Interview with Edo Zylstra of KinetaCore - June 2014

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. The reproduction is intended to preserve & share Cinema's insightful interviews.

Awareness of Dry Needling is quickly growing amongst Physical Therapists across the US. KinetaCore is one of a few premier Continuing Education programs offering courses in Dry Needling and they’ve recently opened up a Teaching Center in Brighton, CO. Dr. Edo Zylstra, PT, DPT, MS, OCS, IMSP is the Owner & CEO of KinetaCore. He also owns a private practice – KinetaCare – in Brighton, CO. You can read his bio here.

I had the pleasure of interviewing Dr. Edo Zylstra recently. It was very detailed, informative, and entertaining! I hope you enjoy it & learn as much from it as I did. 

Tell us a bit about yourself and what first sparked your interest in physical therapy?

I was the typical kid who wanted to be outside and play every sport that was in season with all the neighborhood kids. Through lots of years and lots of minor injuries, I had the typical attitude of, “ignore it and it will go away”.  After getting my neck wrung out playing back yard football in high school, I attended chiropractic treatment and was impressed by the x-ray machine and the manual manipulation that the chiro used to treat my neck.  At that time, I was a three sport athlete in high school with tennis as my key sport.  The assistant coach, a cardiologist, asked what I had planned on doing after school and I said I was considering chiropractic.  He recommended I look into physical therapy instead, explaining that PTs were getting paid in the high eighty thousand dollar range and it was a vastly expanding field.  I researched PT and felt the focus on anatomy, physiology and movement science with the opportunity to work in athletics was perfect for my interests, and the cardiologist was adamant that I would do better being a PT than Chiro.

In College, I was able to work in a hospital system as a Rehab Aide in virtually every setting in both inpatient and outpatient rehabilitation.  This was an incredible experience for me to learn what direction I would head in PT school and beyond.  One of the PT’s I was partnered up with was a clinical spine specialist trained through Stanley Paris.  She was hugely influential to me and motivated me to work in orthopedics and eventually specialize in the spine.

I now would consider myself a neuro-orthopedic physiotherapist with a strong framework for assessment and treatment in the regional interdependent or, for lack of a better word, holistic model of rehabilitation.

Professionally, I am in my fourteenth year of practice, have an incredible wife of almost 19 years, three kids all smarter than dad, and two successful businesses, KinetaCare and KinetaCore.  KCare is our PT clinic in Colorado, and KCore is our continuing education company which offers courses throughout the U.S. and Canada.

How has the profession changed since your first year of practice? (fads, treatments, themes, etc.)

I would say the two largest changes that I have seen are the transition of programs to the Clinical Doctorate of Physical Therapy and the continued progression of becoming a profession that will work beside other medical professionals rather than being an ancillary profession.  What has impressed me most is the gradual acceptance of Physiotherapists as Doctors of their profession by action rather than by just initials. Previously, we were a profession that many in the medical field would consider benign: “Doing no harm and doing no good”.  Now, we have advanced methods for evaluation and assessment (Dx US, functional movement, etc.) and more advanced and effective tools/treatment techniques to improve effectiveness and efficiency of treatment (Manipulation, Dry Needling, Class IV laser, Functional Corrective Exercises, etc).  We also have a greater risk to hurt or cause harm to patients.  Thankfully, we are a very risk averse profession that takes seriously the increased responsibility for choosing the right intervention on the right patient using our skills of evaluation, assessment, differential diagnosis and understanding when not to apply a specific treatment based on those findings.  We are also well trained in how to handle the adverse event if one were to happen.

Biggest lessons you learned from taking 24 continuing education courses in 2 yrs?

That was a tough 2 years. Not to mention that those courses didn’t include the dry needling education I underwent. That would increase that number quite a bit. I am continually reminded of how blessed I have been to have a wife who supported my passion for learning and my unquenchable thirst for the knowledge that would affect the patients who trusted me to help them achieve greater function. I also learned that the education we received in PT school set us up to become PTs.  But it was up to us to blossom into the practitioners that merit the respect of our peers and other medical practitioners.

