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www.defendphysicaltherapy.com - March 15, 2005 8:22:00 PM
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JDMBBuilder
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Joined: December 16, 2004
From: Long Island
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This is my first post to this board but I’ve been reading it for quite some time now. There is a lot of good information on this site about manual therapy, regarding input from DCs as well. I've been always taught the "team" approach in regards to patient care, although direct access is a positive step towards autonomy in the PT profession. MDs, DOs, PTs, and DCs, all have their respective fields and approach to treatment. The problem arises when the scope of practice of one profession overlaps with another profession. DCs feel that they “own” joint manipulation, from my understanding, and are doing all that they can in terms of legislation and lobbying to keep it way. Similar to the way in which PTs feel that they own rehabilitation (e.g. physiatrists’ scope of practice includes rehabilitation).
As a second-year DPT student at NYiT, I am relatively new to the field, and was wondering what PTs, in general, feel about this dilemma. My interests in PT are leaning towards Manual Therapy (thanks to the BEST manual therapy teacher and mentor, Dr. Howard Makofsky, OCS) and I was wondering what the future holds for this particular area of physical therapy.
By the way, I have nothing against DCs and would also like to hear their opinions on this matter. Their contributions to this forum have been helpful to me as well.
Here is a link to a site that describes they litigation between PTs and DCs: [URL=http://www.defendphysicaltherapy.com]www.defendphysicaltherapy.com[/URL]
-Jeff S
_____________________________
"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT
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Re: www.defendphysicaltherapy.com - March 15, 2005 10:37:00 PM
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Alex Brenner PT MPT OCS
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From: Kentucky
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I remember reading this a few years ago when it happened. It is pretty crappy what the Chiro board down in Arkansas is doing and it breaks down any good relations that we may have between our two professions. I don't agree with what the Chiro board has done down there and it does upset me especially since I am a PT who performs manipulation regularly. What a shame that this is happening. Thanks for the link.
_____________________________
Alex Brenner, PT, MPT, OCS
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Re: www.defendphysicaltherapy.com - March 16, 2005 3:34:00 AM
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JLS_PT_OCS
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From: USA
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I think it is important to realize that as bad as this situation in Arkansas is, and it is bad, we have our share of the blame for the poor relations between our professions as well.
We as a profession have done our share to attempt to restrict practices of paraprofessionals such as athletic trainers and massage therapists, as well as state PT boards have been known to attempt to limit the chiros practice regarding modality use, and probably rehab as well, I'm not sure.
I think most PTs go through several stages of chiropractic feelings:
1. How could they do that?! I can't stand them! Nonscientific cultish voodoo charlatans!!
2. Well, maybe we contributed to this situation as well.
3. I'd be interested in working with them (not FOR them) maybe they have something to add to my skill list.
4. Doesn't much matter what a chiro does. We don't seem to compete really for the same population of patients, and given our practice scope and established authority in research and practice excellence, it really isn't my concern what they do. Defensive actions to practice scope attacks (such as in AR and also recently in TX) are the only real actions taken regarding DCs. And welcoming with open arms the good DCs (read non-subluxation, musculoskeletal practitioners) to the team of patient care.
I think I am at stage 4 now. A DC was an assistant instructor in my PT program, and he was very nice and a great instructor, knowledgeable and approachable. I just thought chiros were trained like us, but focused on passive care and manipulation and not active rehab. I didn't have a problem with that.
Then I graduated, and learned all about the education and training of DCs and the history of our professions. What a shock for me!
I worked my way through the stages above. I now remain convinced that our professions have far more to gain by calling a cease fire than by fighting each other.
I have come to understand that there are good and bad chiros just as there are good and bad MDs and PTs, and that I should be focusing my efforts on working with individual providers and judging from that, not based on what their credentials say.
We will have some overlap with lots of other professions, and I feel the best way to approach this is to just leave each other alone about it. As long as an athletic trainer or chiro doesn't call what they do "Physical Therapy" it shouldn't be any of our business if they choose to provide rehab services. As long as I don't call my work with athletes and sports teams "Athletic Training" or call my manipulative care "Chiropractic", I don't see how other organizations can tell me how to practice.
I think that all of us non-MD/DO providers have a ways to go yet on unrestricted public access and communicating what we have to offer to the public, and that our organization's money would be better spent that way, than by fighting each other. Especially in PT, where the biggest obstacle to direct access and reimbursement is really physician organizations, not the chiros or the trainers.
I realize not everyone in PT feels this way and that they feel our environment is by nature one of exclusion and limitation of practices, and they choose to fight battles within that system instead of trying to see past it, as I try to do. I'm not sure which is better for us in the long run, and I trust that those in our professional organization are working for us in our best interest.
Sorry for the rant...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: www.defendphysicaltherapy.com - March 16, 2005 4:05:00 AM
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Jeep
Posts: 353
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From: USA
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Excellent post Jason-
Perhaps the real bottom line is:
What is the Arkansas PT practice act/scope?
Was this PT in violation of his STATE practice act?
What may be within one state's scope is NOT in another state's. VERY IMPORTANT
I have not seen this particular item addressed here.
