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Re: Chiropractic madness!!!!!!!!!!!!
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Re: Chiropractic madness!!!!!!!!!!!! - October 3, 2002 12:31:00 PM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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Crack,
DPT education is a 4 year BS, followed by a 3.5 to 4 year post-graduate training. They are the experts in soft-tissue diagnosis and treatment, just as DC's are the experts in spinal alignment and subluxations. Diagnosis, both NMS and that resulting from medical screening (not the same thing as medical evaluation) is within our practice scope as much as in yours. In short, DPT's are clinical doctors just like OD's, DDS's, etc., and are equally offended by the subordinate role that DC's incorrectly tend to think of us as. I trust that the following will help to educate.
Our limitations, with respect to DC's, is that we can't yet x-ray or prescribe medication, nor be reimbursed as a direct-access portal of entry provider under Medicare --- but that's certainly what the near future holds for our profession. DC's limitation with respect to DPT's, is diagnosis and treatment of soft tissue injury, such as, for example, rotator cuff dysfunction --- though some militant mixers with delusions of competence in that area tend to stretch beyond their practice bounds while at the same time hypocritically trying to claim manipulative medicine as their own.
Hope that clears up any confusion for you. Thank you for your question.
For more information on DPT education rigor, I suggest you visit the APTA website at [URL=http://www.apta.org]www.apta.org[/URL] and search the education section.
Dr. Ball
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Re: Chiropractic madness!!!!!!!!!!!! - October 4, 2002 1:29:00 PM
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PC-CRACKER
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From: Kailua-Kona, HI
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Thanks for the link to APTA. Most of my questions were answered.
I was suprised to find that the APTA apparently has no official position on the future of the DPT. I was also suprised to find that there is no official accrediting agency that regulates the education relating to conference of a DPT degree. The perceived liability mentioned in the APTA website,"The physical therapy clinical science and its associated body of knowledge does not justify doctoral-level preparation." is a valid concern in my opinion. This was a concern in the past days of chiropractic education. This concern was addressed and the current DC has a quite well rounded physician caliber education outside of the chiropractic associated body of knowledge.
DCs do, and justly so, perceive a PT(not DPT) to be subordinate to them. A PT is a para-professional. Always was. Always will be. It is good to see this new program (DPT) developing. It needs to evolve further. There are many issues to address not the least of which is the legislation regulating scope,etc...
It is probable that in the future our fields will be one.
PS-By the way I am one of those "militant mixers" that is quite well educated in soft tissue and does know how to address a rotator cuff dysfunction.
Crack
[QUOTE]Originally posted by Andrew M. Ball PT PhD:
Crack,
DPT education is a 4 year BS, followed by a 3.5 to 4 year post-graduate training. They are the experts in soft-tissue diagnosis and treatment, just as DC's are the experts in spinal alignment and subluxations. Diagnosis, both NMS and that resulting from medical screening (not the same thing as medical evaluation) is within our practice scope as much as in yours. In short, DPT's are clinical doctors just like OD's, DDS's, etc., and are equally offended by the subordinate role that DC's incorrectly tend to think of us as. I trust that the following will help to educate.
Our limitations, with respect to DC's, is that we can't yet x-ray or prescribe medication, nor be reimbursed as a direct-access portal of entry provider under Medicare --- but that's certainly what the near future holds for our profession. DC's limitation with respect to DPT's, is diagnosis and treatment of soft tissue injury, such as, for example, rotator cuff dysfunction --- though some militant mixers with delusions of competence in that area tend to stretch beyond their practice bounds while at the same time hypocritically trying to claim manipulative medicine as their own.
Hope that clears up any confusion for you. Thank you for your question.
For more information on DPT education rigor, I suggest you visit the APTA website at [URL=http://www.apta.org]www.apta.org[/URL] and search the education section.
Dr. Ball[/QUOTE]
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Re: Chiropractic madness!!!!!!!!!!!! - October 4, 2002 2:15:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Crack,
For the "official position," on the DPT, you'd have to look at APTA's vision 2020, also on the APTA website. There is an official accrediting body that regulateds the education relating to the conference of an entry-level DPT degree (people with a BS who go to PT school), that's CAPTE. What you're referring to, perhaps, is the fact that for people already with a PT degree (BSPT or MPT), the transitional programs are not accredited by CAPTE. This, strangely, is common for transitional programs that moved professions from MS to doctorate level (such as transitional Au.D., trasitional Phar.D., etc.).
