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Re: www.defendphysicaltherapy.com
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Re: www.defendphysicaltherapy.com - March 19, 2005 10:12:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Jeep,
Your post is so riddled with error, there isn't much use in my responding to it. I can't and won't argue with someone who makes up the facts and puts them forth as truth other than to say that you should take a look at the same thread running on Chrioweb.com. You'll find that you're not only in a minority among PT's here on Rehabedge, but your own colleagues as well.
SJ,
Jeep is only twisting the facts (or reporting the flawed propaganda that he was fed), and responding to statements that he takes out of context in an effort to support his own flawed argument --- Ignore him.
As for your post, you make a good point. The Arkansas Board of PT examiners should have been involved. You should know then that the the Arkansas Board of PT examiners WAS involved. They said that Mr. Teston was not operating outside the scope of physical therapist practice by performing the grade III and grade IV mobilization that he did. They concluded that the technique applied was not a grade V/manipulation, cavitation or not.
The Board of Chiropractic decided that this was an incorrect interpretation, and in so doing, inappropriately assumed authority to try to regulate PT practice --- slapping Mr. Teston with a $10,000 fine.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: www.defendphysicaltherapy.com - March 19, 2005 1:13:00 PM
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SJBird55
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From: Michigan
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Hey, I don't live in Arkansas... beats me what happened. No one mentioned that the Arkansas board ever ruled on the allegation. I'm still not quite understanding how in the heck the Chiropractic board got involved...
On the flight out to New Orleans from Chicago, I did talk to one of the guys that presented on manipulation being a part of PT programs. I don't remember who he was... but when I struck up a conversation with him, he really didn't want to discuss the Arkansas occurrence. I was kind of disappointed that someone who wants to support manipulation in educational programs would not have been completely aware of that particular case - then again, maybe he was but just didn't want to say anything?
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Re: www.defendphysicaltherapy.com - March 19, 2005 2:22:00 PM
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FLAOrthoPT
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From: West Palm Beach
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In some states it is illegal to state that you offer "physical therapy" without a licensed PT on staff. One such place is Virginia. When the VPTA began to issue cease and disist orders to chiroporactic offices that offered "physical therapy" the chiro board was all up in arms...laws are laws, so why the argument...but when you say laws are laws regarding manipulation...let's talk about cracking knuckles for a second. This manipulation is easily done and done by many. Well if I do the EXACT smae technique with the EXACT force I cannot produce a manipulation immediately following a preceding pop. So what I am trying to get at, is the second one NOT a manipulation because there was no cavitation? And if so..then there is no specific manipulation because the result of a manipulation will not occur everytime, and in the contrary can pop a knuckle with little to no force if it has been several hours, so is this technique with LESS force slow mobilization NOW a manipulation because of the effect? In the osteopathis world which both PT and DC spun off of, the TECHNIQUE constitutes what is and what is not a thrust technique...the RESULT has NOTHING to do with it. Therefore how can someone be prosecuted on a RESULT of a treatment rather than the technique used...and can a swallow carry a 40 pound coconut from europe to africa?
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Re: www.defendphysicaltherapy.com - March 19, 2005 3:10:00 PM
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SJBird55
Posts: 2292
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From: Michigan
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Yes.... It's not a matter of where he (swallow) grips it, it's a matter of weight ratio.
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Re: www.defendphysicaltherapy.com - March 19, 2005 3:18:00 PM
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dross
Posts: 54
Joined: March 16, 2005
From: NJ
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Chiropractic as a whole is a the equivelent of a Schitzophrenic. Any DCs reading this must understand it is not an insult because as doctors you are well aware that physical or mental illness is a condition we treat and not judge. Please note I did not say that chiropractors are schitzophrenic, just the profession.
Schitzophrenia is characterized by delusional thinking, paranoia, hallucinations, disorganization from internal conflict and unimpaired cognition. Schitzophrenics are obsessed with their paranormal ideas and will do everything they can to try to prove they are right. They are highly defensive from paranoia. They will not tolerate anybody taking their ideas from them because they are speacial, they have the power and they are the only ones who can understand.
Chirpractic exhibits these behaviors. The subluxation is a hallucination. It must be imagined. They are constantly trying to defend their position because the most innocent comment or question is taken as an attack. They own manipulation in its many forms. Only they can do it, only they truly understand it. They will not tolerate anybody else doing it.
This what your people in Arkansas are up against. Try working it out with in mind. You guys have the support of the medical commuity, the hospitals, the nursing home etc. Tap into that.
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Re: www.defendphysicaltherapy.com - March 20, 2005 10:11:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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Wow, this got heated quick.
Jeep, you mentioned my name in your post...if you are under the impression that something I said agrees with the Arkansas chiro board...let me gently disabuse you of that notion.
This issue is one of definition. There are no clearly delineated, mutually agreed upon definitions of these terms, mobilization and manipulation. I mentioned one possible way to look at it, and only that.
My earlier post also supports the notion that one can do all sorts of HVLA techniques without ever performing a 'manipulation'. Simply call them Grade IV or V mobilizations.