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Re: www.defendphysicaltherapy.com - March 16, 2005 4:22:00 AM
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jma
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From: NY
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Hello,
As a former graduate of NYIT myself, I enjoyed the experience of Dr. Makofsky's teachings of manual therapy. Just wait until you get his last manual therapy course! It took us to our limit.
I know about the overlapping of professions but I do not let it concern me. As far as I am concerned, no one "owns" a technique. This is not a problem where I work. I only hear about this when it comes to billing for services. When this is resolved, then it should no longer be an issue.
JMA
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Re: www.defendphysicaltherapy.com - March 16, 2005 4:45:00 AM
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JDMBBuilder
Posts: 56
Joined: December 16, 2004
From: Long Island
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Hi JMA,
We actually just completed Manual therapy 1 and 2 (in fact, i have the final and practical tommorrow, so im a little stressed...im sure u understand). Cant wait for Manual therapy 3 : sacrum. Anyway, It's nice to hear from some NYiT graduates...
My concern is that if PTs lose in Arkansas, wouldn't that set a precedent for other states as well?
-Jeff S
_____________________________
"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT
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Re: www.defendphysicaltherapy.com - March 16, 2005 4:53:00 AM
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jma
Posts: 2414
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From: NY
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Hello,
My best advice for you, if you haven't figured it out by now, is to take with practicals with the lab assistants. I had Makofsky for 2 of them and he can take the practical to a level you never thought possible before. Got through them fine.
I assume he let the class look at the Greenman videos, which were a big help to me before I took the practicals. Nice but they were VHS. Eventually, I got the DVD videos and they are fun to look at.
Yes, the case in Arkansas may have an influence on other states. Haven't heard anything new about that particular case so far.
Good luck on the practicals.
JMA
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Re: www.defendphysicaltherapy.com - March 16, 2005 7:40:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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I also haven't heard about the case in a while.
Mobilizations are fully within the PT practice act in Arkansas, manipulation is not.
The issue therefore, is what is the difference?
Well, depends who you ask.
For PTs, manipulation is just another name for the highest grade of mobilization (V or IV depending on the system you subscribe to). So manipulation equals a Grade V mobilization.
In Arkansas, PTs even have an exemption from the Chiro act for items that are within scope of practice for them. Mobilization clearly is OK.
From my reading of the site, it seems that the Chiro board had a hard time trying to really proven when a mobilization stops and manipulation begins. I would agree that is not really possible to determine, since the term mobilization includes manipulations by definition. They attempted to use the cavitation sound as the difference. Which is funny since we all know you can get that sound doing an ADL activity also.
I think the issue is the chiro board trying to decide what is or is not in the scope of practice for the PT. That obviously is a big problem, both for this innocent PT as well as for relations between the professions.
Even the most open minded PT can be angry about this type of crapola, just as the most open minded chiro can be angry when a PT board tells him he can't use Ultrasound.
I think the precedent angle is interesting, the unfortuate part is that if it does go through, and having read the arguments it seems doubtful it will, that it will have deep repercussions for both professions. That will polarize us, not bring us together. Can you imagine how much money both professions will have to spend on fighting this battle!??! What a waste...
At the end of the day, there are people who prefer more passive care and who may or may not subscribe to the subluxation theory. Those people will end up with a chiro. And clearly some chiros can provide some active care/rehab as well. And should be allowed to, as long as they don't call it "Physical Therapy".
There are others who prefer more active care and will end up with a PT. And clearly most PTs can/will provide manual and manipulative care as well. And they should be allowed to, as long as they don't call it "Chiropractic".
So really, though there is overlap, I really think we are trying to treat two very different patient populations here. And therefore, aren't as at odds as some would like us to be.
I really hope that one day we will leave all this fighting behind us, for the good of both professions.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: www.defendphysicaltherapy.com - March 16, 2005 8:26:00 AM
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Jon Newman
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From: Amherst, WI
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I'll assume the role of health care consumer here.
As a consumer, what can you tell me as the difference between chiropractic care and physical therapy care if neither professions "owns" approaches such as manipulation or exercise or modalities? Here I'm speaking about an up to date chiropractor and an up to date PT.
Why should I go to one versus the other, I'm confused?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: www.defendphysicaltherapy.com - March 16, 2005 10:14:00 PM
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nari
Posts: 1568
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From: Australia
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jon,
A good point made.
A consumer tends to think of chiros as professionals who treat spines, and PTs treat arms and legs. Many try to go to both, PT for their 'sore arm' and to the chiro for their 'sore neck'.
Nobody owns any technique; it is all there for anyone to take a hold of. Psychologists treat pelvic floors (in this city they do, anyway) and OTs teach relaxation techniques. Fitness instructors teach exercises and go into muscle physiology. Masseurs 'mobilise' (passively) the spine. For the consumer, it is total confusion, and word of mouth speaks loudest. I saw someone today who had hours of pain relief from Reiki, about the same he gets from me (he has intractable 24/7 pain from spinal stenosis).
In another post somewhere in cyberspace, someone mentioned that the patient 'appreciates EBM care from a PT', or words to that effect.
