Chiropractor = Physiotherapist?

[truthseeker]

Wow, I couldn't agree with you more chirodoc. The only exception I take is with the scientific education stuff. If schools are still teaching the subluxation model, they are dabbling in religion, not science. Otherwise, spot on.

I don't remember if we have tangled before but you won't get an arguement from me on this one.

Well said.

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[DocMatt]

The word chiropractic comes from Greek words meaning "treatment by hand", which is exactly what chiropractors do—they use their hands to manipulate the body and promote healing and wellness.

 

[DocMatt]

The word chiropractic comes from Greek words meaning "treatment by hand", which is exactly what chiropractors do—they use their hands to manipulate the body and promote healing and wellness. For more info you can visit http://www.doctorroller.com

 

[rcheeley]

Quick notes


- While I am on the soap box.....As for the Doctor of PT, Not sure that is the greatest path for the profession = Don't Bite the Hand that Feeds You (Side note, I am in Medical School....not that I fear PT's as competition, but I just don't want to see a good PT act as a poor doctor....the term doctor has really got watered down).....

I would have preferred to see more of a promotion of the specialty certifications (Experience + Credentials should be the path to PT career advancement, instead of 6 more months in grad school)

How can you say that the DPT is not good for the PT profession? All the DPT entails is a higher degree of education that makes the PT student more knowledgeable as they enter into a world of medicine that needs them to know more and more information.

Doctors (MD/DO) do not have the time these days to spend a lot of time w/ each and every patient, and because of this things often get over looked and missed.

A prime example is a patient that was sent to me for low back pain (LBP) and I determined their pain was due to a possible AAA that the physician seemed to "over look." This patient was sent to the ER where it was determined he had an AAA and his life was probably saved.

Without the differences in education I had received in my DPT versus what I might have received w/ a BS in PT or a MS in PT I might not have known to look for something like that. Now I'm not saying this is something they would not have known, but I do work w/ many PTs w/ just their BS or MS and they all agree we get a lot of education that they did not receive and they had to learn on their own through experience (good or bad).

I couldn't imagine how I might have felt if I had seen that patient for LBP and not recognized the problem. Then when that patient didn't show up for their next visit due to the fact they had "passed" because of something I might have missed (or didn't even know to look for) I would have been devastated.

Then just talking about Orthopedics, which is what I do, I don't understand how you can say "Don't bite the hand that feeds you"? In my experience most physicians are very surprised and relieved that that I (the PT) understand what he/she is talking about and they don't have to "dumb down" the conversation.

We are not physicians, nor do we want to be. I had a chance to go to MedicalSchool, but chose not to as I wanted to spend more 1-on-1 time w/ patients and not see patients for very short periods of time. I just didn't want to be a physician, I wanted to be a PT.

Now, could I perform my job w/ a BS or a MS degree? Obviously, yes, as there are PTs out there that do this. But I am more prepared coming out of school my DPT and feel I am better prepared to deal w/ issues today that were not present just 10 years ago - severe shortage of medical professionals.

To sum it all up, PTs are not looking to "compete" w/ physicians, we are only looking to be prepared as best as possible to provide the highest quality of care for all patients, as they deserve this. To say we should have a more "limited" education is basically saying we should just be "techs" only trained to perform PROM, exercise, and massage.

The term "doctor" is not a term reserved only for physicians. It is a term used for a person who holds a doctorate degree. The M.D. degree was just the 1st of it's kind, which is why when you speak of a "doctor" most people feel as if you are speaking of an MD (or DO, and dentists). However, even the first doctors didn't have a MD degree; they started as bachelor's degrees as well (MB). Which is where the PT profession and nursing professions started.

Now most medical professions are moving to the "doctorate" level of education in order to be more prepared professionals. It is not a slap in the face to physicians, and should not be looked at in such a way. Even nursing has/is looking at moving to a doctorate degree.

So to say the term doctor has become watered down is....I don't know what to say. Most PTs do not go by "Doctor such and such". The only profession that I know of that consistently goes by "doctor" that is not a MD/DO/DMD is the Chiropractic profession. I believe the only reason the DC profession goes by "doctor" is because there were several MDs that began the profession, and it gradually evolved into what is has become today - less MD/DO, more DC - but still goes by "doctor."

The extra "professional/specialty" post-professional education that PTs obtain is great, but it should not need to replace the necessary background, baseline, foundation of education that is received in the PT program.

You speak highly of PT in your initial statements, but your last 2 statements make you sound as if you don't want to be questioned by other professionals. No offense, but that is how you come off, and considering you are still a student this makes sense.

Good luck in medical school and I hope during your coursework and experience you develop a greater knowledge of the educational levels required by other medical professionals, not just PTs, but all areas. That way when you call them on the phone, or speak to them in person, you do not address them as "laymen" and insult their intelligence.

 

[jenny07]

Chiropractors have a big difference from physical therapist, the individual you had talked to is just bragging out things

 

[truthseeker]

Chiropractors have a big difference from physical therapist, the individual you had talked to is just bragging out things

Me therapist you chiro me speak in riddle.

What??!?

 

[drlogiudice]

I wonder where both the chiro and PT professions will be ten years from now. I can say it is certainly looking more optimistic for PT.