Taking as many courses as I did in such a short time, I likely forgot as much as I learned and that it is always beneficial to go back and study what we learned.  Repeating a course you took a few years ago can be more beneficial as you mature as a clinician and are better able to develop pattern recognition and apply the theoretical model that was taught and/or the clinical techniques from a completely different perspective.  When you have numerous patient interactions to reflect upon with the new or newly perceived theories and treatment techniques, it makes it that much more valuable.  There are a number of courses I have taken twice and there are a few I plan on taking again.  That is the beauty of continuing education courses.  You get out of them what you put into them and, if they are a progressive company, the instructors and educational company continues to modify and advance their courses to be relevant to the current research and change with the experience of the instructors.

One of my concerns and what I worry about for our profession, is if the grandfathers and grandmothers of manual therapy are not able to pass on their knowledge, skills and the pure “art meets science” skill they have developed over their many years of clinical practice. They are all aging and we are not aggressively learning from them and are likely going to wait until it is too late to fully help them pass on to us their skill set.

Tell us about the evolution of KinetaCore. How did it begin? How has it evolved?

KinetaCore was born out of a company that I developed with an Aussie Physio, Robert DeNardis. I exposed him to dry needling during a training session for the multi-cervical unit, a device for evaluation and treatment for neck strength/weakness and range of motion testing. He had developed the Melbourne Protocol to properly evaluate patients on the device and needed to have someone else trained to instruct clinicians how to properly use the device when purchasing it from Baltimore Therapeutic Equipment.  On that training course, Robert had been complaining of a headache and, being the dry needling junkie that I am, I pulled out the needle kit that goes everywhere with me and did a quick eval and treatment. Robert felt full relief of headache and was completely sold on a treatment that he thought was snake-oil.  Long story short, he and I developed GEMt (Global Education of Manual Therapists). I taught in Australia for about 18 months, teaching 13 courses and about 250 practitioners with Robert.  We then decided that an international company would be too expensive and intricate, so we decided to separate our companies.  He has kept the GEMt brand while we transitioned to KinetaCore® for our teaching company in the US and Canada, and KinetaCare for my clinical practice (previously Sport and Spine Physical Therapy, Brighton, PLLC).

Being sole owner of KinetaCore has allowed me to follow my dream of creating a company with a vision to advance the practice of physical therapy and advocate for that advancement, while teaching practitioners our passion of incorporating Functional Dry Needling® into their clinical practice.

How did you first meet Gray Cook? Describe your current relationship with him and how it fits into your philosophy.

This is a seriously funny story. I was teaching a course in Columbia, Maryland, for about 36 people. We had a staff of six instructors, as we like to keep an average instructor to student ratio of 1:7. One of our instructors walked up to me in a very excited way and said, “Do you know who is taking this course?” I said, in my typical sarcastic way, “Uh 36 people? Bob Duvall is taking it!”  Bob Duvall from Atlanta Sports Medicine, a good friend of mine and relatively well known on the east coast. “No” he said. “Gray Cook!” I looked at him with a blank stare and said, “Who’s Gray Cook?” He was dumb struck and said, “Only one of the foremost experts in strength training and functional movement! You seriously don’t know who he is?!”  “No.” I said, “and by the way, he is taking our course like everyone else, so don’t treat him any different!” He walked away with a grin on his face and a bit of a star struck look. I really didn’t know who Gray was. Never heard of him, let alone what he was known for. I think that is why we became fast friends. He was tired of being treated like some kind of celebrity and I treated him like everyone else, like he actually is. I am not saying he hasn’t done amazing work with Functional Movement and has had a huge impact on our profession!  But to me, he is just like every other PT who has passion for what they do. He was fortunate enough and worked hard enough to make an impact that people really respected. Well, that was day one on that course. What I didn’t realize was that he came with a small (in number) entourage, who were actually huge in size. Funniest part is they picked the treatment plinth that was rated for likely 150 lbs and was from the 1940’s or something. That table swayed and wobbled under their weight all weekend and they were affectionately called the Three Ballerinas for their graceful way of managing the flimsy swaying plinth.