To me, they don't care. They just want to feel better. And if Uncle Bob went to a chiro who fixed up his back...then one point to the chiro and relatives of Uncle Bob.
Jason, I couldn't agree more with your last sentence, Why don't we get on with doing what we think is best practice/care, and may the best man/woman win?
Nari
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Re: www.defendphysicaltherapy.com - March 17, 2005 3:24:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Jon,
Good point on the issue of who to go to.
Certainly we have one profession producing quality outcomes research on a foundation of scientific education, a long history of involvement in the medical model, collaborative relationships with other providers, and a widely varied skill set.
We have another that is producing a relative dearth of quality research on outcomes and appropriate use for their interventions, an education that is as much religion as it is science, poor relationships with other providers, and a fairly unidimensional approach to issues.
(I realize these are generalizations, and clearly not every PT or DC fits them, but I would bet we can all agree they are close)
Ironically, it is the second profession which seems to have the best marketing, public relations, and status in the minds of many consumers. Funny, huh? Or maybe sad.
I think competition is good for both professions. It helps the PTs more toward greater autonomy and forces them to retain manual/manipulative care, and it helps the chiros isolate those providers doing things that hold them back, like Contact Reflex Analysis, Applied Kinesiology, Activator Methods, Homeopathy, subluxation mumbo-jumbo, etc.
So in the long run, competition is good for both of us. It helps us both leave behind segments of our professions that we know are... best left to the rubbish heap of history, perhaps?
I think in the future we are looking at some type of combination of the professions?
Hope I haven't offended any DC readers, I really am not anti-DC, and think this is just part of the ongoing issues and development of our professions.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: www.defendphysicaltherapy.com - March 17, 2005 3:37:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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Nari,
"Jason, I couldn't agree more with your last sentence, Why don't we get on with doing what we think is best practice/care, and may the best man/woman win?"
I'll answer your question. Because the chrio association at least in Arkansas is attacking Physical Therapy and this is comming to a town near you. Would you rethink your statement if the same thing was happening in Australia in the form of muscle energy? I think you might.
Todd
_____________________________
Todd
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Re: www.defendphysicaltherapy.com - March 17, 2005 4:22:00 AM
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jma
Posts: 2414
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From: NY
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How do those in Europe feel about this particular case?
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Re: www.defendphysicaltherapy.com - March 17, 2005 4:33:00 AM
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january
Posts: 70
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Jma,
In Europe we aren't concerned for now. For an example, in France, there is 50,000 PTs and less than 2,000 chiros. Chiropractic is not recognized as legal exercise and not recognized neither as a health profession but as a commercial one. Patients and physicians may pursue them in law for illegal exercise of Medicine but in fact, there is a tolerance. The less you talk about them, the less they get power.
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Re: www.defendphysicaltherapy.com - March 17, 2005 5:15:00 AM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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This is new to me. I never imagined the differences between them.
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Re: www.defendphysicaltherapy.com - March 17, 2005 6:15:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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january,
Are you aware of the practice priviledges for PTs in France, or any other European country?
Do you know if manipulation/mobilization of the spine is within their allowable activities or not?
Thanks...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: www.defendphysicaltherapy.com - March 17, 2005 7:41:00 AM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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Here's two links to compare and contrast what our official organizations say we are
[URL=http://www.amerchiro.org/media/whatis/]what is a chiropractor?[/URL]
[URL=http://www.apta.org/pt_magazine/oct99/closer.html]what is a PT?[/URL]
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: www.defendphysicaltherapy.com - March 17, 2005 4:22:00 PM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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I think, as a consumer, I would view the following excerpts from each of the links I’ve provided in my prior post as summarizing the difference between the professions.
From the chiropractic website:
“Such procedures specifically include the adjustment and manipulation of the articulations and adjacent tissues of the human body, particularly of the spinal column. Included is the treatment of intersegmental aberrations for alleviation of related functional disorders.”
And from the PT website:
"In today’s health care system, physical therapists are the experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect peoples’ abilities to move the way they want and function as well as they want in their daily lives."
While I’m not sure what other conceptual framework chiropractors work from, I was taught to work from a disablement model. There was a recent editorial on this in the Feb 2005 issue of PT journal. Perhaps this link will work.
[URL=http://www.ptjournal.org/Feb2005/Feb05_EdNote.cfm]Editor's note[/URL]
Is the difference here one of "the end justifies the means" versus "the means justifies the end"?
If so, which profession is which? Is that an assest or liability?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: www.defendphysicaltherapy.com - March 17, 2005 9:45:00 PM
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january
Posts: 70
Joined: January 3, 2005
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Jason,
[QUOTE]Do you know if manipulation/mobilization of the spine is within their allowable activities or not[/QUOTE]In France, manipulation (HVLA) is "reserved" to physicians and GPs.
DO and Chiros may do these ones but it is regarded as illegal Medicine! :D
PT can't do manips because they aren't in our scope of practice but mobilization (slow motion) are seen as exercises. ;)
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Re: www.defendphysicaltherapy.com - March 17, 2005 10:28:00 PM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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Nari,
Still haven't heard from you or the chiro friendly Silvernail about the question that was thrust upon you both!
_____________________________
Todd
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