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How do I know if manipulation is legal in my state?
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How do I know if manipulation is legal in my state? - August 9, 2005 1:59:00 PM
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certMDT
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Joined: April 5, 2004
From: Durham, NC
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Does anyone know how to find out unequivocally whether manipulation (Grade 5 mob) is legal under their state practice act? I worked with an excellent and influential chiropractor in my state of Rhode Island, and he has discussed with me his testimony to the state legislators that makes it illegal for PTs to manipulate. I have many patients, however, who tell me of going to their PTs for manipulation.
My basic practice act doesn't discuss it (that I could find), and an email to the state chapter president wasn't returned. Does anyone have any other leads? Thanks.
P.S. Before everyone starts bashing this chiropractor, his argument was that no one who wasn't trained in manipulation should be allowed to perform it, including PTs and MDs. He always said that he would encourage PTs to use it, if they could show that they had some minimal level of training. How MDs are trained is another story, one that brought a grin to both of our faces...
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Charles Sheets PT OCS Dip MDT
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 2:19:00 PM
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Jon Newman
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From: Amherst, WI
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I don't think I can definitively answer your question but here is a link to the [URL=http://www.wpta.org/graphics/practice-act.pdf]WI state practice act[/URL] . As you can tell from Gil's, Shill's and my posts we practice in an enlightened state. If you read through the practice act you will find info about manipulation and the use of the term chiropractic (sect 448.522). You will find info about the term physical AND physio therapy and the requirements of its use (488.52(1m)). Those who are suffering from a history of poor wording in your practice act may want to forward this to their favorite state rep. if you feel they are stuck on wording.
There was much resistance from the chiros in amending our previous practice act to make it read as it does now. We happened to win this one and both sides survived just fine making one wonder what the battle was all about. The Borg.
Of course our practice act is not perfect but what do you expect from a bunch of cheese heads?
(Sorry if I left anyone out of the WI Enlightenment camp)
jon
P.S. What constituted minimal training in your discussion. The 2 minute video of the procedure used in the CPR for manip?, A CE course? 120 hour certification course?
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 2:45:00 PM
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curio
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"State laws related to the practice of mobilizations/manipulations vary including a few states restricting physical therapists from utilizing spinal manipulation interventions.
Indiana, North Carolina, and Puerto Rico preclude physical therapists from performing manipulation of the spine, ****unless prescribed by a physician*** ( If it's in your Plan of Care then your good ... ??).
Washington State prohibits spinal manipulations or advertisements of manipulations by a physical therapist with or without a physician’s referral.
Florida has adopted a statute stating that physical therapy practitioners are not authorized to practice chiropractic medicine, including specific spinal manipulation.
In Wisconsin, a physical therapist may not claim that any manipulation service is in any manner a chiropractic adjustment that is employed to correct a spinal subluxation.
Arkansas, Iowa, Minnesota, Nevada, Utah, and Washington also have some restriction on the practice specified in law.
All Other states "I" ( To my understanding ) believe are legally allowed to mobilize/manipulate.
Guide to Physical Therapist Practice:
Mobilization/manipulation: A manual therapy technique comprising a continuum of skilled passive movements to the joints and/or related soft tissue that are applied at varying speeds and amplitudes, including a small-amplitude/ high- velocity therapeutic movement.
To access state regulations, go to the Federation of State Boards of Physical Therapy Web site (www.fsbpt.org) and click on the link “Directory of State Boards.” Then select the state for which you want to read the state practice act for specific restrictions or regulations.
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 3:10:00 PM
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Randy Dixon
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448.522 Manipulation services. A physical therapist
may not claim that any manipulation service that he
or she provides is in any manner a chiropractic adjustment
that is employed to correct a spinal subluxation.
I think it is reasonably clear here that a manipulation is allowed, just not a "chiropractic" manipulation.
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 3:30:00 PM
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Jon Newman
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From: Amherst, WI
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Yes it is clear Randy. I like our practice act because in a nutshell it says "you do your thing but don't call it physical therapy (or physiotherapy) and we won't call what we do something other than physical therapy". I feel a group hug coming on.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 4:29:00 PM
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certMDT
Posts: 154
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From: Durham, NC
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JMA - I appreciate the effort - I've been through those sites several times without being able to find the answer I was looking for, thus my request for aid here.
Where are you in Brooklyn? I grew up in Park Slope, but I don't think I could afford a studio apartment there now.
