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Re: Chiropractic madness!!!!!!!!!!!!
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 6:39:00 AM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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Perhaps I stand corrected, but I'd like a bit more information before saying so. Can you point me to an online version of the California Chiropractic Practice Act so that I may objectively review both claims? Otherwise, could you fax me a copy of the practice act at (919) 560-3018?
If my information is indeed wrong, I'll be the first to say so.
I will, however, say that the line about "as taught in chiropractic schools" is a pretty suave move. That way, your profession can be expanded to infinity so long as it isn't said to be any of the aforementioned clinical doctoring professions (of which physical therapy, psychology, and pharmacy are apparently not listed) just by adding a class or two into chiropractic education. Want to add acupuncture to DC practice? Just add a class! How about labor and delivery? Just add a class! Want to roll over PT's and OT's in the care of rotator cuff injury? Just add a class.
If your quote is accurate (and I suspect it is), once something is the standard of DC education, it is de facto protected by the practice act, unless treading on MD, OD, DDS, etc. I've got to admit, physical therapists aren't nearly as logisically or legally creative in that regard. Hats off!
That may be dangerous to the patient as the first wave expands DC scope (just as I have concerns about the first wave of DPT's), but I've got to admit I admire the political tactic.
That's brilliant. Seriously. As DPT programs are adding more and more into the education of physical therapists (such as radiographic imagaing, medical screening and diagnosis/primary care practice, phamacology/nutrition, etc.) that's a play that physical therapists should STRONLGY consider. Thanks for pointing us to it. I love it!
Thanks,
Drew
[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 12:07:00 PM
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function
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Dr. Ball,
I would be happy to fax you the requested information. I will try to get it to you before 5p.m. eastern time.
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 2:21:00 PM
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flexion
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I'm getting the vibe here that PTs think DCs should just stick to spinal problems since thats all we do in school with addition of a few classes on everything non-spinal.
I would have to assume that PTs would then be referring all their spinal cases to a DC since they aren't as well trained seeing they spend so much more time on all the other parts of the body. After all it would be in the best interests of the patient since DCs are better trained in spinal problems especially if there is a joint involved.
Can a PT see how dumb the above paragraphs look to you when the concept is reversed? I'm reading all this dabbling about soft-tissue and extremity distinctions and really am scratching my head.
We all need to just stick to what we are good at and refer out things out of our league - we have overlapping skill sets... lets drop the DC/PT gloves for a bit.
DCs treat soft-tissue injuries all over the body. Some DCs stick to spinal problems using manipulation. PTs use manipulation.
Some PTs don't use manipulation.
Both are good or bad at it depending on experience and further training. Legislation dictates each of our scopes in our area.
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 3:32:00 PM
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Bournephysio
Posts: 576
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From: Calgary
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I can't say that I know anything about chiropractic education but I find it hard to believe that they learn only about spinal problems over four years. I don't have problems with chiropractors treating extremities if they are properly trained.
Properly trained doesn't mean just reading a book. Clinical rotations, experience, and keeping up to date with the literature are also important parts of the equation. This isn't rocket science but lets give ourselves some credit. It is not easy treating soft tissue injuries and in many respects it is harder than rocket science.
There is no way that we will be able to split NMS conditions between us. Manipulation/no manipulation only spinal/no spinal. No classification will work. We have to accept that there is overlap between our professions like flexion said.
Function: I am encouraged that you feel able to share your knowledge with PTs and vice versa. I would like to be able to discuss and trade ideas with chiropractors about manipulation and other treatment techniques. The person I originally learned spinal manipulation from refuses to teach to chiropractors and he has friends who are chiropractors.
In Ontario there is an inquest into a death that is thought to have been caused by a chiropractic manipulation. The chiropractors are using this forum to promote their belief that only "doctors" should be performing manipulation. This kind of posturing will not lead to better relations between our professions.
I hope that in the future that we will be able to get along better. I think that we have made some inroads amongst ourselves both here and at chiroweb eventhough this discussion has deteriorated.
As for the Christensen article, it was rather basic. I hope nobody was calling it brilliant. I wasn't sure if it was directed at patients or chiropractors.
Doug
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Re: Chiropractic madness!!!!!!!!!!!! - October 9, 2002 4:31:00 PM
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function
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Bournephysio,
You make an excellent point. Sometimes treating the soft-tissue injuries seems like it is worse than rocket science. Treating soft-tissue injuries, be they acute/traumatic or cumulative, can be very frustrating. Especially when you want everyone to be 100% better and you know that it is just not going to happen. And you are correct that just reading a book does not equate to proper clinical knowledge.
Flexion is quite correct about the overlap of the professions. I believe learning from and about the other professions makes one more efficient as a treater.
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Re: Chiropractic madness!!!!!!!!!!!! - October 10, 2002 5:20:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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I used the word Brilliant, but not as people seem to think. It was more along the lines of, "Oh great. This is just great."
Back to the California DC practice act. I'd like to thank Function for sending bits and pieces to me. Having reviewed the act, thought not in its entirety. I think we're both wrong.
