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A novel approach to the DC/(D)PT relationship
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A novel approach to the DC/(D)PT relationship - March 22, 2007 1:15:00 PM
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Andrew M. Ball PT PhD
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This ought to spark some debate among PT's and DC's alike. It's an interesting philosophical premise . . .
As printed on Dynamic Chiropractic:
U.K. donates $20,000, Denmark gives $10,000. WFC sets fundraising goal of $100,000.
Submitted by David Chapman-Smith, WFC Secretary-General
As reported in the March 26 issue of this publication, in a new threat to the independence of chiropractic, physical therapists in Brazil, Peru and other countries in South America are lobbying governments for laws making chiropractic a specialty and part of the physical therapy profession.
In these countries, PTs are numerous and recognized by legislation. They see pioneering chiropractors and their patients pushing for recognition of the chiropractic profession. Their response is to claim that chiropractic is part of what they do. In Brazil, for example, there are 95,000 PTs and their licensing body, COFFITO, has supported new short-term postgraduate courses in chiropractic for PTs; started an advertising campaign in the media claiming chiropractic is a specialty of PT; and is fighting to undermine the legislative campaign of the 125 members of the Brazilian Chiropractors’ Association (ABQ).
The World Federation of Chiropractic (WFC), whose 87 member national associations include the ABQ, has commenced an international fundraising campaign to help the Brazilian chiropractors in their David-and-Goliath battle against the PTs – and to stop Brazil from becoming the first country in which a government decides chiropractic is not a separate and distinct profession. Any such decision would have obvious danger for the profession elsewhere in Latin America and internationally.
“The WFC urges all chiropractors and chiropractic organizations to support our fellow chiropractors and the profession in Brazil,” said WFC President Dr. Gerard Clum. “The ABQ has draft chiropractic legislation and the support of some senior legislators, but there is a major battle ahead and the WFC would like to raise $100,000 to help fund that battle.”
“Major thanks to the British Chiropractic Association and the Danish Chiropractors’ Association for early donations of $20,000 and $10,000 [respectively],” said Dr. Ricardo Fujikawa, a Palmer graduate who is ABQ president and represents the Latin American Region on the WFC Council. “This is exactly the type of generous support we need to succeed against COFFITO and the PTs.”
For more background information on the campaign for Brazil, and to make your donation to help, go to [URL=http://www.wfc.org]www.wfc.org[/URL] and visit the newsroom. You will see what the Brazilians are doing to help themselves, and how donated monies are being collected by the WFC and then paid out to reimburse approved and verified costs. [Editor’s note: As mentioned, DC reported on this situation in the March 26 issue. Read “No Carnival for Brazilian Chiropractors” online at [URL=http://www.chiroweb.com/archives/25/07/14.html.]]www.chiroweb.com/archives/25/07/14.html.][/URL]
Chiropractic has been growing rapidly in Brazil since the opening of two university-based chiropractic colleges in the late 1990s – Feevale Central University in Novo Hamburgo, in partnership with Palmer College; and the University of Anhembi Morumbi in Sao Paulo, in partnership with Western States Chiropractic College. The legislation to protect chiropractic and being promoted by the ABQ was approved by a third and final parliamentary Commission in late November 2006 and must now go back to the full house or Camara for final vote. It is being stalled by legislators working with the PT profession, while PTs are providing short courses in chiropractic to try to create a competing chiropractic profession.
It is important for chiropractors everywhere that the profession wins this battle. Make your donation now, and then tell someone else to do the same.
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: A novel approach to the DC/(D)PT relationship - March 22, 2007 1:41:00 PM
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ginger
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You're an odd Ball Andrew
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The Grand Pediculator
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Re: A novel approach to the DC/(D)PT relationship - March 22, 2007 2:25:00 PM
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Marc Bronson
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Andrew,
That's a pretty big bomb you planted there. I'm going to get my kevlar body suit on before opining on this.
Out of curiosity, what do orthopaedically inclined, more manual based PT's think of a future merger or new profession with evidenced based DC's? A doctor of physical medicine or something of the like. Up North it seems like the reforms of the curriculums and profession of mid 90's are starting to produce dividends as DC's are inching closer to integration within the health care system. Only having 2 chiro schools and 6500 DC's helps, since mobilization of the profession can occur much quicker than the US. Like I posted in another thread, DC's are in a couple of hospitals in Toronto and pilot projects to include them in community health centres are in the planning stages.
