IFOMPT Issues!

I am pleased to bring you a guest blog from David, who shares his experiences of his recent IFOMPT Physio Master's Degree. Unfortunately, his experiences mirror all the issues I faced when I attempted to complete my IFOMPT Master's Degree nearly 20 years ago. Being taught a lot of pseudo-scientific bullshit, and any questions and challenges to this being met with anger, ridicule, and scorn!

It's incredibly disappointing to see that a highly respected and influential organisation like IFOMPT is still guilty of quashing and shutting down others' respectful questions and challenges to their outdated methods and practices, and that so-called leaders in our profession attack, abuse and even threaten those who do.

Personally, I think IFOMPT is an organisation riddled with biases and vested interests, with some of its senior members drunk on power and influence, and I dont think IFOMPT deserve to be held in high regard or considered leaders in our profession in anyway.

But enough of my views and experiences, let's now listen to David's...

My Experience of an IFOMPT Master’s Program: Flashes Of Isolated Excellence But Masses Of Systemic Dogma

Why Outdated Education is the Real Risk Factor in Physiotherapy

My name is David Marotta a physiotherapist based in Italy, and I recently enrolled in an IFOMPT-accredited Master’s program with the ambition to grow as a clinician, to navigate complexity with confidence, and to strengthen my practice with the most advanced, evidence-based tools available.

What I found instead was a curriculum marked by contradictions: isolated flashes of brilliance quickly overshadowed by outdated dogmas, excessive focus on low-validity manual techniques, and examinations that reward good memory while punishing critical thinking.

Despite moments of genuine inspiration, much of the program was spent on palpatory anatomy, pseudo-diagnostic orthopaedic tests, and rigid protocols disconnected from clinical reality. Attempts to raise constructive criticism were met with silence, dismissal, or even personal insults.

This reflection is both a personal account and a call to IFOMPT: if we truly wish to raise the standard of musculoskeletal physiotherapy, education must align with the best available evidence, foster critical thinking, and abandon obsolete traditions.

Background

The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) is recognised worldwide as the accrediting body for advanced musculoskeletal physiotherapy education. Its mission is to set high standards, ensure evidence-based curricula, and prepare clinicians capable of managing complexity in line with contemporary science.

It was with these expectations that I enrolled in an IFOMPT-accredited Master’s program in Italy. The director proudly introduced it as the most prestigious and advanced of its kind in the country. For me, this represented both a personal and professional investment: thousands of euros, countless weekends, evenings of study, and time taken from clinical work and personal life.

My hopes were clear: to emerge as a physiotherapist better equipped to handle complexity, to integrate biopsychosocial perspectives into practice, and to contribute to the evolution of my profession.

The reality, however, was profoundly different.

Isolated Excellence, Quickly Overshadowed

The program was not without its bright moments. Some modules were genuinely enlightening:

- Clear and practical sessions on pain neuroscience education

- Evidence-based teaching on yellow flags and psychosocial risk factors (nearly absent in other master’s programs)

- Rigorous modules on evidence-based practice and clinical reasoning

- An outstanding day with a psychologist focused on recognising mental health conditions and making appropriate referrals

These were moments of clarity. They demonstrated how physiotherapy can be taught in an innovative, useful, and patient-centred way.

Unfortunately, these flashes of excellence were quickly overshadowed by the rest of the program. The very principles introduced in these sessions, such as empowerment, evidence, and critical thinking, were systematically contradicted in subsequent modules.

Manual Therapy and Orthopaedic Tests: The Weight of Obsolescence

Entire days were devoted to outdated manual therapy techniques and pseudo-diagnostic orthopaedic tests: innominate rotations, rib dysfunctions, imaginary force lines, endless palpatory anatomy, and low-reliability orthopaedic tests.

The literature is unequivocal:

- The diagnostic accuracy of most orthopaedic special tests is extremely poor and often misleading (3).

- Manual therapy mechanisms remain poorly understood; evidence suggests effects are largely non-specific, transient, and mediated more by neurophysiological and contextual factors than by mechanical correction (4).

- Despite this, IFOMPT curricula continue to dedicate extensive time to such techniques, ignoring stronger evidence supporting exercise, communication, and patient-centered interventions (5,19).

Decades of research have dismantled common myths:

- Human hands cannot meaningfully deform fascia or “melt adhesions”; proposed mechanical effects are implausible (7,8).

- Range-of-motion gains after stretching derive primarily from sensory tolerance, not structural lengthening (9–11).

- Therapist-selected “specific level” mobilisation/manipulation is not superior to random level selection (12,13); spinal motion palpation is unreliable (14).

- Meta-analyses show effects of manual therapy are modest and short-lived, with no superiority over active approaches (5,15,16).

Yet students in the program were repeatedly told they had to learn these techniques to pass exams, even though the evidence base has long questioned their relevance (1,4–16).

Exams: Rewarding Dogma, Punishing Reasoning

If the curriculum was contradictory, the exams were even more disheartening. Rather than testing advanced reasoning, they rewarded rote memorisation and penalised evidence-based thinking.

Exams often included:

- Poorly written, ambiguous questions

- “Official answers” in direct contradiction with literature (1,12–16)

- Excessive focus on low-validity tests

- No structured feedback, no open discussion

Examples included memorising fracture patterns few will ever see, listing lever classifications, or reciting the supposed existence of accessory movements. Meanwhile, communication skills, reasoning strategies, and patient-centred approaches were marginalised (17).

No Dialogue, No Respect: When Criticism Meets Insults

Throughout the program, I raised questions. I wrote detailed, evidence-supported emails. I asked for clarifications, highlighted inconsistencies, and proposed constructive improvements.