The thing is it is about turf. Chiropractic students and professionals are concerned about the DPT. The one thing they've always had is autonomy to practice and this is the main reason the clinical doctorate was implemented. If the PTs can show effectiveness in treating LBP, utilize "joint mobilization" techniques effectively, and demonstrate a low risk of treatment than what else does the chiropractic profession offer that the PT profession wouldn't? Nutrition supplements? Don't dietitians do this? Add onto this low risk of treatment and credibility within the healthcare community and you have a very precarious position for the chiropractic profession in my opinion.

Like everything the climate changes with time. I wonder what's in store for both of these professions ten years from now. Both are in a state of change.

Manual Medicine = Kinetics, Kinematics, Kinesiology, and Kinesthesia, mobilization vs. manipulation -- aren't we all in this ship together? Why does there have to be a "TURF" war? We all want our patients, clients, or customers to have a fully functioning body. We should work together, not against. If we can't see the benefits we offer each other, then one of is driving with our eyes closed. There are multiple PT/DC practices that succeed. I am in a solo practice myself. However, I have visited several mult-disciplinary practices. In a perfect world, the chiropractor would do some physiotherapy (e-stim, US, Hi-volt), + Hot packs, GRASTON, ART or MET if you want to call it that. The chiro can go review self stretches and send them down the hall to the PT for muscle pattern evaluation, work hardening, and isometric strengthening, some more ballistic stretching (if warranted). Every visit is a re-eval. If you hate manual medicine then get out, don't bash us, we all do a great job with our patients. Patient satisfaction is at 90% for manual medicine. If its not broke, then lets not break it.

 

[Fiveoboy11]

"In a perfect world, the chiropractor would do some physiotherapy (e-stim, US, Hi-volt), + Hot packs, GRASTON, ART or MET if you want to call it that."

The chiropractor doesn't do physiotherapy, or physical therapy. If you do e-stim, US, Hi-volt, hot packs, you are doing e-stim, US, Hi-volt, hot packs. NOT PHYSIOTHERAPY! Get over it and stop floating on PT. By the way, you are wasting the patient's time with all that quackery.

"The chiro can go review self stretches and send them down the hall to the PT for muscle pattern evaluation, work hardening, and isometric strengthening, some more ballistic stretching (if warranted)."

The chiro can do whatever they feel is best for the patient. The PT can do whatever they feel is best for the patient. Not I do this, you do that. You don't know what a PT has to offer so limit your commentary to what you're knowledgeable in, CHIROPRACTIC! I wouldn't doubt if you were one of the many genius chiropractors who would say something like "I'm going to send you to a physical therapist for a strengthening program," if you had the authority to. Maybe you should think of it like this "I think it might help you to see a physical therapist as well and see what he/she could do."

No wonder why so many PT's have a negative view of DC's. Many are unprofessional/disrespectful without even realizing it. Stay away from PT and just stick to curing diabetes.

 

[drlogiudice]

"In a perfect world, the chiropractor would do some physiotherapy (e-stim, US, Hi-volt), + Hot packs, GRASTON, ART or MET if you want to call it that."

The chiropractor doesn't do physiotherapy, or physical therapy. If you do e-stim, US, Hi-volt, hot packs, you are doing e-stim, US, Hi-volt, hot packs. NOT PHYSIOTHERAPY! Get over it and stop floating on PT. By the way, you are wasting the patient's time with all that quackery.

"The chiro can go review self stretches and send them down the hall to the PT for muscle pattern evaluation, work hardening, and isometric strengthening, some more ballistic stretching (if warranted)."

The chiro can do whatever they feel is best for the patient. The PT can do whatever they feel is best for the patient. Not I do this, you do that. You don't know what a PT has to offer so limit your commentary to what you're knowledgeable in, CHIROPRACTIC! I wouldn't doubt if you were one of the many genius chiropractors who would say something like "I'm going to send you to a physical therapist for a strengthening program," if you had the authority to. Maybe you should think of it like this "I think it might help you to see a physical therapist as well and see what he/she could do."

No wonder why so many PT's have a negative view of DC's. Many are unprofessional/disrespectful without even realizing it. Stay away from PT and just stick to curing diabetes.

I refer almost all of my MVA patients for PT. You totally showed your true colors, you obviously don't know that chiros send patients for PT, and need a signature from the DC before they start therapy (in Oregon). Let's talk about not biting the hand that feeds you. You are so negative, I was only trying to state that we are in this profession to improve the ADLs of the patient. I have never claimed to heal diabetes, I have two family member that have diabetes, and frankly your statement makes me sick. You are rude in professional forum. Physiotherapy is defined as the treatment of disease by physical exercise, massage, not drugs. To say a modern evidence-based chiropractor is not performing physiotherapy, frankly is obscene. I'm changing life's, one at a time, just like you.

 

[ptinaz]

To say a modern evidence-based chiropractor is not performing physiotherapy, frankly is obscene. I'm changing life's, one at a time, just like you.

Depends on the state. In AZ, if you, as a chiropractor state you are performing physiotherapy, you are breaking the law....http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/32/02042.htm&Title=32&DocType=ARS. I believe this is the law in several other states (Minnesota springs to mind). You just have to know the laws for the state you practice in.

 

[Fiveoboy11]

And I am a licensed PT in the state of AZ. The idea that I would need a DC's prescription for me to see a patient in Oregon is laughable, considering my education was just as long, not to mention more competitive and evidence based.