Thoughts on a possible merger in the US? Why or why not?
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: A novel approach to the DC/(D)PT relationship - March 22, 2007 3:30:00 PM
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Andrew M. Ball PT PhD
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There certainly ARE a few DC's and (D)PT's that can play nice together . . . and when they do, the patient benefits. It's hard, however, to move beyond turf-war discussions of scope of practice, to more important conversations about scope of relative clinical expertise (which is going to be different in EVERY INDIVIDUAL DC/DPT relationship. While I'm not in agreement of any clinical doctoring profession attempting to absorb another, the merger idea is interesting. I will confess, however, that is the first I've heard of this, and I will say that claims and posts made on Dynamic Chiropractic are more often than not "alarmist" and professionally confrontational. Honestly, I would seriously doubt the validity of the claims made --- I would instead question who is trying to collect these funds for political action, and why.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: A novel approach to the DC/(D)PT relationship - March 22, 2007 6:41:00 PM
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Marc Bronson
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Drew,
I've always thought, that first and foremost DC's best attributes was delivery manual therapies. I'm not sure if you've heard of ART, but that was developed by a DC, being taught to thousands of DC's each year and my school is teaching a defacto version of it but cannot call it ART since it is a medically patented technique.
Think of it this way, in terms of relative clinical expertise:
DC: Major in manual therapies (STT, SMT) Minor in rehab
DPT: Major in exercise rehab, minor in manual therapies.
Both professions would be equally adapt at assessment, diagnosis, management and so on. They would just primarily do one thing more than the other.
My point is, is that a future merger of the MSK wing of PT and the evidence-based wing of DC could happen if they could agree on the above (what is the major area I want to focus on and be the best at?)
Regarding Dynamic Chiropractic website, it's just not professional enough in my opinion from an academic/clinical perspective. It's more showmanship than content and I personally think that it's a fitting microcosm of the current chiropractic situation in the US. If schools like National and NYCC were to somehow revolt against the straight schools like Life and Sherman there might finally be a breakthrough down there. I'm not holding my breath.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: A novel approach to the DC/(D)PT relationship - March 22, 2007 6:51:00 PM
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ONstudentPT555
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interesting
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Re: A novel approach to the DC/(D)PT relationship - March 23, 2007 2:58:00 AM
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jlharris
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[QUOTE]
Marc Said:
"DC: Major in manual therapies (STT, SMT) Minor in rehab
DPT: Major in exercise rehab, minor in manual therapies."
[/QUOTE]I'm willing to partially accept this. But feel the DPT should be "Major in MSK, Nueromuscular, cardiovascular and itegumentary rehab, minor in MT"
I had 1 class specifically on exercise prescription in my PT training. I think the problem is we tend to call everything we do (gait training, neuromuscular re-ed, manual stretching, functional training, work conditioning, cardiovascular training/conditioning, etc) exercise. Just as it seems anything a DC does tends to be referred to as an adjustment.
Not trying to discredit your statement, but it's needed to pointed out that PT's can be found operating in many different environments in the healthcare field. Often with very dissimilar function than another field. Examples are the PT that works in a cardiac clinic, the PT that does wound care in a hospital, the PT that works with acute TBI, CVA, MS (and more) patients.
In the US, where does the public see DC's? In a clinic "adjusting" their patients. If this is an unfair representation of DC practice (in the US at least) I'd be happy to learn more.
I know you, specifically, have needed to make a point of your training to help convince some of us of your credibility. However, DPT training is equally rigorous. Besides a 4 year undergrad degree, my PT curriculum included Pathophysiology, Anatomy, physiology, embryology, pharmacology, Medical differential Dx, Imaging studies and prevention and wellness in addition to our "PT" classes. In fact, at our University, we spend most of our first year in the same classes with the physician assistant and pharmacology students.
