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Spinal Manipulation and States practice acts
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Spinal Manipulation and States practice acts - March 16, 2006 3:44:00 PM
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MPTSTUDENT
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Could anyone provide me with a referrence that discusses which states do not permit PTs to perform spinal manipulation (I believe I have heard there are 2, arkansas and one other) and which states have no specific mention either way in their practice act but still allow it (the case here in indiana). I am doing a case report on a patient who who met the CPR for spinal manipulation for school and need to include special issues such as this is the discussion.
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Re: Spinal Manipulation and States practice acts - March 16, 2006 3:59:00 PM
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jma
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Saw this on a website: Congress of Chiropractice State Association at: http://www.cocsa.org/pubs/resources/88_681_12666.cfm
"PT STATE ACTS PROHIBITING MANIPULATION
Arizona, Florida, Iowa, Maine, Minnesota, North Carolina, Utah, Washington, and West Virginia
*California Attorney General Opinion
A physical therapist cannot manipulate or adjust the spine or any other bony structure since such activity is a chiropractic technique (Atty. Gen. January 21, 1976)."
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Re: Spinal Manipulation and States practice acts - March 16, 2006 4:06:00 PM
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Andrew M. Ball PT PhD
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They are certainly incorrect about North Carolina. PT's in this state can, and do, manipulate. It is SPECIFICALLY stated in our practice act --- what we much have, however, is physician pre-authorization to execute.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Spinal Manipulation and States practice acts - March 16, 2006 4:46:00 PM
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TMondale
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Whatever COCSA is they are wrong. The only two states that prohibit PT's from grade 5 thrust manipulations to spine or extremities are Arkansas, and Washington; Isolated mistakes by state associations that will be rectified in time.
Tim
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Re: Spinal Manipulation and States practice acts - March 16, 2006 5:05:00 PM
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MPTSTUDENT
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Tim do you have a reference for that info?
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Re: Spinal Manipulation and States practice acts - March 17, 2006 2:44:00 AM
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SJBird55
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LOL You always gotta consider the source.
Would you necessarily believe everything you read from a chiropractic site - especially with all the politics and the fact that more than anything, they have a vested interest in desiring physical therapists to NOT have the legal ability to manipulate?
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Re: Spinal Manipulation and States practice acts - March 17, 2006 2:47:00 AM
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chiroortho
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Tim Florida specifically uses the term manipulation as being prohibited. I'd be careful because if, heaven forbid, a patient complains to the Board that you 'cracked my back and hurt me' or something like that, you will be in a serious bind trying to explain that a "grade 5 thrust manipulation" isn't a manipulation.
For example if I was in Pennsylvania (where I think the PTs have succeeded in getting legislation passed so that DCs can't use modalities), and I wanted to use ultrasound anyway, calling it "a transducer generated mechanical energy device" isn't going to be much of a defense if I'm called out for using ultrasound.
Just dealing with reality here.
Drew, could you copy the line in your state practice act and post it here? If what you say is true, and what jma says is true, then clearly there is a conflict in practice acts and you may need to clarify it with your board. They in turn may need to deal with the 'no manipulation by PTs in N.C.' chiro board rule.
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 17, 2006 3:04:00 AM
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SJBird55
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Drew, I have a question that has been brewing in my head for quite a while. And this is a bit off track, but it does deal with manipulation.
You mentioned that you are employed in a setting that also has chiropractors. Politically, with the goals of the APTA and autonomous practice, how do you reach that goal when you obviously aren't going to be functioning at your full capability? Meaning... obviously, you are going to do less and less manipulation of anything since there is a chiropractor in your setting. In the setting that you are employed, you are reducing your role and not using your whole skill set and over time, not be at an adequate skill level to optimally perform manipulation. That may not be an issue unless you move or change employers, but how do you mentally rationalize that you have made a decision to reduce your clinical role?
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Re: Spinal Manipulation and States practice acts - March 17, 2006 3:50:00 AM
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dosrinc
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FYI,
The Florida Practice act for PT's specifically says that PT's may not perform and I quote (as I seem to have to do often on this site):
"Specific chiropractic manipulations to correct a subluxation"
Since I am not a chiropractor and have never been to chiropractic school I can be very confident that I have never performed a specific chiropractic manipulation, and because I have never seen a subluxation I can be very certain that I have never tried to correct one.
I do occasionally manipulate with the goal of inhibiting pain and gaurding and restoring motion around a physiological axis. I also know that the APTA and the FPTA have repeatedly told me that manipulation by this definition is protected in the PT practice act of Florida.