Look up the word physiotherapy, it is not defined as massage and exercise. By the way, DC's commonly refer to US, E-stim, hot pack, cold pack as physiotherapy. Pretty hilarious. You can even search it on wikipedia and find that out. Sorry to tell you Mr. DC but it is not up to you to define words. Physiotherapy is physical therapy, and to say you practice physical therapy is an insult and unprofessional. Thus, it is you who lack professionalism.

I think it is a joke how much DC's get away with and how much authority they have. Anytime any DC would like to objectively compare education to my DPT I'll gladly debate.

 

[facetguy]

And I am a licensed PT in the state of AZ. The idea that I would need a DC's prescription for me to see a patient in Oregon is laughable, considering my education was just as long, not to mention more competitive and evidence based.

Look up the word physiotherapy, it is not defined as massage and exercise. By the way, DC's commonly refer to US, E-stim, hot pack, cold pack as physiotherapy. Pretty hilarious. You can even search it on wikipedia and find that out. Sorry to tell you Mr. DC but it is not up to you to define words. Physiotherapy is physical therapy, and to say you practice physical therapy is an insult and unprofessional. Thus, it is you who lack professionalism.

I think it is a joke how much DC's get away with and how much authority they have. Anytime any DC would like to objectively compare education to my DPT I'll gladly debate.

Pride in oneself and one's profession is fine, but why are you so full of yourself? Your 'us vs. them' mentality is unproductive and, quite frankly, a bit juvenile. Get over it. (Note: these comments are directed solely at 5-0-boy, not the PT profession-at-large, for which I have lots of respect.)

 

[Fiveoboy11]

Full of myself in what way? Come be a PT and you will find out a few things in terms of toe stepping and lack of respect.

 

[atstudent]

Full of myself in what way? Come be a PT and you will find out a few things in terms of toe stepping and lack of respect.

LOL. Right. A good professional wouldn't care what another profession does. They do their job and that's all that matters. Crybabies on the other hand just complain about "toe stepping" and "lack of respect." PTs are all for "what's best for the patient" provided it is a PT who gets to bill and collect on that patient. But if "what's best for the patient" is to have a chiropractor or an athletic trainer treat the patient, then those two professions are stepping on toes.

 

[jesspt]

LOL. Right. A good professional wouldn't care what another profession does. They do their job and that's all that matters. Crybabies on the other hand just complain about "toe stepping" and "lack of respect." PTs are all for "what's best for the patient" provided it is a PT who gets to bill and collect on that patient. But if "what's best for the patient" is to have a chiropractor or an athletic trainer treat the patient, then those two professions are stepping on toes.

FiveO -

I think you're getting what's coming to you. While I essentially agree with your stance, your posts come off as extremely harsh and emotional. This is the perfect opportunity to educate a fellow health care provider on exactly what physical therapy is, as I think both you and I can agree that drlogiudice doesn't seem to have been exposed to much quality rehabilitation thus far in his/her career.

atstudent -

LOL. Right. A good professional wouldn't care what another profession does. They do their job and that's all that matters. Crybabies on the other hand just complain about "toe stepping" and "lack of respect." PTs are all for "what's best for the patient" provided it is a PT who gets to bill and collect on that patient. But if "what's best for the patient" is to have a chiropractor or an athletic trainer treat the patient, then those two professions are stepping on toes.

Can't say that I agree with the first part of your statement at all. I'm pretty concerned that spinal surgeons are performing spinal fusion surgeries at an ever increasing rate, that some of those fusions may be performed because surgeons are financially incentivized to perform them, as placing titanium in someone's back pays a great deal more than conservative care or even a microdiscectomy, that worker's who undergo a fusion have a less than 30% chance of returning to work whereas injured workers who receive conservative care (including physical therapy) have over a 65% chance of returning to work. So I guess you could say that I get a little concerned with other professions and their outcomes.

As to the later part of your post, well, I think you've brought some of your own issues into this thread that are unrelated to what we have recently been discussing. Your prerogative, I guess.

 

[Fiveoboy11]

Did you really just say that a "good professional wouldn't care what another profession does"? That has to be one of the most idiotic comments I've heard.

I never said another provider performing patient treatment is toe stepping or lack of respect. Telling another professional what to do within their scope for a patient, and when they can perform treatment within their scope IS toe stepping and lack of respect, and it happens all the time in PT.

It would be toe stepping if a DC was standing on a football game sideline, telling you how to perform a patient evaluation on the field, and what to do with the athlete, wouldn't it?

You wouldn't see me argue that a ATC needs clearance from a physician or a DC to perform their job duties they have been trained to do either. Because, that would be baseless. Although I have no doubt that is the case, which is a pathetic joke.

 

[atstudent]

atstudent -

Can't say that I agree with the first part of your statement at all. I'm pretty concerned that spinal surgeons are performing spinal fusion surgeries at an ever increasing rate, that some of those fusions may be performed because surgeons are financially incentivized to perform them, as placing titanium in someone's back pays a great deal more than conservative care or even a microdiscectomy, that worker's who undergo a fusion have a less than 30% chance of returning to work whereas injured workers who receive conservative care (including physical therapy) have over a 65% chance of returning to work. So I guess you could say that I get a little concerned with other professions and their outcomes.

As to the later part of your post, well, I think you've brought some of your own issues into this thread that are unrelated to what we have recently been discussing. Your prerogative, I guess.

