CEU Review: DN-1 & DN-2

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I recently attended DN-1 & DN-2 by the Spinal Manipulation. The courses were fantastic experiences and have provided me with new means of addressing a variety of conditions in the clinic. Both courses surprised me on two fronts:

1. The Research. I wasn’t expecting so much time spent on discussing the research and how it guided their approach. The amount of research presented simply blew me away. Research is research regardless of which geographical region of the world it was done and in which professional journal it was published. And so, they pulled research from all over the planet and thought a decent variety of disciplines. This was strangely refreshing. The lectures were quite heavy on the current relevant research; and, it was presented fairly in that both positive and negatives were mentioned. I don’t know about the nuances & specifics of these studies, but the fact that they exist and haven’t been explored in other courses is very interesting.

2. Pain Science Lectures. Yes, I know what you’re thinking…it’s a dry needling course and they’re presenting lectures on pain science? Oh, yes they did. The phenomenal lectures on pain science as it relates to Dry Needling also caught me completely off-guard….in a very good way! I gotta admit: pain science talks in both courses were in-depth on biochemical and mechanical levels as related to dry needling. It was fantastic and convincingly presented. Very convincing. Tommy presented a very detailed & balanced lecture, and Ray bled passion during his lecture.

Now onto specific critiques on the courses themselves, as well as recommendations for future attendees.

The Negatives.

About 40% of the manual was summaries of research reports. While this provides a nice foundation of research on which to base Dry Needling treatments, it could easily be converted into a PDF to be emailed and downloadable to course attendees. Another issue with the current manual (DN-1 2016) is that it didn’t always correlate with the material presented. In other words, material was presented that wasn’t in our course notes, and there was no way to obtain an updated manual. Why? Apparently the new manual wasn’t yet approved for publishing. It would be fantastic to make this information accessible to 2016 course attendees (with a reduced price) when it is available. Maybe you could save paper and simply email/download it in PDF form; printed manual could be an extra charge.

The manual had a couple more short-comings. 1) There was very limited space to take notes. 2) The semi-standard protocols weren’t to be found; however, there is ample instruction on palpation, needle placement, and needle technique. It would’ve been nice to have drawings/pictures of the protocols alongside written instructions for future reference within the manual itself.

When it came to lab time, there was often ran into extremes of either excessive or short practice periods. This was the first Dry Needling course for a number of attendees, and spending a little longer on basic needling practice would’ve been more beneficial. Then again, maybe I was just too slow to get comfortable before moving on to labs 2 or 3. DN-2 did a much better job of managing lab time.

Finally, there should’ve been more time spent on the technicals of employing Dry Needling in the clinic – things like how to bill insurance for it, how it’s incorporated into a cash practice, orchestration of Dry Needling into the Plan of Care to address questions of stretch after/before or skip exercising entirely. All these items should be addressed up front and as clearly as possible. I had these questions addressed in DN-2 by asking the instructor during lab time. Be sure to ask this question to multiple folks – instructors & other DN practitioners.

Some Tips & Recommendations.

Take lots of pics from a variety of angles – at least 2 different angles. This will allow you to get a better appreciation of needle placement when you’re practicing it on your friends, family, and coworkers after the course.

If you’re a visual learner like me, then it might be a smart idea to sketch out the lab demo with all the insertion markings. It might also be useful to re-create this on your own after the course is over. This way you feel more confident about inserting the needles, and know exactly what you’re doing before you start poking your friends, coworkers, and/or family members.

Let’s stick with the lab demo for a bit longer. As I mentioned earlier, the course manual provides very little room to take adequate notes. So, it’s a really good idea to jot down instructions/sketches during the lab demo into either a separate notebook or sheets of paper. Using a clipboard with unruled sheets of paper works best for me. This allows freedom to sketch and jot down info as it suits my visuals without the constraints of ruled pages.

Consider reviewing the relevant anatomical regions prior to taking the course. Here’s how I would’ve done it: cover the insertions of major/important muscles and their innervation, trace major nerves (for DN-1 think brachial plexus), and, finally, roughly familiarize yourself with the “spaces” (for example, the quadrangular space) that are created by the framing muscles and/or other structures – no need to be very meticulous about this, just consider the obvious ones.

Finally, bring some cash. They tend to supply needles like your grandmother would supply dinner items: better too much than too little. This allows you the opportunity to purchase some needles right after the course and start practicing right away. $50 worth of needles should be a nice start.

The Positives.

Their conceptual application of combining spinal manipulation and dry needling certainly peaked my interest. It made me want to explore these “segmental effects” deeper on my own prior to taking a spinal manipulation course. I really appreciate the work behind creating these protocols (much of which was lifted directly from research articles).

