Why "Manual Therapy" Holds OMPT Back (Fellowship Director Responds)

Mark Shepherd: [00:00:00] Should we use a more broad-based term like musculoskeletal therapists? Does that better encapsulate what we're doing? And on the flip side people are saying if we change the name we may lose several aspects that we feel are important to the name itself, and that is the historical perspective of where we've come.

Mark Kargela: Should we stop calling ourselves manual therapists? That's the question I'm asking today, and it's one that might make some of you uncomfortable. I'm joined by Mark Shepherd, a fellowship director and friend. I deeply respect. We both went through the same rigorous training. We both know that orthopedic manual physical therapy is about so much more than putting hands on people.

It's about clinical reasoning, complexity management, and multimodal care.

But here's the problem. The name doesn't say that. When we brand ourselves as manual therapists. We're anchoring our identity to one intervention. An intervention that research says is helpful but not uniquely special.

And whether we like it or not, that name is shaping how patients see us, how physicians refer to us, and whether younger clinicians even want to pursue fellowship training.

[00:01:00] Mark, and I don't fully agree on the solution, but we do agree on this. The conversation needs to happen, so let's have it.

This is the Modern Pain Podcast with Mark Kargela.

Mark Kargela: Those of, you've been keeping up online. I've had my posts and discussions around manual therapy and our, my perception of still, we're clutching to that as our identity as what advanced practice entails yet. I have had some concerns of, is that really representative of what the research telling us as far as where it's, where it sits and different things.

Mark, I'm wondering if you can speak to your thoughts on. Because, well, let's go back to IFOMPT 'cause we spoke to this before we went on and that was one of the things I guess that was personally frustrating to me. 'cause I saw that as we're gonna broaden, we're gonna really embrace the comprehensiveness of our abilities as physios.

And I know I was not privy to all the details of what went into that decision. I had, Dan, Rhon and others who commented on social media. So I had a little bit of some perspective, but still struggled to understand why we struggled to move [00:02:00] towards. Musculoskeletal physical therapist versus a manual physical therapist.

I'm wondering if you can and maybe there's some things, groundwork you wanna lay into that discussion. I'm just curious where you sit with that.

Mark Shepherd: First I'm happy to have the discussion on this topic. I think, mark, as I mentioned earlier, before we got on, I think you're. Good at thinking through this stuff and asking why and not just like going with the status quo. And I think that's important in.

In PT and really in manual therapy world as well. And I first wanna say, my, my biases, obviously I have some, my bias is informed by my training. I went through fellowship training in manual therapy. I'm a program director of OMPT fellowship program. So, as listeners listen to this, just understand that's where the context of where my perceptions and belief systems

fall. Now, I've evolved over time as I know Mark you have as well, because we come from the same training. But you know, when you look at like the naming structure [00:03:00] musculoskeletal versus orthopedic manual physical therapist. IFOMPT was wrestling with this year, a few years ago. And I think the challenge was some of our global stakeholders were thinking, what, are we limiting ourselves too much by calling ourselves manual therapists?

Should we use a more broad-based term like musculoskeletal therapists? Does that better encapsulate what we're doing? And on the flip side people are saying if we change the name we may lose several aspects that we feel are important to the name itself, and that is the historical perspective of where we've come.

We, whether we like it or not, we've come from the placing of hands on a person. And obviously using techniques, manual techniques, hands-on techniques to try to create change and modulate pain. The way that we've obviously [00:04:00] learned about technique driven care has evolved greatly, especially over the past 20 years.

And so I think that's why the conversation comes up. Number one, we have a historical perspective. Number two, I think the big piece is that we traditionally have done such a horrible job at really messaging behind what orthopedic, manual physical therapy is, and I feel like the tide is turning. I think folks like Jason Silvernail, Roger Kerry Chad Cook, or some of the folks.

Damion Keter is another one who are really pushing us to, to say what are we really looking at trying to say that we do as orthopedic manual physical therapy practitioners and Jason Silvernail et al's Work, obviously you're very familiar with their updated definition, I think is to me is one of the most seminal papers, at least in my world to say.

Look we are now defining [00:05:00] what that looks like. And so I, I don't know if changing the name will change really what we do, because it still doesn't change the definition of the standards of what we have. And so I think manual therapy to me is like that historical perspective. And also we haven't really defined it appropriately.

So I think that's why a lot of the pushback came to say, Hey let's not get too far ahead of ourselves. We haven't done the work yet to really define, and if the issues still persist or we see that there's, challenges there, then maybe we can look at it. So I think it was just too soon.

And the evolution of OMPT.

Mark Kargela: And you won't hear me argue about the definition of OMPT. The paper definitely, I think validates a lot of the training and different things you, you speak about. I guess my concern is, we have, and I think manual therapy is undergone a, obviously [00:06:00] sometimes a little bit inflammatory criticism.

