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Tuesday, June 6, 2023

The "Real Cost" of Manual Therapy Certifications

The "Real Cost" of Manual Therapy Certifications
Brent Brookbush

Brent Brookbush


Comparing the Cost of Manual Therapy Certifications

By Dr. Brent Brookbush DPT, PT, MS, CPT, HMS, IMT

What is the cost of comprehensive manual therapy certifications, including price AND lost work, time spent, child care, travel, lodging, additional study aids, texts, and/or equipment?

Our Intent

We compared a small group of high-quality, well-known manual therapy certifications, with a similar breadth of manual therapy courses. There are likely several more continuing education companies we could add, and may add in the future, and there are many great lesser-known manual therapy certifications. We also did not bother to mention certifications that we considered to be poor-quality manual therapy courses. Our intention was not to demonize any manual therapy certification or continuing education company; our intent is to apply positive pressure to the continuing education industry for physical therapists, physical therapy assistants, chiropractors, certified athletic trainers, licensed massage therapists, occupational therapists, osteopaths, etc. (manual therapists).

Any of the certifications below would be a good investment, but we think you will agree that our innovations in delivery, price, access, flexibility, clinical reasoning, treatment approach, and manual skill instruction are worthy of consideration for your next credential. The Brookbush Institute's Integrated Manual Therapist (IMT) certification was designed to disrupt the delivery of a manual therapy credential and promote an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Most importantly, we hope our innovations help to inspire positive change from all of our colleagues working within continuing education companies, and perhaps inspire entrepreneurial educators to launch new companies with innovative new ideas. We have already seen some examples of individuals (not companies), providing better education (based on delivery and clinical approach) than large companies. Every company does not need to attempt a comprehensive manual therapy certification, some companies could innovate with a single course in their area of expertise. Examples of single course offerings could include, advanced techniques for upper extremity pain, field sports manual therapy, lower extremity manipulations, or a functional manual therapy approach for low back pain. We hope this article aids in the continued evolution of continuing education for manual therapists, and we are excited by the trends already in progress.

Compared Companies (and Abbreviations)


Additional Costs

Far more consideration is needed regarding the student's cost/hour for education. Most certifications give little thought to the "actual cost"; that is, the price of the course(s), AND the additional costs of time spent, lost work, child care, travel, lodging, additional study aids, texts, and/or equipment. Although a comprehensive analysis of these costs is beyond the scope of this article, we have tried to highlight which companies include more cost-effective methods.

  • Self-paced online education results in the lowest costs by exponentially increasing flexibility and access (reducing additional costs), and is generally offered at a lower price because of significant decreases in company overhead expenses.
  • Live-stream (Zoom) workshops aids in improving access, and reduces costs associated with travel and lodging; however, they still have the disadvantage of large time commitments and inflexible schedules. The price of these courses is generally much higher than self-paced online education, but lower than in-person workshops.
  • In-person workshops can be the most effective method for teaching certain types of information; however, they are exponentially more expensive than self-paced online education and live-stream workshops. The unfortunate truth is that in-person education is far more expensive for educators to facilitate, and burdens students with many additional costs. At the very least, self-paced online courses should be created for any content that is not less effectively delivered in this format (e.g. all didactic learning). Food for thought; the complete reliance on in-person workshops may be an unfair tax on individuals practicing in communities outside of dense population centers where workshops are likely held. This could be viewed as our industries version of the caste system developing in post-secondary education (especially in the United States), in which the "higher-paid, big city therapists" have access to resources that great professionals in smaller communities don't have.

Additional Cost Comparison:

  • BI IMT & IMT-C: Ideal - Heavy reliance on self-paced online education, live-stream workshop available, in-person workshop available for those who want the experience.
  • IPA CFMT: Poor - No self-paced online education, some live-stream workshops available, heavy reliance on in-person workshops
  • MAPS COMT: Poor - No self-paced online education, some live-stream workshops available, heavy reliance on in-person workshops
  • NAIOMT CMPT & COMT: Poor - No self-paced online education, some live-stream workshops available, heavy reliance on in-person workshops
  • ART CP: Bad In-person workshop dependent