Both instructors were knowledgeable, presented the material well, AND presented it fairly. They pointed out studies that showed both sides of the argument. Their perspectives on utilization of the literature was refreshing and made me open my eyes a bit more toward how some (many?) folks view the literature through tainted lenses while wearing blinders. 

This course provided me with incorporable content and manual intervention options that can dove-tail nicely with my current clinical framework. While I don’t think wearing the “osteopractor” label is in my future, the concepts were intriguing and definitely warrant more of my curiosity.

Final Take.

I came away from this course with much more appreciation of an intervention that I had ignored just 4 years earlier. Dry Needling seems to have the potential to address multiple fronts at once: save my hands, access structures that are difficult to reach/treat with manual palpation, provide another route to address chronic pains, and provide me with another differentiator with which to market my services for the benefit of my future clients. Good content. Engaging instructors. Worth the time.

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How to Study for Physio Specialty Certification Exams

Having been through 2 certifications (so far) in my career, I thought I should provide current & aspiring certification candidates a birds-eye peek into my study routine. Each section listed below can become more involved based on your learning habits and learning strengths. So, if you have thoughts, questions, or opinions on any of them, then feel free to leave a comment to help make this a more productive post.

Certification can be quite stressful and overwhelming. You have to give it everything you’ve got. Might as well use all 5 senses! Here we go…

See.

  1. If you can rent DVD’s or stream videos of the course, then definitely do so. You’ll become more familiar with the techniques and clinical reasoning process by watching the instructors. Not only will this help you didactically, but it’ll also get you used to seeing the teachers who may be testing you. This way you’ll be (relatively) less intimidated when you’re in the testing room with him/her. Visual familiarity calmed my nerves by giving me a read on their facial responses and general movement patterns. Not only did this help me respond better during testing, but it also allowed me to get a sense of their psychological atmosphere, which cued me to choreograph my performance to fit their disposition at that particular period of time.
  2. Another way to utilize your visual input to sharpen your skills is by watching your study partners. For this reason alone, it might be worth your while to work in a group of 3. Another option is to use mirrors. Since one major way we learn is by watching others, it is important to choose an appropriate partner for visual feedback.
  3. Diagram everything as much as you can. I’m a visual learner, so this helped me immensely. Sequences, lists, groupings… even the page of contents.

Hear.

  1. Audio record the DVD’s or streaming video. Put them onto your iPod or smartphone so that you can access them quickly during your commute or review it audibly before bed.
  2. Record yourself reading or reasoning through the manual. This would be a much more personalized means of audibly reviewing material.
  3. Verbalize the material by yourself before talking it out with your study partners.

Smell & Taste.

  1. Build routines into your study. A certain coffee or tea. The smell of a location: bookstore, study partner’s home, etc. Then, imagine or recollect the same smells or tastes as you’re reviewing materials independently or with a study buddy. Make a joke about it. Connect it to whichever material you’re having a tough time recalling. The more sensory neurotags you create around your study content, the better the odds of performing under pressure.
  2. Have some dry finger foods while you study. I have no idea why this made the study process more productive, but I covered more ground and made sharper connections while my hands kept popping food into my face.

Touch.

  1. Kinesthetic awareness. If your certification includes a hands-on portion, then you should develop an awareness of what it feels like when a technique is done correctly and incorrectly. Feel for the sense of effectiveness both as the tester and tester’s partner. Be able to tell when your partner is on the right track when s/he is working with you. Provide constructive and precise feedback. The more precise your feedback, the sharper you develop your kinesthetic awareness. This in-turn can guide your performance during testing.
  2. Work on as wide range of people as possible. If possible, work on either the instructor and/or others who have recently passed the certification. Also, have them work on you so that you get a physical sense of how it feels when done right, and how they use their body/hands/etc.
  3. Re-write the manual in your own words. I know. It’s a bit strange to put this under “touch,” but the physical act of writing somehow helped coalesce the material better for me. I tried typing, but it wasn’t as effective. Also, writing allows you to draw arrows, smiley faces, or whatever else you’re into, to make connections and highlight important sections requiring further attention.

As, mentioned earlier, you can make this a more productive discussion by leaving helpful advice in the comments section.

Good Luck!

Cinema

P.S. – As many of you are well aware, I enjoy reading books. Early March 2016 saw the first edition of my Quarterly Readings Newsletter. It is an update on some of the more interesting reads of the 3 months preceding publication of the email Newsletter. Email me with “I love to read!” in the subject line, and I will add you to the email list. 

Twitter Interview!

I decided to close out 2015 with an interview with questions from twitter.

Check it out!


