Interview with Dr. Justin Dunaway, DPT… Part 1 - March 2015

The following is not original material. This interview is reproduced with permission from Cinema, a former Twitter personality & blogger who left the social media world years ago. The reproduction is intended to preserve & share Cinema's insightful interviews.

Dr. Justin Dunaway DPT, OCS, Cert. SMT, Cert. DN is one of those individuals that makes me want to give much more than I get. Aside from his role as a staff Physical Therapist at One Accord Physical Therapy, he is an Executive Board Member of the Arizona Physical Therapy Association, AND President of STAND – The Haiti Project. I highly encourage you to learn more about & donate to STAND Haiti, click here for more info. 

This is an inspiring & very informative 2-Part Interview. Enjoy Part 1!

Lets start at the beginning – the beginning of your day. What is your daily morning routine? Describe the first hour of your day starting from the moment of waking.

I wake up and jump in the shower (usually late) while my amazing, brilliant, also a PT girlfriend makes coffee and breakfast. We usually sit at the breakfast bar and talk about nothing, or skim the news or Medscape for something to discuss; or bounce plans and ideas back and forth about Haiti. Then I jump in the car and head to the office.

Share with us the story of how you ended up in the wonderful world of Physical Therapy.

I was actually raised to be an engineer and take over a family run business. At 15 years old, I began work in our shop. Over the next decade I did every job there was to be done: sweeping floors, running manufacturing machines, welding, drafting, and working on traveling road crews. I had a mind for mechanics, but did not enjoy the work, whether it be at a desk staring at blue prints or in the factory doing 90 hours a week of manual labor. I was a mediocre student through high school, much more interested in cross country and track and field than class.

Once I graduated, I started into engineering school where I was a less than mediocre student and hated all three years. At that point, I was going to school full time and working for my father in the summers. My mother was a firefighter and an EMT in the small town I grew up in. I was spending all my time in my Dad’s shop or school, but thought it would be nice to spend some time doing what my mom loved. I got my firefighter and EMT certificates and started working in the same department as my Mom during the hours I wasn’t on campus. I really enjoyed the excitement of the firefighter work and fell in love with the aspect of helping people medically.

A few years later, I picked up a job at the local high school as the cross country and distance track coach. Again I enjoyed the work, but found working with the injured athletes to be the most rewarding. This is where I got my first exposure to the profession of physical therapy and decided that PT was the thing that combined my life long training in mechanics, my love of helping those in need, and my strong interest in injuries.

After three years of mechanical engineering, I switched to Exercise Science and quickly moved to the top of the class. With a lot of hard work, even more luck, and probably some influence of people that will never admit it, I somehow got into PT school despite my poor performance during my first undergraduate years in engineering.

Tell us about your fellowship. Why did you decide to do it? And, looking back on it, how has it change you as a Physical Therapist so far?

I decided to do a fellowship because it is the highest level of training and credentialing you can receive as a clinician. I believe the program will make me a better therapist and give me access to the best clinical mentoring. It will also lend credibility to me professionally: as a mentor, an educator, and while working in advocacy for our profession.

I am still in the middle of the fellowship and my mentorship hours have not yet begun. I believe this will be an important piece, tying together all the skills and didactic knowledge into clinical decision making and expert practice. And for this, I’m excited.

You were an instructor with SMI. What drew you to this group? And, how has SMI impacted you as a Clinician and as a Professional?

SMT-1 was one of the first continuing education courses I took after graduation. Coming from a strong mechanical background, there were many concepts we were taught in physical therapy school about specificity and biomechanics that I never quite bought into. Dr. Dunning was the first to present concepts more in line with some of the beliefs I had and then followed it with large volumes of well presented research. Dr. Dunning is a straightforward, no BS, dynamic educator, as well as a strong advocate for our profession. I immediately felt that this organization had the potential to change the profession for the better.

SMI has had huge impacts on every aspect of my career: as a clinician, educator, PT advocate, and humanitarian. In the clinic, I now possess evaluative and hand skills that allow me to very successfully treat conditions that I struggled with fresh out of school. I have a very good understanding of the literature as it relates to the spine and feel that I have really developed the ability to consume and critically appraise research; all through the SMI.

I have also had the opportunity to develop the skills involved with creating and delivering seminars, from start to finish. This has been an exciting and challenging endeavor, from which I have discovered how much I enjoy teaching.

The story of “Dry Needling in Arizona” isn’t well understood by many in the field (including me). Can you expand on this history for us? Also, include take-aways from this experience that can/should be applied to similar cases in the future.

This is a great question that I wish more people were asking. We had many successes and failures during this multiple year battle and learned a lot of things that would be very useful for other states to know.

Physical Therapists (although very few) have been practicing Dry Needling in Arizona since the late 70’s. In 1998, the Arizona Acupuncture Board of Examiners was formed; and in October of 2011, they filed their first complaint with the PT board against a PT performing Dry Needling. The PT was deemed to be practicing within his scope and the complaint was dismissed. Over the next few years, more complaints were filed, including ones specifically against Sean Flannagan (co-founder of MPTA) and Sara Demeure (vice president of the AzPTA). I was called before the Acupuncture Board for a complaint against my license (along with many other PTs), which were ultimately dismissed as the Acupuncture Board has no jurisdiction over our licenses.