My clinical education, is a 5 years MSPT degree, other than not having had imaging (which I've picked up through novice level by independent study), and differential medical diagnosis, I am subordiante to no chiropractor. In fact, having a Ph.D., I "outrank" any clinical doctor, be it DPT, DDS, DO, DC or even MD, in the world of academics. Problem with that? Deal with it.
I agree that DC education has improved, but the way that they've self-anointed themselves "chiropractic physicians" is laughable. Just as comical as OD's calling themselves opotmetric physicians. I can play that game too, from now on, please refer to me as a "Physiotherapeutic Physician." What's next, Automotive Physician? Come on!
I'm not even going to justify your "PT always was a para-professional" crack with a response, other than to say MD's, PT's, DO's, OT's, SLP's etc., generally consider chiropractic the ugly step-child of the healthcare system, and justly so, it's not evidence-based. Not in the least. Never was. Never will be. It's barely healthcare, much less a "physician." The point is, two can play it that game, and neither one of us is wrong. Now that you've gotten that out of your system, and I out of mine, let's talk reality shall we? PT and DC are on equal footing within healthcare.
As for rotator cuff injury. You may have skill, but you the chiropractor aren't the expert, the physical therapist is. BS, MS, or DPT. Period, end of story. Respect my profesisonal turf and I'll respect yours. Otherwise, you have no right to even attempt to claim manipulative medicine as your own. NONE!
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited October 04, 2002).]
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Re: Chiropractic madness!!!!!!!!!!!! - October 4, 2002 2:35:00 PM
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flexion
Posts: 151
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DC/PT people:
I think both professions need to understand something - the regarded experts in rotator cuff are orthopedic surgeons.
If you fight that assumption then you fight the public, insurers, government and the entire medical and legal system - good luck.
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Re: Chiropractic madness!!!!!!!!!!!! - October 6, 2002 12:21:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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BackTalk,
Yes. That's exactly what I'm saying. It's good to know that there are DC's out there who truly "get it" when it comes to integrative medicine.
Drew
P.S. Kim continues to show himself as a real jerk.
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Re: Chiropractic madness!!!!!!!!!!!! - October 6, 2002 7:34:00 PM
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function
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This is my first time posting on this board, I usually just pop in and read the debates and then pop out. However, I have to post this time. Mr. Ball your comment about Kim Christensen being a real jerk is way off base and very unprofessional for someone who in your position. I went over to the chiroweb site and read the back and forth that you two had. He was very respectful to you and in no way suggested that PT's were subordinate. You on the other hand were very rude...starting off the debate by calling him a hypocrite. For someone who constantly goes on and on about being a DPT and PhD., you have much to learn about professional decorum and plain old manners. I respect your opinions and you are an intelligent person. However, your rudeness gets in the way of the points that you are trying to make. It was evident that Dr. Christensen did not want to continue a debate with you and because of that you call him a jerk. You do a disservice to yourself and your profession with such unprofessional behavior from one who considers himself a professional.
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Re: Chiropractic madness!!!!!!!!!!!! - October 6, 2002 8:53:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Function,
Having defended a Ph.D. dissertation, I'm quite sure that I've earned the title "Doctor," although here on RehabEdge, Drew will do just fine. "Mr. Ball" however, is insulting and inappropriate. That said, you may have a point about my message sometimes being lost in my communication style. I'll try to check that in the future.
As for Kim's article, however, the very nature of it was patronizing and insulting to the clinical doctoring profession of physical therapy. Had I written an article about how physical therapists could and should manipulate patients with spinal misalignment, I assure you that the wrath of chiropractors would have been much greater, and much less tactful than my initial posting to Kim.
Taken in that light, to call me "inappropriate and unprofessional," isn't a fair assessment of the situation. In fact, I maintain that Kim's failure to defend his position was FAR more unprofessional and inappropriate than anything I posted. Being challenged by another professional, and realizing that you don't have a leg to stand on doesn't necessarily mean that the other professional is being unprofessional. It may mean, as in this case, that Kim just doesn't like being wrong.
Kim, in my opinion, is WAY out of bounds. My posting was kind considering that this guy is advocating that chiropractors practice outpatient orthopedic physical therapy without a license. Frankly, he's lucky no one's yet reported him to the Washington Board of Physical Therapy examiners. I'm sure they'd be delighted to hear about his activities. All I did was ask him questions that put him on the defensive and didn't bow to the superiority that he seems to think he deserves.
I'm unprofessional? Maybe --- but not because of that exchange!
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - October 7, 2002 4:46:00 AM
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mcap1
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Group:
I will admit that there are many, many substandard PTs. I will also admit that I know very little about chiropractic education. But there are many PTs who are quite good and, in my opinion, it isn't even close. A patient with a RTC would be far better served seeing a PT. I will list the reasons below:
1. We have extensive experience in this area and are prepared very well (in most programs) to handle outpatient orthopedic injuires after some clinical experience.
