Physical Therapists may win one in turf war with chiropractors

Physical Therapists may win one in turf war with chiropractors

Chiropractors have for years tried to block physical therapists from performing spinal manipulation by claiming that PTs don't have the education and training to do so safely and effectively. This is laughable coming from a group that purports to detect and correct the non-existent "subluxation" and proceeds to reduce this phantom problem with spinal manipulation. Their objective is to unblock "nerve impulses" and thereby "restore health." So much for effectiveness of chiropractic manipulation.  To add insult to injury, some chiropractors maintain that manipulation of the cervical spine does not present a risk of stroke. So much for safety. 

Physical therapists are trained to employ spinal manipulation as a conservative manual therapy for treating back pain. Some chiropractors employ spinal manipulation in the same manner. The evidence of effectiveness for back pain is slim, no matter who does it.  PTs do not, however, purport to detect and correct the chiropractic vertebral subluxation because they, like the rest of us, realize there is no such thing.  

Chiropractors have been successful in preventing PTs from using spinal manipulation by getting state legislation passed barring them from doing so, even though there is not a shred of evidence that PTs are any less capable at it. PTs using their signature treatment scares them, because patients might start using PTs just to avoid the woo-ishness of chiropractic.  And, of course, MDs prefer to refer patients to PT, so when manipulation is in order the PT will get the business.

Washington State currently bars PTs from doing spinal manipulation, but hopefully they, as well as patients and MDs, won't have to put up with this foolishness much longer.  If the Governor signs House Bill 2160, which passed with little opposition in the House and Senate, this specious ban will be lifted.  

It is not an unmitigated victory however.  There are a number of roadblocks in place before PTs get their hands on this manual therapy.  I don't know this, but the fingerprints of chiropractors are all over these fairly onerous requirements, leading me to believe they didn't take this one lying down.  The additional education and training are apparently to address the chiropractors' position that PTs are insufficient in this department, an argument they base on the number of hours chiropractors spend learning how to do it.  No one seems to have asked what level of education and training is actually necessary to safely and effectively use spinal manipulation. Brain surgery this ain't.  

PTs will have to get a "spinal manipulation endorsement" from none other than the Washington Secretary of Health, acting on the approval of the state physical therapy board.  This requires a one-year full-time orthopedic postgraduate practice experience consisting of direct patient care which averages at least 36 hours a week. The bill is a bit fuzzy on whether additional requirements (I'm about to list them) must all be part of this practice experience or can be separate -- for example, in their undergraduate program. In any event, the PT must also have 100 hours of training in differential diagnosis, 250 hours related to delivery of spinal manipulative procedures, 150 hours in spinal diagnostic imaging, and 300 hours of supervised clinical practical experience in spinal manipulative procedures. The clinical supervisor can be a PT who holds an endorsement from the Secretary, a chiropractor, or a DO.  Obviously, until there are enough PTs with an endorsement, the supervisor will have to be one of the latter.  

Even after the endorsement is framed and on the wall, the PT is subject to additional restrictions.  He (or she) can't do more than 6 treatments without consulting with a health care provider "authorized to perform spinal manipulation."  I read this to include MDs, because their legal scope of practice includes manipulation even if they don't do it and haven't been trained in it. Otherwise, I can imagine some ticked-off orthopedic surgeons who might chafe at the PT having to consult with a chiropractor before continuing with spinal manipulation when the MD thinks more treatments are perfectly appropriate.  In addition, if the PT knows the patient is also being treated by a chiropractor for the same diagnosis, the PT must make "reasonable efforts" to coordinate with the chiropractor.   No duty is imposed on the chiropractor to do likewise.  There are also limitations on PTs billing for spinal manipulation and how much he can use it in his practice. By 2019, the PT board must report to the legislature any disciplinary actions taken against PTs whose use of spinal manipulation results in harm. Funny, there is no requirement for the chiropractic board to do the same.  

 PTs can't even advertise that they perform spinal manipulation or manipulative mobilization of the spine.  This seems to be a violation of their First Amendment rights -- the courts frown upon prior restraints on speech, particularly when there is absolutely no compelling government interest in prohibiting truthful information from getting to the public.  Nor can they advertise that they perform "adjustments" (that is, spinal manipulation when it is employed to reduce the non-existent subluxation), maintenance or wellness manipulation (which based on the false claim by chiropractors that regular adjustments are necessary to good health), or chiropractic care of any kind. But, of course, why would the PTs want to do that anyway? 

Points of Interest: 3/24/2014
Points of Interest: 3/22/2014