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Re: chiropractors working with PT's
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Re: chiropractors working with PT's - May 29, 2007 10:53:00 PM
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ginger
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From: Melbourne Victoria
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Jcoy, I had not written my question very well I admit. By ,"manipulations" I was referring to occasions of treatment, where manipulation is the central theme. The underlying thought driving my enquiry being, is it your intention to become redundant with each patient ?, if so , during a routine combination of treatments, , to what degree would you usually expect a full recovery. Say , cervical pain and dysfunction in the non injured subject. A healthy otherwise normal individual .
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: chiropractors working with PT's - May 30, 2007 8:57:00 AM
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proud
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JCOY,
I am a PT. My area of expertise is the diagnosis, differential diagnosis and treatment of NMSK conditions.
PT's are highly skilled at screening for health concerns outside of our scope of practice and thus sourcing the appropriate medical provider. For a really good description of this skillset, please look up an article by Moore et al JOSPT 2005 on risk determination.
I refer to the physician when dietary consultation may be warrented. I stay within my scope of practice.
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Re: chiropractors working with PT's - May 30, 2007 9:30:00 AM
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drbuddy
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From: Pennsylvania
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That's the thing, nutrition is within our scope of practice. Addressing a person's condition holistically is what I feel we are all about. If we are leaving out ergonomic, lifestyle, and nutritional/dietary counseling, then we are not doing our job.
The other thing to consider is that we are not talking about offering nutritional counseling for severe diabetes or renal failure, we are offering general nutritional advice. It's not rocket science and not a problem for me to tell patients that eating refined foods and excessive fats, oils, caffiene, etc. will make them hurt more. It's also not rocket science to send someone for a lipid panel, see high cholesterol, and get them on a diet to improve those numbers. In fact, after noticing that a large majority of my patients suffer from non-nms problems that are NOT getting better after being treating medically, I think I am going to go for some additional training and take those things head on.
If you think a physician is going to address dietary issues, then I think you are very mistaken (unless things are very different in Canada). I'm not too impressed with dieticians either. The ones I know basically teach the food pyramid and know nothing about treating/curing conditions with diet and nutrition.
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Re: chiropractors working with PT's - May 30, 2007 10:10:00 AM
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proud
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I agree Buddy. In Canada we do have something called the "canada Food Guide" and I have no problem directing patients down the appropriate nutritional path:
http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html .
I am no sleep expert either but many studies show that sleep difficulties can have significant negative effects on sensitivity to pain, physical health, and recovery from injury. This is why quality of sleep is part of my history portion. But significant sleep disturbances is too diverse a field with many experts far better suited than I do deal with it.
Basic good nutrition is not rocket science.
Bottom line is that if I suspect nutritional dysfunction above what the guidelines offer is a factor...I am not sending my patient to a chiropractor as 3.5fig seems to suggest the PT's he works with will do. I am worried about the PT's he is working with if this is the case.
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Re: chiropractors working with PT's - May 30, 2007 12:39:00 PM
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3.5fig
Posts: 97
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Proud,
You just dont' get it. The PT I work with doesn't send me the patient as if I am in a separate office. We co-manage many patients and part of my management is nutritional assessment. The PT has no training in nutrition and it is not within his scope of practice, therefore he does not address nutritional factors. If he suspects something he may mention it to me and if I see the patient then I will perform an assessment to see if it is something that needs lab work, referral, or can be managed in office.
Just referring someone to some guidelines is not proper management. That does not cut it with me. I am going to have a patient keep a food diary and then do an analysis of it to see the good, bad, and ugly of their diet. I then work with the patient creating a healthy weekly eating plan that incorporates up to date knowledge on nutrition. Guidelines will inform my decision making, but every patient is unique with allergies, likes, and dislikes...just saying "follow these guidelines" does not treat the patient as an individual. As Buddy said, we try to address a person's condition holistically and nutrition is well within our scope of practice, which is why we do address that with our patients. I think you are doing the right thing to refer out as you don't have any nutrition training. And please don't worry about the PT in our office. He is equal to me in his skills, we just have different skill sets, which help with patient care....I don't see why you have such a hard time seeing the benefit of that
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Re: chiropractors working with PT's - May 30, 2007 2:21:00 PM
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proud
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..."I don't see why you have such a hard time seeing the benefit of that "
Again, I would not defer to a chiropractor if I felt nutritional analysis was on the menu...I would go with the university educated dieticians. That's just me.