2. We see a tremendous volume of these patients. How many people actually consult a DC with a RCT or similar injury. How many has the average DC seen.
3. We have been trained in hospitals and traditional medical settings. How many DCs have ever stepped foot into a hospital in a professional capacity or observed an orthopedic surgery? I know there are some that do function in hospitals. We even have a DC here at the medical center I work in. But it isn't that common. And......do DCs get clinical experience as a student in any traditional setting?
4. We have always worked closely with physicians. We are the primary referral source for sports med MDs and orthopedic surgeons.
5. We see the vast majority of post-operative cases. How many RC repairs or ACL reconstructions do you see referred to a DC?
6. We publish regularly in Am J Sports Med. I haven't seen many DCs publish there.
7. When do you actually have time to rehabilitate an injury properly?????????? Most DCs I know see can see over 50 patients a day. I know some that have seen 70 or 80 in a day!!!!!! An orthopedic injury such as an RCT is not something that can be addressed in 10 or 20 minutes. To bill for rehabing these people you must be with them, not with the next patient!!!
8. Even in cases of spinal disorders, manipulation, the foundation of your intervention has yet to prove a significant long-term benefit. (Yes there are some studies that do show a good benefit in chronics but for the most part it has been proven to be a good choice for acute pain control only). We aren't even sure of what happens when you do manipulate. Is it actually subluxation reducing? Is it a neurophysiological effect? Is it both? The subluxation theory is questionable at best. As someone who is pursuing a PhD in biomechanics, I shudder to think of what could happen if vertebrae actually moved in and out of place so easily. (I have the same argument with PTs regarding the SIJ by the way).
There are some DCs who are well read, articulate and are probably first rate clincicans. I just heard a great one speak at the McKenzie conference. And yes, some could probably handle an RCT better than a second rate PT. Bu this isn't the norm. I find the DC attitude towards PTs to be arrogant and condescending at times. Until recently, it was significantly harder to be accepted into a physical therapy program (admittedly it is not as hard as it used to be). We are part of the medical mainstream (for better or sometimes worse [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
This may be a totally ignorant comment but I think the nature of the DC employment market leads them to adopt certain postures. When you graduate as a DC, for the most part, the primary opportunities involve joining a practice or starting your own. Therefore, from a very early point, DCs are constantly touting the benefits of their care over everyone, not just PTs! While newer DCs are setting up practices and marketing aggressively, PTs are working in school systems, hospitals, nursing homes, outpatient clinics, industrial settings, cardiac rehabs, etc. Therefore we are less likely to adopt an aggressive posture towards other professions. In some regards this has made us a little complacent. DCs consistently and aggressively look to protect their turf and stake out new turf. That is why we must be aggessive in our own postures. As a nurturing profession this isn't always easy.
Respectfully,
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - October 7, 2002 11:08:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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A few months ago I went to see Dave Attel (host of Insomniac on Comedy Central) in Raleigh, NC. In one of his bits, he went to a skate park where skaters and kids on bikes were clashing at 1:00am to defend their "turf" of the half-pipe.
Dave united the groups with a single line, "We can all agree on one thing . . . we all hate guys on unicycles. Am I right?"
In that vein, I ask how we, the skaters and freestylers of the healthcare world, feel about Doctors of Oriental Medicine (DOM's) and Doctors of Acupuncture (D.Ac's) vieying for time on "our" half-pipe. Are chiropractors prepared to give up acupuncture to D.Ac's? If not, how can a DC justify superiority in acupuncture over someone with a clinical doctorate IN acupuncture? Similarly, are PT's prepared to give up Yoga-like techniques to DOM's in post-surgical rehabilitative care?
DOM and D.Ac. programs are growing, and if they are in fact a threat to our (DC's and DPT's respective lifeblood), we'd better stop infighting and deal with it. Otherwise, the same thing will happen with them as with ATC's and MT's who have snuck by us in several states with a practice act --- and now both are claiming competence in rehabilitative care of the "athlete," which is increasingly being defined in as broad terms as possible so as to allow small raids upon our practice turf.
WAKE UP!
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - October 7, 2002 12:39:00 PM
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function
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Dr. Ball,
Lets see...first Dr. Christensen's article was brilliant,then it is patronizing and insulting. By your logic, the only legitimate subject matter that a chiropractor could write about would be the spine. "Forget about educating the profession...you are a chiropractor and all you shall know is the spine." Please!
