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Sam Fischer, DPT, OCS, FAAOMPT, RMSK

@samfischerdpt

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Teaching DN, manual therapy & MSK clinical reasoning
Director of @activept_ortho_residency
Assistant Director for @americanacademymt Fellowship

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Meet Heather Hulinsky, PT, DPT, one of our current orthopedic residents diving deep into all topics that make a clinician an orthopedic clinic specialists.

Heather is in the thick of our residency program, building the clinical skills and critical thinking to become a specialist with a special interest in lower extremity care. We’re proud to have her on the ActivePT team.

#OrthopedicResidency #PhysicalTherapyResidency #OrthoResidency #PTResidency #SportsPhysicalTherapy taken in Rochester, Minnesota by @samfischerdpt

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21 hours ago

Most of us learned the Wainner cluster as students. It’s been around since 2003. Does it still hold up?

An independent team tested it in 85 patients referred to neurosurgery, using MRI and a neurosurgeon’s exam as the comparison. The results looked a lot like the original.

With 3 of 4 tests positive, the chance of cervical radicular pain was about 78%. With all 4 positive, it was 100%, though all 4 lighting up was rare. Spurling’s with arm pain was the standout single test, because a positive result made radicular pain very likely. And distraction caught nearly 9 in 10 true cases, so a negative distraction makes radicular pain much less likely.

No single test tells the whole story. Run all four, count the positives, and let that shape what you do next, whether that’s how you load the neck, where you put your hands, or who you refer.

Grondin et al. Braz J Phys Ther. 2026.

#physicaltherapy #cervicalradiculopathy #clinicalreasoning #orthopedicphysicaltherapy #manualtherapy taken in Rochester, Minnesota by @samfischerdpt

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6 days ago

🏋️‍♀️ Lifting & Loading Progression Lab!

Last week, our residents got hands-on with Olympic weightlifting and CrossFit movement progressions alongside lifting specialists Courtney and Adam!

We dove into the snatch, clean, and jerk, breaking down points of performance, movement phases, coaching cues, and common faults. We also explored strength training principles, workout stimulus, volume management, and how to modify movements based on an athlete’s needs and injury presentation.

From Olympic lifts to CrossFit gymnastics, our residents learned how to analyze movement, modify exercises, and appropriately progress or regress loading for patients with a variety of upper and lower extremity injuries.

And, of course, we put everything into practice by finishing the lab with an AMRAP CrossFit workout! 🔥

A great couple of days learning how to bridge the gap between rehabilitation and performance! 💪 taken in Cross Fit Progression by @samfischerdpt

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6 days ago

“It’s just stenosis” usually means sit more, bend forward, and wait it out. For a lot of older adults, that’s the whole plan.

This multicenter trial from the @americanacademymt research group tried something more. Everyone got solid PT: flexion exercise, cycling, mobilization, stretching. One group also got lumbar thrust manipulation and electrical dry needling to the paraspinals and glutes, with optional needling along the sciatic nerve and its branches.

By 3 months, that group had less back, buttock, and leg pain and less disability. Far more of them called it a success, and nearly twice as many had stopped taking pain medication.

Two things I’d take from it. The difference built over time, so judge the plan at 3 months, not after three visits. And an older patient with a structural diagnosis is not automatically off-limits for manipulation or needling. Side effects were soreness and some bruising, and nothing serious.

Young I, Dunning J, Butts R, et al. Spine J. 2024. doi:10.1016/j.spinee.2023.12.002

#physicaltherapy #spinalmanipulation #dryneedling #spinalstenosis #orthopedicphysicaltherapy taken in Rochester, Minnesota by @samfischerdpt

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8 days ago

Learning, growing, and making the most of our time in LA! 🌴☀️

Our orthopedic residency experience isn’t all classroom time—we also made sure to explore the city, enjoy some sunshine, and spend time together outside of the course. From new experiences to good food and even better company, these trips are a great reminder that some of the best learning happens alongside the people you get to share it with.

