Featured Fellow: Dr. Tim Fearon PT, DPT, FAAOMPT

Timothy Fearon received his PT degree from The Ohio State University.  He completed the graduate program in the Musculoskeletal Sequence at Northwestern University.  He completed his Doctorate in Physical Therapy at Northern Arizona University.

He founded Phoenix Manual Therapy (PMT), which initially offered courses, based on the Nordic System of orthopedic manual therapy.  Phoenix Manual Therapy progressed to offering a long-term course frame for study of the Australian clinical reasoning approach to orthopedic manual therapy with integration of Norwegian techniques and therapeutic exercise.  The course has been running over the last 25 years.  In 2011 PMT began to sponsor Dr. Peter Gibbons & Dr. Phillip Tehan’s spinal manipulation course work and Fearon is lead faculty for course one.  He earned his Full Fellowship status in the American Academy of Orthopedic Manual Therapy by the challenge process in 1999; he renewed that status in 2010. 

Dr. Fearon is currently adjunct faculty at A. T. Still University where he teaches manual therapy of the spine and extremities at the entry level and in the residency track.  He has been a guest instructor for NAU, Arizona School of Health Sciences, Regis University, Langston University, and North Georgia College.  He is lead faculty for Evidence in Motion manual therapy courses, the Clinical Decision Making Class and Fellowship Virtual Rounds. He has taught manual therapy courses over the last 20 years, spoken at numerous meetings for the Arizona Physical Therapy Association, and for the APTA.

Dr. Fearon currently practices in an outpatient private practice specializing in orthopedic manual therapy and spinal rehabilitation where he has been for the last 28 years.

 

What inspired you to pursue fellowship training?

Plain and simple I saw no value in being mediocre at what I was choosing to do for a career when the avenues existed for developing expertise. Once I had seen the genuine clinical expert, the individual who could consistently create changes in patients who were seeking help, it was not possible to not want to acquire that skill. Anything less was clearly saying that being adequate was all that I aspired to in life.

What fellowship did you attend and why?

I am old school, when formal programs did not exist. When I awakened to the fact that academics & research were enhancing my knowledge base but not my skill I sought out clinicians who genuinely did what others were talking about.

Folsom Physical Therapy was the first where Michael Moore, Dennis Morgan & Tim McGonigle practiced and taught a long-term course in orthopedic manual therapy based on the Kaltenborn/Evejenth system of OMT integrated with an extensive back ground of PNF. I then began a long-term class in Phoenix with Barbara Stevens & Margaret Anderson leading the course. This took on a life of its own and continues to this day. For me the best part of the class was having my mentors arrive a day early and see my patients with me . Here I had to repeatedly expose my thinking, my handing skills and my ability to progress patients to self management with the expectant mentor in the room with me.

When the fellowship process was initiated it was clear to me that I had training which surpassed the requirements and I challenged the examination to attain my fellowship.

What did your fellowship program entail (as far as specific training, etc.)?

This custom made pathway was almost exclusively hands on time with master clinicians either in the clinic with actual patient time or hands on skill development with the same clinicians and your cohort. Reading current state of OMT literature was assigned but completely the responsibility of the student.

Are you trained in any specific areas of manual therapy (e.g. Maitland, McKenzie, etc.)? If so, why did you choose that area?

As mentioned above the primary instruction began with a foundation in the Kaltenborn/Evjenth nordic system. The emphasis on therapeutic exercise was founded in Proprioceptive Neuro Muscular Facilitation with both Dennis Morgan & Michael Moore being graduates of the Vallejo PNF program under Maggie Nott & the Norwegian OMPT program. The Australian clinical reasoning model founded by Geoffrey Maitland was the framework for the duration of the long term study and both Barbara Stevens & Margaret Anderson were graduates of the Australian program. Barbara Stevens had also sent some of her Australian time in New Zealand with Robin McKenzie.

What advice would you give to new grads aspiring to pursue residency/fellowship training?

Identify what your goal is in pursuing residency/fellowship. Learn what is included in the curriculum prior to any commitment of your time or money. Interview the directors to find out what instructional methods are used to deliver the content. Make sure that all of these match before you make any decision.

Some have described described residency as the method to attain competence & fellowship to become a teacher. I disagree. Our present education system, including fellowship programs, emphasizes immersion with those whose expertise is in teaching, research or both. I have seen a disturbing emphasis on more academics with inadequate hands on training time to genuinely allow for the student to advance in their handling skills.

Manual therapy is a psychomotor skill that requires good psychomotor teaching from those who actually do it and understand the nuances that occur from patient to patient. The student needs focused practice time to develop the physical skill set. We as a profession have yet to acknowledge that there is a difference between education and training.  Advancing the actual premise that we sell to the public is not about having more academic command of theory, this is foundational essentials for the aspiring clinical master. We however need to openly embrace that this profession and manual therapy in particular is an artistic application of our intellect. Environments where learning alongside a master clinician can be arranged and have something to offer that is absent in the majority of the formal programs which often are no more than another business model for selling higher levels of unconscious incompetence.