Rick
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Re: Spinal Manipulation and States practice acts - March 17, 2006 3:50:00 AM
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chiroortho
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Drew, found this: [QUOTE]G.S. 90-270.24-90-270.39
PHYSICAL THERAPY PRACTICE ACT: NORTH CAROLINA
Effective: December 30, 1985
Fees Changed August 1, 1999
Article 18B Physical Therapy
90-270.24. Definitions.--In this Article, unless the context otherwise requires, the following definitions shall apply:
(1) "Board" means the North Carolina Board of Physical Therapy Examiners.
(2) "Physical therapist" means any person who practices physical 'therapy in accordance with the provisions of this Article.
(3) "Physical therapist assistant" means any person who .assists in the practice of physical therapy in accordance with the provisions of this Article, and who works under the supervision of a physical therapist by performing such patient-related activities assigned by a physical therapist which are commensurate with the physical therapist assistant's education and training, but an assistant's work shall not include the interpretation and implementation of referrals from licensed medical doctors or dentists, the performance of evaluations, or the determination or major modification of treatment programs.
(4) "Physical therapy" means the evaluation or treatment of any person by the use of physical, chemical, or other properties of heat, light, water, electricity, sound, massage, or therapeutic exercise, or other rehabilitative procedures, with or without assistive devices, for the purposes of preventing, correcting, or alleviating a physical or mental disability. Physical therapy includes the performance of specialized tests of neuromuscular function, administration of specialized therapeutic procedures, interpretation and implementation of" referrals from licensed medical doctors or dentists, and establishment and modification of physical therapy programs for patients. Evaluation and treatment of patients may involve physical measures, methods, or procedures as are found commensurate with physical therapy education and training and generally or specifically authorized by regulations of the Board. Physical therapy education and training shall include study of the skeletal manifestations of systemic disease. Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, manipulation of the spine unless prescribed by a physician licensed to practice medicine in North Carolina, or medical diagnosis of disease.[/QUOTE]So it does clearly appear that Drew is correct that manipulation of the spine is specifically allowed by PTs in N.C. if specifically prescribed by a physician.
Drew, I'm curious. Do you get many prescriptions from physicians that specifically include spinal manipulation? It would seem to me that 'Eval and Treat' would not suffice, as it doesn't specifically include spinal manipulation, which is one of the few specific restrictions listed in your Practice Act.
It does appear that the N.C. PT Practice Act is very favorable for you though, and I'm happy for you in that regard. In fact, if you look at the bold part of my post, it even implies that you could do SURGERY if 'prescribed by a physician licensed to practice medicine in North Carolina'. Goodness gracious, that's broader than my own practice act (although, practically speaking, I understand that PTs aren't going to be removing gallbladders - but your state legislation is remarkably broad!).
Greg
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 17, 2006 3:53:00 AM
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dosrinc
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Greg, eval and treat would certainly suffice as long as the treatment plan that the physician eventually signed included the use of manipulation as a component of treatment, the physician signs that this is medically necessary which is what the practice act calls for.
Rick
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Re: Spinal Manipulation and States practice acts - March 17, 2006 3:55:00 AM
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chiroortho
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Yes Rick, that makes sense.
Just an odd thought here - wouldn't it be weird if you had a great relationship with a really open-minded physician and you gave him a call and said 'hey, there's a mole on this guy's back that's suspicious - would you mind if I removed it?' and he said 'Sure, no problem'?
My goodness, what a practice act. The NC state PT Association has done a fabulous job of getting VERY favorable legislation written into their practice act. Again, I realize that no PT is going to ask to remove a mole from a patient's back, but based upon the Act it almost looks as though they could! Very strange indeed.
Greg
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Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 17, 2006 4:31:00 AM
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USAPT
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I found some info for FL PTs as I practice here:
486.021(11) FL PT Practice Act
…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, including specific spinal manipulation. For the performance of specific chiropractic spinal manipulation, a physical therapist shall refer the patient to a health care practitioner licensed under chapter 460. Nothing in this subsection authorizes a physical therapist to implement a plan of treatment for a patient currently being treated in a facility licensed pursuant to chapter 395.
Ch 460(9a) of FL DC Practice Act
(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 malpositioned 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 physicians using specific chiropractic adjustment or manipulation techniques taught in chiropractic colleges accredited by the Council on Chiropractic Education. No person other than a licensed chiropractic physician may render chiropractic services, chiropractic adjustments, or chiropractic manipulations.
