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Re: Chiro Board Fines PT $10,000
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Re: Chiro Board Fines PT $10,000 - September 19, 2003 10:29:00 AM
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Scanner
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I can tell you I have had at least 10 or more patients in their 60's/ 70's in the last 2-3 months stating they had their neck manipulated by a chiropractor. Thats pretty scary.
Natch.
You should be scared to do it.
Many MD's and DO's and PT's would be scared to approach a "hot low back" the way I approach it. Many times these patients need an agressive adjustment/manipulation, especially if it is classic facet syndrome. A first year DC could tackle this. An MD/DO/PT may just do palliative things (and thus they end up in our offices).
You have now crossed into the realm of a "professional". You fear is validated, not because a DC shouldn't be manipulating a 60 or 70 year old neck, because you are ignorant of the risk/benefit ratio present.
I always say:
A "professional" knows what he doesn't know.
[This message has been edited by Scanner (edited September 19, 2003).]
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Re: Chiro Board Fines PT $10,000 - September 19, 2003 3:24:00 PM
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Sam B
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Scanner: I am glad you are such a professional. We could all learn alot from you. I'll keep reading your posts to learn more on how to treat "hot backs" with methods other than palliative care.
Backtalk: Tremendously amusing ( but really not) that you are manipulating 80 and 90 year old patients necks. You must be right, that IS safe practice. You wrote the list of contraindications for manipulation, so I guess we can strike that off any future lists.
Much to learn, so little time. Back to my hot packs and ultrasound....
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Re: Chiro Board Fines PT $10,000 - September 20, 2003 12:14:00 PM
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Sam B
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Age is not a condition, or a pathological state. it is the degenerative co-morbidities that are often undiagnosed that increase with age. Not just degeneration of the musculoskeletal system, but every system in the body. Vascular lumen and endothelial lining change with age, bony osteohytes on X-ray do not always give you an appreciation of the degenerative tissue covering the spur, which may give you much less room between a spur on xray and its proximity to the vertebral artery than realised.
Re-testing vertebral artery after every gain in range of motion makes sense. Who knows if a gain in range may not bring a bone spur too close to a vertebral artery; if the patient in later life has not moved their neck more than 50 degrees for the last 20 years, a gain in 10 degress of rotation for them may prove fatal after they leave the clinic.
My reasons for disagreement in manipulation of an old patient rests of the presence of unknown co-morbidities. I also know that I have many many other techniques to use to help someone, other than manipulation so I do not bother with the risk.
Manipulation of an 80 or 90 year old patient as you have proclaimed as safe, is something I am personally am unwilling to risk for the patients sake. I am sure the public would be thankful for clinicians due consideration of this risk.
I do not question that you may be a highly skilled manipulator and diagnostician, hence have your own comfort level with older patients.
Sincerely,
Sam
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Re: Chiro Board Fines PT $10,000 - September 20, 2003 4:31:00 PM
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Andrew M. Ball PT PhD
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I'm going to have to back BACKTALK on this one. Far too often I see patients that were treated by another PT without relief with hot-packs, e-stim, and ultrasound --- only to end up in my office and with a single evaluation and cervical mobilization walk out of my office pain free. Similarly I can't believe how many other PT's and DC's alike miss simple SI joint problems and treat them with hotpacks, e-stim, ultrasound, McKenzie exercises, and mobilization or manipulation of the lumbar spine.
Does this make me some kind of supertherapist? No, hardly. But considering how often I see "seasoned" PT's treat palliatively, and how remarkably well patients seem to do with mobilization or manipulation of the correct joint --- Backtalk has a point.
Personally, I don't use manipulation much, I fell that I can usually get better results with grade IV mobilizations --- but that doesnt' mean that I never do manipulations. When appropriate, I get a physician script and have at the hypomobile facet joint. I never do a cervical facet however, I'd rather refer that to the chiropractor down the road.
There is something to be said here. Not all chiropractors are created equal. Having spent some time in chiropractic school I know of what I speak. I've seen some rather sloppy manipulations out of DC's graduating from two DC schools in particular, and more often then not their ligament locks are so bad that even though the patient feels better in the short term, they're probably mobilizing hypermobile joints above and below the facet joint that they really want to treat. On the other hand, I've seen some expert technique out of a handful of DC's from a handful of schools, and a handful of PT's with post-graduate manual therapy credentials.