Absent confidence in their ability to guide the patient from where they are presently to where they need to get next, the fellow in training is taught to seek certitude in supposed established knowledge, current best evidence, test item clusters, CPRs, etc. rather than in their own thinking which they then check with their command of all of the aforementioned safe grounds.  This is what I refer to as evidence driven practice as opposed to evidence informed practice.  I am not a nay-sayer on current best evidence! It drives the low and marginal practitioners up toward the middle of the bell curve for an elevated standard of care.  However, the heavy handed bias that is disseminated from the current posture of the profession seeming to have an absolute need for certitude drives the other side of the bell curve populated by the intellectually analytical who are engaged in the emerging data while they are treating, down toward the middle of the curve and suppresses the potential rise of the fledgling brilliant clinician.  

What I have seen over the years is current research about that which real clinicians were talking about decades ago. The reason I raise the point is that suppressing the clear thinking, focused clinician facilitates placing a lid on our growth potential. What if Bowling & Erhardt had never freely discussed when they do or don’t see value in manipulation, use of directional preference or exercise. Further if they had never collaborated with Steve Rose to establish the inception of TBC. What if McKenzie had decided that the current best evidence of flexion exercise is how he should continue practicing. What if the European, Nordic & Australian manual therapy communities had never decided to mobilize joints, manipulate and know when to choose each? What if Geoff Maitland had never decided to put thought process at the front end of treatment and have it remain the dominant player in decision making during treatment? They trusted their own intellectual engagement enough to exit Plato’s cave without evidence and sought it on their own.

Be certain that the “manual therapy fellowship” includes more than manual therapy. The current psyche of the profession seems to be driven by the need to do passive intervention or generic exercise that a patient could learn them selves with a little online study. First and foremost we should be physical therapists with an intellectual curiosity about what the nature of a patient’s problem is and how we can best assist them. We self proclaimed ourselves to be the movement experts in our 2020 vision statement and seem to have completely abandoned the desire to design and implement genuinely therapeutic exercise preferring to relegate that to some support personnel, as if it were beneath us, or simply better for the balance sheet to relegate that to cheaper personnel.

The FiT needs to develop a tactile vocabulary in their hands.  They must begin to accumulate normative data in their manual assessments as to what the usual feels like, then the usual in this body type, the usual in this type of presentation or this type of injury, the quantity of range, the response to moving the structure through the range, the end feel of typical joints, abnormal joints, soft tissues, the list goes on but the point is that they need to be able to determine what is amenable to change, how that change would best be gained and how to retain it. Again this requires hands on training and practice in clinical environments rather than more reading or listening in educational environments.  

There are some inescapable facts that go along with human existence amongst them are the influence of gravity, physiology & time on the body.
If we persist in giving all populations of patients the same exercises because they fit in a given category, then we are no more than personal trainers with an expensive albeit unapplied education. If we do not guide the individual who has lost the physical capacity to overcome the constant force of gravity, the effective ground reaction force and the resultant interface on the body then we turn a blind eye to elementary physics. If we continue to ignore that all human motion was created by that individual’s self generated movement as the neurologic system stimulated it to enhance function so that the body might flourish, then we will continue to ignore the means by which all living creatures establish & sustain function. All the while declaring our self to be a doctoring profession, the experts in movement.

Make your decision clear. If you want to master educational skills then choose a fellowship which emphasizes education and uses master educators to lead you. If you want to master research skills then choose a track that emphasizes research and enjoins accomplished researchers to guide you. If you want to be a master clinician you need to enter a fellowship which emphasizes clinical skills from clinical reasoning through clinical application of psychomotor skill, and uses master clinicians to guide you. Always remember that there is value in all three, and that indeed we are interdependent, yet there is only one which we are all totally dependent on. If there are no real clinical masters, then there is no profession.

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2 Comments


  1. Hi Tim, nice commentary, always appreciate your grounding voice in “real practice” and yet your willingness to share in the academic and more formal educational experiences. Cheers

    Reply

  2. My mentor saw this and sent this quote to me:

    “Theoretical concepts influence examination and treatment, while examination and treatment lead one back to a reconsideration of theoretical premise”.

    “…the accepted theoretical basis of our profession is continually developing and changing. The gospel of yesterday becomes the heresy of tomorrow. It is essential that we remain open to new knowledge and open-minded in areas of uncertainty, so that inflexibility and tunnel vision do not result in a misapplication of our “art”. Even with properly attested science applied in its right context, with precise information concerning the patient’s symptoms and signs, a correct diagnosis is often difficult. Matching of the clinical findings to particular theories of anatomic, biomechanical and pathologic knowledge, so as to attach a particular “label” to the patient’s condition, may not always be appropriate. Therapists must remain open-minded so that as treatment progresses, the patient is reassessed in relation to the evolution of the condition and the response to treatment.”[1]

    [1] Maitland GD: The Maitland concept, p137-138. Twomey LT(ed) Physical Therapy of the Low Back. Churchill Livingston, 1987.

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