Not every rotator cuff problem is a surgical candidate or let alone post-surgical. Understanding how to diagnose soft-tissue problems is not rocket science and is fully within the scope of a chiropractor. Treating soft-tissue dysfunction is within the scope of a chiropractor as well. I really don't see the problem with educating oneself to benefit one's patients. Why would I want to send a patient across town for something that I can treat just as easily. How about if I live in a rural area with only 1-2 PTs and the patient doesn't want to see another provider because they have a busy life and refuses to drive across town to be seen by someone else. These are real world situations that must be addressed and if the chiropractor has the knowledge to help that patient, by all means do it.
I agree that the preferred person to see for post-surgical rehab is a PT. Most DCs understand that and wouldn't perform the rehab on a post-surgical patient. I think you miss the complete point of Dr. Christensen's article. I do not like to speak for others, but after reading the article and his replys to your attacks it sure seems as if he was simply stating that properly trained...a DC can diagnose rotator cuff dysfunction and can perform/prescribe the proper rehab for said dysfunction. Wouldn't you agree that if the DC is sending a patient to PT for rehab that it would be better for the patient if the DC had a solid understanding of what the rehab would be? That way the DC could make sure that the patient was getting the proper care,would know what to look for, and could better communicate with the PT. Increased communtication is in the best interests of the patients and having a greater understanding of certain conditions is likely to facilitate increased communication.
After reading Dr. Christensen's article the typical DC will have a greater understanding of rotator cuff dysfunction and the rehab of that dysfunction. I doubt that you will see many ortho PTs out there start screaming about losing patients because the "**** Chiro" down the street is doing shoulder rehab now. What you will probably see is more Chiros referring to PTs because they have a greater understanding of the condiditon. There will be some DCs that will do the rehab themselves because that is what they do. Like me...I work in a rehab gym in a occupation medicine center with PTs, OTs, MDs, PAs, DOs, and another DC. We all respect each others skills and learn from each other everyday. We tend to let the PTs and OTs handle the post-surgical stuff because that is their bag, but like I said before...it is not rocket science and properly trained a DC can do just as good a job...so quit with your chicken little and lighten up.
by the way, I purposely called you Mr. Ball in the first post to see if you liked being disrespected...I didn't think that you would.
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Re: Chiropractic madness!!!!!!!!!!!! - October 7, 2002 3:30:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Function,
Actually, I don't altogether disagree with your points, but why you incorrectly assume that PT is only appropriate for post-surgical rehab is beyond my comprehension. Pre-surgical care is the primary function and goal of outpatient orthopedic PT. The post-surgical nonsense is something the chiropractic establishment cooked up to feel a bit more ethical about practicing physical therapy without a license.
It's not only wrong and would be insulting if it weren't such a good example of the average chiropractor's poor understanding of the role of equivocal clinical doctors in the healthcare community --- and just another example of why allowing chiropractors to even think that they're qualified to practice as primary care practitioners, much less primary care physician, is detrimental and potentially dangerous to the patient population.
I don't have a problem with a chiropractor trying to dabble in soft tissue diagnosis and treatment, unless he or she happens to use the "what am I supposed to do, refer the patient to someone 'cross down for something I can treat?" and then FREAK OUT when a physical therapist educates him or herself in the art of mobilization/manipulation and uses the same logic to treat without referral to a chiropractor. Dr. Christensen is such a person, and he can't have it both ways. That, by definition, is hypocracy.
I'm more than happy to debate professional issues and DC/DPT misunderstandings and misgivings, but disrespect for the sake of disrespect with a childish "Mr. Ball" comment, is a personal attack and will not be tolerated. You have a lot to learn from true integrative DC's PT's, even at the BS level, are not your subordinates in most states, a physician referral isn't needed for a PT to work with a patient, and even in thoses states, all but a handful don't consider a DC a physician for that referral purpose. So drop the 'tude, okay bro?
You have a lot to learn from DC's who started out with delusions of grandeuor, and eventually came around to understand what it truly means to be integrative and value your non-chiropractic colleagues. Talk to BackTalk for a while. Then get back to me.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited October 07, 2002).]
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Re: Chiropractic madness!!!!!!!!!!!! - October 7, 2002 7:07:00 PM
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function
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Dr. Ball,
If you read my post, I never assumed that PTs only do post-surgical rehab. In fact I spoke of a chiropractor referring to a PT for a patient that had rotator cuff or shoulder dysfunction. Please don't put words in my mouth!