It's not the professional degree folks, it's the skills. It's irresponsible to judge the technique en masse, or on the basis of the professional using it. It's like a loaded weapon, only as dangerous as the person holding it --- but even when all precautions are taken, in the hands of an expert, accidents do happen.
At issue here, is where the Arkansas board of chiropractic examiners gets off trying to regulate the practice of another profession that happens to be trained in the art and science of joint mobilization and manipulation as well. Even if manipulation isn't specifically in the physical therapy practice act, it's not out of a PT's scope of practice to do a manipulation in Arkansas --- but that's beside the point entirely. Shouldn't the board of physical therapy examiners be regulating a PT?
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited September 20, 2003).]
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Re: Chiro Board Fines PT $10,000 - September 22, 2003 8:28:00 PM
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teston
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According to the Arkansas Chiropractic Practice Act the definition of “Spinal manipulation” is:
“Spinal manipulation” and “Adjustment” mean the skillful or dexterous treatment whereby a corrective force or passive movement of the joint is made to realign vertebrae or articulations to their normal juxtaposition.
The Circuit Court Judge ruled to uphold the Chiropractic Order Friday. ......
The Judge stated that there was evidence that Michael intended to “realign vertebrae” when he treated the patient. That’s interesting if you consider that the only time the terminology “Realign Vertebrae” was spoken during the chiropractic hearing was when Michael’s attorney directly asked him if it was his intent to “realign vertebrae” and Michael clearly stated “No”. There was no evidence introduced in the hearing that showed that Michael’s intent was to “Realign Vertebrae” much less in order to move vertebrae “to their normal juxtaposition”.
The Chiropractic board based their decision on the positioning of the patient during treatment and that there was an audible noise. They never even used the words “Realign Vertebrae”.
BTW, Michael wanted Bournephysio to know that he never used a grade IV or V on either patient.
The Physical Therapist in Arkansas need to be very afraid that this is not going to overturned. If Michael loses this then PT’s in Arkansas will not be allowed to treat backs or their articulations.
And, if Arkansas PT’s are not allowed to treat backs than it will only be a matter of time before other states will have similar actions.
We are appealing to the Arkansas Supreme Court next. We need some support.
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 4:14:00 AM
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nrl
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From: israel
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i use manipulations (other then cervical). Any PTs here ever tried to “realign vertebrae” ?
i haven't.
nirit
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 9:42:00 AM
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Andrew M. Ball PT PhD
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Yes. Well sort of. Muscle energy techniques (resisted isometrics) are used to torque rotated vertebrae back into place, but I've never, ever, heard an audible click when performing the technique.
Drew
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 12:41:00 PM
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Diane
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Hi Drew,
I don't think MET rightly belongs to the catagory "manipulation". It seems to me it's way more active and way less passive (from the patient's perspective) than, for example, HVLA with a pop. I think MET more properly belongs in the catagory of "neuro-orthopedic manouver" (a catagory I have just invented, just now..), or regular orthopedic manual therapy. When we start to call everything under the sun and the moon "manipulation", it only murkifies the situation and doesn't identify the dangerous forced techniques out from the non-dangerous non-forced ones, that require a bit of brain output/awareness from the patient.
Just my opinion,
Diane
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 1:51:00 PM
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teston
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From what I have seen and experienced it doesn't matter what you call it. It matters what the chiropractors think it is.
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 5:44:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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Mike,
I'd have your lawyers press the Chiro Board to objectively define manipulation. Is it a pop? Is it a re-alignment of the vertebrae? Is it (as I would argue) both?
If the latter, being that your intent was not to re-align, but rather to increase PROM of a hypomobile facet, and given the fact that your aim was a grade III/IV mobilization, not a grade V (e.g. the pop was incidental). It would seem to me that what you did wasn't a manipulation. I'd suggest that from a legal standpoint, the chiro board cannot enforce "manipulation" if it can't define exactly what that means beyond abstractions.