Sorry jesspt, a misunderstanding likely my fault. What I mean is FiveO shot down chiropractic just because it's not physical therapy. He appears much too worried about what another professional (who receives similar training) is doing rather than being concerned about his own. My opinion is that rather than bicker about it, a "good professional" would just prove he/she is better at that specific skillset. Fact of the matter is physical therapy may be exclusive to PT and PTAs, but rehabilitation is not. And there is a lot of overlap between physical therapy and rehabilitation. Oftentimes, right or wrong, the two are used interchangeably.

I got news for you-- I am going to see the BEST professional that is going to fix my problem. If that's a PT, great. If it's a chiropractor, great. If it's an athletic trainer, awesome. But I want my problem fixed. For the record, I despise most chiropractics because it has been my experience that they are a "quick fix" and don't really work to solve the problem.


FiveO, I am willing to work with just about any healthcare profession as part of my sports medicine team. I have worked with nurses, chiropractors, PTs, PTAs, strength coaches, and a variety of doctors in my short career. In fact, I do so on a regular basis especially since I am employed by a PT clinic.

And jesspt, on the last point, I brought it up because once again PT posters here are more than happy to disrespect other professions.

It shouldn't be an "us vs. them" mentality with any of this. It should be about helping the patient so that individual can return to their normal activities healthy and safely.

 

[goyo1010]

And jesspt, on the last point, I brought it up because once again PT posters here are more than happy to disrespect other professions.

It shouldn't be an "us vs. them" mentality with any of this. It should be about helping the patient so that individual can return to their normal activities healthy and safely.

I don't think those other PT posters mean to be disrespectful. Well, maybe they do. I guess it the territoriality that some people have with their profession, trying to protect it basically and maintain its integrity, as we've seen already, many professions also performing habilitative services, e.g. nurses, chiropractors, which these PT posters see as mostly meant to be in the realm of physical therapy. It's similar to the whole Medicine vs. Allied Health thing, where you'll see medical students on SDN slamming other health professions down, claiming that medicine is "top of the food chain" or whatever. The PT poster on here simply wants to maintain scope of practice.

And I wholeheartedly agree, we should do whatever is best for patients, not being afraid to work with other professions for the benefit of the patient, within legal and ethical parameters of course. It shouldn't be "us vs. them". Rather, it should be "us for them", them being the patients--granted this was a perfect world. But this has nothing to do with the original post. Just wanted to reply back to atstudent.

 

[truthseeker]

The point of protecting the term/title "physical therapy" or "physiotherapy" is not to protect the things that we do, but the thought process that is supposed to be involved in how we decide what to do. We are protecting the training that we recieve in school.

The competitiveness of the selection process and the difficulty of the boards, and the continuing education requirements mandate that "the least of us" has demonstrated academic ability.

Yes there are good D.C.s and good athletic trainers (heck I am one) but I am not sure that anyone would argue that the "least" D.C. student, and the "least" AT student would not be capable of being admitted into PT school, let alone pass boards.

I know that the average entry level GPA of D.C. schools is below 3.0/4. I know that the average entry level GPA of PTschool is north of 3.5/4. When the standards are lower, there will still be superstars. But, unfortunately, there will also be dangerous people with a degree that gives them credibility that they perhaps do not deserve.

 

[goyo1010]

I know that the average entry level GPA of D.C. schools is below 3.0/4. I know that the average entry level GPA of PTschool is north of 3.5/4. When the standards are lower, there will still be superstars. But, unfortunately, there will also be dangerous people with a degree that gives them credibility that they perhaps do not deserve.

Yikes, I was always wondering why the GPA standards were sooo low. Texas Chiropractic College is trying to raise the GPA to 3.0 in the next few years... Hm...

 

[truthseeker]

it may be changing but look at this link

http://www.chirobase.org/03Edu/adm.html

for a comparison of different GPAs for different professional programs. PT is not listed unfortunately.

 

[TheOx777]

it may be changing but look at this link

http://www.chirobase.org/03Edu/adm.html

for a comparison of different GPAs for different professional programs. PT is not listed unfortunately.

I cannot be certain about this, but given the fact that this article is approximately 12 yrs old I don't know how much one can extrapolate from these numbers. I think the trend has been that the level of competition for most health care professional schools has increased over the years(again I can't say that with any certainty) It is a very interesting comparison though. If the trend still holds true, it would lead to, at the very least, an interesting conversation piece. As it relates to the PT, the APTA states that the mean GPA for applicants using PTCAS was 3.47. Not too shabby in the realm of GPA comparisons with other healthcare professions.

 

[PTapp]

A friend of mine who had a GPA 2.4-2.5 got into a chiro school 3 years ago. They even waived his organic chem requirements because he was getting his Exercise Science degree. That is a joke! Don't even compare PT to chiro admissions.

 

[TheOx777]

A friend of mine who had a GPA 2.4-2.5 got into a chiro school 3 years ago. They even waived his organic chem requirements because he was getting his Exercise Science degree. That is a joke! Don't even compare PT to chiro admissions.

Wow,

That is pretty shocking honestly! Did he have some extenuating circumstances that led to such a low gpa? Maybe that played a role in his admission. I am trying to give him the benefit of the doubt, because I cannot imagine how a person would be admitted with that GPA without every other part of their application being FLAWLESS!

 

[goyo1010]

A friend of mine who had a GPA 2.4-2.5 got into a chiro school 3 years ago. They even waived his organic chem requirements because he was getting his Exercise Science degree. That is a joke! Don't even compare PT to chiro admissions.

lol. that's pretty amazing stuff! haha. how in the world does the exercise science degree have anything to do with organic chemistry...