Cost versus Efficacy

The issue with "actual cost" is likely worse if we considered the "actual cost" relative to the efficacy of the certification based on comprehension, retention, application, the effect on patient outcomes, and/or the potential to improve a professional's compensation. For example, some certifications charge students nearly $100/hour for live workshops, before considering costs for travel, lodging, loss of work, and child care (raising costs closer to $200/hour), and then spend significant amounts of time teaching techniques that are ineffective (e.g. grade 1 and 2 mobilizations), rarely if ever used (e.g. lumbar anterior to posterior mobilizations), or could be taught using more cost-effective methods (e.g. didactic lectures should be taught online). For example, many manual therapy certifications focus on teaching mobilizations for every joint in every direction, or release techniques for every possible muscle. Rather than, focusing on the techniques that are commonly implied by assessment, and/or have demonstrated the greatest efficacy in practice, and/or have demonstrated significant outcomes and findings in original research. This leads to many certifications teaching 100s of techniques, when 20-40 of those techniques are used 99% of the time, and the rest of the techniques are used so rarely that it is likely you will have to look them up again when you need them. At the Brookbush Institute , our goal is to optimize outcomes, so we focus on the most successful techniques, leaving room to teach the best techniques of each modality, with the goal of creating optimal intervention plans, to optimize patient outcomes. The educator's goal should be on improving practice, not encyclopedic knowledge for the sake of knowledge. This is especially true for formats that result in high costs to the student. There is almost no excuse for attempting to teach "mobilizations in every direction for every joint" or a "release technique for every possible structure" during live workshops that may be costing the student 100+/hour. Many of our comparative certifications could teach the techniques used 99% of the time with less than half of the live workshop time mandated.

Cost versus Efficacy Comparison:

  • BI IMT & IMT-C: Ideal: Live workshops focus solely on the most effective techniques using a case study approach.
  • IPA CFMT: Fair: A good mixture of the most effective methods and case studies; however, a significant amount of live workshop time is used to teach techniques for very rare presentations.
  • MAPS COMT: Poor: Encyclopedic knowledge is prioritized over the most effective techniques with cost-effective delivery.
  • NAIOMT CMPT & COMT: Fair: A good mixture of the most effective methods and case studies; however, a significant amount of live workshop time is dedicated to developing encyclopedic knowledge.
  • ART CP: Poor: Encyclopedic knowledge is prioritized over most effective techniques and cost-effective delivery.

Price Comparison:

Note: Total costs are estimates. Many of these organizations offer discounts if you are a student if you purchase early, or if you purchase bundles. We did our best to publish "conservative estimates (without additional costs)". We put in significant effort to err on the side of underestimating cost.


  • IMT-C: 64 credits, self-paced online courses, included in 29.99/month "Netflix-like" membership that you can cancel at anytime.
  • IMT: 64 online credits and 1 live workshop ($899.00)
  • Recertification: Included in membership
  • Estimated Total Cost: 29.99/month or $700.00


  • CFMT: 10 Workshops x $800/workshop + $1500 for certification week
  • Recertification: Unknown
  • Estimated Total Cost: $9000.00


  • COMT: (6 Workshops x $450.00/Live-stream or $640.00/live workshop) + $675.00/Certification Prep Course + $975/Summative Practical and Written Exam *(not all workshops are available live-stream)
  • Recertification: 1 course/2 years ($450.00 - 640.00)
  • Estimated Cost: $5000.00


  • CMPT & COMT: 7 or 11 Courses x $349/Live-stream or $599/live workshop + unknown oral exam fee *(not all workshops are available live-stream)
  • Recertification: Unknown
  • Estimated Cost: $2500.00 - $6500.00


  • CP Level I & II: 4 - 6 courses x $1499.00 – 1699.00/course
  • Recertification every 12 months (1 course/year x $899.00/course re-take)
  • Estimated Cost: $6000.00 - $11,000.00

Additional Benefits of Online Education:

Live education is great for developing initial confidence and refining skills, but mastery is not going to happen in the classroom. Mastery takes practice and a lot of it. Mastery may be developed first during introductory courses, then with practice on colleagues and friends, and then professional application, repeated again and again, over 1000s of hours. There is no evidence to suggest that developing mastery occurs faster when forced to attend multiple information-crammed workshops, generally months or years apart from each other. Self-paced online education allows learners to control the tempo of learning, pause learning to take notes or create other study aids, repeat all or parts of a lesson, review lessons before, during, and after application, and as many times as the student desires, all without the risk of frustrating classmates or instructors. This is the reason online education is growing so rapidly; it is very advantageous for the student. We suggest listing to Sal Khan's Ted Talk - Let's Use Video to Reinvent Education (Start at 1:35 when he discusses his nephews; so powerful). At the very least, self-paced online courses prior to a live workshop result in more effective learning during the live workshop, and can be reviewed following the live workshop, in real-time, during practice with colleagues, and/or after implementation in clinical practice. There is great research to demonstrate the superior efficacy of this hybrid learning approach. For more, check out our course: Evidence-based Teaching and Learning . The Integrated Manual Therapist-Candidate (IMT-C) certification is comprised of 64 credits (hours) of self-paced online learning with detailed instructional videos, all included in a Netflix-like, low cost monthly membership (no additional fees, cancel anytime). We have made a single 16-hour live workshop, completely dedicated to lab and practical application, necessary to achieve the "full" Integrated Manual Therapist (IMT) certification. We could certainly make an argument that more live education is better, but we know that mastery is not going to happen in a workshop. You cannot repeat a live workshop whenever it is beneficial to your learning, and the cost (price and additional costs) of live education is prohibitively expensive, especially when considering the repetition necessary for mastery. We will gladly add more live workshops in the future, for the colleagues that want them and can afford them, but we will also continue to increase and improve our online self-paced course offerings. Our goal is to optimize education, and that includes quality, delivery, access and cost.

Amount of self-paced online learning available:

  • BI IMT & IMT-C: Majority or All
  • IPA CFMT: Very little
  • MAPS COMT: None
  • ART CP: None

Dr. Brookbush teaches the lateral hip mobilization at end range hip flexion and internal rotation
Caption: Dr. Brookbush teaches the lateral hip mobilization at end range hip flexion and internal rotation


"Levels" of Evidence-based

Evidence-based has become a buzzword in the industry, but the truth is that very few organizations are putting in the effort to refine practice with a "fair" review of all relevant peer-reviewed and published, original research. Most courses are built from the opinions and personal biases of a founder or leader, retrospectively supported by cherry-picked studies, a few hand-selected reviews, and/or a random smattering of articles. Although many of these organizations are well-intended, these methods are not particularly helpful in refining practice. In our comparison below we have divided "evidence-based" into 4 levels.

  • Ideal: Courses should be built following a comprehensive review of the literature (prospective review), ensuring that only the most effective techniques and practices are incorporated into the curriculum. We have set out to be the first education company to do this, building every course from a comprehensive and transparent review of all original experimental and observational studies, with a focus on the aggregation of effect directions to build nuanced, and reasonably objective conclusions. It has taken us years to refine our review methods, and years to build courses from this labor-intensive review strategy, but it is the most accurate methodology we are currently aware of; and therefore, the right thing to do. We want to be the organization you can trust, because we rely on data and outcomes, with unprecedented transparency, and not because of faith in a founder or leader.
  • Good: A few manual therapy certifications are built from legacy content, and are now refining their curriculum based on published research (retrospective review). Unfortunately, the impetus to find research to support developed content increases the risk of confirmation bias, and the investment of time and resources in the development of content may result in friction when research implies that certain content should be discarded. However, a consistent and concerted effort to refine the curriculum is far better than cherry-picking research, and/or failing to review research.
  • Fair: Some organizations teach methodologies that are supported by some peer-reviewed and published original research. Although this is evidence of efficacy, and it is supported by an objective 3rd party using the scientific method, it is also a type of unintentional cherry-picking. There is a difference between "it works" and "it's optimal". Optimal can only be discovered by reviewing all potential options (research); it cannot be found if you only review the research that mentions your approach, technique, or modality.
  • Not Evidence-based: There are several manual therapy certifications that cannot be called evidence-based. These are certifications that either lack any research support, or demonstrate willful academic dishonesty with practices like cherry-picking, misrepresentation of research findings, lies about conflicting research, and or support built from fallacious logic (e.g. only new research is good research). We did not include any such organizations in our comparison.

Evidence-based Comparison:

  • BI IMT & IMT-C: Ideal
  • IPA CFMT: Good
  • MAPS COMT: Good
  • ART CP: Fair

Integrated, Systematic, Outcome-driven Approach:

Must be Integrated:

If a joint mob didn't work, the answer is probably not more joint mobs. If soft tissue therapy didn't work, the answer may not be more soft-tissue work. It is strange how our profession becomes fixated on a modality or technique, rather than a systematic approach that is built from assessment, considers the intent of each modality, and optimizes based on outcomes. Joints, muscles, fascia, and the nervous system are integrated systems, but they do not respond the same way to all techniques. Optimizing outcomes has to be at least in part dependent on our ability to address changes in each component of the human movement system. After all, what carry-over can we expect if joints are addressed, but trigger points, or instability, or fascial restriction are left behind? Further, dozens of randomized controlled trials have demonstrated the superior efficacy of an integrated approach (e.g. a minimum of joint mobs/manips, soft tissue therapy, and exercise). The results are nearly unanimous. The Brookbush Institute is less focused on a single modality and instead focuses on "integrated intervention plans (flows)" to address compensation patterns (not isolated impairments). Techniques are tools and should not be confused with systems.