All the points that support his argument are in the act, but a few critical points are missing. In section 7, it is stated that a chiropractic license shall not authorize a chiropractor to practice any other clinical doctoring profession. Specifically listed are medicine, surgery, osteopathy, dentistry or optometry.
Article One section 302 describes scope of practice thusly:
"(1) A duly licensed chiropractor may manipulate and adjust the spinal column and other joints of the human body and in the process thereof a chiropractor may MANIPULATE THE MUSCLE AND CONNECTIVE TISSUES RELATED HERETO. (2) As part of a course of chiropractic treatment [as described in section one, manipulation only] a duly licensed chiropractor may use all necessary mechanical hygienic, and sanitary measures incident to the care of the body, including but not limited to air, cold, diet, exercise[defined as general fitness, NOT REHABILTATIVE THEREX], heat, light, massage, physical culture, rest, ultrasound, water, and physical therapy techniques [defined as PASSIVE MODALITIES}, IN THE COURSE OF CHIROPRACTIC MANIPULATIONS AND/OR ADJUSTMENTS."
As such, California law limits chiropractors from performing rehabilitative care, such as say deep tissue work on the psoas, unless it's used "in the course of chiropractic manipulations and/or adjustments." Rehab of rotator cuff injury, at any stage of the process, just isn't ever adjunctive. In my opinion, therefore, to a chiropractor to touch it crosses the line.
I'll admit, however, that legally, orthotic care, and perhaps knee rehabilitation may arguably be adjunctive care to spinal care and may therefore fall within scope. Chiropractors ARE allowed to treat the whole body, but anything other than spinal care must be directly adjunctive to that spinal care. Administering post-surgical knee rehabilitation exercises, or off-the-street rotator cuff treatment, is therefore clearly out of bounds for the chiropractor.
If that paragraph isn't clear enough, paragraph 7 goes on to state that a "A duly licensed chiropractor may only practice to attempt to practice or hold himself or herself as practicing a system of chiropractic." What's been described here, in my opinion, is not adjunctive to spinal care and therefore not considered chiropractic. I think it’s a stretch to say that because ankle and foot problems impact the spine, that a chiropractor has the right to frabricate and dispense orthotics, but the California law seems to allow this. There is, however, no justification under the law for a chiropractor to evaluate or treat a patient with a rotator cuff injury for it isn’t ever adjunctive to spinal care. It’s therefore physical therapy under California law and a violation of California law because, "A chiropractor may not hold himself or herself out as being licensed as anything other than a chiropractor or as holding any other healing arts license or AS PRACTICING PHYSICAL THERAPY . . . unless he or she holds another such license."
A chiropractor CAN treat the whole body, my mistake, but that treatment of any other body part MUST be adjunctive to the spinal care. Treating a rotator cuff injury, therefore, is not considered chiropractic care under your practice act, but is considered physical therapy under the physical therapy practice act. I stand corrected that Function may place himself in an actionable situation not only under the PT practice act, but under the Chiropractic practice act as well.
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - October 10, 2002 7:40:00 AM
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function
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Dr. Ball,
I tire of this back and forth especially when you play fast and loose with the truth. As someone who has done a dissertation should know, when you add your own interpretations to a state regulation you should make that known. You didn't and that is dishonest. NOWHERE in the act does it define exercise as general fitness nor physical therapy techniques as passive modalities. That is your addition and to not acknowledge that is distrubing. Your unelegant twisting of the facts does not change the act of chiropractic in California.
Once again your faulty logic does not make the grade. I will apply your logic to the following situation...Patient A comes into my office for a evaluation after a MVC...cervical sprain/strain is diagnosed and a treament plan is decided upon...during that first visit it is evident that said patient is way too acute for any manipulative therapy...however some light massage, ice, and maybe some passive modality would be of benefit. According to your logic, I could not perform any of the passive modalities because they were not performed in the course of a chiropractic adjustment. I would have to tell patient A, "sorry, I can't help you until I can adjust you...see you in a week...hope you feel better." Sorry, but that isn't how it works.
I am done. You asked that I fax you the information and if it showed that you were wrong that you would admit it. Well, i faxed it to you and you kinda did admint you were wrong while you were trying to dig your way out of a hole by adding your own interpretations to an act without making note that the added interpretations in BOLD PRINT were your own...which in my opinion is intellectual dishonesty. I once again am reminded of that old quote..."You can tell a Stanford man anywhere...but you can't tell him anything"...think about it...
by the way...I only faxed you the parts of the act that pertained to scope of practice because that was the crux of the debate. The whole act is 177 pages long and I was not going to copy and fax all of that.
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Re: Chiropractic madness!!!!!!!!!!!! - October 10, 2002 8:52:00 AM
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mcap1
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"We all need to just stick to what we are good at and refer out things out of our league - we have overlapping skill sets... lets drop the DC/PT gloves for a bit.
DCs treat soft-tissue injuries all over the body. Some DCs stick to spinal problems using manipulation. PTs use manipulation.
Some PTs don't use manipulation."