Canadian DC schools seem to be moving in the right direction in terms of education. I think US PT schools are also moving in the right direction in making us better prepared to be primary care providers as DC's have been for years. Now if the DC schools around here would get rid of the 4 years of "Philosophy" classes and replace them with the EBM Canadian DC's are getting, pt care in the midwest would be greatly improved.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: A novel approach to the DC/(D)PT relationship - March 23, 2007 10:29:00 AM
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Marc Bronson
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Jason,
I agree with what you're saying. I've always wondered how PT's can learn 3 major specializations at once (MSK, neuro, cardiopulmonary). Wouldn't it make more sense to have a separate and distinct training for 4 years completely in MSK alone (along with the medical sciences, of course).
Regarding the DPT programme, I trust the educators have come up with a curriculum that is worthy of the primary care stature and doctorate level. With the shift towards EBM, all NMSK providers are drawing from the same lit as Steve suggested in the other thread.
I think that the future of chiropractic in the US, in terms of long term viability and survival of DPT is to first pay hommage to chiropractics roots, but not let the philosophy override the science and come up with diagnoses that are accepted across the medical field. Second, is to become completely proficient in all aspects of manual therapies, from SMT to STT. Inclusion of active-release-technique type protocols and Graston technique into the curriculum would go a long way to meeting that goal. The Canadian schools have indeed adopted this position too, and myofascial work (a la ART) and Graston technique are being integrated into the "technique" classes.
Just as an aside, when I first started DC school in 2002 there was about a lot of SMT based extracurricular technique clubs (Motion Palpation, Thompson, Gonstead that were there. MP was by far the biggest draw. Fast forward to 2006, my grad, only MP was formally still there, but an ART club, Graston club, and Trigenics club, all soft tissue based arose. Each graduating class has used soft tissue techniques which is why the entering class needs to have that tool up their sleeve. Whereas before clinic was exclusively necks and backs, there's a lot more hips, knees, shoulders, wrists, feet, etc. that could never have been dealt with effectively by extremity adjusting alone. If DC's are going to survive they need to master manual therapies outside SMT and I'm glad up North someone had the foresight to acknowledge this.
That being said, the old timer DC's who are more traditional and rigid think we're ****ing the profession by abandoning the traditional tenets (subluxation, innate intelligence). I'd say we are scientists now first and foremost as opposed to philosophers. Philosophy/Dogma should never overrule science. I hope my colleagues who are educators down there really take time to absorb this, because it's fundamental to the reform of US chiropractic.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: A novel approach to the DC/(D)PT relationship - March 24, 2007 6:41:00 PM
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ginger
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Marc, the fight to bring EBM related manual therapies into mainstream chiro is a daunting one, the fight won't be won in one generation as we discussed. The vanguard of change will likely be in the minds and buying power of educated consumers . All you can do is be an outstanding contributor and believe you make a difference, persistance will always pay off.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: A novel approach to the DC/(D)PT relationship - March 24, 2007 6:52:00 PM
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Andrew M. Ball PT PhD
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Marc,
I hear what your saying, but I think you've historically inaccurate. Although there has been a shift from massage, modalities, and exercise toward manual therapy, physical therapists have been doing SMT since the profession was developed in the 1920's. This is much like chiropractors being developed from some BS story about a good whack curing a janitor's deafness. Suffice to say that both professions have evolved considerably since their respective inceptions.
Manually oriented physical therapists owe NOTHING to chiropractic. Cyriax, who popularized manual therapy among PT's as early as the 1950's, was an osteopath, not chiropractor, and his work was co-opted and built upon by the Australians (Paris, Maitland, Grimbsby --- all physical therapists). The only thing DC's have added to the debate, has been backdoor political bribes in shady bathrooms in Charlotte, NC aimed at restricting physical therapy practice, and the elevation of their profession to be regarded (laughably) as "physicians" entitled to non-specialist status for co-payment purposes.
So I'm not sure what DC you're thinking of that any PT owes his professional roots. The same can't be said for your profession now can it? The co-opting of rehabilitative exercise and extremity treatments by DCs' some would call co-opting of physical therapy by DC's (and others would call downright professional theft) . . . we'll I've yet to hear a DC pay homage to physical therapy for that!
Needless to say, the so called "facts" that you may have been presented while in chiropractic school were, I'm sure you'll agree, jaded at best.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 12:18:00 AM
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nari
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Physical therapy owes quite a lot to osteopaths (Cyriax, Still et al) but as far as I know, nothing to chiropractic. Only relatively recently in Aust have chiros attended established universities; and their practice here seems quite different from what I know of chiropractic in North America. Here some of them do rehab type work, but it's not a big part of their curriculum.