@therapyinsiders: Which Bourne movie was your favorite and why?

This is a tough one. I really enjoyed all three – yes, I’m excluding the one with Jeremy Renner. I’ll choose my favorite Bourne flick based on 2 things: villains and motorcycle scenes. And the winner is… The Bourne Ultimatum! Desh was the perfect roleplaying villain. I loved his fight scenes which seemed like a mix of Wing Chun Kung Fu and Capoeira. The motorcycle scenes were incredible! Watching Bourne ride through Tangier at a fast clip while negotiating daunting street obstacles in narrow alleys was thing of beauty.

@MattBobman: Biggest professional regret and/or failure?

I should’ve casted a wider net in my first few years as a PT. While I was lucky enough to have a role and gain experience on both sides of the business, I could have developed a wider view and started developing a Framework of thinking and action much earlier than I did. Here’s what I would recommend:

Experiment enthusiastically with different approaches of treatments.

Connect with a wide variety of professionals within driving distance and through social media.

Take more risks in terms of: creating new products, developing new platforms, re-inventing yourself.

Read a kaleidoscopic selection of books and authors. And, follow Jeff Bezos’ “Regret Minimization Framework.”

This is a great question! Jeff Goldblum – not because I look like him, but because he plays some interesting roles and for some reason his personality resonates with me. Anyway, check out his Top 10 Moments:

Anonymous: When are you going to Haiti with STANDHaiti?

Hopefully some time in 2016. In the meantime, check out STAND’s 2015 Re-cap and this inspiring story.

Doesn’t matter. Just get moving in anyway that you enjoy – play sports, lift heavy things, dance, run, yoga, climb things, conquer things… If I were forced to pick team or exercise, then I’d say go with whichever fits your personality the best.

@DrBenFung: If you could change one thing about the person that annoys you the most, what would it be?

This is a tricky one, and here’s why. If you find someone that annoying, then odds are this person means something important to you. Maybe s/he is someone you want to hold onto and have agree with you. Maybe s/he is someone you want to impress. Maybe you believe changing him/her will make your professional or personal life complete. Here’s what I think: maybe you should work on yourself & your environment before you think about think about changing someone. Changing someone is often a futile effort. Changing yourself is a much more powerful endeavor with compounding returns over time. Book Recommendation: The Education of a Value Investor by Guy Spier.

@Eric_in_AmERICa: If you could put a billboard anywhere in the world where would it be and what would it say?

https://twitter.com/Cinema_Air/status/682608338383683584

@rupalPT: what is your pride and joy?

Spending time with my family & friends and providing as much value to the world as I can are my prides & joys.

https://twitter.com/TheAwesome_PT/status/682663763305082880

Careful whom you marry.

Explore wider and faster. Do not ignore your instincts. Learn widely from outside the field of Physical Therapy. You need a framework – work hard at developing a foundational framework on which you can build further. And, don’t fear failure. Just make sure you learn from it. You might get more out of my interview with Dalin.

Hello. My name is Indigo Montoya…

Thank you everyone! And, best wishes for a fantastic 2016!

Connect with me @Cinema_Air

Book Review: You Can Run Pain Free! by Brad Beer

I had the pleasure of interviewing Brad Beer last year. It was a fantastic interview – I learned a ton.

Not too long after the interview Brad published a book titled “You can run pain free!” For full disclosure, Brad provided me with a copy of his book for review – Thank You!

My verdict: It’s worth your time.

Physiotherapists and other clinicians will benefit from Brad’s pragmatic blend of research and reality. The book also provides the general public with a solid background of how to evaluate themselves, progress their running, and communicate better with their Physiotherapist when needed.

5 REASONS THIS BOOK IS WORTH YOUR TIME

IT PROVIDES A GUIDING FRAMEWORK. This framework puts the novice runner into a better first step, and can give him/her a more nuanced view on efficient and pain-free running than the average new runner. Many weekend and seasonal runners can also benefit from this book for the same reason: they are now equipped with tools for faster and pain-free running.

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PSYCHOSOCIAL PERSPECTIVES. Brad does a very nice job integrating the psychology of running injuries and their impact on returning from injuries. His views on this are beneficial to both runners, as well as Physiotherapists who work with runners. Here’s one of my favorite passages on this topic.

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METAPHORS & COMMUNICATIONS. It is becoming ever-more clear that the way we (Physio’s) communicate with our patients has a direct impact on their recovery. Brad uses a variety of metaphors in his book to steer the runner into a healthier mindset that allows him/her to believe in their own potential. This alone is worth the read for clinicians and runners in general. His concept of “Frame Weight” is one of many clever expressions peppered through the book.

