1.  Let's channel our energy, time, and resources into researching safety factors regarding mobilization/ manipulation.

2.  Research also should focus on verifying quality of techniques (translation or sidebending vs. rotational, general vs. specific)

3.  Philosophy of chiropractic is based on nerve conduction - research could be focused on the support or refuting of their philosophy, especially concerning treating diseases normally treated medically.

I am looking forward to comments from others about how to make peace between these groups.  Perhaps their are ways to collaborate?  Meet?

Chiropractors have accused manual therapists of taking from their field.  If someone has taken from the other's field - it is in the reverse of what has been proposed.  Manual physical therapists are not performing "chiropractic."

1.  Manual physical therapists are performing manual therapy as taught by M.D.s and osteopaths and other manual therapists.  Chiropractors have had a different origin and training.  Both go back to Andrew Still, an osteopath, after which Palmer branched off from there to begin chiropractic.

2.  Chiropractors bill insurance under physical therapy codes.  Physical therapists do not bill under chiropractic codes.

3.  Chiropractic web sites are promoting "Maitland" techniques, supporting "chiropractic" with articles from the Journal of Manipulative Physiotherapy,  and selling books to their members written by manual therapists.  See links below:

http://www.mbmc.org/healthgate/GetHGContent.aspx?token=9c315661-83b7-472d-a7ab-bc8582171f86&chunkiid=37431

http://www.rohlfsen.com/workcomp.htm

4.  In Tennessee (as in other states), through aggressive legislation, chiropractors have been changing their definition, or trying to change their definition of manipulation, to be the same as manual physical therapists definition.  They then call it "chiropractic".  Our definition has stayed the same, and in Tennessee is still different from theirs, but they have gotten it close.  They then charge that manual therapists are performing "chiropractic."  This is not historically accurate and is a sneaky manuever.   

Is this an example of one group wanting to create a monopoly for reasons of self-interest?

Several things were brought up in an April Tennessean news article that require comment.  It looks like the article has expired.  I will keep looking for it in the archives, but this is a blog from the journalist about the article, and a comment in myphysicaltherapyspace.com about the article.

http://support.tennessean.com/blogs/?p=2362

http://blog.myphysicaltherapyspace.com/2007/04/another_arkansa.html#comments

The Arkansas case:  Arkansas and Tennessee laws are different.  The Arkansas physical therapy practice act states that a physical therapist may not perform "spinal manipulation."  This is not the case in the Tennessee.  Our practice act permits manual therapy - defined in the rules and regs as manipulation and mobilization.

Physical therapists were accused of doing "chiropractic."  There is a sub-group of physical therapists that are manual therapists.  We are performing "manual therapy."  Look back at the history of manual professions in this blog and you will see that physical therapists were taught manipulation/ mobilization from doctors and osteopaths, not chiropractors.

Manual therapists and chiropractors have different definitions and different philosophies of treatment.  The article listed the chiropractors definition under the therapist's paragraph.  Manual therapists do not manipulate according to the definition listed in the chiropractor's practice act.  Our definition comes from the APTA's guidelines for practice.  Their philosophy relates to "nerve flow/ conduction", ours is based in biomechanics.

Public safety is discussed in relation to manipulation and the fact that manual therapists do not take x-rays.  This is a poor diagnostic tool for trying to predict a predisposition to an injury by manipulation.  Only an MRI will be of value in forstalling a disc herniation or aggravation.  PTs do not manipulate disc herniation, chiropractors do it rountinely.  X-rays are useless in preventing vertebrobasilar injuries, only angiography is helpful.  Chiropractors do not have access to MRI or angiography.  If they refer a patient to a medical doctor for these tests, they may lose that patient, due to the fact that a lot of medical doctors are not supportive of chiropractic.  Manual therapists have good communication and working relationships with medical doctors. 

Last year the chiropractors opened up their practice act to say that they are able to perform acupuncture.  The legislators decided that it was a "turf war", not a quality of education hours.  They passed the bill.  Why is this issue different?

More specifically, in 1999 chiropractors changed their practice act to alter their definition of manipulation and to allow only chiropractors, doctors of osteopathy, and physicians to perform it.  In 2006 they changed their practice act to say that they can perform acupuncture.   This year they are the only ones opposing a physical therapy direct access bill (HB0964) which is supported by the Tennessee Medical Association and Tennessee Orthopaedic Association.  The Chiropractic Association has added amendment 2 whose purpose is to limit the scope of practice of physical therapists from performing manipulation.  There is also another amendment that limits direct access from 45 days to 30 days.  This bill passed the Senate 30-0 without amendments. 

Do you agree with the legislation to help the public have better access to care and not to have the scope of practice of physical therapists limited?

Write or call your representative and tell them you'd like them to vote yes on House Bill 964 and no to amendment 2.

Find your legislator:  http://www.legislature.state.tn.us/house/members/hmembers.htm

For contributions to the tennessee physical therapist political action committee:

http://www.tptaonline.org/Assets/PDF/tpt_pac_contribution_form.pdf

This is a brief history of manual therapy from Orthopaedic and Sports Physical Therapy  second edition by James A. Gould III, 1990.

Hippocrates (460-380 B.C.)

Galen (131-202 A.D.)

Ambroise Pare (Renaissance) physician

Bone-setters (17th century England)

William Merrell (1853-1912 A.D. London)

In the U.S., two types of healers developed - osteopaths and chiropractors. "They were competitive and today are completely independent of each other.  Initially both advocated treatment of all diseases by manipulation."

Andrew Taylor Still (1828-1917) introduced osteopathy in the United States.

Daniel David Palmer (1845-1914) founded chiropractic in 1895.  [Palmer broke off from Andrew Still.]

"(James) Cyriax, a British orthopaedist, believed that almost all spinal pain arose from a distruption of disks, which could be reduced by manipulation and traction.  He was an enthusiastic proponent of the use of manipulation by qualified physical therapists because of their training and expertise in understanding the musculoskeletal system."

Maitland, a physical therapist from Australia developed a system of graded oscillations.

Kaltenborn and other Scandinavian physical therapists describe disc degeneration and facet dysfunction.

McKenzie, a physical therapist from New Zealand developed a method of classification for low back pain.

Stanley Paris, a physical therapist from New Zealand advanced the concept of facet disorder.

For a more in-depth discussion of the history of these professions:

http://mywebpage.netscape.com/davidigrove/Osteopathy.pdf