The RMSKC Founder’s Experience: Dr. Manning’s credentials and training

Consulting and training requires trust. Does this person offering a service really have the credentials to meet my needs? Has this person had enough experience in the field to know how to overcome roadblocks? Is what this person is teaching safe, compliant, and consistent with other leaders in the field?

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These are all important questions to address, so I will do my best to share how I got to where I am and how this experience can be individualized to meet your needs. Whether you are a business owner/administrator trying to provide more value to your patients by adding another line of service and need to know where to start, a clinician wanting to offer innovative strategies to provide excellent outcomes to your patients with MSK pain, or a seasoned interventionist wanting to offer non-corticosteroid, non-opioid therapies, I am confident that I and/or my network of associates can help.

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Why RMSKC:

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I founded Regenerative MSK Consultants (RMSKC) because there still is a bit of a wild wild west connotation with regenerative medicine. In my clinical practice, and many others that I personally know who are thought leaders in this field, our results are real, reliable, and have many satisfied patients who have avoided the need for surgery. Contrarily, there are clinics and clinicians that are taking advantage of the stem cell and PRP hype, in order to generate revenue, yet they have no idea how to safely or appropriately administer these therapies. There are organizations that are offering great training as far as interventional technique. There are many conferences offering great scientific sessions regarding the evidence of orthobiologics. There are business masterminds and other business coaching services promising the moon if you switch to a cash pay orthobiologic practice. Yet none of these tie it all together. I am here to help clinicians implement regenerative medicine appropriately, so that the clinicians, the patient and the field benefit, from orthobiologics done right.

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Why Naturopathic Medicine?

Some clinicians are initially taken aback to learn that I am a naturopathic physician. I won’t go into all the intricacies of the differences between an ND and MD/DO and their respective scope of practice, as it would take several blogs to cover this. The table below shows a comparison of the basic training requirements between naturopathic medicine, allopathic medicine (MD/DO), and nurse practitioners. What I will say is that I chose naturopathic medicine for a reason. I chose naturopathic medicine because I was disillusioned with the care that I and my family had received with conventional medicine. That being said, I had the academic, medical experience, extracurriculars, and MCAT scores to be a very competitive MD school candidate. I chose naturopathic medicine because of its unique and profound philosophy.

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Many detractors hypothesize that people go to ND school because they don’t get accepted into conventional MD or DO programs. While that may be the case for some, it definitely is not the case for me, nor my ND wife, or the majority of the ND students I teach at the National University of Natural Medicine. We chose this profession because it is legitimate, evidence based, compassionate, precise, individualized, and requires a deep understanding of the human organism.

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Our bodies are not machines, yet so often conventional medicine treats the human body as discrete parts and function as a machine. Yet by definition of life, our bodies can regenerate, they have systems to adapt and maintain homeostasis, they can synthesize proteins and enzymes to build and replace tissues throughout time…machines cannot do this. Obviously we need our well trained and skilled conventional medicine colleagues when there is a disease or traumatic damage the overwhelms our bodies innate mechanisms, but for the majority of people, if we work on the foundations of health we can prevent many diseases from developing in the first place.

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Post Graduate Training:

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Naturopathic residency are very competitive. Unfortunately there are not enough residencies for all of our graduates. Our residencies are self funded, that is private clinics and individuals invest in the profession by training new graduates in accredited residency programs. Without federal and state funding programs, like those available to conventional MD and DO training, there are a lot of barriers for developing residency programs. On the other hand, the residency that are established have a lot of graduates applying for few spots. This means they are quite competitive.

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As graduation was approaching for me, I knew that I wanted to complete a multiyear residency. At the time, I had not known much about regenerative medicine or injection based therapies. I had fully intended on taking a residency in primary care with a focus on cardiometabolic health. Yet knowing that residencies are very competitive, I applied to every program on the west coast. I interviewed at a lot of programs and found some really good potential fits. It was almost time to match when I got a call from one last program that I had applied to, yet had not interviewed with yet. Part of that interview involved a shadow portion, and I was blown away. I shadowed with an interventional radiologist and watched him perform several interventional procedures. Some involved corticosteroid injections, while others involved using orthobiologics. One cannot ignore the synergy between orthobiologics (using an individual’s own tissues to improve tissue health, reduce pain, and improve function by using the properties of the tissues but also harnessing the body’s innate mechanisms) and naturopathic medicine (utilizing natural processes and substances to promote health). Luckily when match day came, I match with this interventional regenerative medicine residency.