MORE THAN THEORETICAL. While Brad cites published literature throughout his text, he manages to integrate the lessons he has gleaned from his personal and professional empirical distillations. A nice example of this is his perspective on overtraining.

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OPPORTUNITY TO LEVERAGE BRAD”S EXPERIENCE. Brad experienced a knee injury that eventually underwent surgical repair and was told that his running days were behind him. Well, time has proved those words false. Brad completed the NYC Marathon in 2015!

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How did he do it? What did he learn through his years since his knee injury? What can you learn from his experiences? You Can Run Pain Free! is a synopsis of what he has learned and applied over the years. It’s more than an academic exercise, it’s a pragmatic text based on his personal & professional experiences.

Here’s a quick blurb Brad posted just prior to his book launch.

You can pick up You Can Run Pain Free! here.

@Cinema_Air

A Financier & his Backache

Back pain as an expression of internal/external incongruency that can generate a fortune? Possibly. The following two passages are from George Soros‘ book, The Alchemy of Finance.

My biographer quotes my son Robert as saying:

My father will sit down and give you theories to explain why he does this or that. But I remember seeing it as a kid and thinking, Jesus Christ, at least half of this is bullshit. I mean, you know the reason he changes his position on the market or whatever is because his back starts killing him. It has nothing to do with reason. He literally goes into a spasm, and it’s this early warning sign.

Mr. Soros goes on to explain,

My son is right about the backache. I used to treat it as a warning sign that something was wrong in the portfolio. It used to occur before I knew what was wrong, often even before the fund began to decline in value. That is what made it so valuable as a signal. It would be wrong, however, to dismiss the theory on that account because it was the theory that me take the signal so seriously. I knew that I did not act on the basis on knowledge; I was acutely aware of uncertainty and was always on the lookout for mistakes. As I mentioned earlier, it is when I did not know the flaws in my positions that I had to worry. When I finally discovered what was wrong my backache usually went away.

The Irish Times celebrated the 84th birthday of “the most successful hedge fund manager in history” with an article on some lessons you can glean from Mr. Soros’ storied career. Included in the article was the following:

Soros has admitted to relying greatly on “animal instincts”, saying the onset of acute pain was often “a signal that there was something wrong in my portfolio”.

His decisions, then, “are really made using a combination of theory and instinct.

Sometimes our bodies express themselves from a base of unexplainable manifestation and intelligence. The question is: What do you do when your body speaks to you?

@Cinema_Air

Why Physical Therapists Need Physical Therapy

I wrote a guest post for Dr. Erson Religioso, DPT on Why Physical Therapists Need Physical Therapy. Here’s a preview:

Until recently, I didn’t consider seeing a fellow Physio for any other reason than necessity – pain, injury, etc. However, curiosity got the best of me, and I signed up for a few PT sessions and learned more than I expected. Here are my Top 5 Lessons so far.

Prima – every physio should know what it’s like to be a patient. Let’s drop the fact that you are a physio and might quietly (or not!) critique your care. View it purely from the perspective of a patient looking to return to full function: running, walking, sex, lifting, etc.

Here’s how Jill Baugh put it: “Only way to know if we get good care is to know if we get good care.

[Continue reading….]

5 Lessons Physical Therapists can Learn from Bruce Lee

I wrote a guest post for Strive Labs. Check it out:

“Bruce Lee is one of my personal heroes. While there are many reasons I admire him, I find his philosophical approach to everything the most salient and magnetic feature of admiration. We can learn numerous lessons from his life. Here are 5 lessons that apply to Physical Therapists as individuals, and Physical Therapy as a profession.”

Continue reading…

Andre Agassi on his Back Pain

Tiger Woods’ remarks about his back pain spawned a rumble in the physio community. This piece by Peter O’Sullivan sums things up nicely. My favorite thing about Peter’s write-up is that it’s aimed at health care providers, not the athlete. Tiger’s latest injury involves his right wrist:

Keeping with the theme of athletes and their bodies, check out the following excerpts from Andre Agassi’s autobiography, Open, describing his experience with back pain. It’s a great first person’s view on the relationship between back pain and emotions.

Now rising from the center of the fatigue comes the first wave of pain. I grab my back. It grabs me. I feel as if someone snuck in during the night and attached one of those anti-theft steering wheel locks to my spine. How can I play the U.S. Open with the Club on my spine?