Regarding your point about Dr. Christensen. After reading his reponses to your attacks, I find nowhere does he mention anything about "FREAKING OUT" about PTs doing manipulation. He doesn't even mention it. He actually strives to state that he respects PTs and works with them. Once again you assume something when the facts on the table do not back you up. Yes, some DCs do "FREAK OUT" and the ACA is fighting against PTs performing manipulation. However, that is politics and a power struggle between the political branches of the professions. You can't apply the policies of a political organization to the rank and file DCS. Just as you can't apply the views of the AMA to the rank and file MD.
Your statement about chiros "dabbling" in the treatment and diagnosis of soft-tissue injuries says much about your attitude. It reaks of arrogance and disrespect. Please realize that we don't "dabble" with our patients. A properly trained DC is easily able to diagnose a soft-tissue injury. The majority of spinal injuries are soft-tissue!
Yes, calling you Mr. Ball was "childish". It was meant to be and it got a rise out of you didn't it? I lowered myself to your level to make a point...calling other professionals names (hypocrite) gets you nowhere, which is probably why Dr. Christensen declined to debate you further. The title of your response to an article that you called "brilliant" was "Chiropractic Hypocrites". You started off a professional dialogue with an insult. How do you expect to further debate with that attitude.
Dr. Ball, you assume way too much and your anger at chiropractic and chiropractors is self-evident. I work in the rehab gym of an occupational medical clinic and daily work with PTs, OTs, DOs, MDs, PAs, and another DC...trust me...I know what true integrative care means, I am there everyday. I doubt you work in such an integrative environment. I feel very lucky to work in such an environment. I have the upmost respect for the PT profession and the skills that they have. We all learn from each other. In fact, I have been teaching the PTs manipulation and I have continued to learn the skills that they have...it is all done in the interest of better patient outcomes. Isn't that what it is all about...getting the patient back to normal function as quickly as possible? I really don't care who does it!
You are an intelligent man, but you are too quick to make assumptions. It reminds me of something my grandmother used to say..."You can tell a Stanford grad anywhere...but you can't tell him anything".....
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Re: Chiropractic madness!!!!!!!!!!!! - October 8, 2002 12:42:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Function,
Understand that the exchange you're pointing to is a small piece of a larger discussion. Nothing has been assumed, and having dropped out of DC school in order to pursue something more than a repeat of the clinical degree in physical therapy that I already had, I understand chiropractic education, philosophy, and ethics all too well. It’s why I left in pursuit of a Ph.D. At the top of my class, at one the more respectable and “evidence-based” of the mixer schools. (I say “evidence-based” a bit tongue in cheek as it was, among other cult-like pseudoscience pushed as fact, the AK nonsense and the inability of the professor to have a scientific discussion about the one piece of supporting literature and about 10 pieces of obliterating literature against it --- that exposed mixer schools for the sham they are and ultimately had me leaving in disgust). The fanatical straights are no better, mind you. What is it that Psycho Sid used to say at Death College of Chiropractic during orientation every year? Used to give my professors and classmates a HUGE laugh. Wasn’t it something like, as he took the stage with a gun in his hand, “If I shoot myself in the head with this loaded pistol, I’ll survive and thrive if my atlas is in line?” The comedy of chiropractic isn’t that Life lost accreditation, it’s that tales of Psycho Sid circled AT LEAST 10 YEARS AGO, and it took the CCE that long to do ANYTHING about it. Forget that I’m a PT, or a Ph.D. in healthcare management. As John Q. Public, when I go to a DC, am I REALLY supposed to trust that the chiropractic establishment is filtering whaco’s and those who practice beyond their practice act and/or training out of their ranks? How can the ACA, CCE, state chiropractic board, or individual DC claim to given this reality? In my opinion, they can’t. They simply can’t be trusted . . . at least not in that regard.
As for your specific points, employing a PT who's "sold his/her soul" and resolved to work as some kind of passive modality technician, subordinate to the chiropractor ISN'T integrative practice. It's a chiropractor taking advantage of a spineless PT. That's not to say that there aren't a few truly integrative organizations out there, but it's not the norm. I respect my dog, doesn't mean that I consider him my equal. That's the problem with chiropractors, as a group, they seem to think they're deserving of being considered somehow superior to the physical therapists. It's not "respect" to use a professional with equivocal clinical doctoring rights within the healthcare community as a subordinate. Those PT's who allow themselves to be professionally abused are at just as much fault.
The ACA represents the DC, ALL DC's, be they ACA members or not, and sets the tone by which they practice. It's every bit appropriate to hold an individual chiropractor responsible for the policies of the professional organization. Likewise, I expect that you'd be justified in confronting a PT on any APTA policy. Furthermore, the response, "I'm not a member," isn't an excuse. Simply put, the professional organization, be it ACA or APTA, speaks for the individual practitioner. If you (the generic you) don't agree with the rhetoric, it's up to the individual to get involved and change what's being proclaimed from the soap-box. In my opinion, inactives are MORE responsible for the professional policies that they don't agree with than the professional association members are.