 

[PTapp]

Wow,

That is pretty shocking honestly! Did he have some extenuating circumstances that led to such a low gpa? Maybe that played a role in his admission. I am trying to give him the benefit of the doubt, because I cannot imagine how a person would be admitted with that GPA without every other part of their application being FLAWLESS!

They were actually at the university I graduated from last week. I got this through the ES club messages on facebook. This was forwarded to all the group members. He got into NYCC.

Fast Facts:
1. Chiropractic is one of the fastest growing health professions in the country
2. One of the highest ratings in job satisfaction among all professions.
3. Average annual salary – approx $105,000
4. ES students with > 3.0 GPA priority acceptance to NYCC!
5. 2.5-3.0 GPA given special consideration

So none of those extenuating circumstances. It was just a part of their selection process.

Back in 07 when I was a junior in college, I also filled one of their brochures, but did not send in my application, because I wanted to go to PT school. I have received incredible amount of stuff from them in the mail. They are so damn desperate, it is not even funny. I had to call them to stop killing trees, and sending me all that BS!. It was aggravating.

 

[PTapp]

lol. that's pretty amazing stuff! haha. how in the world does the exercise science degree have anything to do with organic chemistry...

lol yeah... And also what does that have to do with Chiropractic? Go figure man.

 

[TheOx777]

They were actually at the university I graduated from last week. I got this through the ES club messages on facebook. This was forwarded to all the group members. He got into NYCC.

Fast Facts:
1. Chiropractic is one of the fastest growing health professions in the country
2. One of the highest ratings in job satisfaction among all professions.
3. Average annual salary – approx $105,000
4. ES students with > 3.0 GPA priority acceptance to NYCC!
5. 2.5-3.0 GPA given special consideration

So none of those extenuating circumstances. It was just a part of their selection process.

Back in 07 when I was a junior in college, I also filled one of their brochures, but did not send in my application, because I wanted to go to PT school. I have received incredible amount of stuff from them in the mail. They are so damn desperate, it is not even funny. I had to call them to stop killing trees, and sending me all that BS!. It was aggravating.

I don't know what to say but......Bwaaahaaahaaa, especially to
2.5-3.0 GPA given special consideration . Utterly speechless honestly!

 

[facetguy]

I'm wondering if PT's extremely rigorous admissions standards and notoriously difficult coursework makes PT more effective than chiropractic for, say, LBP? (Hint: the literature would say 'no', and since we are all supposed to be evidence-based...)

 

[Fiveoboy11]

Post a link/article that proves what you're saying. I strongly doubt that is true, and probably something you have fabricated within your mind because you read one article written by a chiropractor that projected (without evidence) what you're arguing. So, I'll be waiting for your article, and if you do actually cite one (hopefully one you actually did read), we can have a literature debate.

 

[truthseeker]

I'm wondering if PT's extremely rigorous admissions standards and notoriously difficult coursework makes PT more effective than chiropractic for, say, LBP? (Hint: the literature would say 'no', and since we are all supposed to be evidence-based...)

Facetguy,

I think the point here is that those with higher gpa's and more rigorous academic screening may be more suited to safely be portal of entry providers simply based upon the level of training that can be provided to those who have demonstrated academic ability. The point of the post was to ask why PT is a protected term.

The average PT is simply put, more capable of identifying "other". i.e red flags etc . . . where simple treatment of NMSK injuries/disability is inadequate at best and life-threatening at worst. With PT behind the providers name, I think the public has the right to expect that the "other" will be recognized and with DC behind their name they may (not will, but may) have someone who got more C's than A's in college and may not recognize those things. Please do not take this as an indictment of all chiropractors and all that you do because there are plenty of good ones, however, you have DC behind your name and so does the idiot with deep pockets and a 2.5 GPA in PE who got into chiro school and they kept him in until daddy's money ran out or he passed his classes and boards. I am just saying that the bell curve is skewed to the right in PT and, compared to all other direct access providers of health care, well to the left with chiropractic.

This is why PT is not just ultrasound and electrical stim and exercise.

 

[facetguy]

Post a link/article that proves what you're saying. I strongly doubt that is true, and probably something you have fabricated within your mind because you read one article written by a chiropractor that projected (without evidence) what you're arguing. So, I'll be waiting for your article, and if you do actually cite one (hopefully one you actually did read), we can have a literature debate.

Let me again preface my comments with a few words since, as a chiro posting in the PT forum, it would be easy for my comments to be misconstrued. First, I am in no way anti-PT; to the contrary, I refer patients to PTs and have found PTs helpful over the course of my career. There is no us vs. them. Second, once you've worked with enough patients, you will realize that nobody fixes 100% of them; it's often a team effort and, like it or not, you will have patients that DCs help more than you do (and vice versa, of course). Also, if you follow the literature, you will generally find that spinal manipulation plus exercise is usually better than either alone (yes, there is lots of literature for spinal manipulation, the vast majority of which-- 94% -- is performed by DCs). Next, although I wish chiro education standards were higher, chiro education has improved tremendously over the last several decades; this is a good thing for which the chiro profession should be commended.

These comments are more of a reality check to hopefully reduce cockiness and promote mutual respect.

Now, you asked for some studies:

1) http://www.ncbi.nlm.nih.gov/pubmed/21407100 Compared LBP-related disability episodes among work-comp patients among PTs, MDs and DCs. This study found that disability recurrence among PT patients was double that for DC patients.

