pain reducers 41:38 — One assumption clinicians should rethink tomorrow 42:12 — Don’t forget the jaw 42:27 — Neck pain may reflect sensitivity, not source 43:16 — Final reflections and closing

    When Headache Starts in the Neck: Gwen Jull & Zhiqi Liang on Migraine, Cervicogenic Headache, and Clinical Reasoning

  7. Apr 7

    Why Kyle Feldman Never “Works a Day”

    In this episode, we sit down with Kyle Feldman, National Director of Physical Therapy for ReEnvision PT and owner of WE ARE Physiotherapy. Kyle shares how clinical reasoning, therapeutic alliance, and intentional growth have shaped his work as a clinician, educator, and leader. We discuss: Why clinical reasoning is often misunderstoodHow strong therapeutic alliance amplifies patient outcomesSafety, intent, and application of spinal manipulation in elderly patientsUsing fellowship training to step into leadership or ownershipKyle’s career path and the mindset that keeps him energizedThis is a must-listen episode for clinicians looking to level up their reasoning, build meaningful patient relationships, and explore new opportunities in the profession. Key Takeaways: Clinical reasoning is more than pattern recognition — it’s dynamic decision-making.Therapeutic alliance isn’t “being nice”; it’s a critical clinical skill.Older adults are often under-treated due to clinician fear, not evidence.Fellowships can be springboards for business ownership and leadership innovation.Growth in PT requires curiosity, reflection, and courage. Guest Info: ???? Kyle Feldman – kylefeldmandpt@gmail.com ???? ReEnvision PT ???? WE ARE Physiotherapy

    Why Kyle Feldman Never “Works a Day”

  8. Mar 24

    How to Teach Clinical Reasoning in OMPT

    What happens when you mix decades of movement science, deep mentorship, and a passion for solving complex MSK problems? You get Lee Marinko — one of the most beloved educators and mentors in OMPT. Lee has been teaching in the Boston University DPT program for more than 20 years, serves as Chair of the AAOMPT Program Director SIG, and launched the BU OMPT Fellowship in 2014 with one goal: “We can do better than that.” In this conversation, Lee shares her philosophy on mentorship, the joy of Ah ha moments, how to keep clinical problem-solving fun, and what young professionals really need from their teachers and clinical leaders. In this episode, we explore: ???? Why movement science is the foundation for great OMPT ???? Lee’s favorite teaching moments — and what they reveal ???? How to guide learners through complex cases ???? Mentorship tips for faculty, fellows, and CI’s ???? The origin story of the BU Fellowship ???? Why curiosity beats certainty in clinical reasoning ???? The mindset that makes clinicians grow faster ???? How to “do better” for people with MSK pain If you teach, mentor, or simply want to think better as a clinician — do not miss this one.

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The Hands On Hands Off Podcast from the American Academy of Orthopaedic Manual Physical Therapists explores the debate at the heart of modern rehab: How much treatment should be hands-on… and how much should empower patients to move independently? Through conversations with leaders in manual therapy, orthopedic physical therapy, pain science, and rehabilitation, we break down: • clinical reasoning • manual therapy techniques • patient education • exercise-based care • evidence vs tradition in PT If you’re a physical therapist, manual therapist, DPT student, or rehabilitation professional, this show will challenge assumptions and sharpen your practice.

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