Plus, the Latest Advancements in Physical Therapy Research
In a recent podcast episode, Breakthrough Founder Chad Madden, MSPT speaks with Mike Fink — Physical Therapist, CMPT, and Department Chair at Lebanon Valley College. In this conversation, Chad and Mike discuss the latest advancements in physical therapy research, the evolution of manual therapy, and what to look for when hiring an entry-level DPT.
Who is Mike Fink?
Chad: Mike and I have been good friends now for the last 13 years. He is the Department Chair Head of the Physical Therapy Program at Lebanon Valley College here in Central Pennsylvania. We also work together at Madden and Gilbert Physical Therapy. Today we’re going to talk about the latest in physical therapy research, specifically around the evolution of manual therapy. And since Mike teaches DPT students, I’ll ask him about what practice owners should know about hiring entry-level DPTs and what to look for.
But first, can you tell everyone about yourself? I think our audience would find your background in the military really interesting.
Origins as a Physical Therapist in the Military
Mike: Sure. I’ll take you through a brief history of my Air Force career. I first graduated from Thomas Jefferson University in 2000, then joined the Air Force after graduation. I saw a benefit to serving my country as well as being a PT in the military, and heard the military was where you can grow as a physical therapist. There’s a lot of autonomy and you get to treat patients at the first point of care.
So I was stationed in California at the Travis Air Force base, and eventually deployed in Iraq. It was in that arena that I realized the value of manual therapy and hands-on care, and what physical therapists can offer as that first point of care. I was the only physical therapist in a base population of about 5,000 airmen, soldiers and sailors. As the single busiest provider at the camp, I saw more patients than any other healthcare professional, including the surgeons and physicians.
After my deployment, the military offered continued education. I went to the West Point Sports Medicine Residency in New York, and from there was stationed at the United States Air Force Academy in Colorado Springs.
Chad: So you were in Colorado Springs and I recall in the early days when we were talking, you said you would walk in at 6 in the morning and there was a line of like 35 waiting to be seen by you. You also mentioned the significant autonomy that you have as a physical therapist within the air force and the armed services. Then you rejoined civilian life and private practice. What were some of the major differences between working in the military and working in private practice?
Differences between military PT vs. private practice PT
Mike: Okay, so I think one of the biggest differences that I saw was in the mindset of the other clinicians in the private practice sector compared to those in the military.
In the military, I was used to having a lot of autonomy and responsibility, and that was the mindset of other clinicians too. When I came to the civilian sector and private practice, I saw that not everybody wants that level of responsibility as a professional or believes in the value that they could bring to patients soon after injury. I think they hadn’t realized that job satisfaction increases when you have more responsibility and can see positive patient outcomes.
By the way, almost everything that’s coming out of the latest literature shows that the sooner we as physical therapists can treat after the point of injury, the better the outcome. So that’s what we always want to do, is get close to the point of injury.
The evolution of manual therapy
Chad: As we’re now 20+ years into our professions, I know we’ve both seen a lot of change. I’m not sure what amount of manual therapy training that you had at Thomas Jefferson, but as for me and my peers, we didn’t get a lot of manual therapy training in college. What changes have you seen over the last 20 plus years within physical therapy education and the services we provide?
Mike: Chad, I’m much like you. I did not have a lot of manual therapy coming out of a physical therapy school. Most, if not near all of my manual therapy training came through the military. Historically, before you or I graduated, manual therapy had a pretty significant place in physical therapy. However, I think many of the individuals that were leading the way in manual therapy really put it on a pedestal, and made traditional physical therapists feel like it was almost unattainable without decades of practice. That was part of the problem.
Because of this, many physical therapists felt like we had enough other resources that could get patients better and could get away without it. Then we realized we gave away the golden ticket and we needed to bring it back. Today, we’re still evolving our understanding of manual therapy. A lot of the research that’s come out is around how we pick the right technique for a particular patient.
Chad: That’s great. So there’s a more developed and mature decision tree today than we had 10, 20 years ago.
Mike: Absolutely, yes.
The latest advancements in physical therapy research
Chad: So the other thing I want you to talk about is the trends you’re seeing from the latest research. I know you do quite a bit of research yourself. How has physical therapy research evolved and where is it going?