The funny thing is the amount of effort and number of witnesses brought in by the chiro board to attempt to define such a thing. Ridiculous.
And clearly not a way for our two professions to get along better.
Either way this shakes out, I find it hard to believe that the result with satisfy anyone in either camp, nor lead to a laying down of arms.
Sad.
And for FLA and SJ.... i believe you have two empty halves of coconuts, and you're banging them together. :)
_____________________________
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 22, 2005 6:55:00 AM
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JDMBBuilder
Posts: 49
Joined: December 16, 2004
From: Long Island
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just curious...
Why don't the chiros go after the DO's as well? HVLA is in their curriculum from the second week of starting school. Is it because PT's are using these techniques more frequently then most DO's that practice similar to MD's now? If this is true and it IS about the $$$, then chiros need to seriously rethink why they are in this profession to begin with? For the patient or for the money? If they are truly going after this litigation for the safety of the patient*, then they should go after ANYONE that practices "manipulation", not just PT's. PT's are their sole competitor's, from the BUSINESS point of view. It looks as if this is the reason why they are targeting us. If these techniques can heal a patient then I see no problem from PT's using it because it is OUR BUSINESS to use the best judgement in healing the patient.
Bottom line, Physical Therapy is evolving...Chiropractic medicine needs to evolve as well, or risk the danger of being phased out of the medical world.
*some DC's argue that "manipulation" is only learned in "weekend crash courses" for PTs, therefore it is not safe for PTs to perform these maneuvers on patients. But thats all changing...my DPT program will begin to incorporate high velocity thrust into the curriculum.
_____________________________
"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 22, 2005 7:06:00 AM
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JLS_PT_OCS
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From: USA
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....and I learned a whole host of manual treatment in my entry level PT program, to include HVLA.
The assertion that CEU courses are our primary education in this area is not true.
To answer JDM's question...as a Physician, DOs in most states have an unrestricted practice act, and can do whatever to whomever they choose. They are constrained by malpractice and peer review, and in some states there is more of a codified system. Also, DOs and MDs have the state medical association, a very rich and influential group. They don't go after DOs because they are too well-funded and established. It truly is that simple, the DO/MD is simply too big a schoolkid to try to push around...now the PTs are a smaller, much less rich group, who do not have uniform representation in their associations (read: APTA membership) and therefore are a much smaller kid to try to pick on.
I just don't see schoolyard fights solving or benefitting anyone, anytime. Though I have to say, if someone were to start the fight, I sure would finish it...
But again, it doesn't help us move forward, either DCs or PTs....
_____________________________
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 22, 2005 9:02:00 AM
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Dr.Wagner
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From: Indianapolis
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Primarily it is difficult to "go after" a group such as osteopathic physicians who have been in existence and practicing manual medicine LONGER than DC's. Remember, chiropractic is an offshoot of osteopathy (as it is said in DO programs).
Alas it has come to pass that DCs in some states have requested that DO s take CME's for manipulation to maintain their status to practice OMT. Reasonable.
As for OMT, remember, it is essentially "all things manual", from muscle energy to myofacial to HVLA to LVHA. All of it is taught to DO's from the beginning of medical school.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: www.defendphysicaltherapy.com - March 22, 2005 9:35:00 AM
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JLS_PT_OCS
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Joined: January 30, 2005
From: USA
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Wags,
Given the fact that research currently indicates length of training or instruction does not affect outcomes from manipulation, why do specific CMEs for those who are already trained make sense?
Would you say CMEs for using your stethoscope is reasonable? How 'bout exercise programs CMEs for me? I agree with CMEs for licensure and board cert renewal, but that is a separate issue from getting them in one specific area to be able to continue to do one specific thing.
That CME requirement seems nothing more than an attempt to limit the practice of this simple modality to a precious few, thereby cornering the market. That has nothing to do with 'protecting the public' and everything to do with economic protectionism.
Not good for the consumer at all, wouldn't you say?
Surely the issue of what came first DC or DO is not really relevant to the issue in legislatures. There are pictures of egyptian hieroglyphics of this type of treatment. Healthcare providers of all stripes have been doing this for hundreds, maybe thousands of years. Even laypeople do it sometimes. I doubt the chiro board would have gone after uncle Babaganoush who was popping backs at a family reunion, you know?
The choice of who they select to go after here is really a key part of the discussion...
_____________________________
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 22, 2005 9:49:00 AM
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UTDC
Posts: 221
Joined: December 21, 2003
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Wow this did get heated. Drew, I think you need a time-out. Jeep does have a point that if manipulation is considered to be out of a PT's scope then I guess they could be challenged. I don't think that Jeep is saying that PT's are wrong to perform manipulation, but that they can be challenged when working outside of their scope. That's all. I assume this particular PT was targeted for a reason, I have no idea. In the end, this case may clarify the issue and end up as a positive- except for the poor PT who has to go through the stress and financial difficulty- I would not wish that on anyone.
Interestingly, here in Utah, there is a law on the books that states that only DC's, MD's, ND's and DO's may perform manipulation. However, I know of a number of PT's who do it openly. Hopefully there will not be a repeat of the Arkansas situation here.