I was born with a spondylolisthesis, meaning a bottom vertebrae that parted from the other vertebrae, struck out on its own, rebelled. (It’s the main reason for my pigeon-toed walk.) With this one vertebra out of sync, there’s less room for the nerves inside the column of my spine, and with the slightest movement the nerves feel that much more crowded. Throw in two herniated discs and a bone that won’t stop growing in a futile effort to protect the damaged area, and those nerves start to feel downright catastrophic. When the nerves protest their cramped quarters, when they send out distress signals, a pain runs up and down my leg that makes me suck in my breath and speak in tongues. At such moments the only relief is to lie down and wait. Sometimes, however, the moment arrives in the middle of the match. Then the only remedy is to alter my game – swing differently, run differently, do everything differently. That’s when my muscles spasm. Everyone avoids change; muscles can’t abide it. Told to change, my muscles join the spinal rebellion, and soon my whole body is at war with itself.

The cortosine injection:

I stretched out on the table, face down, and the nurse yanked down my shorts. The doctor said he needed to get his seven-inch needle as close to the inflamed nerves as possible. But he couldn’t enter directly, because my herniated disc and bone spur were blocking the path. His attempts to circumvent them, to break the Club, sent me through the roof. First he inserted the needle. Then he positioned a big machine over my back to see how close the needle was to the nerves. He needed to get that needle almost flush against the nerves, he said, without actually touching. If it were to touch the nerves, even if it were to only nick the nerves, the pain would ruin me for the tournament. It could also be life-changing. In and out and around, he maneuvered the needle, until my eyes filled with water.

Finally he hit the spot. Bull’s-eye, he said.

In went the cortisone. The burning sensation made me bite my lip. Then came the pressure. I felt infused, embalmed. The tiny space in my spine where the nerves are housed began to feel vacuum packed. The pressure built until I thought my back would burst.

Pressure is how you know everything’s working, the doctor said.

Words to live by, Doc.

Soon the pain felt wonderful, almost sweet, because it was the kind that you can tell precedes relief. But maybe all pain is like that.

Perception of our bodies, pains, and injuries can have stunningly strong effects on our daily function.

Andre Agassi’s book is the first autobiography I’ve read cover to cover. And, it’s one I’ll be re-reading over & over. Pick it up here.

@Cinema_Air

Edo, Nelson, & I chat about the new KinetaCore Educational Center

Dr. Edo Zylstra, PT, DPT, MS, OCS, IMSP recently reached out to me about the latest KinetaCore evolution: The KinetaCore Educational Center in Ashburn, VA launching on March 19th.You can find some introductory information about it here, and the interview you are about to read will go in-depth into the intentions, hopes, and experience of the new Facility. He partnered with Nelson Min, PT, MS, ATC to launch this First-Of-Its-Kind facility. Not only is Mr. Min a lead instructor for KinetaCore, but he is also a practicing clinic-owner. Many of you are already familiar with Dr. Edo Zylstra; if not, then check out our first interview.

Congratulation & Good Luck to KinetaCore, Dr. Zylstra & Mr. Min on their latest venture!

Enjoy the interview!


First, let’s get to know Nelson Min. Nelson, what lead you into the wonderful world of Physical Therapy?

Nelson: I am very blessed to be a physical therapist.  I think the PT’s I came across early on were amazing people and they had a strong and lasting influence in my pursuit of being a physical therapist.  I grew up in Delaware and they have an incredibly strong PT program there at the University of Delaware.  These were some amazingly skilled PTs who had such a good presence in the community.  They were also such a close knit group.  I just saw how interactive and rewarding this field can be because of these individuals who were really good PT’s and even better people.

Nelson, tell us about your history with KinetaCore. How did it start? And, how has it grown to where it is today?

Nelson: One of the keys to being a good PT is drive for continued learning.  There is so much to learn and I am continuously amazed at how much good info is out there.  I really enjoy taking continuing education courses and I realized that the more I progressed in my training the more these highly respected educators recommended incorporating dry needling into my skill set.

I took my first course at Regis University in 2009.  The professionalism and expertise of Edo and his staff for that class was such an inspiration.  The immediate results I noticed on my self over a weekend were undeniable.  Dry needling is such a great adjunct to any physical therapist and I knew I had to be a part of this company.

So, Edo & Nelson, there’s a new venture that’s about to launch on March 19th. Tell us about The KinetaCore Educational Center. What motivated its formation? And, what is it that you hope this will do for the profession of Physical Therapy?

Nelson: Functional Dry Needling® has changed my practice and how I practice.  It has made my already successful clinic into an even more successful and thriving one.  We want to share this with as many PT’s out there to hopefully make them even more successful in their businesses.

We also want to share this technique with the public.  It helps with such a diverse number of dysfunction that patients deal with, improved function is the goal but it also helps with pain and increased mobility and muscle function to name a few other benefits.  It has dramatically helped me in improving my patient’s outcomes.