I get it. But, and it's, I'm not, a huge proponent. I don't think that really, but, maybe it generates a conversation, but. I, and I get the historical perspective, and I can understand like we've had some giants, the Stanley Parises, the Maitlands, the Mackenzies, and we can name on and on.

Some of the, folks that I sometimes wonder though if we're not the prisoners stuck in Plato's Cave, still staring at the shadows and seeing it through a kind of biased lens of manual therapy. When the research to me. Again, I won't say, it doesn't show that manual therapy can't be helpful.

I would question is it been proven to be, and I don't think anybody argues with it. I've at least my OMPT buddies and fellow buddies. It's not necessarily, and it's been portrayed as it's probably part of a multimodal approach. Yet we're trying to harness our ourselves to define ourselves through a singular name of this multimodal approach.

It's orthopedic surgeons are we saying I'm a arthroscopic? Although we know that's not probably the ideal procedure in the [00:07:00] knee anymore, but I just think we harness in on the intervention. I don't know. I guess my questions are if we're so much more than manual therapy, which is what Fellowship to me, fellowship like surprised me on what I learned.

'cause I honestly went in thinking I'm gonna become a better manual therapist. 'cause at the time I was thinking that was the definition. Of success. That was what was gonna make me separate myself. And I think you've probably would agree from our discussions in the past, that manual therapy, we got so much more, the manual therapy was like the, I don't know, icing on the cake or like the, like it was so secondary to what the really meat of what we learned in fellowship was.

Yet I still see, and I guess my big concern also is the public perception of physios who are coming up and granted they're living in a social media world where manual therapy. It was getting criticized and I think sometimes unfairly I get it, it gets characterized and I understand how we have to harness and fight.

Here's what OMPT is. We're not gonna lump ourselves in with the, the crazy stuff we see on social media. I get that. Yet I don't [00:08:00] see the science to support. That it needs to be such a defining characteristic. To me. A fellow can know when and what context, hands-on care can be used, but also understand that it's one option of many that can be, doesn't have to be the primary for everybody, but definitely can be a hallmark of clinicians, why the need to. To really come under to one intervention of what we know is so much more than that intervention of what we learn in fellowship training and what really defines an OMPT therapist of what that definition is.

Mark Shepherd: It's such a good question to think about. And so I think at the crux of the challenges is again, a messaging thing, because we have been programmed to think that manual therapy equals manual technique. That is not the case in my mind, and that's what I've been advocating to say.

Manual technique is a thing that we do, right? It's, [00:09:00] place hands on somebody to do something, to change something. Manual therapy is beyond that. It's like physical therapy is multimodal, right? And so we don't say that we're exercise therapists, right? Even though we use exercise quite a bit, we don't say we're transfers transfer therapists because we do transfers quite a bit in the acute care setting.

We don't say we're ambulation therapists because we work with people to help them ambulate better, right? So we look, if we look at that same lens to say that manual therapists encapsulate. Manual techniques but are beyond that, then we can start to look at and say, okay, now that's what we're looking at is a person that is using a systematic reasoning approach.

Is grounded in good communication skills, uses exercise education, and has a long-term mindset. And that's why I think that the definition, as is really helpful. Now, I think the [00:10:00] criticism, which I will say I want to, I want people to hear this clearly. I think the criticism is warranted. I welcome it.

Yes, some of it is very loud, but that's okay. That is okay if we feel that our egos are so big that we can't be criticized, and that's a problem on us. And I think that's, sometimes we see that in the manual therapy world, and I can understand because people have worked very hard to get to where they are and yes.

They built ConEd behind it or whatever it may be, but again I look at this and I say, what can we learn from it? Take the emotion out of it. What is the person saying? And I think when I look at some of the louder criticisms, I actually agree with a lot of it. But I think what they're talking about is technique, not manual therapy, not orthopedic, manual physical therapy.

And I would agree. What I don't like is seeing people use techniques and use [00:11:00] technique driven reasoning. And I think there's a lot of that out there. And my guess is. And this is total perception. I've never practiced in Europe. I've never, done courses over there. I very rarely engage with people.

Overseas, but I'm often wondering is this, is this what's happening over there? There's not a ton of fellowship programs that are really rooted in a systematic reasoning approach, and I wonder if they're seeing more of that press and guess. Poke, poke and pray type thing, and the language used behind.

That is flavoring some of what they're doing. So like when I hear some of the criticisms, I echo what Jason Silvernail says and I say, that's not my manual therapy. That is not the brand that we use. That's not the brand that you use, mark. And that the thing I also will tell people is. A orthopedic manual physical therapist may very well not use any manual techniques as part of the plan of care.