2) http://www.ncbi.nlm.nih.gov/pubmed/20053720 Compared SMT, PT and 'back school'. From the study:
"CONCLUSIONS: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy."

And we should bear in mind the findings of the large UK BEAM trial from several years ago (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535455/ ) which looked at SMT and exercise for LBP. The findings are that both work, both together are probably better than either alone, but that "manipulation alone probably gives better value for money than manipulation followed by exercise".

Again, in the real world, PT is more than just exercise, and chiro is more than just SMT. But these studies remind us that there is a role for everyone in the care of these patients.

 

[facetguy]

Facetguy,

I think the point here is that those with higher gpa's and more rigorous academic screening may be more suited to safely be portal of entry providers simply based upon the level of training that can be provided to those who have demonstrated academic ability. The point of the post was to ask why PT is a protected term.

The average PT is simply put, more capable of identifying "other". i.e red flags etc . . . where simple treatment of NMSK injuries/disability is inadequate at best and life-threatening at worst. With PT behind the providers name, I think the public has the right to expect that the "other" will be recognized and with DC behind their name they may (not will, but may) have someone who got more C's than A's in college and may not recognize those things. Please do not take this as an indictment of all chiropractors and all that you do because there are plenty of good ones, however, you have DC behind your name and so does the idiot with deep pockets and a 2.5 GPA in PE who got into chiro school and they kept him in until daddy's money ran out or he passed his classes and boards. I am just saying that the bell curve is skewed to the right in PT and, compared to all other direct access providers of health care, well to the left with chiropractic.

This is why PT is not just ultrasound and electrical stim and exercise.

As I've stated, I wish chiro admission standards were higher. But you may be placing a little too much weight upon them. To think that DCs can't detect red flags is simply not realistic. Remember, DCs have always been direct portal of entry providers and have always had to consider red flags and other diagnostic issues, while PTs have traditionally had their patients pre-screened and traditionally have much less responsibility diagnostically. Evaluating patients for red flags is foremost in the minds of DCs, whether they got Cs or not.

 

[Fiveoboy11]

http://www.nejm.org/doi/pdf/10.1056/NEJM199810083391502

http://www.annals.org/content/138/11/871.short


I'm impressed that you have some literature to support your comments. It's nice to see an argument with a basis. It's a shame that being a clinician isn't made any easier by the fact that one study may contradict another.

 

[Fiveoboy11]

Here's some info on a good book I ordered about a week ago (actually got it on ebay) that was written by DC's, PT's, and physician's for treatment of the spine.

Rehabilitation of the Spine: A Practitioner's Manual: The foremost authorities from chiropractics, orthopaedics and physical therapy present a practical overview of spinal rehabilitation. This clinical resource presents the most current and significant spinal rehab information, showing how to apply simple and inexpensive rehabilitation in the office. The updated Second Edition includes clinical/regional protocols and chapters on diagnostic triage, acute care, functional assessment, recovery care, outcomes, and biopsychosocial aspects.

Can't wait until I get this book.

FWIW I respect other healthcare provider's too (including DC's), but I have a lot of issues with them at the same time.

 

[facetguy]

Here's some info on a good book I ordered about a week ago (actually got it on ebay) that was written by DC's, PT's, and physician's for treatment of the spine.

Rehabilitation of the Spine: A Practitioner's Manual: The foremost authorities from chiropractics, orthopaedics and physical therapy present a practical overview of spinal rehabilitation. This clinical resource presents the most current and significant spinal rehab information, showing how to apply simple and inexpensive rehabilitation in the office. The updated Second Edition includes clinical/regional protocols and chapters on diagnostic triage, acute care, functional assessment, recovery care, outcomes, and biopsychosocial aspects.

Can't wait until I get this book.

FWIW I respect other healthcare provider's too (including DC's), but I have a lot of issues with them at the same time.

This is Craig Liebenson, DC's book. You won't be disappointed. Every chiropractic student knows, studies and uses it.

The issues you have with DCs are more than likely the product of preconceived notions based on poor information you've been given. Keep an open mind and keep reading the literature.

 

[facetguy]

http://www.nejm.org/doi/pdf/10.1056/NEJM199810083391502

http://www.annals.org/content/138/11/871.short


I'm impressed that you have some literature to support your comments. It's nice to see an argument with a basis. It's a shame that being a clinician isn't made any easier by the fact that one study may contradict another.

As you familiarize yourself with the available research, you'll find that there are no magic bullets for neck and back pain patients. No one discipline has all the answers for these patients. Each discipline has its successes and its failures with them. Knowing that, it's important to make the distinction between a form of treatment having no beneficial effect vs. no MORE beneficial effect than anything else. As it relates to spinal manipulation, the studies show us that it is at least as effective as anything else out there (and sometimes more so). That's not a bad place to be. In other words, manipulation is no worse than exercise, or meds, or injections, etc. So when, for example, the authors of the Annals study you linked state "There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain", that doesn't mean SMT doesn't work, it means it's no better than anything else.

As I've said before, in practice many of these patients will require a joint effort. Your patients won't think any less of you if you co-manage them with a DC, or a pain management doc, or whoever. They just want to get better. Your patients might, however, think less of you if you make a habit of denigrating other professionals in their presence.