And back to the original question of this thread, I do not see a requirement for PT and chiro's working together. I think if the PT is deficient in manipulation, then the two can compliment each other. Perhaps this is the case in your collaborative practice.
But I then have to question the PT who has not established and ability to manipulate when indicated.
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Re: chiropractors working with PT's - May 30, 2007 2:29:00 PM
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3.5fig
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we agree to disagree...respectfully
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Re: chiropractors working with PT's - May 30, 2007 6:03:00 PM
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SJBird55
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From: Michigan
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There is a difference in my opinion between choosing a chiropractor versus a dietition for nutritional information.
I'd be willing to bet that a chiropractor would have something - a supplement or whatever to sell to me (and depending on the year or current dietary fad the chiropractor I chose to seek for consultation might recommend something different than a chiropractor up the road)... whereas a dietician would educate and provide information and probably not sell me something.
And an edit... I'd also be willing to bet that whatever product the chiropractor wanted to sell to me would have lots of testimonials behind the product, but no valid evidence to support its benefit.
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Re: chiropractors working with PT's - May 30, 2007 7:42:00 PM
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goodlooks58
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From: CA
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Ditto...SJ: We respectfully agree to agree!
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Re: chiropractors working with PT's - May 30, 2007 8:18:00 PM
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Tom Reeves DPT ATC
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I agree with SJbird. Most of the "counseling" has some strings attached. Like, " I have just the thing for you to take, after all, I am a doctor."
The problem is that there is assumed responsibility and competence that is not necessarily there when a chiro does the nutritional assessment. Often, there is a product for sale and the salesman is the doctor. Not cool. The MD/DOs don't sell the pharmaceuticals, they refer to the pharmacists. Whenever there is a sale to be made, buyer beware.
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Re: chiropractors working with PT's - May 30, 2007 8:18:00 PM
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Tom Reeves DPT ATC
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I agree with SJbird. Most of the "counseling" has some strings attached. Like, " I have just the thing for you to take, after all, I am a doctor."
The problem is that there is assumed responsibility and competence that is not necessarily there when a chiro does the nutritional assessment. Often, there is a product for sale and the salesman is the doctor. Not cool. The MD/DOs don't sell the pharmaceuticals, they refer to the pharmacists. Whenever there is a sale to be made, buyer beware.
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Re: chiropractors working with PT's - May 31, 2007 12:28:00 AM
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ginger
Posts: 660
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From: Melbourne Victoria
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Chiros hooking into kickback deals with x-ray and other imaging providers,in deals where new patients are routinely sent for scans , whole of spine x-rays etc. of dubious diagnostic value and then not being able to take them away from chiros offices. Chiros locking dim witted patients into contracts for multiple crackings ad infinitum, chiros selling magnets, vitamins and various hocus pocus devices. Chiros using wind up toys that go boing on unsuspecting patients spinous processes , billed as "treatment" that their own research indicates are useless. Chiros promoting the subluxation myth as a means to pump up the virtue of short term manipulation effects . ETc. Etc. Now we are expected to believe the same group has access to a depth of diet understanding that is second to none.
Sorry guys , your collective respectability has suffered so many body blows , it may take a miracle for a return even to a state equal to those whose nutritional education came from the back of a coc pops container. You certainly have a challenge. I wish you well however. If by enduring the gauntlet here, you still had a mind to push a "trust me, I'm a doctor" line, you'll have only yourselves to blame for evoking a rain of somewhat caustic responses.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: chiropractors working with PT's - May 31, 2007 12:37:00 AM
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nari
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So the assumption is that ALL chiros have "something to sell" on top of their fee?
Is this just a nutritional supplement or two,(most of which have been shown to be useless) or are we, as well, talking about the sort of stuff PTs sell - lumbar rolls, wedges, theraband etc etc, which cost just as much. (A lumbar roll can be made from an old towel which works just as well; theraband rots and the old Y-front elastic is $2, lasting for months on end)
What is the difference between a person walking into a health food shop and buying these socalled healthy supplements or buying them off a chiro?
Is a health food proprietor any more or less ethical to sell nonuseful items?
It all sounds like the old "all chiros are bad" mantra,to me. But I know no-one agrees and that's OK too.