In fact, that is frequent. I may use [00:12:00] 5% of my total plan of care of the laying of hands on the person to try to modulate their pain, especially if they have a pain mechanism that may not match well to that specific technique. So to me, I think that's important to, to message. And I remember when I was in fellowship, Dan Rohn said to me, he said, it's equally as important to know not when to use a manual technique than when it is to use it.

And that has stuck with me so much because obviously our bias is, hey, we're trying to learn to be better, more skillful with a hands-on technique to use it more. But I think as I've. Practiced, a. A decade since I've graduated from fellowship, I've realized to use it way more precise with more precision on the type of person to use it on.

And when I know I'm like, this is not, these patterns I'm seeing in this presentation don't bode well for using it either because this person might become dependent upon it or it's just not gonna change things in the long run when I [00:13:00] can be better using my time towards. Education, communicating with them, mi, whatever it may be.

So I think the criticisms, again, are on technique and using it in a non reasoned approach, but that to me is not OMPT. And if we lose that naming structure, I think we lose all the ground that we're starting to build and defining what it actually is.

Mark Kargela: with the branding components. 'cause I think this is a key piece of things I see brand, who are we branding towards, I guess would be my question. Because branding within our profession is one thing, but branding to the general public and I think,

Terrible.

yeah.

Yes. And I, to me, I just think. That name w we can define it. And again, I think this discussion always stays in academic circles, right? It's at conferences, it's at, yeah. It becomes this massive Echo chamber. And to me, having studied branding and things, for, trying to brand my teaching and get people to be a little bit more broad with their, ways of applying things.

Whether we like it or not, [00:14:00] we get lumped in with manual therapy 'cause we're brand, we're anchoring ourselves to the name. Whether we wanna define it as well, ours is a different brand of it. We're still in the manual therapy thing. I completely agree that I don't want to be lumped in with people frigging throwing plungers on people and doing all sorts of crazy stuff with hammers and things that I see on social media that is technically manual therapy and sometimes gets thrown back at.

Folks will look at this manual therapy garbage. I fear. We're in a disconnect with what, the realities of the brand is. And I think we can try fight it and try to name it. And do as much as we want to make it sound like, well, we have a special version of it, but in the end, the public's gonna see what the public sees.

And we're gonna, and I, to me, that's who we need to message and brand ourselves towards because in the end, academic circles and Oh Yeah.

Well, Yeah.

it makes sense in the, in research, because I get it from a research perspective, right? We wanna make sure we're researching on what the. True nature of what we're applying is not just we got some person performing this outlandish, ridiculous thing called manual therapy.

And yet in [00:15:00] systematic reviews and meta-analyses, we're getting lumped in with all sorts of like pseudoscientific garbage. Completely get that. But to me, I just def, I just see fellowship in advanced orthopedic practice. I don't know what it is. I'm not by any means a brand specialist, but I think our branding efforts.

Still pigeonhole us whether we like it or not. We can make it sound as advanced in the reasoning 'cause I'm all fully on board with it. I just don't see branding ourselves to that name, getting us what we want. If we want to be seen as like advanced practice primary care, first contact ortho spine practitioners.

I don't see how that branding strategy moves us there. And am I wrong on that or what are your thoughts?

Mark Shepherd: I think it's a valid point. I think number one, the branding of what we do as physical therapists in general is not always accurate, obviously. I think, when it comes to manual therapy, obviously, because there's so many different types, soft tissue [00:16:00] massage, thrust mobilization, this and that it does become watered down to some degree.

So we can have these academic debates on what to do here and there, but at the end of the day, it's do. Patients truly know what a FAAOMPT is. So fellow of the American Academy of Orthopedic Manaual and physical therapy, do they really know that? And to me, to be honest, yeah, I have people who will come back to see me.

But are they coming back to see me because of a label of any sort or because of whatever? Are they coming to where I work because I'm there? Probably not a lot, and it is not because maybe I'm terrible, but, people are looking for things like, all right, what's most convenient to me? Where is my insurance accepted?

I don't feel that because of the title and the letters after my name that people are searching me out specifically. Now what I do think people realize and what [00:17:00] people have told me. Is that I'm more thorough than other therapists they've seen. I provide more specific guidance than what other people have seen.

So I think they, when they see it and they recognize it, they're like, wow, this is different than what I've seen else was, but you know, they're not coming to that knowing that's what they're gonna get. So I think, at the end of the game, the end of the day, is the name gonna necessarily change that?

Probably not. I keep going back to the messaging that we do, and. I think regardless, say we changed the name to musculoskeletal, whatever practitioner, we still have the same issue. At the end of the day, people don't really know what that means. And it could be argued that if we're changing names and all this stuff, does that even messy the brand even more potentially.