As for me, not that it's relevant to this discussion, but I work in early intervention pediatrics. Furthermore, I work in an interdisciplinary diagnostic center with MD, NP, PT, OT, SLP, Social Work, Psych, Education, and Nutrition. Prior to that, I completed a post-graduate fellowship in interdisciplinary leadership in neurodevelopmental disabilities. Although I’ve seen transdisciplinary care work in some well-funded systems where a PT provided for not only the primary intervention of neurodevelopmental therapy/gross motor training, but also the secondary issue of speech-language articulation therapy (of course under the direction/supervision of the SLP). Conversely, I’ve seen the horrors of transdisiplinary care when, in a communication disabled child, intervention is provided by an occupational therapist or motor therapies provided by a speech-language therapist in a child with cerebral palsy --- because decisions were made on the basis of nothing more than who happened to have an open slot on their caseload.
Being that the latter is FAR more common in my universe, I suppose I’m a bit biased in my views on the issue. I agree that the patient is primary, and that blending of roles is in the patient’s best interest, and I suppose I owe you commendation for “walking the walk,” and role releasing manipulation to PT’s in kind, but you must understand that this is NOT the norm. Furthermore, DC’s are FAR more aggressive in absorbing education and then claiming the expertise as their own. PT’s are far more passive. Role release for the PT to the DC, therefore, may yield eventual destruction of the profession of physical therapy as chiropractic raids the turf. PT’s as a profession (female dominated), tend to store any “weapon” given to them in a passive and non-threatening manner, DC’s as a profession (male dominated) tend rather to conquer new territory with the knowledge altruistically role-released. Maybe it’s a small percentage, but they are encouraged by articles like Kim’s, and the chiropractic establishment encourages it’s professional terrorists upon other professions such as doctors of physical therapy, doctors of acupuncture, nutritionists, etc. --- doing less than Arafat to police the fundamentalists among them. How can that be seen as anything other than threatening? Even if the intention is virtuous, as you proclaim Kim’s to have been, how can it be viewed as anything less than professionally irresponsible? How can a physical therapist, for example, not be offended by the presumption?
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - October 8, 2002 6:31:00 PM
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johnjfraser
Posts: 102
Joined: June 11, 2000
From: Staten Island, NY
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What business is it for a DC to be treating anything outside of a spinal issue? If you want to start treating hips, knees, ankles, shoulders, elbows, wrists, hands. . . please, the PT profession would love to have you educated as, and practice as a physical therapist. If you are already treating the above body parts, please by all means, post your name, license number, and the state you practice in. I would love to let the state board know of your unlicensed practice as a PT.
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Re: Chiropractic madness!!!!!!!!!!!! - October 8, 2002 7:58:00 PM
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function
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Joined: October 5, 2002
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Mr. Fraser,
Please educate yourself before your spout off about something you obviously do not understand. I practice in the state of California and the scope of practice here allows me to treat all of the above body parts. Even though Dr. Ball and I disagree, at least he demonstrates a knowledge base that allows for an intelligent debate. If you honestly believe that a chiropractor is only trained to treat the spine you have alot to learn. Yes, in school the emphasis is on the spine and spinal issues are the bread and butter of chiropractic, but the spine does not function within a vacuum. Hmmm...let me think...the piriformis is a hip rotator...by your logic I would have to ignore it and just treat the spine. How about the hamstrings, foot pronation/supination, tibial rotation, the ability of the gastroc to load and unload, functional hallicus limitus?... I guess I should just ignore all those conditions and adjust away. Sorry to burst your bubble, but I treat all of the above and more. In fact we just returned a football player to full painfree function by treating the gastroc...and what do you think that he was suffering from....LOW BACK PAIN. The MDs he saw treated his back, the PTs he saw treated his back, the other DC he saw treated his back. The problem is that they immediately went to the site of pain instead of looking for the area of dysfunction and addressing that first. You should learn the teachings of Karel Lewit MD, a well known european manual medicine doctor, "Doctor, when you go first to the area of pain, you are treating the wrong area" (I paraphrase the above quote). My "business" is treating patients to the best of my ability. I have spent a great deal of money and time on continuing education after graduation to improve my abilities and that includes the entire musculoskeletal system. I have taken continuing ed courses from MDs, DCs, and PTs and apply what I learn to my practice. In fact the next seminar I will be attending is Gary Gray's PT chain reaction functional approach and I have to say that his stuff is amazing. I could care less that he is a PT. He has a wonderful approach to the treatment of the musculoskeletal system. You post could be considered insulting if it wasn't so humorous.