Mike: Okay. The latest research today is looking at manual therapy, its immediate and long-term effects, and the difference between those. But more importantly, how do we select techniques to yield the best outcome? That has created a whole generation of what we call clinical prediction rules. How do you select the right patient, how do you select the right treatment and match those two together? That’s where the research is right now. We have a lot of great clinical prediction rules that lead us down that pathway of what the best technique is for any given patient.
And when we’re looking at most clinical prediction rules, they have one common criteria: The time from onset of injury or onset of symptoms and time of treatment. Meaning patients have better outcomes with hands‑on care manual therapy, if it’s closer to that onset point. So that really plays into the argument of why direct access is so necessary because direct access saves us time. It helps us get closer to treating soon after the onset of injury.
Chad: That’s a great overview of the latest research and the overall evolution of manual therapy. The other thing that I wanted to ask you about is hiring entry-level DPTs. A lot of private practice owners are really struggling with hiring right now. It’s a real problem. We have a shortage of workers across the board but particularly in healthcare. Moving forward, demand for physical therapy services is increasing greater than the supply of DPTs that are graduating.
So, I know you understand both the private practice sector as well as the educational sphere, and you interact with students every day. Can you help us tap into their minds? What we should be looking for in an entry level DPT?
The disconnect between PT clinicians and academia
Mike: Yes. So there’s two mindsets that are usually on polar opposite sides of the spectrum that create this lack of communication between private practice and academia. There’s the private practice clinician who thinks that academia is full of out-of-touch professors that live in an ivory tower. And they’re teaching things from this textbook as their tech level, but they have no understanding of how the rubber meets the road. That’s one side.
The other side is from the professor side that says, “Oh, the clinician is just worried about one thing, the almighty dollar. They’re not worried about treating patients; they’re not looking at research. They’re still the dinosaur running off what they learned 20 years ago.”
It’s this opposition that keeps people from coming into conversation with one another. So what needs to happen is to bridge that gap between private practice and academia. There are ways to build that relationship, rather than work in silos and wall yourselves off from each other.
Bridging this gap will help you attract new DPTs to your practice. Many clinicians are lab instructors or TAs, so they’re embedded into the academic system. And if you have any individuals that have any interest in that, I would encourage you to foster that connection because that can be your hiring pipeline.
I always tell students, “Many of you will work for companies that are staffed by your instructors. And what you don’t realize is that you’ve been going on a three‑year interview where your future employer saw your true colors, your work ethic, and your intellect.” Making inroads into academia is a great way to build relationships with future DPTs.
What should practice owners look for when hiring an entry-level PT?
Chad: Very well said. So if I’m an employer and I’m going to hire a DPT, how can I evaluate their manual therapy skills?
Mike: I have very strong thoughts on this, as I do with many things, Chad. The first thing is to ask them about their program’s curriculum itself, and where manual therapy was introduced. What you want to see is that it’s introduced in the earlier stages. That’s because when hands-on manual therapy is introduced earlier, there’s less fear of it. We’re seeing that this new generation doesn’t fear it like our generation did.
So the question that I would ask would be, where is it layered into the program? Earlier is better. It’s also a good idea to test their skills, because manual therapy can mean different things to different people. It’s an umbrella term that can be anything from massage type strokes all the way to thrust techniques at the cervical spine. So what level of manual therapy have they been taught? It’s a good idea to actually test their skills on this.
Manual therapy certification and courses
Chad: Great. So Mike, I know you actually offer various manual therapy courses. Do you have any manual therapy courses coming out?
Mike: Yes, we do. We are filling up for the spring, but we have our cervical-thoracic level 1 and 2 courses, along with our lumbar-pelvic level 1 and 2 courses. We have upper and lower extremity courses as well. These courses funnel into a certified orthopedic manual therapist certification. What a lot of practice owners like about this is it creates a level playing field for their clinics. So rather than having one therapist’s schedule be super full and in-demand while another is lighter, these courses help create parody so you can universally fill schedules.
Chad: What’s the best way for somebody to get in contact with you or learn more about those courses?
Chad: Thanks, Mike. You’ve covered a lot of ground from the whole scope of manual therapy and how it’s evolved over the last 20 plus years, to what employers should look for in entry-level DPTs. Thank you!