And so, to me, I think where we need to focus our attention, and I know a o is working a lot on this. Is trying to really direct what we do and define what we do and get the message out a little bit more to our stakeholders. [00:18:00] And right now, I think we do we are doing such a focused effort in our profession, like you mentioned.

I think that's a hundred percent accurate. I think we're really just trying to do this in front of e each other as PTs versus being like, well, what do patients find? What do they think we are? What name would they give us? And I think manual therapy actually is something that resonates with people because they know, oh, this person is going to use touch in some way to help.

And we know that's actually from qualitative research done. That is something they want. As much as it may not be helpful in the long run, that is something that people want. And if we go back to. Roger Kerry's kind of paper from 2024 on modern teaching of manual therapy, which has been another paper that I think has been very good.

Again it's looking at efficient use of manual therapy, comfortable use of it safe use of it. I think if we put those things in to the way we teach and the way we use [00:19:00] it I think we can be more clear with. Our marketing of that, our branding of that. So again, I see where you're coming from name and I could, I can see that argument, but I think at the end of the day it's the messaging that is important.

Mark Kargela: I get it. I think, sometimes your name speaks to the problem you solve. Right? And I and I just having studied, again, branding a bit, and I'm by no means would I consider myself an expert, but you know, maybe less of a dummy than I used to be on it. But. I just try to put myself, okay, I'm gonna, I'm a physician or an ancillary healthcare person who's considering, who do I send somebody with this pain issue to, right?

And I just see like a manual therapist, orthopedic manual, physical therapist, I one. And as you, I don't think you'd disagree that. The vast majority of physicians, PAs, nurses have no freaking clue that what difference that is from Joe other PT in the world as much as we want to, I guess too. And if they see this is, this person's an manual physical therapist, I [00:20:00] don't see how that name goes.

Okay. They're gonna be very advanced. S'S gonna be able to do things that are not just hands-on things. just think from a, just a quick blush of who's the person? And I agree. Not a lot of people are coming in be I, have, I don't think I have anybody come in because Yeah.

you're a fa and that's why I'm seeing you. But I also just think of what we and I, and physical therapy has had an identity crisis of like in a public perception crisis from the dawn of time as far as, but I do think we can better from a fellow healthcare professional, if I see somebody who's a. Fellow in advanced orthopedic practice where I'm seeing a bunch of orthopedic patients, some of which I don't want people to bump their hands on this condition.

This person's got a persistent pain issue, which I think Fellowship uniquely, trained me to better be able to help folks in persistent pain. Maybe didn't go as in depth as some of the other, things that you can go with the that training, but I just feel like. There, the branding from outside our profession, I just feel like we limited, and you're right to say, Hey, if we switch this, [00:21:00] there's probably gonna be a short-term pain that we're gonna have to go to.

Holy, well, this is new. There's gonna be some confusions. But I think if we look long-term and we also look what the research tells us, I don't think we need to discount all the amazing things that the, the folks that founded our founders of a o and the IO folks, like we need to celebrate them and thank them for all the amazing things they've done to bring us to where we are today.

I would agree. I just think there's a part of us that has to realize that as amazing as some of the things are, and if you look at the history of science you'll hear some of amazing massively, influential scientists who were wrong in what they thought, in parts of what they thought.

They had massive con contributions. My fear is that our need to beholden to like, and I think it's outta fear where. I think we're losing hands on care because we're holding onto this name personally. That's my belief is because we're not adapting to the world of where the perception and public perception, both outside our profession, within healthcare culture, but also in [00:22:00] patient culture.

But I'd argue even within our culture, I've ran some surveys. I gotta look at the LinkedIn one I haven't seen, but it was pretty convincing. That name pushes people away. And whether we like it or not, manual therapy has become. A little bit of a turnoff for some, and I can understand why I don't think it should be, but I can understand why with how it's been portrayed on social media.

But I just see that with the research, I don't know how we have such a strong ground that we could want to say I'm a manual therapist when I do so much more than that. Like I just I'm so much more than that, but I'm a manual therapist. I just don't.

I think we're setting ourselves up for future struggles and especially if science continues to question that, man, guys, this isn't massively improving, shown, drastically more. I'm sure we can pull studies here and there, but from my lay of the land of research, it's an option for short term pain and it can be a very helpful one and it can be one that people seek.

I'm a hundred percent with you on the touch thing. I just don't see how [00:23:00] we. Honestly, I think we would put manual therapy into perspective. We would put it where it's comfortably in somebody's without having to define ourselves by it. Right? then you put the pressure on a clinician like, I have to have this manual therapy.

Oh, whether we like it or not, even though we know the training is much more than that, we, I just think we have such a branding issue from inside out, outside in with this name and our need to. To find something that we're going out of our way to say we're so much more than yet, we're branding ourselves to it.

I guess that's my, I think there's just a disconnect in my opinion in that.

Yeah.