Dr. Ball,
I commend you on the acedemic achievements that you have made and I am sure that you do a wonderful job in your chosen profession. However, I am still stumped with how you make certain assumptions. Our PT did not "sell his soul" and is not a passive modality technician. That is insulting! He is actually part owner of the clinic and is one of our directors. I learn from him everyday and have the upmost respect for him. I have gone over my post and fail to see where you got the idea that he was a passive modality technician. Please realize that not all DCs are Sid Williams wannabees. I think he is disgusting myself. It does disturb me how you immediately assume the worst. And how do you know it is not the norm? What evidence do you have to back that up? Have you done a study on inter-disciplinary practices to back up that statement? Is your opinion "evidence based" or just your opinion?
I also fail to follow the logic regarding all DCs being responsible for the policies of the ACA. How about the ICA? Or the WCA? Am I responsible for there policies as well? If so, I must be the biggest contradiction on earth. To carry your logic out to the extreme...all registered democrats are responsible for the behavoir of former President Clinton. You must realize that holding individual practitioners responsible for the actions of a political entity is a stretch. Sure, I would like to change somethings about chiropractic...I will get to it after treating my patients, paying my mortgage, changing my kids diapers, helping the other with his homework, giving my wife the attention she deserves, and playing a computer game once in a while. While I am at it I will try to create world peace and find a solution to poverty. Hmmm...are all Americans responsible for the actions of their government...even if you never vote? You see the fallacy of your position? The professional organization represents the profession organization which is made up of certain individual practitioners. Those individual practitioners determine the direction of the professional orgainization. Those that do not belong to said organization are not responsible for the the policies of that organization. Legally speaking, that is the fact jack.
I find your back handed complient about DCs being far more aggressive absorbing education and then claiming the expertise as their own interesting. Especially when you consider the fact that chiropractors have long been championing the benefits of exercise and proper nutrition. While the MDs were overprescribing anti-biotics and irradiating the thymus, we were called quacks and cultists because we spoke of the body's ability to heal itself and how proper nutrition along with regular exercise could do wonders (yes, before you say it...chiropractic also expoused some completely insane ideas that have since been proven very wrong). My point is many of the ideas that we were ridiculed for are now consider proper. I guess you would say that we are trying to claim expertise in those areas now as well.
Dr. Ball, I guess I just don't worry too much about the "turf war" out there. I tend to believe that the cream will rise to the top in whatever profession. My chosen profession has two distinct boundaries that I live up to and am proud of...non-surgical and drugless (along with the legal scope of practice in my state being my other boundaries). I fail to see the need to place my or your profession in a box. The respective political organizations will continue to fight over power with the winner being the one with the money...think AMA. Do you honestly think the AMA will just roll over if the PT profession tries to use the DPT designation to obtain more practice rights? Right now they like you where you are. They could care less how well trained you are. It will be seen as a threat to their power and all hell will break loose. No other healing profession has such unlimited practice rights as MDs. They are all legally entitled to perform manipulation even when they have no training whatsoever...who cares about standards and safety there. It is all about power and those with the money have it.
Personally, I just want to help my patients with their musculoskeletal problems and will do whatever I can within my California scope of practice to do just that. You and Mr. Fraser may not like me performing shoulder rehab or fitting for orthotics or treating Osgood Schlatters or pronator teres syndrome causing median nerve compression or TOS or patellar femoral snydrome or functional hallicus limitus or lack of calcaneal eversion or........but I do. And what I can't treat, TMJ comes to mind - cause I don't even want to mess with that joint, I refer out. So while you try to make the box smaller, I will continue to cooperate with my peers in the affiliated health care professions (not subordinates) in order to improve patient outcomes.
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Re: Chiropractic madness!!!!!!!!!!!! - October 8, 2002 9:20:00 PM
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johnjfraser
Posts: 102
Joined: June 11, 2000
From: Staten Island, NY
Status: offline
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[QUOTE]Please educate yourself before your spout off about something you obviously do not understand. I practice in the state of California [/QUOTE]
Function,
Frankly, I havent had the chance to review the practice acts of Chiropractic in the states outside of NY (and havent found a need to). And previous to your post, I did not know that you lived in California, and that your practice act was so lax. In NY, the practice is limited to "detecting and correcting bymanual or mechanical means structural imbalance, distortion, or subluxations in the human body for the purpose of removing nerve interference
and the effects thereof, where such interference is the result of or
related to distortion, misalignment or subluxation of or in the verte-
bral column." I agree that other elements effect the forces applied to the spine, and that treatment would not be complete without addressing these same issues. But in my state, treatment of a rotator cuff is way out of the scope of chiropractic practice. As for your comment "at least he demonstrates a knowledge base that allows for an intelligent debate", I will be more than happy to discuss this issue further. Your condescending comments were unfounded and unappreciated.