We started the Kinetacore Education Center to achieve the goal of educating our profession with this technique in a setting that promotes the learning experience.  What typically happens with con-ed is to offer it in a PT clinic or facility and adjust it to the needs of a con-ed course.  In other words, you work with what you have available.  Our teaching center has no associated clinic. The design is for learning.  Three HD ceiling projectors and total surround sound gives any participant clear audio and visual regardless of their vantage point.

The other speakers we will be featuring include some of the most influential and sought after educators in our profession.  These educators have incredibly tight schedules and share a passion of advancing our profession.  We now have a facility where we don’t have to worry about the logistics of closing a PT clinic which often interferes with hosting some of these professionals.

How did/do you choose the instructors for the new KinetaCore Educational Center? What qualifications and qualities are you looking for?

Nelson: We are looking for instructors who have a passion for the advancement of our profession.  We look for skilled, intelligent and caring individuals who invest in the goal of advancing our profession with this technique and want to further our understanding of its mechanism and how to teach it more effectively.

All instructors are trained in Functional Dry Needling (FDN®) and require one year of clinical use before being considered as an instructor.   They are then required to go through a training process over three separate audits to safely and carefully progress them to independence in supervising and instructing. The training process concludes in a final check off with our senior instructors (Edo if possible)  to ensure quality and consistency with what and how is it presented.

We require that you are trained in our technique to be able to teach our system of dry needling.  These gifted individuals usually stand out during training process and it usually comes as no surprise when they first inquire about the opportunity.

I’m glad you mentioned not just the clinical aspect, but also the business dividends of Functional Dry Needling®. What is KinetaCore doing to promote Dry Needling to increase public awareness in the US?

Nelson: Edo has done such behind the scenes work with working with the APTA and several state boards to help incorporate dry needling into the state’s scope of practice acts .  He is one of the individuals who drafted the resource paper on dry needling for the APTA in 2012 and was recently accepted to be a part of the Federation of State Boards of Physical Therapy Dry Needling task force.  I think Edo brings public attention to this skill the right way by approaching this from the top down.

We also want to empower our participants.  Our website is a labour of love with marketing materials and electronic brochures.  The most important part of the website, however, are the educational videos that are constantly being updated for continued improvement of techniques and also the “Find a Therapist” feature.  This allows the clinician to market their practice.  Our google ranking is so fine tuned that our participants who sign up for the website membership can expect to get a number of people finding them through this feature on the web.  Ultimately, we feel the best way to market this technique is by delivering a good product which is a skilled PT  focusing on safety and proper technique.

Our goal is to be the support for all of our participants in this.  We have a system for participants to communicate with our instructors to answer any questions that may come up as they integrate this technique into their practice.  Each lead instructor receives dozens of emails a day from our past participants with solid questions.

How expansive will the course offerings range?

Nelson: We will be offering our course series of Functional Dry Needling® level 1 and 2, and Functional Therapeutics throughout the year.  In addition we will be hosting several manual therapy courses including Extremity Manipulation by Gail Malloy, The Changing Dynamic of the Scientific and Clinical Rationale for the Treatment of Selected Knee conditions by George Davies, Spinal Manipulation by Louie Puentedera, and SFMA for dry needlers by Kyle Kiesel.  I am still working on adding more courses spanning a vast topic range for the remainder of this year and next.

Edo:  I also have a goal to open up this teaching model and center up to other medical professions to give them a cost effective way to host educational courses for their specific professions as well.  That is as goal that we will try to realize over the next few year.

To the best of my understanding KinetaCore requires 200 treatment session of practice/experience after Functional Dry Needling® Part 1 prior to taking Part 2. Why is it set up this way? And, is this something KinetaCore pushes for when lobbying for inclusion of Dry Needling in State Practice Acts across the US?

Nelson: As expected the skill of handling a needle for people coming into our FDN1 course can be pretty limited.  Our bottom line is safety so we limit some of the more challenging muscles to level 2. Muscles that we feel need a more refined skill level to treat are placed into the level 2 course.   We require 200 practice sessions for our participants so that they are better prepared for the requirements of the level 2 course.  We feel that this skill level can only come about with practice.

Walk me through what it would be like to take my first course at the KinetaCore Educational Center. Class size, number of instructors per course, course progression, lab/hands-on time, etc.

Nelson: The class size varies but shouldn’t affect the learning experience because of our adherence to an average instructor to student ratio of 1 to 7.  We have a rule with our participants that if they feel they are not getting enough supervision, they need to indicate this so we can fulfill their needs.  It is the responsibility of both the instructor and the participant to make sure they have the optimal learning environment.  Exposure to as many instructors as possible gives the participant a much broader understanding of the application of the technique, so we purposefully rotate instructors and have the participants work with various body types through the weekend.