The course ran smoothly and on day two, I had the interaction with Gray Cook that I will never forget and likely began our friendship and clinical synergetic relationship. He walked up to me after the lumbar spine practical session and stuck his big beefy finger in my chest and said, “You are the missing link.” I suppose I could have taken this many different ways coming from a guy a full foot taller than me looking like Billy Ray Cyrus two months late for his haircut appointment. He then says, “Want some golf clubs? I know the TPI guys and we can hook you up if you want.” In a weird way, it was one of the greatest compliments I have received on a course. We, of course, went on to develop a great relationship where we discussed how this technique is really a powerful reset and should not really be considered a “release” of trigger points. The muscle, when treated properly, just flat out works better and this technique allows us to “Reset” the neuromuscular system. We can then better allow “Reinforcement” of the movement behavior or manage the increased range of motion that is now present and then effectively move into the “Reload” phase of rehab/training.

Because of Gray and his Functional Movement Systems’ impact on me, I decided to change the technique to Functional Dry Needling®. It just fit better with the model we were transitioning to, and better defined the “why” behind the application of the treatment.

Gray and I still chat as regularly as two very busy guys can, and it is always a passion filled diatribe about how we can become better at identifying the key reset point/structure and how to more effectively keep our high standards of treatment.

In our courses we often say that we want to teach our students to become snipers rather than carpet bombers. We spend most of our time evaluating, assessing, palpating, and justifying the why behind the dysfunction and the why behind the treatment rationale. This is why we will always progress our courses to become better and more effective education of this tool that is as much a great reset as it is a tool of assessment.

Why is DN still considered “fringe” or “gimmicky” by some professionals?

Plan and simple.  Ignorance.  Ignorance is not a negative word. it just means:  ig – no – rance

noun \ˈig-n(ə-)rən(t)s\ : a lack of knowledge, understanding, or education : the state of being ignorant

I also think this is too often compared to traditional acupuncture, in which the Traditional Chinese Medicine model is based upon a very different education and theoretical model. A quick search online and this definition says it all.

Traditional Chinese medicine is a broad range of medicine practices sharing common concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage, exercise, and dietary therapy.

In no way am I trying to say TCM practice and acupuncture are gimmicky or fringe — I just feel there is significant ignorance here as well.

As for Dry Needling, the APTA has put away the notion that it is a gimmick or fringe. The Dry Needling Task Force that I was fortunate enough to be a part of has developed both a definition and description of Dry Needling in physical therapy practice. These will be included in the new Guide To Physical therapy Practice to be published later this year. The Task Force was also part of developing a White Paper evaluating Dry Needling use not only in the US but internationally.

There seems to be a level of confusion between what constitutes Dry Needling and how that’s different from Acupuncture. Differentiate them for us.

This is a question I am asked virtually every day.  Simply put, there really is only one similarity — the needle.  A tool never determines the profession or rarely the technique being applied.  The education, theoretical model, and assessment for application of that tool determines that actual technique and better describes the profession using the tool.  It doesn’t mean that acupuncturists do not use some dry needling techniques and physical therapists do not influence some acupuncture points.  It would do a great disservice to the Traditional Chinese Medicine profession to say that the use of the acupuncture needle in treatment determines the profession of the person doing it and the technique.  In our courses, we are all physical therapists teaching, for the most part, physical therapists.  We do not teach acupuncture (in the theoretical sense) at all.  The argument comparing hours of training (between acupuncturists and physical therapists) really does not relate to the actual piercing of the skin.  It has to do with the number of Meridians, twelve standard and eight extraordinary meridians with the number of points being in the 600-700 range.  The training requires the TCM provider to not only learn the meridians and points but what points to treat for the various disease processes that they treat.

