The Movement Brainery

Intentional Exercise

August 15-16th, 2026
AT Still University
Mesa, AZ

As always, I’m pretty psyched about this.

In almost every course I’ve ever been to, exercise is shoved in at the last minute. I kind of understand why: there is a lot of other stuff to work on.

A few years ago, we came to the realization that exercise needs to get its due, and the only way to do that was through a stand-alone course.

Tim and I put our heads together to come up with a course that introduced concepts from verbal cuing, manually resisted exercise, focus, breathing, and other concepts all driven toward getting the patient back to activities as fast as possible.

On August 15-16th, we have a course coming to Phoenix that is 100% exercise. No fluff. No sitting in a chair with a pencil and pontificating about theory that doesn’t actually change your practice. You will probably sweat, be tired, and you will walk away with a war chest of exercises and a new way of seeing exercise in the clinic.

Sign up below

https://themovementbrainery.thinkific.com/courses/intentional-exercise

POSTERIOR KNEE PAIN:

I think this is a common place to trip up in ortho PT. I often hear people go down rabbit holes with posterior knee pain or patients who have seen a PT who has diagnosed them with a popliteus strain or something like that...

In this paper from 2016, posterior knee pain was the third-most common region for people with knee osteoarthritis (37%) to experience pain, behind the medial joint line (75%) and patellar tendon (38%) (which again, may be a referral or fat pad irritation).

Most people had diffuse pain that moved around, but it’s helpful to recognize that posterior knee pain is common for intra-articular knee issues.

https://www.sciencedirect.com/science/article/pii/S1063458416010050

There is a longstanding clash between visions for what the physical therapist does: those who envision the PT as the “administrator” of care, doing the high-level diagnostic thinking and evaluation and having their schedule be mostly evaluations while the assistive personnel execute on the plan they create. In contrast, there are those “purist” PTs who enjoy tailoring the daily evaluation and interventions.

I actually think, if both are done well, they can each be viable models for the profession. They each cope with payment cuts in different ways. One by revving up volume, the other by trying to rev up perceived value, hopefully seeing more patients that would pay cash.
There are also many weaknesses with both models, which you probably know well. Besides inherent weaknesses, the other thing to consider is that the APTA only thinks PTAs should be assisting the PT with physical therapy services and AAOMPT and APTA agree joint mobilization (if that’s a part of care) should only be done by PTs.

But something I don’t see a lot of discussion about: are we TRAINING our physical therapists to practice in these two very different models of care?

The first model of care is often justified as “PTs should be using their highest/most valuable skills” such as diagnosis, triage, developing a plan of care, etc. But how well do we train our PTs for that role? At graduation, are PTs well-equipped to be managing 2-3 assistive personnel while doing laser-focused evaluations and developing achievable POCs?

I actually don’t think so.

Conversely, are PTs being trained to be great at efficiency and effectiveness in care, and marketing those services to the public? I also think the answer is no.

I think it’s possible this longstanding conflict between these two delivery models of PT sort of paralyzes educators, where PTs get trained a little bit in each, without being fully ready to execute on either.

Arizona PTs: Our own Seth Peterson will be headlining the state conference this spring along with Cheri Hodges, who has co-taught our Mindful Management courses! Check them out!

Register: https://www.aptaaz.org/events/EventDetails.aspx?id=2003018&group=

The kind folks at Fullphysio just published my masterclass on being a and embracing adaptability in the clinic.

I’m sure this information will be valuable to anyone interested in becoming a better clinician.

Come and have a look and leave your comments!  

https://www.fullphysio.com/en/solution/knowledge

I have to admit, sometimes I wonder if the constructs that underpin our decisions are really even valid.

Thoracic outlet syndrome and piriformis syndrome seem much more rare than I initially was led to believe. SI joints flipping out of place seems dubious.

But subacromial impingement actually might be one of these. I am not sure how much more we can do to disprove this theory, which actually predates Dr. Neer and goes way back to the 1930’s. There are a whole host of things that can impact rotator cuffs, but I think the shape of the acromion is probably far down on the list. Most of these injuries just seem to me like typical tensile overload injuries to the tendon that then become sensitive overhead, where there is more compression on a painful structure, and at 90 degrees, where the lever arm is at its longest.