Bio:
Dr. Matt Morretta received both his Bachelor of Science and Doctor of Physical Therapy degrees from Temple University in Philadelphia, PA. He is residency-trained in orthopedic physical therapy and became an orthopedic clinical specialist in 2011. Dr. Morretta continued his clinical education by completing an orthopedic manual physical therapy fellowship through Evidence In Motion and becoming a fellow of the American Academy of Orthopaedic Manual Physical Therapists in 2016. He has lectured at state conferences on trigger point dry needling and more recently national conferences on self-reflection in entry-level physical therapy education. Dr. Morretta is currently serving on the AAOMPT nominating committee and pursuing a Doctor of Science in Physical Therapy degree through Bellin College. He is an assistant professor at the University of St. Augustine for Health Sciences in the Austin, TX Doctor of Physical Therapy Flex program. In his spare time, Dr. Morretta loves traveling, hiking, brewing beer, baking bread, and playing with his two fine children and dog.
What inspired you to pursue fellowship training?
Never being satisfied in my clinical skills. Despite being residency-trained and accruing experience I continued to recognize that there were patients I was unable to help. Honestly, I was becoming more and more frustrated with the profession of physical therapy, or maybe just myself as a physical therapy professional. I had the ability to determine that patients had neuromusculoskeletal conditions but was not able to provide all of them with answers, guidance, or relief. I just knew there was something I was missing and truly hoped that fellowship training could help me find it.
What fellowship program did you attend and why?
I attended Evidence In Motion’s, now Bellin College’s, Orthopaedic Manual Physical Therapy fellowship. I was lucky enough to have some great mentors in my first job out of PT school who lead me to EIM’s program. I also really connected with the evidence-based practice component of the program as well as the rigorous clinical reasoning curriculum. And that’s how I found the answer to my question. The thing I was missing in my practice was sound clinical reasoning and EIM’s patient management framework and fellowship virtual rounds courses made this shortcoming very apparent. Ultimately, these courses and the program, as a whole, helped turned them into strengths.
What did your fellowship program entail (as far as specific training, etc.)?
My fellowship training included a pretty eclectic approach. There was a large dose of evidence-based practice and Maitland content, especially the use of the SINSS. There was some MDT sprinkled in and really just a lot of clinical reasoning. My mentors’ mantra was always, “Do nothing for no reason.” I was constantly asked, “Why?”: “Why did you ask that question?”; “Why did you choose that exercise?”; Why did you choose that technique?”; “Why didn’t you think of this hypothesis?”
This constant questioning reminds me of when I talk to my 5-year-old, except that I couldn’t make up the answer like I do to some of my daughter’s questions.
Are you training in any specific areas of manual therapy (e.g., Maitland, McKenzie, etc.)? If so why did you choose that area?
My training in manual therapy could probably be described as more of a Maitland approach. It’s really just a combination of the best techniques, approaches, and frameworks that I took from my teachers, mentors, and colleagues. I learned a long time ago to make my own style by taking the best from others. I’m not sure if there’s anything that’s truly original anymore. It’s mostly just adding a twist on others’ genius and calling it your own. I am truly grateful to all of those from whom I’ve learned. I really see my successes as an homage to them because I know I’m not that smart, nor talented.
What advice would you give to new grads aspiring to pursue residency/fellowship training?
The best advice is to try to remove yourself from the equation. Understand that once decisions are made for the best interest of others, including the decision to pursue advanced clinical training, everything becomes easier. The pressure to “fix” someone diminishes; the pressure, whether internal or external, to be the best dissolves; the pressure to constantly succeed, whatever that is, is lifted. It’s really about continuing to assess how, and having the ability, to get the best out of every situation for all of those involved. Not everyone’s journey is the same. Residency and fellowship training were simply the way that got me to this understanding.
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Enjoyed reading this until I got to the approach question. Can we get away from asking about “M” approaches? I studied with Geoff Maitland and he would be rolling in his grave hearing the phrase, ‘Maitland approach’. He NEVER called it his approach.
I strongly believe that there is only one approach and that is Orthopedic Manual Physical Therapy (OMPT). This approach uses clinical reasoning and particularly diagnostic clinical reasoning to determine a diagnosis and hypothesis about pathophysiology of the condition, contributing factors, precautions and contraindications, prognosis, and management, pain mechanism, etc. From this, interventions are chosen (including both exercise and manual therapy) for overall management. Yes, OMPT includes both exercise and manual therapy (and potentially other interventions). OMPT is an approach to patient care not an intervention.
There are former gurus that have used more passive physiological joint movement in their pt management vs some who have advocated for an emphasis on thrust techniques. This is not an approach! This is simply where their own clinical reasoning took them. Dr Moretta alludes to this by saying ‘he developed his own style’. This is his clinical reasoning developing over time and becoming more and more sophisticated – exactly what we expect from fellowship training.