Hands On Hands Off

The Worst Pain Is Unexplained Pain — Rethinking Diagnosis in Physical Therapy

The worst pain is unexplained pain. In this episode of the Hands-On, Hands-Off Podcast, physical therapists Amy McDevitt and Paul Mintkin explore why pain without a clear diagnosis is often the most distressing—and how physical therapists can communicate pain more effectively when imaging, MRI findings, and pathoanatomy don’t provide clear answers. This conversation dives deep into pain science, musculoskeletal pain, low back pain, and the limitations of medical imaging in explaining symptoms. We discuss how over-reliance on MRI results can increase fear, catastrophizing, and confusion for patients—and how language, context, and functional diagnosis can dramatically change outcomes. Learn how to reframe pain using the ICF model, why pain does not equal tissue damage, and how PTs can shift from chasing a pain generator to treating the whole person. The episode includes a real-time patient role-play, practical communication strategies, and insights on direct access physical therapy, lifestyle factors (sleep, stress, activity), and the future of PT education. This episode is essential listening for physical therapists, manual therapists, rehab professionals, and students looking to improve patient communication, reduce fear, and deliver truly person-centered care.

Manual Therapy Mechanisms & the Future of MT Education | Damian Keter

Damian Keter joins the show to unpack manual therapy treatment mechanisms and how our profession needs to evolve its education around MT. Damian is a clinician specializing in complex pain at the VA and a clinical researcher whose work centers on MT mechanisms and manual therapy training paradigms. If you’ve ever wondered what actually happens when we deliver manual therapy — and how to teach it more effectively — this episode delivers clarity. TOPICS: • Manual therapy mechanism research • Contextual effects and clinical reasoning • How MT education needs to evolve • Helping clinicians move beyond outdated models • The future of manual therapy in PT

Lifestyle Medicine Meets OMPT: A Conversation with Mark Shepherd

Mark Shepherd joins the podcast to discuss person-centered clinical reasoning, lifestyle medicine, and how to improve the way PTs make sense of pain. Mark is Program Director of the Bellin College OMPT Fellowship, a DPT faculty member, and a clinician who blends manual therapy, patient values, and lifestyle-based interventions to build clearer clinical hypotheses. His recent publication introduces an updated reasoning model: the person-centered hypothesis, which emphasizes individualized sense-making over rigid diagnostic categories. IN THIS EPISODE: • What “person-centered hypothesis” means in practice • How lifestyle medicine empowers rather than dilutes OMPT care • Improving reasoning in complex pain cases • Why clinicians should anchor decisions in patient values • Mark’s journey through education, teaching, and fellowship leadership A must-listen for clinicians and educators who want a more modern, human approach to reasoning.

How IFOMPT Shapes Global Manual Therapy Education and Practice

What role does IFOMPT play in global manual and musculoskeletal physiotherapy? In this episode of the Hands-On, Hands-Off Podcast, leaders from AAOMPT sit down with IFOMPT President Dr. Paolo Sanzo to discuss international education standards, evidence-informed practice, and global collaboration. The conversation explores how IFOMPT supports clinicians, educators, and researchers worldwide—and why global consistency ultimately improves patient care. 00:00 – Introduction to the AAOMPT–IFOMPT collaborative series 01:29 – Introducing Dr. Paolo Sanzo and IFOMT leadership 03:19 – What IFOMPT is and its role within World Physiotherapy 04:12 – Paolo’s journey through IFOMPT leadership roles 05:21 – IFOMPT’s growth since 1974 07:11 – IFOMPT’s vision and mission explained 09:47 – Education standards and member organization requirements 12:10 – International monitoring and maintaining consistency 17:49 – Evidence-based practice and global context 20:16 – IFOMPT as a research and collaboration conduit 23:14 – Challenges and opportunities of global collaboration 26:18 – Working with international organizations and regions 30:35 – Strategic priorities and future direction 32:46 – Advice for clinicians pursuing excellence 34:02 – Final reflections and closing remarks

Neck Manipulation Myths, Risks & Evidence with Roger Kerry

Professor Roger Kerry joins the podcast to unpack one of the most debated topics in musculoskeletal care: the risks and benefits of manual therapy for people with head and neck pain. Roger is the lead for the physiotherapy program at the University of Nottingham, an interprofessional curriculum designer, researcher, PhD supervisor, and author of the new textbook The Head & Neck: Theory & Practice. His AAOMPT keynote focuses on cutting through decades of misinformation and helping clinicians understand what the evidence actually says. IN THIS CONVERSATION: • Cervical manual therapy: what’s risky, what’s not, and what’s misunderstood • Why head & neck pain is still surrounded by outdated ideas • The problem with the way we teach manual therapy • How educators can break restrictive traditions • What emerging PhD work is revealing about the future of physical therapy • Roger’s personal journey from failed rehab patient → world-class academic This episode is essential listening for anyone who treats neck pain or teaches manual therapy.