DISQUS

BillPT · 1 year ago

I agree with you 100% jscifers when you say "Perhaps we should all take a step back and consider what is best for our patients, rather than for our wallets." This is why I manipulate ONLY when indicated and do not sign my patients and their families up for the "life plan," like our counterparts.

In regards to the NATA-APTA lawsuit, I have no problem with the APTA defending our right to manipulate against ATC who are not trained in Manipulation. After all, for the most part ATC services are not reimbursed in the clinic...So why learn techniques that will not be reimbursed? You don't see me trying to take classes so I can treat on the field. I have the utmost respect for ATC's! I feel that their level of direct access that they have in managing life and death situations on the football field is very important, and outside of my scope of practice. I am willing to admit this. Unfortunately, other professions do not take this stance and want to stray away from their acts. I have no problems with ATC wanting to manipulate...When they are PT-ATCs. If you recall, the main issue with the Orthopaedic section was that PT-ATCs were teaching manipulation techniques to pure ATCs, it said nothing about "manual therapy." This was one of many of the over generalizations that the NATA president chose to sue over. ATCs can do manual therapy...They stretch hamstrings, quadriceps, biceps, etc., it was the manipulation of the thoracic spine that the orthopaedic section had a problem with and wanted to address with NATA.

jscifers · 1 year ago

Bill,

The primary problem with your argument is twofold. First, the letter, sent by the Practice Chair of the Orthopaedic Section of the APTA was not limited to spinal manipulation but also to various other manual therapy techniques and also to mobilization of the extremities (you can find the letter posted on the NATA website if you care to read it). Additionally, the course offerings from the NATA mentioned nothing about manipulation, but rather focused on joint mobilization, strain/counter strain and muscle energy techniques.

Second, you make the assumption that ATC are not trained in mobilization and manipulation and this is completely incorrect. Manual therapy, including mobilization of the spine and extremities, has been a part of Athletic Training education for more than two decades.

Athletic trainers are skilled in manual therapy at various levels, based on practice setting, interest in manual therapy as a treatment intervention and the amount of continuing education they have received beyond entry-level education. This is no different than Physical Therapists. Both professionals receive basic education in manual therapy during their entry-level education. Both professions have members who embrace manual therapy and become proficient in its application and members who shy away from manual therapy as a treatment intervention for a variety of reasons.

I appreciate your comments but want to encourage you to (re)read the letter from Robert Rowe to the speakers at this course and possibly reconsider your stance on whether the Orthopaedic Section of the APTA is just concerned about manipulation of the spine or whether their concern extends to all forms of manual therapy and to the extremities.

BillPT · 1 year ago

Agreed Jason. Very well put!

BillPT · 1 year ago

How I read it (and I am no lawyer) is that it is the APTA's stance that we manipulate and apply manual interventions to the spine and extremities, and that the concern was that APTA members are not following the stance of the APTA as stated in the letter. I do not interpret this as that ATCs cannot perform manual PT, but rather PTs who are APTA members are teaching ATCs, without PT degrees manual therapy. You may say that this is really no big deal, but I will liken it to another profession Chiropractic. Some techniques are similar, but the principle for which they are applied differ. The manual Therapy I apply is not to cure earaches, bedwetting, or constipation. So in closing jscifers, I agree with your stance that manual therapy is a part of ATC curriculum. If ATCs can do manual therapy (which I believe they should according to my previous post), why seek out a course where the lead speaker is a non ATC PT? I don't attend courses sponsored by chiros (I don't think I could for this same reason if I even wanted to). I guess my questions is if ATCs are trained in manual therapy, then why would an ATC want to attend a course that is taught by PTs?

BillPT · 1 year ago

Ultimately, I think we all agree that multiple professions perform manual therapy. We just need to question the motivation of the individual who is willing to teach for the other profession ($$) and the motivation of the professional who is willing to attend and/or sponsor these speakers. Too many continuing education seminars are open to multiple practitioners, and it is for that reason I steer away from them. Regardless of the stances of the professional organizations, it comes down to where we get reimbursement. The APTA maintains a hard line on manual therapy because it is a very strong negotiating tool when it comes to negotiating practice acts legislatively. It is because of this hard stance that the NATA feels violated and sued with a lawsuit that is mostly without merit. There are a few points (like the manual therapy issue) that should be discussed further, but the rest of it is a bunch of non-justified claims.

Regardless of the lawsuit, it all comes down to the fact that PTs can perform manual therapy and get reimbursed in the clinic, where ATC cannot. If an ATC wants to perform manual therapy in a clinic and get paid for it, I fully support them to continue their education and obtain a PT degree (3 clinicians at my clinic have done so at some time in their profession). Afterall, there is a reason why ATCs got to PT school to become dual licensed. Rarely do PTs go to ATC school for the same dual licensure.

breilly23 · 1 year ago

I am still a student of chiropractic, but I would like to add some input as well as ask a question. One the chiropractic field is growing out of its once said Subluxation basis and moving towards spinal dysfunction. I would like to say that although you may learn a lot about the spine chiropractors go to school almost solely for this area of anatomy, however we are broadening our scope as well. I would like to compliment you on your drive for continued growth and evidence base just as the chiropractic profession is taking. Although your statement is not false in regards to Physical Therapists being the leading providers in evidence base you have to admit that the only reason for this is that PT's are supported by the AMA and usually a part of a larger university that is able to get grants. Either way I really don't care I am just glad that there is starting to be proof towards spinal manipulation. I also cannot blame the PT's for stepping on turf and using spinal manipulation since many chiropractors are utilizing physical modalities. I believe that we are all just trying to do what is right for the patient and although we all don't want to share our market trust me there are plenty of people that need our help. I thoroughly believe that if we learned from each other and just as this PT has done constantly give CONSTRUCTIVE criticism that we can grow but the CONSTRUCTIVE portion is key we must not be destructive. Granted the PTs are a larger body and supported by the medical profession they still cannot try to compete with us on manipulation that is our main treatment just as theirs is exercise and modalities. Which is where my question comes in how much education do current Physical Therapists receive on manipulation and is it currently taught throughout your schools or is it only DPTs that get trained in this? Thank you for your time and consideration, and believe me if everyone started focusing on patient benefits and not on the politics we would start helping a lot more people. While doing so though we always have to be constructive and give the opportunity to learn from mistakes.