The counter-suit, therefore, should be a joint ArPTA/individual PT suit, claiming that the board of chiropractic examiners of Arkansas assumed authority that was not it's to assume, in attempting to regulate the practice of physical therapy by claiming that Mike violated the chiropractic act by preforming a technique whose components (e.g. unintentional pops from less than grade V mobs, re-alignment techniques such as MET) rest squarely within the scope of PT practice, and a technique that the board of chiropractic examiners has conveniently failed to define.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited September 23, 2003).]
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 6:41:00 PM
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teston
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Apparently the chiropractic board doesn’t have to define what they think a manipulation is or how it is defined. During the chiro hearing they didn’t even make reference to the definition in their practice act. All the chiro board has to do is decide that the procedure was a manipulation and “IT IS”. That is the problem. We did argue, but they didn’t care. We argued for seven hours and they deliberated for four minutes. They had their minds made up before the hearing even took place, because they don’t want Physical Therapists treating backs.
Have you looked at the chiro practice act in your state? Do you know what power they have to punish anyone they think is practicing chiropractic? Can they enforce the fines they levy? Is there a law in your state that says that only MDs and Chiros can do manipulations? Have you looked at the Chiropractic Congress web site to see what laws the chiros are working on in your state? You might be surprised what you find.
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 6:41:00 PM
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mcap56
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I would seriously doubt that anybody's vertebrae were being "realigned" with manipulation.
Also.....the facet joint problems alluded to above.......please share your diagnostic techniques. Classic facet syndrome? What is this? This has never been defined and no clinical tests have been validated for facet pain. In fact, if you look at those that respond to injections they tend to be pain free in the extact movements that we always think stress the facets I.e. extension and extension with rotation.
mcap
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Re: Chiro Board Fines PT $10,000 - September 23, 2003 8:10:00 PM
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Sam B
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I think Mrs Teston is quite correct. Her husband is the victim of a witch hunt and he is the unfortunate victim. No matter how you label it, any manual technique of the spine can now be called into question in Arkansas. How can you defend yourself when you are guilty until proven innocent?
Sam
[This message has been edited by Sam B (edited September 24, 2003).]
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Re: Chiro Board Fines PT $10,000 - September 24, 2003 3:37:00 AM
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teston
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[URL=http://www.pbs.org/saf/1210/video/watchonline.htm]http://www.pbs.org/saf/1210/video/watchonline.htm[/URL]
Go here and click on "Adjusting the Joints". I bet there will be some PT's that are shocked by the force of the manipulations.
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Re: Chiro Board Fines PT $10,000 - October 11, 2003 3:03:00 PM
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jma
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Hello,
Although, a lot of opinions have been stated, does anyone know the current status of the case going on? I only know that it is on the PT Bulletin but know nothing about current status of the situation.
JMA
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Re: Chiro Board Fines PT $10,000 - October 11, 2003 6:09:00 PM
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mcap56
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I don't know what the status of the case is. For those of us here in New York, the Chiro bill before the legislature is worded in such a way that it would be difficult to perform even mobilization if it were passed. So far, it has gone nowhere. But enough is enough. Taking the high road just won't work!!
mcap
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Re: Chiro Board Fines PT $10,000 - October 11, 2003 6:23:00 PM
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jma
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Hello,
Yes, I just saw the PBS video and I was quite amazed at the techniques used. I am curious to know if the "patient" reported this kind of popping when a technique was performed and if the person sent by the chiropractic board hear this kind of pop. There is no way I would ever use this much force on a patient, nor was I ever taught how to do it that way. Interesting report.
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Re: Chiro Board Fines PT $10,000 - October 13, 2003 8:06:00 AM
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teston
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Michael does not do anything even remotely similar to the techniques that are shown on the PBS video. He was shocked when he saw that video. He couldn’t believe the amount of force used on the patients.
The Circuit Court did not overturn the chiropractic boards decision. The judge said that since the chiro board said he did chiropractic than he did chiropractic. End of story. He didn’t even take the physical therapy boards declaratory order into consideration.
You can read about this case at [URL=http://www.defendphysicaltherapy.com]www.defendphysicaltherapy.com[/URL] . We keep that site updated with what is going on. We have appealed to the Arkansas Supreme Court and are working on getting some amicus briefs from different organizations.
Mcap56,
Does the New York Physical Therapy Practice act allow “spinal mobilizations” and “spinal manipulations”? If it doesn’t you might want to work on getting the right people interested in adding them to your act.
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