Physical therapists extensively learn anatomy, physiology, biomechanics, tissue healing and universal precautions for entry level training in wound care and EMG.  This entry level education gives the PT ample preparation and training to learn how apply the dry needling to the musculoskeletal structures.  They are not learning the meridians and acupuncture points, as that would be an infringement upon the acupuncturists’ scope of practice.

This would be very similar to TCM providers learning musculoskeletal rehabilitation, which I do know is happening in various states in the US.  The question for us is this:  Should we begin to bring this issue up to the various state acupuncture associations and licensure boards?  We, to this point, have decided to not do that as our goal is improving health care overall as well as access to appropriate health care.  The patient’s quality of care and access should be our main focus when discussing scope of practice issues.

The Federation of State Boards addressed this in a position white paper in 2009 in which it addressed this issue of overlapping of scope of practice as we progress our education in all of these various medical fields to improve patient care and access.

With regards to Dry Needling, I would like to offer a different paradigm of thought.  Dry Needling should be considered the umbrella term for all uses of a needle, whether a syringe or acupuncture needle, that does not use some injectate.  The “Dry” constitutes the lack of  injecting a fluid and was based on Karel Lewit’s work in which he found that there was virtually no difference in response when using a syringe with or without injectate.

Dry Needling became the term that that APTA adopted officially over the last 5 years.  Intramuscular Manual Therapy was another descriptive term used to try to put into the manual therapy billing procedure.  That term is being phased out and Dry Needling is the term now being used.  There is a definition and description that the APTA will be presenting in the new Guide to Physical Therapy Practice when that is published in the fall.

The interesting part of all of this is the use of the term dry needling by acupuncturists. I am seeing more and more that this is a term they are inserting into their scope of practice and presenting at their conferences.  I do not have a problem with this so long as it is not their attempt to try to control our scope of practice.  Having a goal of controlling other medical professions and their scopes of practice is, frankly, not good practice.  It does nothing to develop professional bridges to support research, collaboration on patient care, and ultimately improved patient outcomes.

Dry Needling in physical therapy practice, as defined by our professional national association is:  Dry needling (DN) is a skilled intervention used by physical therapists (where allowed by state law) that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch and can refer pain to distant parts of the body. Physical therapists utilize dry needling with the goal of releasing/inactivating the trigger points and relieving pain. Preliminary research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation. (Physical Therapists & The Performance of Dry Needling:  An Educational Resource Paper).

What impact is this “turf war” having on health care today?

It is difficult to know for sure but we do know it has not been positive.  It has forced our profession to defend a practice that is well within our scope and, at times, defend ourselves legally.  We tend to be a profession that does not like to rock the boat and favors a positive working relationship with other medical professions.

It really comes down to the most important aspect that is lost on the acupuncturists fighting us in this “turf war” — the patients are being deprived of appropriate care and are confused as to why. I think the term “turf war” is really inaccurate as there is no turf being fought over.  We have our scope of practice as do the acupuncturists. Scope of practice will continue to progress and change as we increase in our education and schools continue to add assessment and treatment to entry level education based on research and advancement of treatment knowledge. We are optimistic about the future of physical therapy’s impact on ever changing health care.  This includes working with all other health care professions to better serve our patients with their care and access.

Is Dry Needling practiced by Physical Therapists outside of the US and Australia? How well-accepted is it abroad?

Dry needling is practiced throughout the world by physiotherapists and has been practiced in various forms for many years.  It is very accepted and there are no significant “turf” issues of which we have been informed.   Terminology tends to be a bit different as many physios can learn traditional acupuncture but also trigger point acupuncture.  Again, that defines the technique by the basic definition of acupuncture and not the theoretical and TCM form of the technique.  Acupuncture basically means “needle puncture”.  How it is applied is dependent upon the education and theory by which it is applied, what tissues are being affected/treated,  and what the end result of the application would be.

Much of the research can be confusing because the term ‘acupuncture’ is used for both trigger point dry needling as well as traditional TCM disease process management.

