In this episode of the Think Small Podcast, Dr. Orit Hickman, founder of Pain Science Physical Therapy in Seattle, Washington, shares the evolution of her practice from a traditional, hands-on physical therapy clinic into a pioneering model centered on the biopsychosocial understanding of pain. After more than a decade in clinical practice, she began noticing that patients with persistent pain were not responding to conventional biomechanics-based treatment. A pivotal pain science course reshaped her perspective, leading her to incorporate neuroscience education and a more holistic approach to care that addresses the role of stress, fear, and perception in chronic pain. This shift challenged long-standing norms in physical therapy and initially created tension with both patients and providers, some of whom were not ready for a fundamentally different approach.

The conversation also explores the business transformation required to support this clinical philosophy, including multiple rebrands, shifts in reimbursement strategy, and a gradual move away from insurance-based care. Dr. Hickman discusses how declining reimbursement rates, workforce shortages, and rising operational costs forced a rethinking of traditional physical therapy business models, ultimately leading to a more direct-pay structure and improved financial sustainability. A major focus of the discussion is the expansion into telemedicine, which opens the door to a geographically distributed network of providers and significantly broadens patient access to specialized care. Looking ahead, she outlines a bold vision of building a nationwide network of clinicians trained in pain science, supported by shared systems, training, and collaboration, while also emphasizing the importance of fair compensation, provider well-being, and sustainable career paths in healthcare.

Connect:

Website: https://painsciencept.com/

LinkedIn: https://www.linkedin.com/in/dr-orit-hickman-pt-dpt-tps-1a096117/