The first part of the course is our didactic lecture in order to lay down the framework of dry needling with its history, theory, research and integration.  We are then in lab for the remainder of the course systematically covering the entire body by regions in our small group labs.

Each of these small groups is first led by our instructors reviewing anatomy and then demonstrating technique.  We then have our participants pair up and practice the demonstrated technique for that region while carefully sweeping the room providing close supervision.

At the end of the second day, we have everyone go through another review process so that they can pair with another partner and get a different instructor to watch them.  We just want each participant to get as much supervision from multiple instructors as possible.

On the third day, each participant is tested both practically and theoretically.  There is no guarantee of passing and we have options for people who do not pass the testing.  We take this very seriously and give our students as much time as possible to practice, often staying late on Friday and Saturday evening working with our participants and giving them more one on one instruction.

Is there anything else you would like to share about the KinetaCore Education Center that we haven’t addressed?

Nelson: Our teaching center was designed to offer the best in continuing education.  We have some high end AV to show our detailed lecture notes as well as an interactive approach to see the anatomy simultaneously.  There are some high end anatomy apps out there now very conducive for learning and we incorporate them with our lectures and labs for a wonderful learning experience.

Because of the layout of the course, there is no bad vantage point.  You get a great view of the screen regardless of where you sit.  We have high end audio spread out uniformly throughout the venue as well so you get a clear sound regardless of where you are sitting as well.

Edo:  This is our first venture specifically developing a center devoted to higher learning for the medical professional.  If this is successful, I anticipate this as a first of many centers around the United States.  We are so thankful for all the support we have received from our families, friends and colleagues as we go faithfully into this adventure.

Thank you Edo & Nelson for this informative interview, as well as for allowing me the opportunity to share it with my audience. I wish both you the best of luck in your latest venture!

Connect with Dr. Edo Zylstra and Nelson Min on Twitter: @EdoZylstra & @NelsonMin2000

Also, find me at @Cinema_Air.

Hindsight Wisdom! Special Post for #solvePT 02/24/15

Tonight’s #solvePT discussion revolved around the following question:

It just so happens that I’ve asked a similar question repeatedly over the last year in my interviews. I highly recommend that you check out the interviews. There are TONS of wisdom and lessons to learn from these shared stories and experiences. 

The question I asked was some variation of: “Imagine you’ve travelled back in time right after your graduation from PT school and are face-to-face with yourself. What advice would you give to your younger self?” I’ve listed the responses below.

Enjoy this special post for #solvePT!


Dr. Nick Nordvedt: LEARN and find a mentor. PT students and new grads that I meet are frequently surprised by the vast amount of knowledge still to learn after graduation. We graduate as generalists, but must find our practice niche after graduation. I think the best way to do this is through taking advantage of every learning opportunity available and find a great mentor that shares core practice values with you.

DR. MONIQUE CARUTH: LOL, shouting out loud to my young self…”You do not know it all!!!!”,  I would tell myself to welcome constructive criticism because those that offer it they see potential in you and care about you to take the time to invest in sharing ways and means for you to better achieve your goals. Those that don’t care won’t waste time even offering anything good or bad. Don’t beat yourself up about getting a B on an exam, no one cares what your grades are when you leave PT school as long as you pass your boards. Take a few business electives. Chat with managerial students. Meet and sustain relationships with great mentors. Engage in social media. Advocate more for our profession.

Dr. Ben Fung: Get involved in legislative issues – licensure defines practice patterns. PERIOD. If you want to truly be regarded as a primary care, provider of choice for neuromusculoskeletal impairments – one must be first licensed to do so to effectively penetrate the market.

DR. ERICA MELOE: That’s an interesting question because I gave up a financially rewarding career to go back to school. I would advise the student to pay attention to the trends in healthcare. When I graduated PT school, it was during a time when no one was hiring! The Balanced Budget Act was in full swing and the Medicare Cap was just instituted. There is no way as a PT Student you could have prepared yourself for that, realistically. I would also have advised myself to seek a mentor out, someone who was already established as a PT. Mentors are so important for both personal and professional development. And I think as a student in a field that was undergoing so much change, it would have been nice to see the field from a different perspective.

When I was at Stern in my last year of business school, NYU set up “informational Interviews” with alumni and they endeavored to match you both with regards to industry. These were very helpful in the sense that it opened my eyes to the opportunities in my field. When I was in PT school, I did not have that opportunity. I would urge students to request this if their programs were not offering it already.

