Episode 25 | Pain Science, Manual Therapy, and the Economics of PT with Paul Ingraham

Explore the intersection of evidence-based practice, healthcare economics, and pseudoscience in rehab, plus practical strategies for clinicians who want to do better without going brokeIs your physical therapy practice built on evidence, or just what pays? In this episode, we sit down with Paul Ingraham, science writer and founder of painscience.com, to challenge the line between evidence-based practice and pseudoscience in rehab. We explore why manual therapy needs a serious reframe, how economic pressures push clinicians toward uncertain treatments, and whether honest patient communication can coexist with running a profitable practice. Paul doesn't hold back: he argues that most PTs operate in a gray zone where research is weak, outcomes are unpredictable, and informed consent is virtually nonexistent. You might not agree with everything he says—but you'll hopefully question what you do and why you do it. Maybe you'll look into the scientific evidence behind your current common care plans.Topics include:Evidence-based practice vs. pseudoscience: where's the line? Why manual therapy should be reframed as an experimental intervention in many casesThe role of informed consent in uncertain treatments (not unlike what we hope physicians do when prescribing a treatment plan whose results are uncertain)How value-based care incentives better outcomes and discourages pseudoscienceThe economics of PT: balancing integrity with incomeWhy strength training and exercise therapy are still key ingredients in PT treatment plansTeaching intellectual humility and critical thinking in healthcare educationPractical strategies for clinicians who want to practice honestly without going brokePaul Ingraham is a Vancouver science writer and a former Registered Massage Therapist, a profession he left in 2010 over concerns about its pseudoscientific nonsense. Since then, he has been publishing PainScience.com full-time, a website about the science of pain and injury, known for its rich footnotes and anti-quackery activism. The site offers hundreds of articles and ten books, all based on a huge bibliography. Paul was an active amateur athlete for decades, especially in ultimate (the Frisbee sport), but has now retired from competitive intensity and “just” does a lot of running and cycling, despite grappling with his own chronic pain/illness problems since 2015.Here's where you can find Paul! https://www.painscience.com/subscribe [free newsletter]https://www.painscience.com/ebookshttps://www.facebook.com/painsciencehttps://www.threads.net/@painscihttps://bsky.app/profile/painsci.bsky.socialhttps://x.com/painsciSign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy.Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians.Subscribe to our YouTube Channel