Mark Shepherd: I see where I see your point and I think it's a, again, I think it's a valid point to consider. And I'm curious, mark, like what if you could rename something, this thing, like what, what would be your ideal name or names for it? I'm curious to see where your perspective coming from your vantage point.

Yeah.

I've proposed, and again, I've I'd honestly look like what I would probably get in contact if I'm a OED and a PTA, like what I would get branding experts if we can spend as much frigging money as we did the lobby for dry [00:24:00] needling. I'm not against it. I have colleagues friends who use it in clinic that I greatly respect, and I see they use it very judici.

But I also don't see why we had to, again, whole different conversation. But if we're willing to lobby in that, get branding out there to see what best represents our consumers desires and problems. I don't think manual therapy is it personally, I think. Advanced orthopedic practice. Orthopedists are a defined profession that people for musculoskeletal issues go to.

There are surgeons, orthopedic surgeons, orthopedic pain specialists, I don't know, but I don't think it's manual therapists. I advanced pain practitioners really broadens the scope too. I have pain. I go to this person and I think maybe that brings in an orthopedics where we strengthen instead of, and I know it's already there to some extent.

I know in your fellowship it definitely is as far as. We bring in the pain science we bring in, how do we manage these people? I don't think there needs to be a therapeutic pain specialist and a fellow of, I think all the, if a, to me, a fellow at top of their game should be able to manage somebody [00:25:00] psychologically informed.

Whether it's a complex pain presentation or somebody that's a traditional like man, this thing looks like I can manipulate, get them moving quick and get them, re-engage their life quickly through some hands-on stuff that they come in desiring and I know I can deliver and produce a change with, I don't get overly excited about it.

I don't need to put my. Polo on that says I am that I just, it's one piece of, I'm so much more than that. I guess that's where my head's at with it.

And I love that piece, of your vantage point and your perspective there is Hey, it's so much more than just, the manual technique aspect of it. And we should be defined by that. And I think partially what I think I liked, again, going back to Silvernail's work is, we.

I think we're moving away from just saying that we're manual therapists, like it's orthopedic, manual, physical therapists. The whole thing there is what I've been trying to tell myself to say to people and what we're trying to brand in our fellowship. This is OMPT, not mt.

And I think that's that [00:26:00] delineation. And in fact, like. If I could change something, I might say orthopedic and manual physical therapy, and say 'cause I agree, like orthopedic has a very understood. Approach when it comes to patient care. Patients understand orthopedics, they understand like who you go to and why you would go to that.

And then, the manual therapy pieces we've talked about has its positives and negatives. But I also, mark, I don't really know if we, if there is a term that patients truly resonate with, that, that's honestly probably a good research project to say Hey, if we go out and survey 500.

PTs or patients what would they say, if they could pick a name, and you could even look and say, let's look at somebody who sees a fellow in manual therapy, in orthopedic manual physical therapy. And what is it that defined that care?

What was a word? Even just think of like a word cloud. It's what are the [00:27:00] things that resonate to them? And I think. That's the question is I think we are looking at this as a clinician centered name change potentially. And we're not looking at, like you said, this branding thing is like what are cons?

What are our stakeholders and our clients think? So I think that's the question.

Mark Kargela: I think if we want to grow as a profession, those, that's what grows us, right? Our reputation and our stakeholders and what people seek out. 'cause then we get a shortage of everybody wants shoot. Like there I'm, this program positions me to solve the problems that my stakeholders are looking for.

Again huge props to AAOMPT and what they've done. I honestly think these discussions at AAOMPT conferences does not do this topic justice. You need to, these conversations and questions need to be asked beyond that, 'cause you're gonna get a bias sample.

And I've probably add some bias to that. I think we need to strip the bias.

away from, 'cause I don't think, , when we got, I always use the analogy like you survey people at McDonald's if they like [00:28:00] hamburgers and of you're like frigging you're serving McDonald's, right?

think we. Yeah.

a hundred percent. And I think if we want to, we need to have branding initiatives. I would love to see us, like I said, invest some money to ask those exact questions and strip it from bias like it should be what's defining care for somebody who has a successful. Physical therapy and it doesn't have to be delivered by FAAOMPT.

Maybe it is and again, I think we risk a little bit of especially FAAOMPTs that are, struggle to not put hands on and maybe don't have that well reasoned. I'm not saying everybody doesn't, or that it's a massive issue, but I just think to me, one I, and I've just seen it and I've, I have these conversations regularly.

Is our clutching to that name is stifling the ability. I think you'd see big growth. Now, I know a lot of the fellowship programs from my understanding I wasn't there a couple weeks ago at Reno for the conference. I think enrollment's up, but like people aren't sticking around AAOMPT to be members, right?