 

[Fiveoboy11]

The issues I have with DC's are based on what I have encountered in real life. And, I am well aware that the primary author of that book is a DC, I just had to swallow my hatred of DC's, and forgo my preconceived notions to get myself to buy it. Sarcasm off. Clarification - I don't give a damn what type of clinician anyone is, just don't tell me what I can do, when it's ok for me to do it, and that you practice what I do without the schooling.

 

[facetguy]

The issues I have with DC's are based on what I have encountered in real life. And, I am well aware that the primary author of that book is a DC, I just had to swallow my hatred of DC's, and forgo my preconceived notions to get myself to buy it. Sarcasm off. Clarification - I don't give a damn what type of clinician anyone is, just don't tell me what I can do, when it's ok for me to do it, and that you practice what I do without the schooling.

Don't hate...life's too short.

 

[mtm34]

I battled hard between going to PT school or chiro school- the more research I did the harder time I had seeing chrio's sticking around with the ever shrinking healthcare $$$. Being that PT's fit more into the mainstream of the continuum of care within the medical community I felt like it is an uphill battle for chiro's from here on out (especially with the huge debt associated with a private chiro education). Regardless I have worked with good chiro's and PT's as well as bad chiro's and PT's. Hopefully the future is bright for the good ones.

 

[facetguy]

I battled hard between going to PT school or chiro school- the more research I did the harder time I had seeing chrio's sticking around with the ever shrinking healthcare $$$. Being that PT's fit more into the mainstream of the continuum of care within the medical community I felt like it is an uphill battle for chiro's from here on out (especially with the huge debt associated with a private chiro education). Regardless I have worked with good chiro's and PT's as well as bad chiro's and PT's. Hopefully the future is bright for the good ones.

I agree that PT is the much safer choice, with essentially automatic employment opportunities that pay well. Chiro has a significantly larger entrepreneurial component to it, which involves much more risk (business-wise) but also potentially higher rewards, job satisfaction, etc. For most, PT is the better choice, although chiros as a profession will be around for the duration as well.

 

[truthseeker]

FYI,

the chiropractic association in Minnesota has just introduced (actually re-introduced) a bill that would prohibit PTs from doing manual therapy, including but not limited to spinal manipulation.

Discuss.

 

[facetguy]

I don't see that passing, although I admittedly don't know anything about the proposal. Perhaps if it can be shown that PTs have no/limited training in HVLA, perhaps that specific issue will get some traction. But manual therapy in general? No way it passes.

 

[PTapp]

FYI,

the chiropractic association in Minnesota has just introduced (actually re-introduced) a bill that would prohibit PTs from doing manual therapy, including but not limited to spinal manipulation.

Discuss.

That is just ridiculous. What makes them think we are incapable of performing manual therapy techniques. What kind of research have they come up with to introduce such a bill? Since they RE-introduced this bill, no matter how many times it is turned down, they will keep re-introducing it.

 

[jesspt]

That is just ridiculous. What makes them think we are incapable of performing manual therapy techniques. What kind of research have they come up with to introduce such a bill? Since they RE-introduced this bill, no matter how many times it is turned down, they will keep re-introducing it.

What would make you think they have research to back up their re-introduction of the bill? This a political ploy to try to protect some of their "turf." Something similar occured in Illinois in 2006, although the chiropractic and osteopathic associations at that time were just trying to prevent PTs from performing HVLA.

Facet - I would agree with you. I don't think there is a snowball's chance that this passes, particularly with CAPTE now requiring all PT schools to include HVLA in thier curriculum in order to gain/maintain accredited status.

 

[cdmguy]

This is Craig Liebenson, DC's book. You won't be disappointed. Every chiropractic student knows, studies and uses it.

The issues you have with DCs are more than likely the product of preconceived notions based on poor information you've been given. Keep an open mind and keep reading the literature.

This is such a load of hogwash. Facetguy it really makes me question your integrity when I read comments like this. Craig Liebenson's book is NOT core curriculum for accredited chiropractic colleges-interested parties can look up the accreditation guidelines for the Council on Chiropractic Colleges. Liebenson's book is a simple book on Janda's crossed muscle imbalance patterns and post isometric stretching and by now it is dated. Chiropractic even has additional certification courses in rehabilitation that DCs take to gain knowledge and if Liebenson's book was really "core curriculum" then they would not be learning it in that diplomate course. Moreover referring back to the sad state of rehabilitation training in chiropractic even the physiotherapy class (TENS, ultrasound, etc) is optional. So basic rehabilitation is completely at the discretion of individual chiropractic colleges. Mixer programs that like functional rehabilitation will include it, some straight programs that like high volume manipulation with more vitalistic quackery shun it because they hate medicine and physical therapy others might emphasize posture correction traction and mirror image exercises because they can run high volume visits from that (despite being unable to address ligament laxity and effectively stabilize some patients). Chiropractic is the wild west of rehabilitation.

So if anyone wants to learn false biomechanics, 50 year old quackery based manipulation techniques and nonevidence based practice feel free to join the ranks of the chiropractors-but don't say I didn't warn you. Click here for a current curriculum of Sherman Chiropractic College that includes classic chiropractic quackery including Toggle, Gonstead, leg checks and the rest (Activator etc). You think this college is going to teach evidence based rehabilitation techniques? Don't make me laugh.

Again, everyone here needs to verify all statements from chiropractors. Trust nobody. These DCs are fighting for their lives and every post is a battle to them for survival.