In response to this increased volume of complaints, the AzPTA formed the Dry Needling Task Force, led by Sean and Sara, whose goal was to create an operational definition for DN and present this to our Licensing Board for adoption. The PT board also held three public stakeholder meetings to collect information from the public (PTs, LAcs, and consumers) about Dry Needling and acupuncture. At this time, the Acupuncturists began a large and effective grassroots campaign, using the internet and local news papers/news stations to disseminate information about the ‘dangers’ of physical therapists performing Dry Needling. They argued that PTs were causing life threatening injuries via the ineducated misuse of acupuncture needles. In October 2013, our board voted unanimously that Dry Needling was within the scope of physical therapy and this should have ended this issue.

However, this was also our board’s sunset review year. During our sunset review hearing, representatives from the Acupuncture community came forward, stating that we were a threat to public safety and that this issue needed to be resolved before they could vote on continuance of our board. This was a completely unexpected attack and it shifted the battle from a board versus board issue to a legislative issue. At this time, the Manual Physical Therapy Alliance was formed and we generated a grassroots campaign of our own, working with the AzPTA to help educate the legislature and advocate for our scope of practice. We created a petition to not only gather support, but also to identify people who were willing to speak up and be active. We met with legislators, created educational materials, wrote research based position statements, testified at house and senate health committee meetings, worked with lobbyists, and ultimately helped shift the legislators’ opinions from supporting the Acupuncturists’ to passing a bill placing DN in PT statute, which was signed into law on April 2014.

We are particularly proud of the language used to define Dry Needling in our statute, which, unlike many other states, does not limit Dry Needling only to trigger points, but allows for needling of all neuromusculoskeletal and connective tissue.

Some of the most important things that I learned:

– PTs are not keeping a pulse on what’s happening in their states and the Association is not good at disseminating information to people not looking for it. Each legislator we met with said the same thing, “I understand what you’re saying and you’re right. The problem is I have several hundred letters from acupuncturists and their patients, and maybe ten from your side.”

– A patient speaking to a legislator is far more powerful than any of the lobbying we PTs ever did.

– Just because we know we hold a Doctorate, are experts in neuromusculoskeletal conditions, and are evidence based practitioners does not mean that the people writing and voting on the laws have any idea what we do and what we know. The only thing they know is what they are told. If all they hear is Acupuncturists telling them that we are taking a weekend course in needling and killing people, that’s what they believe.

– The biggest thing I learned is how big an impact a few voices can have in the right place and right time. There are so many times that the wording of a law was changed, a vote shifted, a legislator switched sides because of what was said.  The idea that a few people are not enough to change the course of things is insane. We need to be our own biggest advocates, because no one is doing it for us.

What is the MPTA? How does it fit into the current ecosystem of Physical Therapy?

The Manual Physical Therapy Alliance is an organization that was born out of the need to rally  grassroots support from physical therapists, patients, business leaders, and politicians in Arizona during our battle with the Acupuncturists over Dry Needling. Sean Flannagan, myself, and a few others felt that while the Arizona PT board and association were working very hard to win this battle, there was not enough involvement from stakeholders in the state. We felt that this lack of involvement could be attributed to people not knowing what was going on or how to help.

The bigger plan for the MPTA is that it will become a resource for advocates nationwide. PTs will be able to share information and experience, offer strategies and advice, and collaborate on current legislative issues.

We also foresee the MPTA being a resource for clinicians, students, and patients alike. This will be an informational database covering topics from legislative alerts, physical therapy news, clinical education, continuing education, consumer education, and research.

The aim is to make it an organization that really advocates for the profession and patients, a one stop site for information on all these things.

Favorite Books and/or Authors?

Other than journals and blogs I don’t get much reading in, however I did recently have my entire life consumed by the Game of Thrones books which was a very good break from professional life.

Staying in the world of Physical Therapy, what important truth do very few people agree with you on?

We know nothing… or at least very little. There are so many beliefs and concepts out there that people cling to so strongly. They dig their heels in, defending certain concepts as if they were solid ground. There are a multitude of different camps in our profession and so many explanations for the same occurrence or outcome that are so different. And when we dare to venture outside of our profession, we are challenged with entirely new sets of justifications and approaches to the same concept that are again so different.

In my practice, I have been privileged to interact with a variety of clinicians, professions, and cultural views on medicine. There is one experience with a Doctor of Oriental Medicine that comes to mind at this time. She was giving a lecture to provide needling PTs with an appreciation of the differences between the eastern and western philosophies. I had just so happened to wake up that morning with what I had diagnosed as a unilateral locked cervical facet. I had significant pain and loss of mobility in my neck. Once the lecture was over, she announced that she would perform a demo on a patient and I quickly volunteered. She completed a full subjective interview, followed by tongue and pulse diagnoses, gave me an eastern medicine diagnosis, and placed one needle in my right shin and two in my thumb. After fifteen minutes, she removed the needles. My pain had decreased to 1/10 and I had regained nearly full range of motion. By the next morning, my symptoms had resolved entirely. The PTs were baffled, frustrated, angry even. They suggested a placebo effect, the non-specific effects of treatment, that I was faking, etc…

But the bottom line was: she had assessed me, treated me, and I got better. We can all speculate on the mechanisms at play. Perhaps my elements were out of balance, there was a strong placebo effect, or a bombardment of nociceptive info to the dorsal horn which altered motor neuron activity allowed muscle relaxation and improved mobility, etc. But at the end of the day, we don’t know which it was, or that it was any of those…none of us.

The only thing we do know, all of us, is that we can take a patient, apply a treatment, and make them better.

Part 2 will come out next week!

Until then, make sure you’re following Dr. Justin Dunaway on twitter: @DrDunawayDPT.

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