There's a membership challenge and I think, I just think when we get out of our [00:29:00] fellowship and see that. more than this, then it's hard to want to anchor yourself to something that's, even though the definition says we're much more than that, I just think the branding and the general perception out there is that we can define it as much as we want to, but in, in consumer psychology and brand psychology, it's a first blush.

It's not a, well, here let me stop and read this big document of how mu how much more we're that. I just think there's gonna be a big confusion. I think there is a big confusion 'cause I would recommend people still, despite, I know I get labeled as some sort of manual therapy hater, yet I use it, you know reasoned, I'm criticizing it because I think we can do so much better than be being so strictly defined.

As a manual therapist, I think we can still learn the skill of skillful use of hands doesn't need to go away whatsoever. I'm not saying it now. I think you and I both agree that there was probably a history and there's probably still little pockets of it that massively overcomplicated and do it in pseudoscientific, overly [00:30:00] hyper specific ways that regardless of what gray haired dude teaches it, there's just not a lot of support for it.

And again. That mo mode of care has had ample time to prove itself, to be superior and researched and it just hasn't lived up to it. So I think programs like yourselves, forward thinking programs have moved on from it. But again, I just wish we would just be a little bit uncomfortable, maybe step outside that, cave be that prisoner who escapes and sees that we, and I think we are, we're like the paper tells us like this is the guy who's escaped.

But then we come back and we. We still want to clutch to the name and I do think names matter, and I think if you look at consumer psychology and branding psychology and all that stuff, it matters. And let's invest. I'm willing to shut my mouth and say I was wrong. I'm happy to I don't think I am, but that's my bias and I'm, but again, I'm, I will eat my words and be happily proven wrong, but my understandings of branding and that stuff is, I don't think we're on the right path with it personally.

Mark Shepherd: I think your points are [00:31:00] important to consider and I think, the question becomes, what is it that people, want when they are seeking? Services for orthopedic care and I think it goes beyond pain too. Obviously you and I have treated people, for non musculoskeletal stuff using OMPT approach.

And I think that's important too. There's a lot of neurologic conditions or cardiovascular conditions. I love treating a person who has cardiovascular stuff because there's so much we can do in our wheelhouse as PTs. But, I think you're right. I think names mean things.

I think we, the question still at large is what does that mean to patients who seek our services? And then I do think you made the comment about a o kind of pushing into that discomfort. I do see that becoming more and more of the norm. In, in, in leadership of a OII see that becoming more front and center and I have to say [00:32:00] AUM leadership, the board has been very good about asking why we are doing things the way we're doing things, and then trying to push us to be a organization that really is driven by the evidence.

And some of the evidence, I would say is still unclear of what we do, where's our value? How do we define what a fum is? I'm working on a task force now to come up with competencies related to fellowship training. And the thing that keeps coming up, mark, is this idea that, people who graduate from a fellowship training can they can work with complex people.

And then, my question is well, how do we define complex and do fellows. People who go through fellowship training can, are they only supposed to see complex people? Because I don't always see complex people, but when I see the more straightforward cases, those are like, boom, I recognize the patterns right away and I know a list of interventions and I can hopefully get there [00:33:00] efficiently.

So I think there's still a lot of undefined things. If you look in the literature in, especially in physical therapy, we do not have a definition of what complex means. So again, it's a defining and messaging thing that we can't even we've gone like 30 years, 40 years with fellowship training where we really, we've had standards.

We've had standards luckily, internationally and within the us but we haven't really defined competencies of what, okay, I know these are standards, but what do you actually do? So I think. Part of it is we're at a point now where I think AOP is look we just need to define what we do.

And maybe by those definitions, and maybe if we look at branding, from the stakeholder perspective, maybe then we could say, okay, where are we at now? Here's what we say we do, here's what people think we do. Like, where's that mismatch? And do we need to, do we need to [00:34:00] re-brand?

Maybe it is a name change. So I think. I think the conversation is still out there. I do think there's certain individuals who are very stuck, to it. We gotta stay manual therapy, and I think there's historical perspectives, as I mentioned the advocacy thing, with professional scope of practice for PTs, has really been pushed through our a o and others.

So I think there's a lot of that. Is lost on me because I grew up in the profession where those forefathers did the hard work there and so they may see the name meaning something differently because of the advocacy that's been put in. So I think if you swirl all those things around, I think, it's still like we are evolving now, but I see the tide turning.

Mark. I do.

Mark Kargela: I know you're, you all and at Beillin are, forward thinking. We have other programs out there that are very forward thinking and I think they recognize and the pace of change is never as quick as we'd like it to. Be, I recognize there are a lot of moving parts and a lot of things that can [00:35:00] go into it.

I love to hear that the conversations are happening. I just, I would love to just divorce any of our preconceived biases or of who we think we are and what we do and let's let the general public of physiotherapy, 'cause I think we do need to understand is our branding. Limiting our ability to, 'cause I, from my perceptions in serving in my audience, it's actually, deterring folks from wanting to enter in that specialty training.