 

[facetguy]

This is such a load of hogwash. Facetguy it really makes me question your integrity when I read comments like this. Craig Liebenson's book is NOT core curriculum for accredited chiropractic colleges-interested parties can look up the accreditation guidelines for the Council on Chiropractic Colleges. Liebenson's book is a simple book on Janda's crossed muscle imbalance patterns and post isometric stretching and by now it is dated. Chiropractic even has additional certification courses in rehabilitation that DCs take to gain knowledge and if Liebenson's book was really "core curriculum" then they would not be learning it in that diplomate course. Moreover referring back to the sad state of rehabilitation training in chiropractic even the physiotherapy class (TENS, ultrasound, etc) is optional. So basic rehabilitation is completely at the discretion of individual chiropractic colleges. Mixer programs that like functional rehabilitation will include it, some straight programs that like high volume manipulation with more vitalistic quackery shun it because they hate medicine and physical therapy others might emphasize posture correction traction and mirror image exercises because they can run high volume visits from that (despite being unable to address ligament laxity and effectively stabilize some patients). Chiropractic is the wild west of rehabilitation.

So if anyone wants to learn false biomechanics, 50 year old quackery based manipulation techniques and nonevidence based practice feel free to join the ranks of the chiropractors-but don't say I didn't warn you. Click here for a current curriculum of Sherman Chiropractic College that includes classic chiropractic quackery including Toggle, Gonstead, leg checks and the rest (Activator etc). You think this college is going to teach evidence based rehabilitation techniques? Don't make me laugh.

Again, everyone here needs to verify all statements from chiropractors. Trust nobody. These DCs are fighting for their lives and every post is a battle to them for survival.

Hey, you finally crawled out from under that rock. Where ya been? I've missed your angry, bitter posts.

Liebenson's book is not "a simple book" as you suggest, nor is it outdated. And WTF do you know anyway? You failed/quit chiropractic years ago (and yet you continue to be obsessed and just can't move on).

And a quick FYI: Liebenson designed the first chiro rehab diplomate program. The text and the post-grad courses are not mutually exclusive.

[For those interested, Dr. Liebenson has written a new book, to be released soon, designed to bridge the gap between rehab and fitness. It, too, has multiple authors from various disciplines.]

And speaking of evidence-based, you and I have already been through much of the literature, since I had to school you on that, too.

I think I hear your rock calling. Time to go crawl back under.

 

[cdmguy]

Hey, you finally crawled out from under that rock. Where ya been? I've missed your angry, bitter posts.

I doubt it and where do you get off calling me angry and bitter when you immediately lauch into ad hominem attacks. My point is that you misrepresented chiropractic education-and you did.

Moreoever the book is outdated. The functional rehab gains wear off if you stop doing the exercises so the patients never recover-indicating that underlying problems aren't being addressed.

Liebenson's book is not "a simple book" as you suggest, nor is it outdated. And WTF do you know anyway? You failed/quit chiropractic years ago (and yet you continue to be obsessed and just can't move on).

WTF I know if that I graduated from an accredited chiropractic school and Liebieson's material was completely omitted. Moreoever modalities were an optional course and the closest thing to rehab was a 1 hour extremity manipulation course which didn't even have any hours of patient contact.

And a quick FYI: Liebenson designed the first chiro rehab diplomate program. The text and the post-grad courses are not mutually exclusive.

The fact that the course exists at all supports my statement that rehabilitation isn't part of the core curriculum.

And speaking of evidence-based, you and I have already been through much of the literature, since I had to school you on that, too.

In your own deluded mind.

 

[Fiveoboy11]

I tried to buy this book on E-bay. Actually from a chiropractor. The guy who sold the "book" to me ended up sending me a copyright infringed CD-ROM pdf copy of the book. So, I had to file a complaint to ebay and ended up getting a full refund. But had to pay about 20 dollars to send the CD back. He has since been banned.

Also, I think this book has been well endorsed and has received positive feedback supporting it as evidence based. This is why I chose to buy it, regardless of the primary clinician's credentials. And as Facetguy stated, it is multidisciplinary including physician's and PT's. This book also received a favorable review from the Physical Therapy Journal. If anything, just watch who you buy it from, and make sure you're actually getting the book.

 

[cdmguy]

FiveO,

Wow that's pretty low a chiropractor stealing from another chiropractor. But it isn't uncommon. A popular saying in chiropractic is that "chiropractors eat their young" which refers to the ridiculously low pay most associate chiropractors make. It could also be said that "chiropractors eat prospective underachieving college students" because 50% of them quit at the five year practice mark. Chiropractors don't want to fess up that they have a fundamentally dishonest wanna be profession so instead of admitting the problems are systemic we see clowns like facetguy here blaming the victims. That reminds me, if you ever want to understand chiropractic just get a good book on how cults operate and you'll recognize all the tactics.

isolation
love bombing
propaganda
us versus them/black and white thinking
thought stopping
coercive environment
personally attacking critics

Regarding the book, don't get me wrong, it was great in its time and it does a good job of teaching functional rehabilitation and post isometric relaxation stretching. But what is noteworthy is that all of the methods were taken from medicine (Janda was a European MD).

However I would like to see PTs do more with the neutral zone and mirror image exercise concepts to get patients back to a centered position rather than trying to rehab an off balanced position that will never stabilize. PT needs to upgrade and implement a more accurate theoretical understanding of biomechanics not rehash the tired old functional rehab paradigm when patients could do better. This includes tractioning contractured ligaments.

If they ignore this then chiropractors will leapfrog them because they aren't.