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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:
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:
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 TakeawaysFind 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
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 TakeawaysIn 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 TakeawaysChapters:
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
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
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 TakeawaysNeck 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
Today we’re joined by Liam Globensky, Center Manager at Brooks Rehabilitation and a newly graduated fellow from the Brooks Institute of Higher Learning. Liam’s passion is clear: fellowship is not the finish line—it’s the launch pad for teaching, mentoring, advocating, and elevating the profession.
In this episode, Liam discusses:
Key Takeaways:
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