Then why the extensive legislative efforts to ban other people from manipulating?
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Re: Chiropractic madness!!!!!!!!!!!! - October 10, 2002 8:57:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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It is standard convention to place inserts inside of brackets. There was no distortion of the truth here. Just because you don’t like my interpretation doesn’t make it skewed, nor a distortion of truth.
What we have, is two interpretations of the same language --- broadly by you (which I would interpret, likewise, as a distortion of the truth on your part), and a bit more narrowed (which you interpret as a distortion of the truth on mine).
It is a difference of opinion regarding the same language that is at the root of the DC/DPT debate. It is why chiropractors think they're physicians, why physical therapists think that chiropractors commonly practice outside their scope of practice, and why physicians see you guys as well outside of bona-fide healthcare. You can either learn from this or brand others who don’t agree with your broad interpretation anti-chiropractic. Your choice.
I've been quite objective about this, but I'm finished discussing this issue with you, the only person bringing emotion and skewed opinion to this is you. Waste someone else's time. As MY grandmother used to say, "Never should a learned man argue with the village idiot, for a bystander can't tell whose who."
Not that I'm charging you as an idiot, but I'll not be reduced to the same level of bias and skewed perception that's characterized your posts to date and then be charged in kind as skewed and anti-chiropractic. I think those chiropractors on this site and Chiroweb know me a bit better than that, and I have nothing to prove to you or anyone else by continuing this.
I've said it once and I'll say it again. If you think I'm playing "fast and loose," then I suggest you quit whining with me and approach the California board of Physical Therapy Examiners. It is they, not your chiropractic board, that you'll have to answer to if found to be executing physical therapy without a license. If you're so sure of yourself, why not just ask?
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - October 10, 2002 2:15:00 PM
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flexion
Posts: 151
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mcap1:
I practice in Canada and there isn't any sort of attempts on banning going on here; but, I'll comment on my oppinion of it in the US.
I think the DCs want people to be adequately trained if they perform manipulation. I guess the legislative debate is about what is adequate. Honestly, I'm not sure what a reasonable training timeframe would be... my best guess would be 500 hours. I think the idea of taking a weekend course to learn manipulation is pushing it a bit.
I suppose PTs could rally a group to ban many from performing rehabilition on the same basis - think of all the substandard AT, OT, DCs, etc. out there and it probably bothers your profession as well.
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Re: Chiropractic madness!!!!!!!!!!!! - October 11, 2002 7:20:00 AM
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Bournephysio
Posts: 576
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From: Calgary
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Flexion: There have been attempts at banning PTs from manipulating here. Chiropractors in Quebec sued a PT for manipulating. Comments made at the Ontario inquest suggest that chiroprators are not supportive of PTs doing manipulation.
You would not find any opposition in Canada to having minimum standards for any professional performing a spinal manipulation. Currently, only a couple of provinces have actual regulations for PTs.
What are you including in your 500 hours? If you are only counting in class lab time doing actual spinal manipulations, I think that 500 hours is absurd. If you are counting theory, anatomy, pathology, assessment, self-study, supervised lab time (including mobilization), practice time, etc, the hour count is probably low.
Do you know anything of the Canadian orthopaedic division manual therapy program? If so, how do you think it stacks up? Are there any gaps in this education that you can see? It is an IFOMT certified program. It is also the basis for the clinical masters (not entry level) program at UWO.
Doug
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Re: Chiropractic madness!!!!!!!!!!!! - October 11, 2002 10:28:00 AM
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flexion
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I did not know of the case in Quebec. I get regular updates on the inquest in Ontario but have never seen a mention of PT - is there a reference you could point me to?
My training just in manipulation (biomechanics and manipulation) not including pre-clinical or outpatient portions was 600 hours of our 5150 hours. I figured 500 sounded reasonable for anyone else wanting to learn.
Just a couple of hour breakdowns since I've got the calendar in front of me:
Anatomy 700 hours
Biochemistry 150 hours
Pathophysiology 450 hours
Microbiology and Public Health 150 hours
Diagnosis 500 hours
X-ray/Imaging 250 hours
Point of Interest: 30 hours on subluxation concepts - basically nothing.
I can't say I know anything about the course offered at UWO. It would be interesting to see what they do though.
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Re: Chiropractic madness!!!!!!!!!!!! - October 11, 2002 6:47:00 PM
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Bournephysio
Posts: 576
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From: Calgary
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There is something on the Quebec case on Jim Meadows site: swodeam.com/mto.html click on current column then march 29. The latest news I have heard is that the chiropractic appeal was refused.
My info about the inquest comes from the latest cpa ortho division, CAMT, and COMTA general meetings. This came second hand so I can't be sure of the accuracy.
We spend a lot of time learning mobilization techniques. Most manipulation techniques are thrusts with the same setup as the mobilization so I don't think that it is necessary to do 500 hours on top of the time spent learning mobilization. I have close to 100 hours in specific spinal manipulation courses from some of the top therapists in Canada and one from Norway. In addition to being tested, I think that this is more than enough training.
Doug
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