(b) …
(c)1. Chiropractic physicians may adjust, manipulate, or treat the human body by manual, mechanical, electrical, or natural methods; by the use of physical means or physiotherapy, including light, heat, water, or exercise; by the use of acupuncture; or by the administration of foods, food concentrates, food extracts, and items for which a prescription is not required and may apply first aid and hygiene, but chiropractic physicians are expressly prohibited from prescribing or administering to any person any legend drug except as authorized under subparagraph 2., from performing any surgery except as stated herein, or from practicing obstetrics.
On another note or maybe to start a new discussion, how do PTs (especially in FL) react to DCs advertising PT but there is no PT on site.
I would opinions on this first as I have Practice Act info for BOTH sides on this matter
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Jason, PT
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Re: Spinal Manipulation and States practice acts - March 17, 2006 4:41:00 AM
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USAPT
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Therefore, I agree with Rick that I too have not found, nor do I look for, a "subluxation", (unless it's the shoulder..lol) so I will continue to apply joint manipulations whether they are to the spine or any other joint. I was taught that in FL mobilization and manipulation were synonymous terms as far as documentation occurs.
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Jason, PT
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Re: Spinal Manipulation and States practice acts - March 17, 2006 4:46:00 AM
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chiroortho
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USAPT,
The Florida Board exam specifically includes a certification for 'Physical Therapy', meaning use of PT modalities. It's on the actual license renewal form. If you'd like I can scan it and post it here.
I completely understand though your concern about this and if I was a PT I'd probably not like it either. It goes back to turf issues - chiros don't like PTs doing manip, and PTs don't like chiros doing PT.
We look at it this way - we view 'PT' as a set of procedures, not as a rationale to call ourselves a PT. IOW, we perform 'PT' but aren't PTs.
Hope that's not too confusing. It's just the way DCs look at it. 'PT' to us is just a set of procedures, while to you it is your profession. I'd sure take exception to you saying you do 'chiropractic'. So of course I do understand the angst.
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 17, 2006 4:48:00 AM
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chiroortho
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You don't have to be looking for the 'subluxation'- it says 'including specific spinal manipulation' and is not qualified further with any reference to subluxation. In fact, it says that you need to refer to a DC for 'specific chiropractic spinal manipulation' but prohibits PTs from performing specific spinal manipulation (note the absence of the word 'chiropractic' in that clause).
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 17, 2006 5:02:00 AM
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USAPT
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Greg, I agree with you. I definitely DO NOT want to get into a 'terf' war with this as we are all TIRED of that.
It does say 'specifc' chiropractic manipulation. Let clarify, my mobs or manips are non-specific and are not generated to a particular spinal vertebra or segment. Nor could I tell you that I would be anyway. There are good studies using dynamic MRI from JOSPT that tried to do just that but found multiple locations of movement despite applying "mob or manip" at a differing location. (can get you the site if you want it)
I thank you for your response re: my last question. I appreciate your professional opinion
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Jason, PT
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Re: Spinal Manipulation and States practice acts - March 17, 2006 5:11:00 AM
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USAPT
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BTW, Greg
I saw your web site...not too shabby! Given what I have read of your posts for last few years, I would not lump you into the category of 'your everyday quack'...parden the name. I quote that from several of my pts who see the same DC here in town.
Have a good green beer day
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Jason, PT
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Re: Spinal Manipulation and States practice acts - March 17, 2006 5:33:00 AM
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dosrinc
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From: Bonita Springs
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So, MPT student, as you can see there is no clear answer to your question, State Practice Acts by their very nature are open to interpretation (they are written by lawyers right, and lawyers get paid to interpret them, would be kind of like us going around and tripping people) and the groups on opposing sides of the manipulation issue are going to interpret things differently.
I imagine that we will continue to see legal challenges as the one in Arkansas over the next several years with no one really winning but the lawyers and certainly to no benefit of the people we should all be trying to help, our patients.
My advice to you, if you plan on utilizing manipulation in your practice is to be sure that you have documentation of your clinical training in this field and that you have demonstrated that you can perform it competently.
and, oh-yeah, dont forget to snap your fingers simultaneously with the pop so that if your pt is a goon sent in by your local chiropractors you can assure him/her that no chiropractic treatment was performed.
Rick
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Re: Spinal Manipulation and States practice acts - March 17, 2006 8:05:00 AM
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USAPT
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Well said Rick!
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Jason, PT
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