As a side note regarding this “turf war”:  We have had to change our policy of allowing acupuncturists to take our courses.  We previously allowed acupuncturists to be trained in our courses but found that they struggled with the anatomy, assessment, diagnosis, and actual treatment techniques as we are often treating many deeper structures to treat the musculature involved in the functional impairment found upon assessment.  Their traditional training does not cover much of the biomechanics and orthopedic examination.  We decided to limit which acupuncturists we allow on our courses based on their education and their working relationship with physical medicine providers.

KinetaCore is making headway into new fields of application that you may not have expected; tell us a bit about these, including athletics, neuro, etc.

When we first integrated dry needling into our clinical practice we called it intramuscular stimulation and trigger point dry needling. That was based on our first exposure and education to the technique. We relied on the education we received in our training to explain the “release” of tissues and gave little thought to the nervous system and other structures we would be affecting. After almost fourteen years of using the technique in clinical practice and teaching it for eight years, we see it so very differently. We are really affecting the nervous system and the biochemical processes of the body rather than simply “releasing” a tight tissue or reducing pain in an “active” or “latent” trigger point. I will never forget one of the Regis University faculty presenting in front of one of our classes, speaking on her experience treating children and adults with cerebral palsy. She had decided to integrate dry needling into her treatment and management of the spasticity that is common with CP and was surprised to find that she was getting 2-3 months of improved mobility, reduced spasticity and was able to use less aggressive orthotics for ambulation. The patients were also very happy with this result as the treatment they were used to was significantly more painful and at times more invasive, from botox injections to aggressive stretching and surgical lengthening/release procedures. You can imagine that dry needling to this group is a very amenable treatment compared to the aggressive and often more painful procedures that, at times, result in less favourable outcomes.

After hearing her experience, many of our instructors and I began to offer this treatment to our patients with peripheral neuromuscular issues caused by a central nervous system dysfunction. The results have been nothing short of amazing. One example is a friend of our family who is 26 — a high cognitive functioning person dealing with significant lower extremity spasticity. He has taken a number of falls as he ambulates with a posture control walker but can fall forward if his foot gets caught or he gets fatigued and has difficulty clearing his foot over some obstacles. He asked If I would treat him for his tightness, as his goal was to ride a wave runner on the lake at my parents’ house. His spasticity did not allow for enough adduction and external rotation of his hips to sit on the wave runner. He had tried numerous times after traditional PT stretching and even botox of his adductors but found he did not get enough gain in range of motion to comfortably sit on the seat. I assessed and ended up treating his lumbar spine, bilateral hips, quads, hamstrings and adductors. His comment with regards to the discomfort of the technique was a wave of the hand and a laugh that this was nothing to the years of painful stretching and aggressive orthotics he would have to endure to have minimal improvements. Suffice it to say, to my surprise he was able to comfortably ride a wave runner numerous times over the following six weeks. His spasticity did come back but the amount of functional gain that he had from one treatment was astonishing. He has since asked for a follow-up treatment and we are working on getting that care for him here in Michigan. At the time of treatment, I was still living in Colorado and was visiting family in Michigan when I treated him.

I could write story after story about the impact that dry needling has had in the orthopedic and now more neurologic realm of functional impairments. The lesson for me and all those treating patients is this: We are not orthopedic manual therapists or neuro physical therapists; we are all neuro-orthopedists with specialties in different etiology of impairments that we address with our patient populations.

I have now seen dry needling used in orthopedics, neuro, wound care, and oncology across all ages and activity levels.  Every patient should be considered an athlete.  Whether you are Grandma Smith wanting to knit and participate in bridge club or Bruce Smith and you play professional football, your life activities are your sport.  Our job is to give you the support to play those “sports” at the highest level with the least amount of physical limitation and pain.

One thing we are very proud of as a company is the effect we are having on the profession of PT but more importantly on the patients we are impacting. Dry needling is almost required of the PTs that provide healthcare to the military special forces, and we can say that almost half of the NFL teams now have a PT/ATC trained by KinetaCore in Dry Needling. The impact on the community will be incredible as the high level athletes and the everyday consumer are now able to access this effective tool that physical therapists are now incorporating into their practices.

