Directional Preference When Time Matters | Josh Kidd

When the cost of delay is measured in millions of dollars and operational readiness, guesswork isn’t an option.

In this episode, we sit down with Josh Kidd, physical therapist, researcher, residency director, and embedded clinician working with special operations personnel and fighter pilots. Josh shares how directional preference plays a central role in clinical decision-making when time, performance, and safety all matter.

We explore what directional preference actually is (and what it isn’t), why it should be viewed as an assessment rather than an exercise, and how inconsistent definitions in the research have led many clinicians to misunderstand or abandon it altogether.

Josh also walks through real-world data from a tactical setting, where his team has used directional preference to help service members return to duty 36% faster, while empowering patients to self-manage and reducing recurrence.

This conversation connects research, clinical reasoning, and performance-based care—challenging clinicians to rethink not just what they do, but how they think.

???? In This Episode, You’ll Learn:

• Why directional preference matters beyond the spine
• The most common misconceptions clinicians have about directional preference
• How inconsistent research definitions affect real-world practice
• How directional preference can guide prognosis and return-to-duty decisions
• What clinicians can learn from high-stakes military performance environments
• One mindset shift that can immediately improve clinical reasoning