RobDC · 1 year ago

Informative article. One problem: while PT's are "experts" in fields -related- to the spine, DC's are actually the people that should be seeing the patients with DDD of the spine if that DDD is what causes the symptoms that brought that patient in.

Everything you discussed, and that article discussed, is what chiropractors learn in chiropractic school. While physical therapists can deliver much help, for example the core strengthening the article mentioned, the PT is not trained and quite possibly not legally allowed to deliver the thrust that will reset the nociceptive cycle and diminish the patient's pain.

Furthermore, while susceptibility to DDD is genetically-related it is not something that is unavoidable. Proper spinal hygiene throughout life can help someone avoid the degenerative processes that trigger DDD. Avoiding antalgic postures, strengthening core musculature, educating on posture and ergonomics, and addressing spinal imbalances early on will reduce the occurrence and severity of episodes that would cause vertebral endplate sclerosis. That sclerosis, among other things, is what makes the disc nutrition process break down.

Proper care for DDD is preventative, and that is what the DC offers. Much ink has been spilled in trade magazines about chiropractors stepping on PT's turf and vice-versa, and I am a believer that PT's and DC's should stick to what they are experts in, which is why I don't offer physical therapy services to my patients and why a responsible PT would have the professionalism to refer patients out to DC's if that is what they needed.

BillPT · 1 year ago

You're crazy...PT's have been manipulating the spine since the beginning of our profession. The big difference here is that chiropractic believes that they can treat bladder infections, bed wetting, and constipation. There is absolutely no evidence to back these claims! Also, when someone goes to a chiro with neck pain, why does the lumbar spine get manipulated as well? You guys do not treat the biomechanical restrictions that one presents with cause their pain and dysfunction. The law of the artery and nerve is severely outdated and "subluixations" fail to exist on radiography. Chiros need to step up to the 21st century and realize that the PT practice act supports out right to manipulate (including grade 5) (except in Arkansas) and that there is some validity that research does not back anything they do. I take that back...They use research...Our research, and spin it in their favor. Chiropractors = freeloaders of the modern medical model!

jscifers · 1 year ago

While I agree with Bill's comments regarding the physical therapist's right to perform spinal manipulation, I find it interesting that Physical Therapists become so outraged when another profession attempts to limit their scope of practice.

Yet these same physical therapists have no issues with their national organization's attempt to do the same thing to another profession (see the APTA's attempt to limit ATC ability to perform manual therapy).

For some reason, physical therapists don't like having their educational and professional qualifications called into question, yet they have no problem making outrageous claims about another group of professional's education and clinical proficiency.

It seems like physical therapists feel that expanding their scope of practice (ie: women's health, animal therapy, wellness screening) is "manifest destiny" while other profession's attempts to do the same are equivalent to blasphemy!

Maybe there is enough room in rehabilitation and manual therapy for ALL trained and qualified clinicians to practice. Perhaps we should all take a step back and consider what is best for our patients, rather than for our wallets.

jlharris · 1 year ago

And let's be clear...It's the perception of NATA and not a policy of APTA regarding ATC's and manual therapy. Unlike, say the AMA, who tried to pass a resolution to make it illegal for anyone besides MD's to use the terms "residency" or "physician", it was an OPINION by a division chairman written to a PT suggesting it may be inappropriate for a PT to teach manip to ATC's.

That is completely different than suggesting the APTA wants to block ATC's from performing manual therapy they are trained to do, and their practice acts allow them to do.

jscifers · 1 year ago

Jason,

Please see my comments below to Bill. I know you are familiar with "Dr." Rowe's letter to Dr. Turocy, as we have discussed this before on your website. I suggest you revisit this letter because it is clear that the concern of the Orthopaedic Section extends far beyond Physical Therapists educating ATC in manipulation. The letter and the position of the APTA are clear in stating that all manual therapy techniques are beyond the scope of the ATC.

jlharris · 1 year ago

To RobDC:

Lets make this clear, I do not refer to DC's because there are no such things as "subluxations" and my training (NOT weekend courses as DC's try to claim) included extensive manipulative treatments and techniques. I also had extensive education in PT school in regards to what was discussed in the article. The true difference is that I choose to constantly evolve and provide my patients with evidence based treatments and not a rubber stamp manipulation approach to all ailments.

While I'll give you that a few states disallow PT's to manipulate (IA, WA, AR), we are trained (and currently the leaders in evidence based manipulation) and legally allowed to utilize our skills in 47 other states.

Finally, you stated:
"Proper spinal hygiene throughout life can help someone avoid the degenerative processes that trigger DDD. "

That is simply bullshit. There is NO evidence that this is true. Unfortunately, subluxation based DC's are blinded to the truth and their patients suffer (physically and financially) because of it.