You are a Physical Therapist and are very passionate about the progression of our profession. Why allow chiropractors to take your courses?

We have allowed Chiropractors to take our courses if they have shown that their state’s scope of practice allows them to perform dry needling. It must state dry needling, not acupuncture, as they are not the same thing. We felt that if they were going to learn this technique, we wanted to make sure they had the highest level of training so that when they incorporate this into their practice, they represent dry needling well and it has a positive effect on the consumer’s view of dry needling. I know of one course of study that trains practitioners in sixteen hours to basically treat the whole body. I don’t know how that is possible. We are not a company that focuses on the “hours of training” paradigm, but we hold to the training principle that you do not practice that which you are not trained to do. Meaning, if you learn to needle the quads, it does not mean you now can safely needle the lumbar paravertebral musculature. I would make the same argument for manipulation.  You do not automatically gain the knowledge and skill of manipulating the cervical spine after learning only the lumbar spine techniques. These are very anatomically different areas of the body that require study and training of safety and proper technique to be safe and effective.

At some point, there will need to be official national standards for the treatment that we incorporate into our clinical practice. This should be a competency based standard, not focused on hours of training but minimum standards of education and practice. This should include: indications, contraindications, precautions, universal precautions, clean/hygienic needle technique, managing an adverse event, and a focus on anatomy and palpation skills.

If you had the power to restructure DPT programs today, then how would your PT program look?

That is a bit of a loaded question. I think the above response covers most of it. I would like to see us have the option of specializing in school, especially when it comes to orthopedic manual therapy. It is almost as if our profession is really two professions in one.  Inpatient physical therapy and outpatient physical therapy. It would be interesting to see a school separate their students into inpatient and outpatient specialization after learning the general education that every PT should know.

Obviously this would take a ton of thoughtful evaluation of the program as a whole and would change our licensure and likely our legal definition/designation as healthcare providers.

We live in a world of incredible connectivity blessed and cursed by the deluge of information at our fingertips. Given this data-driven context, what words of advice do you have for young PTs today?

Don’t learn everything you think you need to learn about being a good PT online and in social media. Take hands on courses with experienced clinicians who have a healthy respect for research but do not practice based on the research alone.

How has your practice (and your view of the human body) evolved since your graduation?

The most simple answer is this… After PT school I saw a number of clinicians who labeled themselves as “appendage” specialists. For example, I saw a number of email addresses that were labeled as or I also felt like I was a chronic spine pain manual therapist above all else, and add dry needling on top of that I was an IMS practitioner (intramuscular stimulation) and was treated as such by my first boss. I was literally a needle jockey treating patients with mainly IMS and passive manual therapy, rarely actually trying to reinforce the changes I was making. Now, I see myself as a human movement specialist with a goal of continually learning proper human movement, how dysfunction is compensated for, and what treatment is the best reset to improve the patient’s ability to reinforce the improved movement behavior. My main goal is improving quality of life through reducing dysfunction and increasing the patient’s ability to compensate for the inevitable dysfunction with which age, gravity and habitual movement patterns continue to plague our imperfect bodies.

You managed to bring DN under PT practice in CO. How is it progressing across the US on the political front for DN? And what lessons have you learned about the political process?

I am so proud to see how physical therapists across the country are getting involved in advocating for our profession. When we approached the Colorado Department of Regulatory Agencies with a well thought out presentation supported by the knowledge of our practice act and how dry needling fit into that practice, we were able to educate these decision makers to accept the truth that dry needling was and continues to be well within our scope of practice. Since then, we have had approximately 32 more states plus the District of Washington make supportive decisions regarding the use of dry needling in the US, making the total 37 states + DC. The APTA, as most PT’s know, has also come out with a supportive document and is including it in the updated Guide to Physical Therapy Practice to be released later this year. A special thanks to Justin Elliott for all his hard work with each state and to the President of the APTA, Paul Rockar, for his supportive letters and position.

