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Re: How do I know if manipulation is legal in my state?
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 12:58:00 PM
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drbuddy
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Since we are on the topic, I found the following interesting while looking through PA's practice acts for PTs and DCs. It would appear that manipulation, as in grade 5 mobs or HVLA manipulation, is beyond the scope of PTs in PA.
PT Act:
"Manipulation/manual therapy shall mean a group of techniques... yadda yadda yadda ...throughout the normal physiological range of motion."
Versus the DC Acts:
"Manipulation/adjustment - a passive manual maneuver... yadda yadda yadda ... beyond the physiologic range of motion ... intended to result in cavitation..."
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 1:11:00 PM
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Jon Newman
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So how does one determine if they have gone beyond physiologic limits? Normally, I would consider that an injury.
jon
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 1:26:00 PM
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drbuddy
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Note that it is "physiologic range of motion" and not "limits". Actually, in that act it goes on to say that it is within the "boundaries of anatomical integrity".
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 1:46:00 PM
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Jon Newman
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Sorry about that. I just thought of the physiologic end of range of motion as a limit and thus an odd thing to try to surpass in order to make someone feel better. But the question of how to determine the difference is still a valid one.
jon
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 4:21:00 PM
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drbuddy
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True. I guess if your intention is to cavitate the joint, you can call that a mob beyond the normal physiologic range of motion.
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 4:40:00 PM
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Jon Newman
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Really? Are you trying to say that if a joint pops it is because it went beyond its normal physiologic range?
jon
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 5:02:00 PM
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drbuddy
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It's a good sign that it did. If you use an HVLA manip causing a joint to cavitate, it's a good bet you moved that joint into the paraphysiological space.
I'll have to dig around to see if I can find a paper on the subject. It was either in Spine or one of the chiro journals. It's been a long day and I might be misusing terminology...
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Re: How do I know if manipulation is legal in my state? - August 11, 2005 9:37:00 PM
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Randy Dixon
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I think the question of "intent" then becomes an issue. Did the PT "intend" to produce a cavitation or was it just incidental? How will physiologically normal ROM be measured? Does this apply to extremities as well?
It just clouds the issue more, in my opinion.
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 6:55:00 AM
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JLS_PT_OCS
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Physiological space, paraphysiological space, anatomical limits...who is defining these terms? Oh, that's right. Whoever some board excepts as an expert. That makes sense...
I would think the PT practice act keeps you from dislocating someone's spine, given that wording. Glad we cleared that up.
Seeing as how these cavitations are created by people doing their ADLs and even hugging each other, are we going to prosecute them for daring to move their own spines or those of their family members' into the famous "paraphysiological space"?
Doesn't this sort of make the whole argument silly?
J
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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
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 7:11:00 AM
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JLS_PT_OCS
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Ooh, that should be "accepts" as an expert.
Hopefully no one is accepting me as a grammar expert.
:)
J
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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: How do I know if manipulation is legal in my state? - August 12, 2005 10:09:00 AM
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chiroortho
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You can hit the 'edit' button, the 'pencil-and-paper' icon to the right of the top of your post, and edit your post so that followups are not necessary.
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 10:44:00 AM
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JLS_PT_OCS
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Thanks, Greg.
The things you learn on RehabEdge...
:)
J
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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: How do I know if manipulation is legal in my state? - August 12, 2005 1:20:00 PM
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truthseeker
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So if I crack my knuckles, am I practicing Chiropractic without a license. Or is it only if I intend to crack them? Not clear. What about all of the people that crack their own necks? If they live in Arkansas are they going to be fined?
I'm sorry I'm such a smart a$$.
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 2:08:00 PM
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drbuddy
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How do you define a grade 5 mobilization?
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 4:04:00 PM
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jma
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I agree, how about those who can crack their own necks and then go to PT?
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 4:11:00 PM
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Jon Newman
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Grade 5 mobilization: A largely unnecessary passive maneuver of a joint performed with indeterminable force or localization and intended to fix a problem deduced to exist through unreliable tests and measures.
I made that one up myself but someone may have an official definition someplace else.
jon
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 4:26:00 PM
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jma
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Here is one definition from one of my old textbooks, "Grade 5: thrusting movement done to the anatomical limit of the joint". My question based on this is the anatomical limit the same as beyond the "normal" physiolgic ROM?
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 5:27:00 PM
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FlaDC
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this is the exact wording of the PT practice statue in Florida:
11) "Practice of physical therapy" means the performance of physical therapy assessments and the treatment of any disability, injury, disease, or other health condition of human beings, or the prevention of such disability, injury, disease, or other condition of health, and rehabilitation as related thereto by the use of the physical, chemical, and other properties of air; electricity; exercise; massage; the performance of acupuncture only upon compliance with the criteria set forth by the Board of Medicine, when no penetration of the skin occurs; the use of radiant energy, including ultraviolet, visible, and infrared rays; ultrasound; water; the use of apparatus and equipment in the application of the foregoing or related thereto; the performance of tests of neuromuscular functions as an aid to the diagnosis or treatment of any human condition; or the performance of electromyography as an aid to the diagnosis of any human condition only upon compliance with the criteria set forth by the Board of Medicine. A physical therapist may implement a plan of treatment for a patient. The physical therapist shall refer the patient to or consult with a health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 466, if the patient's condition is found to be outside the scope of physical therapy. If physical therapy treatment for a patient is required beyond 21 days for a condition not previously assessed by a practitioner of record, the physical therapist shall obtain a practitioner of record who will review and sign the plan. A health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 466 and engaged in active practice is eligible to serve as a practitioner of record. The use of roentgen rays and radium for diagnostic and therapeutic purposes and the use of electricity for surgical purposes, including cauterization, are not authorized under the term "physical therapy" as used in this chapter. The practice of physical therapy as defined in this chapter does not authorize a physical therapy practitioner to practice chiropractic medicine as defined in chapter 460, including specific spinal manipulation. For the performance of specific chiropractic spinal manipulation, a physical therapist shall refer the patient to a health care practitioner licensed under chapter 460. Nothing in this subsection authorizes a physical therapist to implement a plan of treatment for a patient currently being treated in a facility licensed pursuant to chapter 395.
re-read this passage: The practice of physical therapy as defined in this chapter does not authorize a physical therapy practitioner to practice chiropractic medicine as defined in chapter 460, including specific spinal manipulation.
it would appear to me that manual manipulation of the spine by a PT is specifically prohibited by your practice act.
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 9:49:00 PM
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Randy Dixon
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Ooh, that should be "accepts" as an expert.
Hopefully no one is accepting me as a grammar expert.
J
No, but we will except you as a grammar expert.
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Re: How do I know if manipulation is legal in my state? - August 12, 2005 9:55:00 PM
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Randy Dixon
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Fla,
Now we have to go back and look at precisely how the chiropractic practice act defines specific "spinal manipulation" and a "specific chiropractic spinal manipulation".
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