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The first year of my residency was split between two private clinics. One supervised by a renowned MD interventional radiologist and the other supervised by a prominent and very experienced ND prolotherapist. Both of these physicians used interventional techniques and therapeutic agents such as dextrose prolotherapy, platelet rich plasma (PRP), microfragmented adipose tissue (MFAT), and/or bone marrow aspirate concentrate (BMAC).  In conventional training, there are only a certain number of approved specialties that one can complete a residency in and then apply for board certification. In naturopathic medicine, we do not, at this time, have true board certifications. We do have specialty associations that have board level certifications, but they do not directly translate to conventional specialties. That being said, most conventional doctors must choose a conventional specialty, none of them are solely on interventional orthobiologics. Mine was. From day one.

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After the first year, I had a choice to make, do I continue for years 2 and 3 with the MD radiologist or do I stay with the ND interventionalist? I chose to stay with the MD and successfully completed 2 more years of residency, completing 3 years in total. I was trained in diagnosis (including MSKUS and MRI), using orthobiologics, and performing advanced peripheral joint and spine interventions.

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After residency, I continued to work at the clinic with the MD and have been an attending there for several subsequent years, nearly a decade within this field. Working at this well respected clinic within this field and one of the thought leaders, has helped me to keep my pulse on the industry standards as well as vett and collaborate with top vendors in the field.

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Professional Experience:

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Since completing my residency, I have continued to develop and contribute to this field.

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I’ve demonstrated proficiency and board level training in diagnostic ultrasound with achieving the APCA RMSK certification. Soon after achieving that certification, I began writing items for the exam as a subject matter expert, and have advanced to being a member of the assessment committee for the exam. I continue to remain involved with the RMSK program and recommend all clinicians seek this credential and consider AIUM (American Institute for Ultrasound in Medicine) clinic certification if they are performing diagnostic ultrasound. In addition, I have given podium presentations at conferences such as the AIUM annual conference.

Since 2019, I’ve taught at the National University of Natural Medicine as a clinical supervisor and academically as an instructor in the MSK block, including diagnostic and interventional ultrasound. While I strongly believe that interventional orthobiologics requires post graduate training, I do teach the basics of diagnostic ultrasound and simple interventions such as arthrocentesis of large joints for diagnostic purposes, to naturopathic medical school students.

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I lectured extensively at grand rounds, by invitation, for MSK diagnostic imaging CE, and for the Stanford University Sports Medicine Fellowship program.

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Furthermore, I am founding member and current president of the Naturopathic Orthopedic Medicine Academy (NOMA). Unfortunately many intermediate and advanced training courses have explicitly excluded naturopathic physicians. Despite the injection therapy scope of practice (varies state by state) that is regulated by the respective state naturopathic board, most allopathic associations that teach interventional orthobiologics have chosen to exclude NDs. In my opinion, this causes more harm than good. NDs know their scope and intent to practice to the full extent of it. If they do not have standard, legitimate, and high level training, then individual NDs are left to their own devices to cobble together training. Not all training is created equal. If the organizations that provide high level and solid training do not accept NDs, then NDs will seek inferior trainings. If the question is patient safety, why not support and allow high level training for ND interventionalists. Also, I remind you, that I’ve worked for several years as the only ND in a practice with multiple MD interventionalists, and I’ve seen and heard of the types of complications and mishaps that happen with MD interventionalists, yet the thought leaders in the field overlook these.

In this setting, a group of NDs who have had advanced training and/or decades of interventional experience, decided to start a non-profit specialty association called NOMA. The Naturopathic Orthopedic Medicine Academy is dedicated to excellence within the clinical practice of interventional orthopedic medicine for the treatment of neuromusculoskeletal pain, injury, and dysfunction. The NOMA integrates many disciplines and perspectives in accordance with the principles of naturopathic medicine.

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I am honored and happy to have taught over 50 clinicians (ND and MD/DO alike) in interventional orthobiologics through my involvement with NOMA.

My latest professional contribution has been to serve on the Oregon Pain Management Commission. As a commissioner on the OPMC, I serve on an interdisciplinary commission that develops guidance and curriculum for training pharmacists and prescribing clinicians with appropriate tools and strategies to treat pain. This course is required for all prescribers to take.

I have co-authored several manuscripts within this realm (which are pending approval for publication), track outcomes with real world data, presented at national conferences, and published case studies exemplifying the benefits of orthobiologic therapies. In fact, I’m currently working on a case series showing the effects of using MFAT and PRP to treat common extensor tendon partial tears.

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In summary, I have unique and advanced training in this field. Not only am I well trained, but also, I have successfully taught many clinicians these techniques and the business side of offering these services–you can see some of the reviews on this website. Lastly, I have demonstrated my commitment to the field with my volunteer positions, research involvement, and committee involvement.

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If you want to get into this field and do it correctly and successfully, I can help you. Please contact me to set up a free consultation to see how I can meet your needs.

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