Kansas HB 2578 allows chiropractors to decide if student can return to play after a concussion

Kansas HB 2578 allows chiropractors to decide if student can return to play after a concussion

Under Kansas law, a school athlete who has been removed from play due to a suspected concussion must get written clearance from a medical doctor before returning to practice or competition. House Bill 2578 would allow chiropractors to provide these written clearances. The bill passed in the House, after an intense debate, and is now before the Senate, which must consider it by March 23rd, according to legislative rules.

Unfortunately, as too often happens when the medical establishment opposes chiropractic scope of practice expansion, physician objections were blown off as a "turf war," instead of legitimate concern.

During the debate, there was some gross overestimation of chiropractic education and training. Rep. Dick Jones (R-Topeka) said that chiropractors have a level of talent and judgment on concussions that comes the closest to brain surgeons. No, they don't. Neurosurgeons must graduate from 4 years of medical school then spend 6 to 8 years in residency. Chiropractors attend small chiropractic colleges that operate outside the mainstream American university system. Their only clinical experience is in school clinics or preceptorships with other chiropractors, where they may never even see a patient with a concussion. They don't do any sort of residency, but go straight into practice after graduating.

Chiropractors can pull an athlete from play when a concussion is suspected, but, then again, so can a coach.  As Rep. Barbara Bollier (R-Prairie Village), a retired physician and the only doctor in the House, pointed out, pulling someone from play is an entirely different decision from allowing a child to return to play. She was described in one news report as "aghast" that her fellow Representatives would allow this bill to pass and said emphatically, "Do not do this." They should have listened to the doctor. Interestingly, the National Athletic Trainers Association is with her on this one. They take the position that only medical physicians should return a student to play.

Chiropractic scope of practice in Kansas already allows chiropractors to diagnose and treat concussions, but in a much more limited manner than a physician.

(a) Persons who examine, analyze and diagnose the human living body, and its diseases by the use of any physical, thermal or manual method and use the X-ray diagnosis and analysis taught in any accredited chiropractic school or college and

(b) persons who adjust any misplaced tissue of any kind or nature, manipulate or treat the human body by manual, mechanical, electrical or natural methods or by the use of physical means, physiotherapy (including light, heat, water or exercise), or by the use of foods, food concentrates, or food extract, or who apply first aid and hygiene.

Neither this statute nor state regulations governing chiropractic practice appear to allow a chiropractor to order a CT scan, an MRI, or other types of diagnostic testing, nor could chiropractors prescribe medications recommended as a part of treatment, all of which may be appropriate according to concussion management guidelines.

No established guidelines recommend any type of chiropractic manual therapy either, and certainly not the detection of subluxations and their correction, because only chiropractors believe in the existence of the subluxation. Yet, a brief review of their websites demonstrates that Kansas chiropractors are doing exactly that. One chiropractor tells patients that concussions can cause "spinal misalignments" which interfere with the nerves' ability to "communicate" with the rest of the body, a simplistic and incorrect view of spinal anatomy. Another practices "functional neurology" and is "board certified" as a "chiropractic neurologist." As Mark Crislip, M.D., noted in his SBM post on a similar bill pending in Oregon:

"There is no subspecialty naturopathic training in neurology; chiropractors can be certified as a chiropractic neurologist in 40 days of internet classes, or 300 classroom hours. Compare that to the over 8,000 hours (assuming a mythical 8-hour workday) it takes to be a real neurologist, much of which is spend in direct patient care." 

Here's what real neurologist Steve Novella, M.D., had to say about this "specialty,"

"Chiropractic neurology appears to me to be the very definition of pseudoscience – it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it."

If this describes chiropractic "specialists" in neurology, it is frightening to think what the regular chiropractor's understanding of neurology might be. 

It is no surprise that chiropractors "adjust" these mythical "subluxations" as a treatment for concussion. They are taught this in their chiropractic colleges.  As Dr. Crislip pointed out, there is absolutely no evidence that spinal manipulation is effective for concussions, and cervical manipulation for any condition comes with the risk of vertebral artery dissection.

If chiropractors can't follow evidence-based practices and established guidelines in their treatment of concussed student athletes, how do we expect them to follow evidence-based practices and guidelines in returning these athletes to play? We can't.

If this bill becomes law, it could become a practice-builder for chiropractors. They will advertise that they have the authority to sign off on return to play authorizations, thereby attracting the parents of patients who need these forms. Let me make an educated guess here that no chiropractor will ever release a student to play without a sales pitch for chiropractic adjustments. It will also add the imprimatur of state approval to the unfounded assumption that chiropractors are competent to make this important determination, one that may affect a child's health for the rest of his or her life. 

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