Should PTs Be the First Provider for Musculoskeletal Pain?

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 Takeaways 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

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

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 Takeaways 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.

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 Chapters 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

Life After Fellowship: Giving Back to the Profession

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”