Integrated Approach

We defined an integrated approach as having a minimum of joint techniques, soft tissue therapy, and exercise contributing significantly to the certification curriculum.

  • BI IMT & IMT-C: Integrated
  • IPA CFMT: Integrated
  • MAPS COMT: No soft tissue techniques, weak on exercise
  • NAIOMT CMPT & COMT: Weak on soft-tissue techniques
  • ART CP: No joint techniques or exercise

Systematic and Outcome-Driven:

Another major issue with manual therapy certifications is the presentation of techniques without context, perspective, relationship to other effective interventions, or effect on objective, reliable outcome measures. If you take enough workshops before you know it, you have this big bag of tricks, but like a bag of anything, there is no order, direction, best fit, or means of testing the effectiveness of the whole bag. To be truly outcome-driven, an approach must teach a system of objective reliable assessments, and the intervention plan has to be a consistent systematic approach that can be refined over time... based on the outcomes from the objective reliable assessments. Our courses are built from comprehensive systematic review, resulting in modeling of compensation patterns, informing selection of reliable objective measures, and a systematic approach to developing integrated interventions. The goal is to build a system that can be a foundation for further refinement and learning. Even if you choose to replace a manual therapy technique from our courses, with a technique learned from a different course, you will know where to put it in your intervention plan, what to test it against, and how to make an outcome informed decision. Switching modalities should not force you to switch systems, leaving you with the feeling that you just walked into clinic for the first time. I am not sure we can do a fair comparison of comparison of the strength of a company's "systematic approach" at this time, but the Brookbush Institute has worked hard to build a congruent set of courses with sample routines that aid in demonstrating how evidence, modeling, assessment and intervention can lead to easy to follow templates.

Summative Final Exams are Bullshit!!!


As an educator, there are very few instances that I can suggest it is necessary to mandate a large, summative exam prior to progress or certification. Perhaps, the only time these exams should be recommended is testing for a minimum standard when the path to achieving that minimum standard is variable. For example, a licensure exam to enter a medical profession following an education that could be attained from dozens or 100s of different programs. In almost all other cases, final exams promote "cram and forget" learning, and demotivate students. This is the opposite of what we should be promoting. Educators should be promoting mastery via a habit of enjoyable learning, incremental improvement, and repetition. Another Ted Talk by Sal Khan presents this concept beautifully - Let's teach for mastery -- not test scores . Another large problem with single, fear-inducing, cram and forget inspiring, single-shot to pass-or-fail, final exams, is that most educators in this industry do not know how to write a good exam. That is, an exam that is sensitive, specific and reliable as an assessment of retention, comprehension and application. How many times have you taken an exam that had several questions that you thought were unfair, hard to understand, or maybe tested something other than the information in the course (e.g. short answer questions being judged based on grammar).

My Horrific Test Taking Experience (True Story):

  • Before I relay this experience, I want to make it clear that it was a certification exam from one of the compared organizations (not the Brookbush Institute ), and I passed the exam on the first try. This is not my attempt to critique an exam I failed. I was embarrassed at the quality of the exam while taking it, I am embarrassed that this exam still exists, and that is implemented by an organization that I respect.
  • The exam started with a fairly long practical that used a "pick a technique from a hat" approach, that potentially included any technique in the entire multi-workshop curriculum. There was no consideration of how often the technique was used, how difficult the technique was to learn, how often the technique was reinforced throughout the courses, or whether the technique aided in fulfilling a learning objective. Although the "random" selection provides some objectivity, the grading was subjective judgment, as is always the case with practical exams. During this practical exam, several comments were made to clarify clinical decision-making that were not explicitly covered during the courses. This is positive from a learning standpoint, but not "fair testing" if those remarks represent a grading penalty.
  • The written exam started with 100+ multiple-choice questions. I'll refrain from boring you with the psychometric item writing errors in the exam, but in short... the exam was not great. Because the test was done on paper, not scantron, with questions having different numbers of possible answers (some A or B, some A - F), the grading was obviously done by hand. This also means little was being done to update questions based on objective data. If objective analysis was done I have no doubt they would have identified questions that were more likely to confuse the student than actually test their knowledge of information. Further, they may have been able to eliminate questions that were too easy, leaving more room to focus on building a set of questions that accurately tested application.
  • The biggest issue with this exam was following an hour-long practical, and more than 100 multiple choice questions, there were dozens of short-answer questions. And, short-answer could only be defined as "may fit on a single page". This is were testing became a torturous endurance event. Worse, most of these questions were not thought-provoking, many did not test clinical application; they were basically rote memorization. Some of these questions were so bad as to basically ask the student to regurgitate a particular list or set of directions. They might as well have asked, "please write out all of page 25 from course 2 by memory". There were so many of these questions on the exam that you left having written dozens of pages out, only to be graded subjectively by an examiner, who cannot give you the option to defend your answer. Much better multiple choice questions could have been written by including these tenants/protocols in a clinical scenario, followed by a choice between 4 approaches commonly seen in the clinic, but with one clear "best option". Further, this would allow for iterative improvement of questions, objective grading, and long-term a better exam.
  • The Result: I would like to say I was proud of passing this challenging certification and exam, but I left not caring at all. Because, I knew that this horrible exam, was not a fair assessment of my retention, comprehension, and application of the techniques learned during the course. What was tested was my ability to memorize, my stamina, my willingness to adjust to the subjective whims of the examiner, and my willingness to pay for the experience. Whether I achieved certification or not, that test had almost nothing to do with my ability.