Grateful for the opportunity to learn from some of the best in the field while making memories along the way! 🦴📚🌴 taken in Los Angeles, California by @samfischerdpt

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11 days ago

Most tennis elbow plans look the same: eccentrics, some soft tissue work, maybe a brace. That’s solid care, and in this trial both groups got it.

What changed the outcome was what one group got on top of it. Electrical dry needling went straight to the tendon and its attachment, not just to trigger points in the forearm. Thrust manipulation went to the elbow and lower cervical spine.

By 3 months, twice as many patients in that group reported a successful outcome, and far more had stopped taking pain medication. The gap between groups widened at every follow-up.

Needling the painful tissue is a different intervention than needling a trigger point. And an elbow that hurts may need you to look above and below it.
Awesome work from @americanacademymt on this one.

Dunning J, Mourad F, Bliton P, et al. Clin Rehabil. 2024.

#physicaltherapy #dryneedling #manualtherapy #tenniselbow #orthopedicphysicaltherapy taken in Rochester, Minnesota by @samfischerdpt

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12 days ago

Most PTs think of ultrasound as an MSK tool. A 2026 narrative review maps the evidence across the full scope of PT practice — and the picture is bigger than most people realize.

Diagnostic accuracy for PT-performed ultrasound is strong across orthopedics, peripheral nerve, cardiovascular, pulmonary, pelvic health, and pediatrics. This isn’t a niche skill for one specialty anymore.

The authors are clear though: none of this works without competency-based training. Point-of-care ultrasound in the wrong hands isn’t an upgrade — it’s a liability.

This is exactly why RMSK exists. The scope of US in PT practice is expanding. The training infrastructure has to keep pace with it.

doi: 10.3389/fmscd.2026.1816879

#diagnosticultrasound #physicaltherapy #RMSK #pointofcare #dpt taken in Rochester, Minnesota by @samfischerdpt

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15 days ago

Palpation-guided needling of the obliquus capitis inferior contacted the spinal cord in 1 out of every 8 attempts. Missed the target muscle 60% of the time. These were experienced clinicians working on cadaveric specimens — no patient movement, no tissue variability.

That’s not a technique problem. That’s an anatomy problem. The OCI sits deep in a region where the margin for error is essentially zero — and surface landmarks don’t give you that margin.

Don’t guess where this muscle is. The clinicians who’ve been teaching this region safely for years at @americanacademymt aren’t guessing either. AAMT now has dedicated ultrasound courses that take the anatomical knowledge they’ve always taught and add real-time imaging to confirm placement before you needle.

This paper isn’t a reason to stop needling the OCI. It’s a reason to learn it the right way, from people who’ve been doing it safely long before the research caught up.

doi: 10.1038/s41598-025-96225-x

#dryneedling #diagnosticultrasound #neckpain #physicaltherapy #RMSK taken in Rochester, Minnesota by @samfischerdpt

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16 days ago

Our orthopedic residents recently had the opportunity to return to USC for another incredible learning experience with Dr. Joe Godges!

We’re so grateful for the opportunity to learn from Dr. Godges and dive deeper into orthopedic physical therapy through hands-on learning, clinical reasoning, and discussion. Experiences like these continue to challenge our residents and help us grow as orthopedic clinicians.

Two trips to USC, countless takeaways, and plenty more to bring back to the clinic! We’re looking forward to returning in January for our third session.

Thank you, Dr. Godges, for sharing your expertise and passion for orthopedic physical therapy with us! 🙌🏼

#orthopedicresidency #physicaltherapy #orthopedicpt taken in University of Southern California by @samfischerdpt

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16 days ago

A new paper just dropped from the AAMT research group — and it asks one of the most practically useful questions in the CGH literature: which patients actually respond to spinal manipulation, dry needling, and exercise?

