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.

1. Great business ideas often come from bad personal experiences.
2. Josh’s own contrast between high-level rehab at Ohio State and community-based care helped spark the Rehab 2 Perform concept.
3. Microdose entrepreneurship before you cut the cord.
4. Josh emphasizes side hustles, coaching, training, and customer service as low-risk ways to build business skills before opening a practice.
5. Free business mentorship exists. Use it.
6. SBDC, SCORE, local accelerators, and Goldman Sachs 10,000 Small Businesses helped Josh build business literacy without draining early-stage cash.
7. Practice owners must understand reimbursement.
8. Josh argues that owners need to understand payer value, administrative burden, MPPR, billing differences, cash services, and the internal economy of the practice.
9. Staff acquisition needs a funnel.
10. Many practices have a patient marketing funnel, but no talent funnel. Josh sees this as a major missed opportunity.
11. Residency can raise the floor across a company.
12. A residency program does not only benefit the resident. It creates a pourover effect that can improve the whole clinical ecosystem.
13. Build a process-dependent company, not a people-dependent company.
14. High achievers may leave. The owner’s job is to operationalize their genius so the organization keeps growing.
15. PT needs to move into healthspan and diagnostics.
16. 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

1. MRI abnormalities are extremely common after age 40.
2. Dr. Ibounig reports that nearly every shoulder over 40 in the study showed some abnormality on MRI.
3. Abnormal does not always mean pathological.
4. 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.
5. Symptoms and imaging do not map cleanly.
6. Full-thickness rotator cuff tears were more common in symptomatic shoulders, but many findings were also present in asymptomatic shoulders.
7. Clinical tests may not add as much certainty as clinicians hope.
8. Even a thorough clinical exam did not clearly improve the ability to distinguish symptomatic from asymptomatic rotator cuff findings.
9. Language matters.
10. Telling a patient their shoulder is “torn” or “broken” can create fear, even when the finding may be common for their age.
11. Shoulder pain needs a broader explanatory model.
12. Dr. Ibounig emphasizes that future research should explore pain mechanisms beyond structure, including psychological, metabolic, occupational, and longitudinal factors.
13. Clinical humility is essential.
14. 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.

1. Manual therapy alone may not create lasting change.
2. 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.
3. Exercise should be reasoned like manual therapy.
4. Tim emphasizes using reassessment after active interventions just as clinicians do after passive techniques.
5. Patient psychology matters.
6. The best exercise is not just biomechanically appropriate. It has to match the person’s behavior, motivation, tolerance, and readiness.
7. Do not overdose the home program.
8. Tim warns that giving too many exercises can reduce adherence and cause patients to abandon even the most important pieces.
9. Exercise should not be treated as lower-value care.
10. Handing exercise off too casually can signal to the patient that it is less important than the manual treatment.
11. The patient must own part of the outcome.
12. Tim repeatedly returns to personal responsibility: patients need to experience that what they do can change their symptoms and function.
13. Generic exercise apps will help some people, but not everyone.
14. Tim sees value for people in the middle of the bell curve, but warns that more complex patients still need skilled clinical reasoning.
15. Skilled PTs integrate passive and active care.
16. 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.

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.

1. First contact PT is not the same as direct access.
2. 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.
3. The study found lower healthcare utilization.
4. First contact PT was associated with 45% less imaging and 71% less prescription medication utilization compared with usual primary care.
5. Clinical outcomes were similar.
6. Pain, disability, and health-related quality of life outcomes were statistically similar between first contact PT and usual primary care.
7. Less imaging is not automatically the goal.
8. The more important question is appropriate utilization: avoiding both overuse and underuse.
9. Implementation is a system problem.
10. Scope of practice, reimbursement, stakeholder buy-in, state law, and health system workflows all influence whether first contact PT can work.
11. Direct triage may be the stronger model.
12. Compared with warm handoffs, direct triage allows patients with appropriate MSK presentations to start with PT as the first provider.
13. PTs need to be ready for real-world first contact care.
14. 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

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.

1. OMPT is more than technique execution.
2. Dr. Smith emphasizes that his own training helped place clinical reasoning at the center of practice.
3. The education continuum matters.
4. DPT, residency, and fellowship training should not be conflated. Each level has different expectations, depth, and nuance.
5. Qualitative research captures what surveys often miss.
6. Dr. Smith’s interest is in the “why” and “how” behind clinician behavior, mentorship, and decision-making.
7. Fellowship programs may vary in method but align in goals.
8. Early observations suggest different programs use different teaching routes while aiming toward similar outcomes.
9. Near-peer instruction may be powerful.
10. Exposure to residents and fellows can help DPT students better understand advanced training pathways.
11. Mentorship drives academic and research growth.
12. Dr. Smith reinforces that being a strong clinician does not automatically make someone a strong educator or researcher.

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.

00:00 — 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:

• Why post-professional opportunities matter more than ever
• How early-career fellows can “raise the tide” for PT practice
• The importance of giving back through mentorship, leadership, and service
• His joint presentation with his wife on orthopedic screening of pelvic floor dysfunction
• Practical ways clinicians can integrate pelvic floor awareness into orthopedic exams
• How new clinicians can shape the future of the profession

Key Takeaways:

• Fellowship is a platform for service, not a credential to sit on
• Growth continues through advocacy, mentorship, and interdisciplinary collaboration
• Orthopedic clinicians play an important role in screening pelvic floor dysfunction
• The profession rises when clinicians invest in the next generation
• Early-career PTs can be leaders today—not just “someday”

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 misunderstood
• How strong therapeutic alliance amplifies patient outcomes
• Safety, intent, and application of spinal manipulation in elderly patients
• Using fellowship training to step into leadership or ownership
• Kyle’s career path and the mindset that keeps him energized

This 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 – [email protected]

???? ReEnvision PT

???? WE ARE Physiotherapy