The big difference is that manipulation for PTs was introduced in the 1950s, and dropped in the 60s-80s, then reintroduced. Not many use it; there are alternative methods which are seen as preferable because of the fuss over the risks of manips. We are quite happy,by and large, to leave it to the chiros, but some PTs use it as they choose to.
As to a merger, I am not much fussed either way.
The best man/woman will still do well in the end, and people will choose who they want to see regardless of what happens.
Nari
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 9:12:00 AM
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Marc Bronson
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Sorry guys, this sentence came out all wrong
"I think that the future of chiropractic in the US, in terms of long term viability and survival of DPT is to first pay hommage to chiropractics roots, but not let the philosophy override the science and come up with diagnoses that are accepted across the medical field."
What I was trying to say (bad communication on my part) is that for chiropractic to survive (in the US) in the advent of the of the DPT programme is for CHIROPRACTIC to pay hommage to its historical roots, but not letting it prevent the profession from evolving and abandoning outdated concepts (like subluxation theory).
Sorry that it sounded like PT has anything to pay hommage to chiropractic for, because it doesn't. Nor was I taught this in school. I just poorly wrote that aforementioned sentence. Sorry for the confusion guys.
:(
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BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 2:09:00 PM
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ginger
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Marc, I agree with Nari on the point she made about the best man/woman for the job. I'm not convinced the ideal background is any of the current methods/schools extant. It rather more depends on what therapists learn after school that stand them either above or below a certain ideal level of competancy. I certainly had to unlearn much of what was taught to me as an undergrad, the same seems to be true for you. I do despair for the poor old osteopaths though in Oz, they seem stuck in a misty no wheres land where imagination rules.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 2:24:00 PM
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proud
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Ginger,
In the area of NMSK, I think the US is leading the way now in terms of research.
The irony is that years ago, Canadian trained PT's were highly regarded in the US for their manual therapy skills. However, times have changed and our "motion palpation" skills are up for ridicule( I worked in the USA and keep in touch with people). And our schools and orthopeadic curriculm is going to have to change. Quickly
So I agree with you that trying to pick an "ideal" from the current schools is difficult. But the USA seems to be emerging as the leaders here. My hats off.
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 2:45:00 PM
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ginger
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Hi proud, nice to hear from you . I'm not against pride, but often it gets in the way of objectivity . For instance it is still taught that the Wright brothers were the first powered manned flyers in a heavier than air machine, when history , considered without the US centric pride that is a distinct part of american zeal, reveals two other flyers, one in NZ, the other scotland, that were in the air up to 40 years before those at Kitty Hawk. Edison touted as the inventor of the light bulb, ( he bought the patents ), the list is long. Not unhappy with your pride Proud, just cautioning against further US centric views that may not stand up.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 3:07:00 PM
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ginger
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Proud, just a quick addendum to above , Canadians and canadian physios in particular are given a great deal of respect here in Oz. In general we see your level of authentic science based research as second to none, along with other collective differences from those of your US brethren. I always ask when speaking to someone with what sounds like a US accent, wouldn't like to confuse a Canadian with an American would I.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 4:28:00 PM
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proud
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Ginger,
I am a Canadian PT. Great PT's in Canada. Just making an observation on the great work of the PT's in the US. There seems to be a great amount of solid work coming from them.
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Re: A novel approach to the DC/(D)PT relationship - March 25, 2007 4:38:00 PM
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physioo
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cont education is way stronger in the US
making US physios better IMHO
those who wanna be
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Re: A novel approach to the DC/(D)PT relationship - March 26, 2007 1:02:00 AM
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proud
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Whao,
I was not suggesting "better". Just more progressive in advancing NMSK research.
Which is moving us away from the "guru" era and leading towards EBM and improved outcomes.
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Re: A novel approach to the DC/(D)PT relationship - March 26, 2007 6:44:00 AM
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Dr.Wagner
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Nari,
Nice point (though Cyriax was a MD), having been through both PT and Osteopathic Medical School, the techniques are virtually the same and the names are borrowed from osteopathy.
If you are a good PT, you can do well in the manual medicine portions of Osteopathic Medical School, it is an easy switch.
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Dr. Wagner DO
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