Imagine a future that involves an expanded scope of practice for PTs. How wide could this scope grow?

I can see manipulation, dry needling, musculoskeletal diagnostic ultrasound, class IV laser use and a significant increase in training and knowledge of functional movement as a part of our neuro-orthopedic examination of our patients.

You’re a busy man! How is your typical day structured? (Wake to sleep)

I am blessed. My wife works with me and we are able to work out of our home in Michigan while communicating with our home office in Colorado. At the moment, I travel back to Colorado once per month and typically teach two courses per month — one in Brighton, Colorado, and another course somewhere else in the country. I love being able to have this type of flexible schedule — when I am home I can spend time with my wife and three kids (Ellen 17, Jonas 15, and Noah 12), and work at times around their schedules. Like right now it is 11:15 pm and I am writing answers to this interview. I keep odd hours but that works well with me as I tend to not work well with a scheduled routine. I am also blessed with all the opportunities that God has provided through the passion that I have, with my wife, for progressing the profession of physical therapy.

What advice do you have for someone trying to balance his/her professional and personal life? How do you do it?

Balance is unique to everyone. Make sure you prioritize your life around your beliefs, family and passions. I try to keep this priority in my life:  God/faith first, relationship with my wife second, kids next, work, and then church. But we know that not everything works as we want. Having accountability in our lives and a clear focus on what our current and future goals are is a key part of this. I know I will likely work on this “prioritization” until the day I die.

I always say, “I get to do this!” It really is a huge blessing and I am so happy being able to follow my passion and really feel like I am making an impact on peoples lives.

Which books and authors have impacted you the most? Recommended readings?

The Bible, fiction for escape, the book Four Hour Work Week at which I fail weekly, Who Stole My Cheese, and any anatomy/physiology book or app. I am a serious anatomy junky.

What (in your view) is impeding the adoption of full Direct Access in the US?

Ignorance and poor education of the consumer of what it means to be a doctoral profession.  We as providers and the APTA need to make this a daily focus. Many PTs do not want direct consumer access because of the increase in responsibility, but we really have a responsibility to become the integral part of modern health care that will improve the quality of medicine and access in this new age of patient care.

Life is an adventure. Share one or two of your most memorable adventures so far.

I think every day is a new adventure.  I am living through some of the most exciting changes in physiotherapy right now and feel blessed to be a part of it.

To pick one or two to describe would do a disservice to the many other impacting experiences.

Not trying to sound cliche, but raising our children with my extraordinary wife over the last 17 years while following and balancing my passion for this profession I have been blessed to be a part of would be likely the most rewarding, challenging, and worthwhile experience.  I am humbled daily by my kids and my wife in that they not only tolerate my schedule of traveling, teaching, treating patients, consulting with professional athletes and continuing to be a part of developing two more companies (details on that to come soon), but they support it, take part in it and share in the excitement.  I believe this adventure of being a PT in the US and sharing it with them will have an incredible impact on their lives.  Likely they will chose not to follow in my footsteps as they think I am crazy most of the time.  I am very proud of my family and their support and impact on me.  I look forward to the next phase when I get to share their adventures with them.

I would be remiss to not mention the consulting and interaction I have had with the military as another adventure that I hope to be a part of the rest of my life.  I have taught physiotherapists in both Canada and the United States and dry needling has become almost a required tool for the PT’s in the US who work with the special forces of our military, particularly on deployment.  I have great pictures that they have sent me where they are treating guys in tents in the middle of Iraq and Afganistan.  Many people close to me know that I had tried to become a military PT but for reasons that I can’t really explain, I was always denied.  I look back now and understand that I have a greater impact on the military by teaching the PTs who treat our soldiers, even though I was not able to be one myself.  I look forward to continuing to support our soldiers who have served, continue to serve and will serve in the future.

Dr. Edo Zylstra, thank you for your time with this amazing interview! I wish you the best of luck in your future professional & personal endeavors.

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