DR. DAVID BROWDER:  Daniel Pink, in his book ‘Drive’ lists three things that drive intrinsic motivation.  1) Autonomy, 2) Mastery and 3) Purpose.  My advice is to seek opportunities to work in an organization where the purpose of physical therapy is embedded into the culture, and where they can gain mastery in the practice of physical therapy.  For those so inclined seek out mentors who can help develop management and leadership skills.  I believe that specialization is an excellent route to this.  Autonomy is more difficult and can definitely be found professionally, but for those that have the ambition and determination to build their own practice – I think there is no better place than private practice physical therapy to find the confluence of these three things.

Dr. Sandy Hilton: Be bold and take chances. You will need to be persistent to get what you want, do it with grace and kindness, but do it.

And publish your masters thesis, because you were right.

Dr. Erson Religioso III: Clinically: You don’t know it all, and for God’s sake, stop beating on people to make them move better!

Personally: Start working on your symmetry and stop with the huge pounding overstrides so you don’t have to quit running due to knee pain. Also, invest in something called google.

Jerry Durham:I would beat the following statements into my Younger head….

-Believe in yourself, your ideas and what you bring.

-Understand that YOU being YOU is the most Valuable thing you can do (Fuck others who say dont be YOU)

-Present SOLUTIONS not just COMPLAINTS

-Don’t be afraid NOT to be the smartest guy in the room…You can learn from Everybody

-Find a Business Mentor TODAY (this woulda helped on multiple fronts, not just starting my biz)

-Set up a financial plan and follow it..

-Your parents are right!!…(almost all of the time).

All of those played a huge role in my personal and professional development.  A couple of those came way later than others.  If those were beat into my head 20 years ago, my learning curve would have been far shorter!

(I would also mention to hold that Apple stock I bought at $14 a share…no joke.  But thats for another day)

TODD HARGROVE: Invest in Google and Amazon. Chicken wing consumption needs to come down.

I don’t regret going to law school at all, it was one of the best times of my life. But I do regret not getting started with my current career a little earlier. Is there a difference between these two things? It feels that way to me. If I had gotten started with this career earlier maybe I would have been more involved in strength and conditioning and sports performance.

BRUCE WILK: It was 1980 and it was my senior year of physical therapy school.  I was disappointed because I was hoping to learn about running injury management and how to keep people running healthy. It took years to reach that goal, but I finally made it.

My advice: Stay the course.

BRAD BEER: Great question. My advice would be two-fold:

1. To not ‘look side-ways’. Avoid the comparison game. The grass may appear to be greener but it rarely is!
2. Be patient. Success is developed through the navigation of an array of challenges and various learning opportunities that life both professionally and personally generates.The degree to which you succeed and progresswill be determined by the degree that you stop to evaluate your learnings and lessons.It has been said that experience is an OK teacher but evaluated experience is an even better teacher.

JESSICA MCKINNEY: Study, travel, and read more before you start your family and trust your gut in bridging pelvic health and your orthopedic manual therapy training. You’ll know enough to do it way earlier than you think.

DR. SETH OBERST: Having a reason for everything that we do as physios. Having a paradigm for progression/regression as well as using a test-retest model that exposes the client to the intervention based on your hypothesis and then gauges their response is crucial! It’s what separates the zeros from the heroes. The key is to recognize patterns and that means a lot of deliberate practice. Experience itself does not equate to expertise; deliberate, thoughtful experience while being driven by what we don’t know yields expertise.

Expose yourself to other ideas outside of physio. Yoga, massage therapy, kettlebells, Oly lifting, anything. We try to own these little silos of information without considering other, often very effective, schools of thought. Way too many PTs have no clue about training methods and movements which is rather ridiculous. If you yourself cannot pull, push, press, and squat how the hell can you expect to have face validity when calling yourself a sports physio or trying to coach a patient (and yes everyone should be able to perform those movements in some capacity). Because ultimately PTs are movement coaches so take pride in owning movement.

ANDY LODATO: This profession and your patients will humble you. They will humble you with their generosity, their complexity and their vulnerability. You won’t realize the power that you have to help someone just by listening and talking. The profession is a “Physical Therapist”, but all of those psychology classes you took in undergrad will be of great use to you. Also, remember to be have patience. Your career and development will take not happen overnight. All of the bumps in the road are part of the journey.

ANN WENDEL: I would tell myself that it’s all going to be ok. That no matter what happens, I can turn it around and make a really satisfying life for myself.

JULIE WEIBE: Change is an evolution, not a revolution. Be patient, and stand strong even when you are swimming against the tide.

Never stop learning.

Stop cursing like a sailor.

Stop dating that guy. Wait for the Canadian….(I would sort of trail that last one off into a whisper, then slink back into the shadows….)

Find me on Twitter: @Cinema_Air