Secondary analysis of the Dunning 2021 multicenter RCT. 142 CGH patients. Logistic regression on 10 baseline variables to predict who achieved ≥50% improvement in headache intensity at 3 months.

Only two variables mattered.
Male sex — males were nearly 4 times more likely to achieve a successful outcome

Higher baseline headache intensity — patients with more severe pain going in were more likely to respond. The worse the baseline, the better the outcome prediction.

What didn’t predict response: age, chronicity, headache frequency, headache duration, BMI, pretreatment medication use, baseline disability, and number of treatment sessions. None of them moved the needle statistically.

That last list is clinically important. The factors clinicians often use to tell a patient “you’ve had this too long for it to respond well” — how chronic it is, how frequently it occurs — don’t actually predict response to this multimodal approach. Don’t use chronicity as a reason to not treat.

The direction is clear: severe CGH in male patients may be your highest-yield population for this treatment combination. But the female CGH patient who’s had it for years and comes in with high intensity pain? The data says treat them too.

Dunning, Young, Mourad, Bliton et al. Musculoskelet Sci Pract. 2026;103662. doi:10.1016/j.msksp.2026.103662

#physicaltherapy #spinalmanipulation #dryneedling #cervicogenicheadache #dpt taken in Rochester, Minnesota by @samfischerdpt

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19 days ago

A 2026 systematic review reviewed 43 RCTs on conservative management for sacroiliac joint pain. They asked one question: how many of these trials screened the thoracolumbar spine before diagnosing SIJ pain?

Two. Out of forty-three. 4.7% did it adequately. Another 20.9% partially. 74.4% didn’t do it at all.
This is a bigger problem than it sounds for this population.

SIJ regional pain is commonly linked to referral patterns from the thoracolumbar spine. Facet joints, disc pathology, and neural structures between T12 and L3 can produce posterior pelvic pain that looks exactly like SIJ dysfunction on presentation. If you treat a patient for SIJ pain when the actual generator is thoracolumbar referral, you’re treating the wrong structure. And if 95% of RCTs did that, their treatment response data tells you very little about what actually works for true SIJ pain.

It’s the same diagnosis problem that runs through the nonspecific LBP literature — just a different joint.

In the clinic: the thoracolumbar spine has to be screened before you call it a SIJ diagnosis. That means lumbar and TL provocation testing, reproducing the pain, and being able to differentiate referral from primary SIJ dysfunction. The SIJ provocation cluster is only meaningful after you’ve done that work first.

If you can’t clear the thoracolumbar spine, you don’t have a SIJ diagnosis. You have a region. And those are very different clinical starting points.

Schumacher MR, et al. J Man Manip Ther. 2026;34(2):118-127. doi:10.1080/10669817.2025.2539783

#physicaltherapy #manualtherapy #lowbackpain #spinalmanipulation #orthopedicpt taken in Rochester, Minnesota by @samfischerdpt

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21 days ago

Jake Hoeppner has been part of the ActivePT family since his final clinical internship in 2012 — and over a decade later, he’s now shaping how the next generation of PTs learns to treat.

As both a Mentor and Faculty member in our orthopedic residency program, Jake teaches headache management, jaw pain, spinal manipulation, manual therapy, and clinical communication — a curriculum that reflects where his own passion has always been.

He’s logged over 700 hours of continuing education since graduating, with deep focus in dry needling, spinal manipulation, IASTM, and chronic pain and headache management.

He earned his DPT from Southwest Baptist University in 2012, became a Board Certified Orthopedic Clinical Specialist in 2018, and holds a Diploma in Osteopractic — a credential that reflects the depth of his manual therapy training.

Before PT, he played college football at Winona State and later coached it at Winona Cotter — experience that shows up in how he communicates with patients and mentors residents.
Hands-on, knowledgeable, and deeply committed to passing it on.

#OrthopedicResidency #ManualTherapy #headache #TMD #DPT taken in Rochester, Minnesota by @samfischerdpt

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22 days ago