Jeff
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Re: www.defendphysicaltherapy.com - March 22, 2005 10:55:00 AM
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hmgross
Posts: 286
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From: Minnesota
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Well then, guess I am happy to be living and working in Minnesota. Statue 148.76 Prohibited Conduct (physical therapy) subdivision 1. No person shall use any chiropractic technique whose end is the chiropractic adjustment of an abnormal articulation of the body.
I don't do that. So if I happen to be mobilizing someone, stretching them, mulliganing them or otherwise muscle energying them and godforbid hear a "pop"--won't have to worry about ending up in hot water.
See also:
[URL=http://www.revisor.leg.state.mn.us/stats/146/23.html]www.revisor.leg.state.mn.us/stats/146/23.html[/URL]
_____________________________
Holly Gross PT
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Re: www.defendphysicaltherapy.com - March 22, 2005 11:47:00 AM
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UTDC
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Holly,
I would think that in your state, you would feel free to perform manipulation. If challenged, you could just say, yeah I was doing a manip, not a "chiropractic adjustment."
Jeff
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Re: www.defendphysicaltherapy.com - March 22, 2005 1:02:00 PM
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hmgross
Posts: 286
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From: Minnesota
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Exactly my point! I have never BEEN worried about it, practicing in MN, but if one were in Utah....
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Holly Gross PT
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Re: www.defendphysicaltherapy.com - March 22, 2005 1:25:00 PM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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This whole Arkansas thing is a chiropractic manipulation.
Rick
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Re: www.defendphysicaltherapy.com - March 22, 2005 5:07:00 PM
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JDMBBuilder
Posts: 49
Joined: December 16, 2004
From: Long Island
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"This whole Arkansas thing is a chiropractic manipulation.
Rick"
....im dying laughing over here!! hahahah. So true.
_____________________________
"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 23, 2005 5:56:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Rick, loved that joke!
Jeff-
If that is the case in Utah, the wording of that statute does not prevent PTs from doing HVLA techniques. This is the heart of the definition issue, and what i'm trying to get at. You can do HVLA stuff with all sorts of cavitations, and it can all be called Mobilization. Now the definition of that word is the issue.
You say PTs do HVLA "openly" in Utah. A cavitation or HVLA does NOT equal manipulation. Therefore they are not in violation of their practice act.
You see what I mean here?
In many states, the law forbids chiros from advertising that they offer "Physical Therapy". But chiros still advertise it in some cases. Talk about an unfair situation, and definitely another case of definitions. No PT in my opinion can tell a chiro what they can/can't do, but they CAN tell them not to call it "Physical Therapy". I think the same approach applies here, PTs treat what you want, do what you want, just don't call it 'Chiropractic' or "Adjustment' or 'Manipulation'.
This guy Teston did none of those things. Yet here he is, going through all this...
The best situation seems to be, to me, to just get out of each other's business, and focus on how things are marketed to the public. That means forbidding advertising and representation of treatment, not on actual techniques. Or else we're into this whole debate again...
Then the cycle of PT/Chiro war continues, and we never make any progress. I don't want that. I doubt my colleagues in Chiropractic want that, either. At least the ones outside Arkansas.
There are better ways for both professions to spend their money, in my opinion.
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 23, 2005 6:42:00 AM
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UTDC
Posts: 221
Joined: December 21, 2003
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"Only primary health care providers licensed under this title as osteopathic physicians, naturopaths, physicians and surgeons, and chiropractic physicians, may diagnose, adjust, manipulate, or therapeutically position the articulation of the spinal column to the extent permitted by their scopes of practice."
Hi Jason, here is the law I was referring to. I'm a little confused by your last post. To me, there is no difference between a manipulation, HVLA, Grade 5 mobilization and an adjustment.
When I referred to PT's openly performing manipulation, they are calling it manipulation, not any of the other hedge phrases.
In any case, I think that the physical therapy lobby needs to change their act, to prevent any more sillyness.
Jeff
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Re: www.defendphysicaltherapy.com - March 23, 2005 8:25:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Jeff,
If you're right, that they are openly doing things not under their practice act, then that IS a problem.
I would also agree that you're right, PT practice acts need to change also. Amen on wishing for the end of the silliness.
When you say you're confused, I know what you mean. Everyone is confused about these definitions, that's kinda the point.
I will agree with you that you and I understand the terms GR V mob, HVLA, and manipulation to be similar. In my practice in the Federal system, I call it "manipulation", because I can.
My point was that if these UT PTs are doing HVLA techniques, they can just as easily call it Mobilization as they can call it Manipulation, and be completely correct in either case.
The law does not restrict a technique, it restricts a word. If the word is not commonly understood and universally agreed upon, that's a problem if we are going to try to enforce the law.
And clearly this word has different meanings for different people.
Like Krishnamurti said "The word is not the thing!"
:)
Jason.
_____________________________
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 23, 2005 9:37:00 AM
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chiroortho
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I don't have any problem whatsoever with PTs performing lumbar manipulations. It isn't hard. Even I can do it with great results, and if I can do it, you can do it.
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Greg Priest, DC, DABCO
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