Which I think is a shame because I think there's a lot of people that if they said, Hey, this can be part of what I do, but it is not all of what I do, even though we know that's what the definition says. Perception is what it is. So again, there comes down to the brand. Same thing with the public, I think. I just think we get caught in academic circles as we already spoke to talking about branding. I would love us to just. Hands off, here's our definition branding thing, here's what, and then go find out what the public thinks and what we need to brand. I, and again, I'm happy to be wrong. I just don't think it's gonna, they're gonna come back and say, yes, you need to brand yourself to be an a manual therapist with [00:36:00] all the things you can do.

I think to me, we, and again, we know manual therapists, OMPT is so much more, I just don't think the public does. I still think there's, despite the paper. I think the general perception of the overall, physio profession. Doesn't, because they just still see this word that, again, we know it's, we're much more than that, but a word is your brand and it is what you are defining yourself by the words you, the banner, you fly under, the flag, you fly under.

And I think the, but again, I'm glad that there's conversations happening and I know hopefully we'll end up in summer. I would just. I guess I'm just like salivating seeing man, we have so much potential to be a solution for so many more people. And I've mentioned this on social media, like people do not buy the tools, they buy the destination, right?

So I think if that's our messaging and things versus, I think we have just opportunity to reach a whole much bigger swath of people and get a little bit more awareness as we mentioned within stakeholders in the healthcare professional sphere, but also patient sphere. [00:37:00]

Mark Shepherd: I'm curious, mark, you know what do you think is driving like with, if we look internally to like PTs, what do you think is driving people maybe moving away from like fellowship training?

Mark Kargela: Just my discussions, it's the it's manual therapies and I know it's the definitions out there, which I think, hopefully a helpful step to, to combat that. The manual therapy sucks Brigade, which. I honestly think and I haven't met Adam personally, I respect, Mr.

Meakins. 'cause I think he's brought out some discussions that I think needed to happen. Maybe not in the exact way. I, I admire him for the way he goes about it. 'cause he is, he probably fills in his dms and inboxes more than I, I'd be probably have broken down through anxiety attacks, going through, putting himself out there like that.

So, again, don't have to agree with the method of it, but I just think it. I think evidence-based clinicians are it's a hard to look away from and we just had a study saying, and how, a lot of manual therapy trials are A compared to A plus B. And yes, of course A plus B oftentimes is gonna, so is that inflating?

So there's a lot of things [00:38:00] that are out there that are showing that. I just think you have a bunch of clinicians saying, man, how can I fly under a banner of something that doesn't really massively separate itself from other options I have. Then there's also probably a little bit of a paternalistic traditional, well, you're less than a therapist.

I remember this. 'cause if you're not putting your hands on and doing all the fancy, locking out from 14 different planes and discriminating millimeters with your fingers. I know all moved past that and that is stuff that, most, the majority, not all manual therapy programs have moved on from.

But Yeah.

I just think there's a perception issue from the profession of. therapy almost has become a turnoff. It has for some I've had to push people back. Just like you said, what are your people expecting? Does touch have value? Does, Yeah.

Granted, we don't have to fly it underneath.

And I don't consider myself a manual therapist. Personally. I consider myself a an advanced practitioner who you, who has manual therapy as one of the many tools I can use that allows me to fit myself. I just think [00:39:00] also there's a little bit of a. Whether we like it or not, a preconceived bias that I have to, apply touch.

Now, a lot of nuanced, well, reason therapists understand that's not the case, like you 5% I think you mentioned. So I think that's probably, that's a long answer to it, but I just think whether we like it or not, science is telling us and giving us some serious questions of, well, why would I define myself on an intervention that isn't showing that it ne it has any reason to be the banner I fly under?

And yet the definition. Says I'm, it's such a small piece and we're so much more than why would I do that? I just think there's, that's the brand issue I see is the perception out there of the general PT public is, and sure there's pockets that's, that say, hands-on care is vital, and I do think it should be an option, and you should have skilled use of it.

You should be, and I, my definition of skill is more towards Roger's definition of skill, not. Some of the antiquated, overly hyperly, complex modes that, 'cause I've been through a lot of the letters on that stuff. So I guess that's my thought is just there, my [00:40:00] discussions with people. 'cause I talk with physios all the time and I've had, mentor sessions.

I'm like, this is a common pattern that if you just lay your hands on and you maybe do some things that meet the patient's expectations, you move a lot further than this bias. You have to not apply it. 'cause I honestly think we're almost moving people further away by, by grabbing more tightly onto this.