Jon - He never specifically said what the training would involve. I would give him the benefit of the doubt and say that if all PT programs incorporate manipulation, he would agree with allowing that.
Charlie
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Charles Sheets PT OCS Dip MDT
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 4:37:00 PM
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jma
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Hello,
Born and raised in Midwood Brooklyn. Have you tried the chapter website or contact:
Chapter Office
James Leahy
RI APTA Administrative Offices
31 Pratt Street 3rd Floor
Hartford, CT 06103
Phone: (401) 490-6880
Fax: (860) 547-0863
Email: riapta@djstrat.com
Website: [URL=http://www.riapta.com]www.riapta.com[/URL]
I guess the contact person would be the best bet to get the specific info you are looking for, since their practice act is not clear on this particular issue, at first glance.
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Re: How do I know if manipulation is legal in my state? - August 9, 2005 4:39:00 PM
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Jon Newman
Posts: 1707
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From: Amherst, WI
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Thanks for that Charles. I had inquired in a thread a long time ago about how manipulation is presented as course work. The manipulation used in the CPR for manipulation is understandable enough but what of all the other techniques given what we know about our ability to accurately assess bony alignment and its dubious relation to pain states. Is course work in PT school to go down that muddy road?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 1:47:00 AM
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JLS_PT_OCS
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From: USA
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Opinions about numbers of contact hours or "training" only serves to try to place this relatively simple modality of treatment into the realm of some sort of mystical power.
If you went to school for 4 years to learn to do primarily one thing, you'd be protective of it, too.
All opinion aside, I find it pretty funny that so many statutes are so specific about stating it isn't to correct a subluxation.
All the good chiros who post here and the quality ones I've met (I've had the pleasure to meet several great DCs) disavow the subluxation and get a rather embarrassed 'here we go again' look on their face when it's brought up. Kind of the same look I get when I hear about PTs doing HUM stuff.
Regardless of the opinion of this otherwise reasonable colleague of Charles', it isn't possible to link "more training" with better outcomes or safer practice; and no evidence for harm when manipulation is used by PTs. So this is quite clearly a territory grab. And one that should be reversed with all speed.
Imagine if we were really nice and said we were going to "allow" DCs to do rehab, they just have to have some more/better training in school. The mere idea that I have any right to tell a DC what they can or can't do...crazy. of course I don't have that right. Why some think their influence extends to other professions is quite silly to me.
I haven't seen any evidence to suggest that DCs are dangerous when providing rehab services, therefore the only reason I might have for trying to limit their practice would be an attempt at monopoly. Which I don't think any legislature should be supporting.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 4:30:00 AM
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dosrinc
Posts: 335
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From: Bonita Springs
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To clarify curio's post regarding the state of Florida:
PT practice act: 486.012 (11)
... the practice of physical therapy as defined in this chapter does not authorize a physical therapy practitioner to practice chiropractic medicine as defined in chapter 460 (the chiro practice act). For the performance of specific chiropractic spinal manipulation, a physical therapist shall refer the patient to a health care professional licensed under chapter 460.
Also, under 486.125- refusal, revocation, or suspension of license; administrative fines and other disciplinary measures:
(j) practicing or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities which the licensee knows or has reason to know that he or she is not competent to perform, including, but not limited to, specific spinal manipulation.
This requires that we view the chiropractic practice act (chapter 460) to get the definition of chiropractic medicine.:
460.403 Definitions (9)(a) "Practice of Chiropractic Medicine"
Means a noncombative principle and practice consisting of the science, philosophy and art of the adjustment, manipulation and treatment of the human body in which vertebral subluxations and other mispositioned articulations and structures that are interfering with the normal generation, transmission and expression of nerve impulse between the brain, organs and tissue cells of the body, thereby causing disease, are adjusted, manipulated, or treated, thus restoring the normal flow of nerve impulse which produces normal function and consequent health by chiropractic phsyicians using specific chiropractic adjustment or manipulation techniques taught in chiropractic colleges by the Coucil on Chiropractic Education.
There ya go, clear as mud. Does that mean I have to believe what I am doing is treating "subluxations or other malpositioned articulations" to "restore normal flow of nerve impulse" for it to be practicing chiropractic medicine? If so then I'm in the clear.
By the way, good pole question, what percentage of PT's do you think have actually read their state's practice act?