End Summative Final Exams

As an industry, we have to end summative final exams and replace them with iterative testing and benchmarks based on progress through coursework. We must find a way to assess ability while motivating students to learn more. The BI IMT curriculum is achieved using a library of 1-4 credit courses (1 credit = 1 hour), each with a short exam (7-20 questions), practice exams available for every course to aid in determining readiness, and credits awarded for each exam. You never lose credits, you can attain credits at your own pace, and when you achieve enough credits you are certified... no summative final exam. And, all of these exams are included in membership, with no additional costs. The crazy part about this approach is that our certified professionals have higher pass rates, having answered a larger number of far more challenging questions, and most go on to complete more courses and exams after they are certified... because they enjoyed the process. It is amazing how much more willing we all are to face a challenge when that challenge is just 7, 10, or 15 questions... and not a grueling 2-hour session of 100+ questions.

Back to Price:

The Brookbush Institute is the only organization from our comparison group that does not charge a large additional fee for taking the exam, with most organizations charging between $500.00 - 1000.00.


  • BI IMT & IMT-C: Iterative testing and credit system
  • IPA CFMT: Written and Practical Summative Final Exam
  • MAPS COMT: Written and Practical Summative Final Exam
  • NAIOMT CMPT & COMT: Written and Practical Summative Final Exam
  • ART CP: Written and Practical Summative Final Exam

BrookbushInstitute.com - Manual Therapy Certification Disrupted

  • Get credit as you go. Certification is achieved by completing a required number of credits per category. (Say goodbye to feeling guilty because you did not prepare for the final exam this week; you already received credit for any course you completed, and it was automatically saved to your account.)
  • Say goodbye to the summative (final) exam! We did away with the fear-inducing, one-chance-to-pass, could cover anything, and charge you $100s extra final exam. (No more worrying about random pieces of information, late-night cram sessions, or having to start over because you did not pass on your first attempt.)
  • Credits are acquired by completing short courses (1-4 hours long) and passing short exams (7-20 questions). (Education should be an enjoyable habit, and exams should not be an endurance event.)
  • You can choose from a variety of courses to achieve the required number of credits in each category.
  • With the website or mobile app, you can get credit on the go, during breaks, for cancelled appointments, etc.
  • Take as long as you want to complete a certification. No pressure, no time limits, and no crazy time commitments (No boring, 4-8 hour long videos).
  • Every course counts toward both CECs and Certification (say good bye to being double billed)!
  • Re-certification with the Brookbush Institute is iterative and automatic.
  • All of this is included in membership, no additional fees, cancel anytime ("Like Netflix for Sports Medicine Professionals").

Clinical Professional Info Pages:

Testimonial - I've been looking for a platform like the Brookbush Institute my whole career; 25+ years integrating physical therapy with exercise physiology. I greatly appreciate your site, thank you! - Bill Burke-Miskell
Caption: Testimonial - I've been looking for a platform like the Brookbush Institute my whole career; 25+ years integrating physical therapy with exercise physiology. I greatly appreciate your site, thank you! - Bill Burke-Miskell

© 2022 Brent Brookbush (B2C Fitness, LLC d.b.a. Brookbush Institute )

Comments, critiques, and questions are welcome!