'cause I think they're seeing science doesn't support our reason to grab onto this part of our title. Even though we're calling it OMPT. Whether we like it or not, it's still manual therapy in the perception of the public and our and physio public, I guess I would say.

Mark Shepherd: ,

It's a shame you see it. I would agree. I think there's a harder pull now towards doing fellowship training. I actually think people. Value techniques over, the real training that Enco encapsulates OMPT. And I think part of that is healthy criticism.

But again, like I said before, I think the criticism is on the technique. I think some organizations out there that focus on technique, are doing [00:41:00] very well. Honestly. Our program is not easy. You know how it is. Mark. Like we, our average time to finish is about a little over three years, and that's, over 200 people going through our program at this point.

It takes a long time. To do our brand of what we align with the modern definition. And I wonder if a lot of PTs just don't want to put the effort in because it's hard. And I don't blame them because they're already tired and potentially burnt out. And I know you, when you started Fellowship, you were there, man you were like, this is my last stitch effort before I leave the profession.

And you were like, how many times have we heard from our colleagues that like Fellowship changed? Their perception and it taught them how to think. And it taught you to be where you are now because you don't go with the status quo. You question everything. You're humble and you're curious. And that's where we are, and that's where we should be.

My fear is that the pendulum is swinging. . We are criticizing the [00:42:00] technique, but not not looking at it for what it is globally as an approach. And so, I think again, it comes down to branding and messaging. , And that's the flag I'll put out there is we need to keep laser focused on, what is it we do, what does our brand look like?

And then I think at that point. We get the stakeholder input and then we can decide on, do we need a name change or not?

Mark Kargela: And I think that's exactly where I would, recommend is like we have to divorce our bias and we have to recognize we may be sitting in Plato's Cave on that discussion. And we need somebody who's standing outside the cave to see, that can take a look at the landscape of consumer psychology, of the stakeholders outside of the AAOMPT conferences and all this stuff.

There's nothing wrong. And again I am thankful that the, all the work that folks in AAOMPT and things are doing to really define and separate what we're doing. 'cause I'm totally on board with the need to. Not be lumped in with, some of the Tom Foolery that is sometimes labeled as manual [00:43:00] therapy and to have here no.

This is what we do. This is our brand. But again, I think I would wholeheartedly agree it is a massive branding issue that let the data speak I think is all I would ask is no gray haired or young whipper snapper trying to challenge the status quo should be let the let's just objectively allow and make sure we're not surveying, hamburger loving and McDonald's and find a way where we can understand what is the, with both within folks that don't have any stakes in the game of what if, what they're considering to advance their practice.

You bring up some great points, like I also think there's people who are. Coming outta school with and staring down a student loan debt, there's all the issues and to lump on training and a residency in north of and fellowship that isn't supported. I like, I know a lot of systems are supporting it, but it's a tough sell these days.

Although, some folks are still, in good numbers enrolling in it, which I think is a great way to obviously help and I recommend folks if they can do it, fellowship's the way to do it. But I just would love [00:44:00] Fellowship to expand to really encapsulate what we are and I just. Personally, think we can do better from a branding and messaging, but it sounds like those questions hopefully will be answered.

So Mark, I want to thank you, man. I always appreciate a discussion with you. We didn't yell at each other. We talked in a nice, calm voices and I think for the most part we agree on most things. I think it's always nice to have these discussions and get perspectives.

And I also wanna thank you for all I know. It's a fricking hard job to run a fellowship and do all the things you do. So I appreciate your work, my friend.

Mark Shepherd: Oh man, I'm just happy, to have discussions. To me it's always nice 'cause I learned something from different perspectives and I think, like I said, you kind. Are such a deep thinker about things and I think you really, think through what it means from all perspectives.

And so I, I appreciate your points and I think it, it echoes some of the issues we have, within our field and specifically in orthopedics and manual physical therapy. So thanks for letting me come on and record, [00:45:00] record our discussion this morning.

Mark Kargela: For those of you listening definitely share this conversation for anybody who's having some difficulties or questions around possibly pursuing orthopedic manual physical therapy training and get some nuanced discussion of it.

'cause I think there's always that social media polarized. So hopefully this discussion is lended. Some nuance and some of the understandings of, some of the reasoning behind our labels and our, and what's going on in programs. Again, I think, the training and fellowship is second to none as far as what you're gonna get in the clinician, you'll come out.

It's what saved my career. As Mark had mentioned, I was ready to quit twice and this is what got me to it. I just, I'm selfish. I want it to be better and better, and I just think we got opportunities to expand and be better than simply. Maybe that label, but, and we are the definition is, I just think, again, branding is a piece of that, and there's a big piece of that, especially if we're trying to change the healthcare landscape.

So we'll leave it there this week. Appreciate you all listening. Share the episode, make sure you subscribe wherever you're listening or watching the podcast, and we will talk to you all next week.

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