Sorry for the long post,
Rick
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 4:59:00 AM
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chiroortho
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[QUOTE]may not claim that any manipulation service that he or she provides is in any manner a chiropractic adjustment that is employed to correct a spinal subluxation[/QUOTE]One of the most useless statements I've ever heard. That really limits your use of manipulation, huh?
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Greg Priest, DC, DABCO
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 5:24:00 AM
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JLS_PT_OCS
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Greg-
I agree, this sort of language is ridiculous.
Rick-
Given your practice act language, do you feel this leaves open the possibility of prosecution if you manipulate a patient, even if you don't represent it as chiropractic?
Under 486.125 (j) above, does "specific spinal manipulation" mean chiropractic? Or does it mean any manipulation? Or does it mean you represent to the patient you are manipulating a specific level (which hopefully everyone knows by now is not possible)?
I think this is the kind of crap that ensnared people in Arkansas...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 5:33:00 AM
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Randy Dixon
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I think the Florida act is so muddled that it can be interpreted a dozen different ways, including that you can manipulate if you believe you are competent in doing so.
Arkansas was different, spinal manipulation was expressly prohibited.
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 5:46:00 AM
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Randy Dixon
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So I went to the Rhode Island Practice Act and there is no prohibitions from manipulation in either the PT act or the Chiropractict act, so you can do them. I'd talk to my state board and try to expressly protect that though. One interesting thing talked about in another post is the use of physiotherapy by Chiropractors.:
§ 5-30-8 Certification to practice physiotherapy. – (a) Every person desiring to practice physiotherapy in addition to chiropractic medicine and who completed a course of four (4) years, of eight (8) months each, in some school of chiropractic medicine approved by the division of professional regulation of the department of health, completed a course of three (3) years, of nine (9) months each, at some school of chiropractic medicine approved by the division and an additional year, of at least six (6) months, in physiotherapy and all branches of that field, at that school, or has served as an intern for six (6) months in any year at an institution approved by the division, and satisfies the division that he or she is qualified, may take an examination before the state board of chiropractic examiners to determine his or her qualification to practice physiotherapy in addition to chiropractic medicine.
So if they advertise Physiotherapy you can hardly blame them.
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 5:56:00 AM
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certMDT
Posts: 154
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From: Durham, NC
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Randy -
Thanks for the help. Just so I understand, the fact that the language isn't included means that I can perform this particular act? There isn't anything in there (that I could find) about it being outside of my scope of practice to perform injections, or order x-rays, but I know that I can't do that.
I recognize that the practice act can't cover every conceivable modality, but is there a specific section of the act that I missed that would help me to clear this up?
Thanks everyone. Sorry if I'm being a pain. If only this information were hidden somewhere in a PubMed search - I'm usually pretty effective with those.
Charlie
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Charles Sheets PT OCS Dip MDT
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 7:35:00 AM
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dosrinc
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Jason wrote:
Rick-
Given your practice act language, do you feel this leaves open the possibility of prosecution if you manipulate a patient, even if you don't represent it as chiropractic?
Under 486.125 (j) above, does "specific spinal manipulation" mean chiropractic? Or does it mean any manipulation? Or does it mean you represent to the patient you are manipulating a specific level (which hopefully everyone knows by now is not possible)?
Jason, your guess is as good as mine but I sure wouldn't want to be the test case in a court of law, especially if your judge was from Arkansas. Can someone please post the specific language from Arkansas, I am going to the FPTA conference this weekend and would like to be able to compare and contrast the two acts with someone who knows how we might be able to get things changed.
Thanks,
Rick
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Re: How do I know if manipulation is legal in my state? - August 10, 2005 9:46:00 PM
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Randy Dixon
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Charles,
You are a pain.
Here is the most applicable part I could find, in the definitions.
(ii) The practice of physical therapy does not include the practice of medicine as defined in chapter 37 of this title.
Xrays and injections are covered under the practice of medicine.
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 3:36:00 AM
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certMDT
Posts: 154
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From: Durham, NC
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Randy -
Got it. When you put the answers so clearly, I'm embarrassed not to have figured it out myself. I'll keep my questions to myself for a while.
Charlie
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Charles Sheets PT OCS Dip MDT
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 10:38:00 AM
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Randy Dixon
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Charles,
I don't think there is anything clear about my answers or any answers to your questions. That's the problem isn't it. This is just my non-expert interpretation.
I was just kidding about you being a pain, in case I have to point that out.
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