Nari
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Re: chiropractors working with PT's - May 31, 2007 12:48:00 AM
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ginger
Posts: 660
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From: Melbourne Victoria
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Nari , my own one size fits all suspicions may not be well founded in respect to the small coccle of chiros gathered here. Lets hope they stick around and relieve us all of our doubts.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: chiropractors working with PT's - May 31, 2007 1:57:00 AM
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Jon Newman
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From: Amherst, WI
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Good point Nari. There's plenty of impulse selling to be found in both professions.
[QUOTE]Would anyone be able to share their experiences and discuss what is the safest way to go about partnering with a chiropractor and red-flags to look out for?[/QUOTE]Maybe we could come up with a screening questionnaire that would help anyone determine whether they're partnering up with the right person regardless of professional designation.
I'll start:
Answer the following yes/no questions:
I can detect and correct vertebral subluxations on most patients with back pain.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: chiropractors working with PT's - May 31, 2007 2:18:00 AM
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proud
Posts: 944
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Funny Jon,
I'll add:
1 " I can localize the specific segement that is either hypermobile or hypomobile. Not only that, but whether the direction of the dysfunction is in flexion or extension...all with my magical hands!!!
2. " I can provide equal or better nutritional advice than a university educated dietician..."
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Re: chiropractors working with PT's - May 31, 2007 6:28:00 AM
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jlharris
Posts: 477
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From: Nebraska
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[QUOTE]
What is the difference between a person walking into a health food shop and buying these socalled healthy supplements or buying them off a chiro?
[/QUOTE]In the first case, the person freely selects what they want, in the second case the patient is conned into believing they have to have "X" to get better by a health care professional. It's a matter of freedom of choice and ethics in using one's position to fool someone into thinking they need an unregulated, untested, "holistic" supplement.
Maybe if the DC told the patient I feel you need "X" supplement and here are a few places you can pick it up, including from me in which I make a profit from. That would be at least a step in the right direction.
BTW 3.5fig, I assume this is not the type of nutritional advice you give. However, I live in the heart of "Palmer Land" and that is how the Chiro's around here operate.
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Jason L. Harris, PT, DPT
My PT Blog
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Re: chiropractors working with PT's - May 31, 2007 6:52:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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How's this for holistic practice; do the best job of providing care for neuromusculoskeletal issues ( preferably based on as much evidence as possible).
Council to control your weight, and get plenty of exercise ( consult a PT if pain or other limitation keeps you from being active) water, omega 3 fatty acids ( fish sources; partic. salmon, provide handout of good sources of same). Eat plenty of fresh fruits and vegetables (mediterranean diet), and eat walnuts if not allergic. A little bit of hooch, not too much, 12 oz beer,3-6 oz. wine or liquor on a regular basis isn't bad. Have a regular sleep routine that allows you to get proper sleep. Think happy thoughts. Not selling anything here but good advice. Leave the meds councilling to the MD's/DO's, and pharmacists. Avoid NSAIDS whenever possible.
Any deeper nutritional counciling should be handled by nutritionists.
Just some thoughts.
Tim
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Re: chiropractors working with PT's - May 31, 2007 8:06:00 AM
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3.5fig
Posts: 97
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ok...I just typed a wonderful response and when to add reply and lost it somewhere in the internet netherworld....so I will try again...
hmmmm...too much for my brain to handle early this morning.
Ginger, I won't take offense at your post as I will assume it wasn't directed at me, but those chiros that do all those things you describe. Those are the bane of my existence. However, never did I say that the "depth of my diet understanding is second to none" and if I gave that impression I apologize. I do not carry any nutritional supplements in my office. I used to, but got tired of mangaing the inventory and got rid of them. I like things to be simple. The nice thing about having them in the office is that I know the quality of the product that my patients will be taking. Any profit made was very small...the same as lumbar rolls, thera-bands, etc...I think alot of chiros out there practice like Tim mentioned which is fine, I am a guiness fan myself...However, I have taken the time and effort to become better trained and educated in regards to nutrition and I utilize that for the benefit of my patients. I refer when necessary, but it is much more convenient for my patients to get the information and education from me instead of having to go to someone else's office across town. There is not hidden agenda here. I utilize my skill set to the best benefit of my patients. I refer when necessary. Nutrition is something I have training in and with that training I can educate and help manage my patients better...I hope that makes sense
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Re: chiropractors working with PT's - May 31, 2007 12:41:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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3.5fig, not directed at you , as mentioned , your willingness to stay the course here, if no other reason sets you somewhat apart. From time to time the odd palmerite flamer self combusts on these pages. Pleased to have your input, and the opportunity to have meaningful discussion rather than the other kind.
Cheers
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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