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John J Fraser, PT, MS
johnjfraser@yahoo.com
[URL=http://www.geocities.com/johnjfraser]http://www.geocities.com/johnjfraser[/URL]
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 4:25:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Function,
Under the California Medical Practice Act, "drugless practitioners" including just about every licensed non-allopathic healthcare practitiner (including not only DC's, but ANY druggless pracitioner) were granted the same general practice rights as allopaths, except that they could not use allopathic drugs or penetrate or sever tissue with a knife. In short in California you're either a medical physician (which Chiropractors aren't), or you're a drugless practitioner "slumming it" with PT's, OT's, and massage therapists. According to California law, the rights of one are the rights of all, with one exception --- chiropractors are actually more limited than any of the other groups:
According to David Prescott,DC,MA,JD,FIACA at Dynamic Chiropractic, "California chiropractors are presently limited to adjusting the spine and only performing additional services as a direct adjunct to the adjustment." As such, John may have a point that for Function, a DC, to practice anything but --- though it may be personally and professionally insulting to him to hear it --- is out of his practice scope and worthy of review by the California board of physical therapists. David writes a very logical argument (that I happen to in most part, agree with and think that DPT's should partner with DC's in increasing rights for "drugless practitioners") for expanding scope of DC practice in California to what you're describing, but that's not the current standard and scope. One can't practice on the basis of what one belives one's degree and scope of practice to be worth. The law is the law --- although I'm sure that David would love Function's help in trying to realize their mutual vision for scope of chiropractic practice in California. Until then --- he's out of bounds and placing himself in a potentially actionable situation. There is no grey here.
Function, I suggest as a cyberfriend and colleague that for your own protection, taking a pro-active position and approaching the California board of physical therapy examiners yourself may be your best course of action. As much as you may hate it, you are answerable to them and or the medical board, not the California board of chiropractic, if your are treating soft tissue injuries/issues that are not a direct adjunct to the adjustment. Any way you slice it, rotator cuff rehab doesn't fall into this category, though I'm liberal in my thinking and would defend on the stand, that SOME orthotic intervention and SOME gastroc issues that you described may be within DC scope --- but not all. It's not an issue of education. In California, it's an issue of law. Law that's not on your side in this matter.
Law, however, are never static. As for being pro-active and marching both DC's and DPT's into the future, I believe that there is middle ground here and work to be done in the mutual interests of both DC's and PT's, but I'd caution you against (as I'd caution any DPT), not to cross that line and assume that it's legally okay. As Ph.D. in healthcare management, and a cyber-friend and colleague --- CYA.
Let's instead work together in the interests of all drugless practitioners. Although it's the history of chiropractic to "push the envelope" and, like Clevland, go to jail for principle, there are more effective ways to build a profession.
Drew
P.S. As you asked, "Have you done a study on inter-disciplinary practices to back up that statement? Is your opinion "evidence based" or just your opinion?" That's a great question and deserves an answer. In very large part, my Ph.D. dissertation looked at the issues of interdisciplinary practices and culture of membership/non-membership between several professions (MD, Psych, PT, and DC to be specfic). You'll find that I rarely make claims that I can't back up.
[This message has been edited by Andrew M. Ball PT PhD (edited October 09, 2002).]
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 5:51:00 AM
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function
Posts: 29
Joined: October 5, 2002
Status: offline
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Dr. Ball,
I am not sure where David Prescott got his information, but he is dead wrong. I will read you verbatim from the Laws and Regulations Relating to the Practice of Chiropractic in California..."License to practice chiropractic, which license shall authorize the holder thereof to practice chiropractic in the State of California as taught in chiropractic schools or colleges; and, also, to use all necessary mechanical, and hygienic and sanitary measures incident to care of the BODY, but shall not authorize the practice of medicine, surgery, osteopathy, dentistry or optometry, nor the use of any drug or medicine now or hereafter included in materia medica."
By the way, wouldn't you think the insurance companies would be denying treatment to anything but the spine and reporting chiros that break the act if we could only treat the spine. I get paid all the time for treating the BODY, not just the spine.
I suggest that David Prescott read the chiropractic laws and regulations before he speaks his mind...I just happen to have my own copy at home and one in the office.
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