The response was silence or worse.

I was told, “Your opinion doesn’t matter.” “You don’t have the credentials to criticise.” “No one cares what you say.” “Your criticisms aren’t accepted because of your age.” “If I examine you, I’ll fail you 100%.”

On several occasions, the situation degenerated further. The director shouted openly at students who dared to criticise pseudoscientific content. In one episode during the cervical module, students who raised concerns were publicly insulted as “sheep, sheep, sheep.” Another student was directly called an “asshole” in front of the class.

Lectures often promoted claims such as “repositioning vertebrae” or “changing alignment” as clinical truths without evidence. Some of us reported these events through official feedback questionnaires, particularly after the cervical module. Nothing appeared to change.

Missed Opportunities: Exercise, Comorbidities, and Modern Approaches

Perhaps the most disappointing aspect was the absence of crucial, evidence-based content that should form the core of modern musculoskeletal physiotherapy.

- Therapeutic exercise: Sometimes taught well; too often fragmented or framed with nocebo narratives. Little discussion of exercise medicine despite strong evidence (5).

- Comorbidities: Depression, obesity, diabetes, cardiovascular disease, sleep problems and mental health were rarely addressed, despite their clear impact on pain and disability (5,23–25).

- Social determinants of health: Rarely discussed, despite their central role in outcomes for musculoskeletal recovery (18).

- Modern approaches: Contemporary strategies such as Cognitive Functional Therapy (19) and the StressModex trial for whiplash (20) were not meaningfully covered.

Iatrogenic Disability: When Education Becomes Harmful

Outdated teaching risks iatrogenic disability. In Aboriginal Australian communities with low back pain, biomedical labels and fragile-spine narratives have been linked to fear, dependence and worse outcomes (21,22). Programs that teach myths of vertebral “repositioning” risk harming patients via the messages they spread.

Moving Forward

IFOMPT accreditation should ensure alignment with international standards. My experience shows a gap between aspirations and reality. Rather than developing clinicians who navigate complexity, this program perpetuated outdated knowledge and rewarded dogma. This risks shaping generations unable to meet contemporary healthcare challenges (5,17,18).

Patients deserve clinicians who use the best evidence, embrace uncertainty with humility, and prioritise empowerment. Education must reflect that.

In Summary

In musculoskeletal care, yellow flags are psychosocial risk factors for chronicity. In this so-called modern, evidence-based IFOMPT program, the yellow flag was the education and some of the educators themselves: discouraging critical thinking, perpetuating outdated models, undermining autonomy, and silencing dissent. If IFOMPT wants to raise standards, its ethos, philosophy and educational curricula must change.

References

1. IFOMPT. Educational Standards in Orthopaedic Manipulative Therapy. Part A: Educational Standards. 2016.
2. IFOMPT. Governance Manual. Part B: Guidelines for International Monitoring of Member Organisations and OMT Programmes. Jan 2005.
3. Hegedus EJ, Wright AA, Cook CE. Orthopaedic special tests and diagnostic accuracy studies: house wine served in very cheap containers. Br J Sports Med. 2017;51(6):421-422.
4. Bialosky JE, Beneciuk JM, Bishop MD, et al. Unraveling the mechanisms of manual therapy: modeling an approach. J Orthop Sports Phys Ther. 2018;48(1):8-18.
5. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383.
6. Shoemaker JK, Tiidus PM, Mader R. Failure of manual massage to alter limb blood flow. Med Sci Sports Exerc. 1997;29(5):535-540.
7. Threlkeld AJ. The effects of manual therapy on connective tissue. Phys Ther. 1992;72(12):893-902.
8. Chaudhry H, Schleip R, Ji Z, et al. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 2008;108(8):379-390.
9. Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther. 2010;90(3):438-449.
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14. Nyberg RE, Russell Smith RC. The science of spinal motion palpation: a review and update. J Man Manip Ther. 2013;21(3):160-167.
15. Menke JM. Do manual therapies help low back pain? A comparative effectiveness meta-analysis. Spine. 2014;39(10):E613-E623.
16. Kent P, Marks D, Pearson W, Keating J. Does clinician treatment choice improve outcomes of manual therapy for nonspecific low back pain? A meta-analysis. J Manipulative Physiol Ther. 2005;28(5):312-322.
17. Peterson S, Weible K, Halpert B, Rhon DI. Continuing education courses for orthopedic and sports physical therapists in the United States often lack supporting evidence. Phys Ther. 2022;102(6):pzac031.
18. Rethorn ZD, Cook C, Reneker JC. Social Determinants of Health: If You Aren’t Measuring Them, You Aren’t Seeing the Big Picture. J Orthop Sports Phys Ther. 2019;49(12):872-874. doi:10.2519/jospt.2019.0613.
19. O’Sullivan PB, Caneiro JP, O’Keeffe M, et al. Cognitive functional therapy: an integrated behavioral approach for disabling low back pain. Phys Ther. 2018;98(5):408-423.
20. Sterling M, Smeets R, Keijzers G, Warren J, Kenardy J. Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention. Br J Sports Med. 2019;53(19):1240-1247.
21. Lin IB, O’Sullivan PB, Coffin J, et al. Disabling chronic low back pain as an iatrogenic disorder: Aboriginal Australians with low back pain. Pain Med. 2013;14(4):571-577.
22. Lin IB, O’Sullivan PB, Coffin J, et al. “I am absolutely shattered”: the impact of chronic low back pain on Australian Aboriginal people. Eur J Pain. 2012;16(9):1331-1341.
23. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X.
24. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-2445. doi:10.1001/archinte.163.20.2433.
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