Oh you're a physical therapist, just like a chiropractor, right?

[wright6]

Is it just me or does it get old hearing this, whether you're telling someone that you're studying physical therapy or are a physical therapist? How would you respond?

---

Members don't see this ad.

 

[wright6]

Oops sorry for the double post

 

[Azimuthal]

Don't be offended by that question. Instead, take it as an opportunity to educate the population of the similarities and differences.

 

[goyo1010]

Don't be offended by that question. Instead, take it as an opportunity to educate the population of the similarities and differences.

I also get "massage therapist" and "personal trainer for sick people".

 

[LeSeanMcCoy]

Someone once asked me if I needed a high school education to be a PT. I didn't even know how to start to respond to this inquiry.

 

[markelmarcel]

I'd say, yes, I do know how to do manipulations, but I also know how to do a lot of other things too. And like another person said, I use it for an opportunity to educate on what PTs can do!

 

[DPTErudition]

A lot of chiropractors now do more than manipulations. Many will go through a full exam, prescribe therapeutic exercise, and they also do modalities.

 

[a0pitre]

A lot of chiropractors now do more than manipulations. Many will go through a full exam, prescribe therapeutic exercise, and they also do modalities.

Many will also advertise physical therapy, however referring to modalities such as US, MHP, cold pack, E stim etc

 

[AlanWattsBlues]

And for all of the challenges facing the PT profession, it seems like the chiropractors have some substantial hurdles as well. Student loan default seems like a pretty horrible thing to struggle with and chiropractors deal with it disproportionately: http://www.chirobase.org/03Edu/

Hopefully with the increasing tuition rates/move to DPT, PT doesn't become a profession filled with student default....at least for the moment that is one way that we aren't like chiropractors.

 

[facetguy]

And for all of the challenges facing the PT profession, it seems like the chiropractors have some substantial hurdles as well. Student loan default seems like a pretty horrible thing to struggle with and chiropractors deal with it disproportionately: http://www.chirobase.org/03Edu/

Hopefully with the increasing tuition rates/move to DPT, PT doesn't become a profession filled with student default....at least for the moment that is one way that we aren't like chiropractors.

From the link you posted (and bearing in mind it's chirobase), it appears the loans in question are HEAL loans. It also appears that the HEAL loan program was discontinued in 1998, making these loans pretty old. I would guess that the actual overall default rate for chiros is quite low.

 

[AlanWattsBlues]

From the link you posted (and bearing in mind it's chirobase), it appears the loans in question are HEAL loans. It also appears that the HEAL loan program was discontinued in 1998, making these loans pretty old. I would guess that the actual overall default rate for chiros is quite low.

Good observation. But FWIW I would note that the program ran for 20 years (from 1978 to 1998) and was open to "schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, public health, pharmacy, chiropractic, or in programs in health administration, and clinical psychology" (from http://bhpr.hrsa.gov/scholarshipsloans/heal/aboutheal.html). In some ways it's a pretty powerful data set.

The fact that half of defaulters are chiropractors--accounting for 40% of defaulted debt--leads me to believe that chiropractors were defaulting disproportionate to other health care professionals. Though to really know that we'd need to see a breakout of loan origination by profession.

I don't know if the professional outlook for chiropractors has improved over the last decade and a half. Perhaps you do. But I imagine that for every person in default there are many more making their payments at great personal sacrifice.

From what I read on this forum, it seems like you have been successful as a chiropractor and don't really fall into the practice patterns that PTs so often complain about. It's not my intention to paint a profession with one broad stroke. I brought this up because I often hear a "grass is always greener" mentality from PTs who envy some of the liberties that chiropractors have. I think it's worth reflecting on the challenges that chiros face in order to help put this in perspective. And to understand the danger of members of the PT profession starting out their careers in an untenable financial position. There but for the grace of....

 

[Azimuthal]

From what I read on this forum, it seems like you have been successful as a chiropractor and don't really fall into the practice patterns that PTs so often complain about. It's not my intention to paint a profession with one broad stroke. I brought this up because I often hear a "grass is always greener" mentality from PTs who envy some of the liberties that chiropractors have. I think it's worth reflecting on the challenges that chiros face in order to help put this in perspective. And to understand the danger of members of the PT profession starting out their careers in an untenable financial position. There but for the grace of....

Unfortunately, he's an outlier in his profession. Just had an in-patient that went through a C4-C5 discectomy and fusion. C/O headaches and went to see a what I presume as an old school quack chiro. He was told that he had a c-spine subluxation and then proceeded with treatment. Pt. stated that he heard an unusually loud pop and asked if everything was okay. He informed the chiro that he had a funny sensation running down his arm. Was told it was normal and should go away and for him to go home and rest. Pt. went home and took a nap. Woke up minus sensation and strength in all four limbs. Wife called 9-11 and imaging showed a ruptured disc. Fortunately, the Sx went well and he was able to walk a few hundred feet w/o assistance before discharging home with family 2 days later.

This is only anecdotal, however, the more I have been exposed to the chiropractic profession, the more I question the clinical reasoning behind their treatments. I'm currently in acute inpatient clinical rounds.

 

[facetguy]

Good observation. But FWIW I would note that the program ran for 20 years (from 1978 to 1998) and was open to "schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, public health, pharmacy, chiropractic, or in programs in health administration, and clinical psychology" (from http://bhpr.hrsa.gov/scholarshipsloans/heal/aboutheal.html). In some ways it's a pretty powerful data set.

The fact that half of defaulters are chiropractors--accounting for 40% of defaulted debt--leads me to believe that chiropractors were defaulting disproportionate to other health care professionals. Though to really know that we'd need to see a breakout of loan origination by profession.

I don't know if the professional outlook for chiropractors has improved over the last decade and a half. Perhaps you do. But I imagine that for every person in default there are many more making their payments at great personal sacrifice.

From what I read on this forum, it seems like you have been successful as a chiropractor and don't really fall into the practice patterns that PTs so often complain about. It's not my intention to paint a profession with one broad stroke. I brought this up because I often hear a "grass is always greener" mentality from PTs who envy some of the liberties that chiropractors have. I think it's worth reflecting on the challenges that chiros face in order to help put this in perspective. And to understand the danger of members of the PT profession starting out their careers in an untenable financial position. There but for the grace of....

Truthfully, I'm not sure of default rates and whether they are increasing, declining or staying the same. If I had to guess, I'd say things are probably getting tougher, but I'd include most of healthcare in that.

As far as making a good career out of chiro vs. PT, it's way easier to be successful as a PT. Or let me put it this way, it's harder to fail as a PT. Yes, chiros can theoretically have a much higher income potential, but that end of the payscale is uncommon. Chiros also have much more risk in terms of surviving in practice. As PTs, you guys can graduate, get a decent job somewhere, and do pretty well. Chiros are pretty much out there by themselves, starting and maintaining a business with (in many cases) no real sources of referrals from the at-large medical community. That can be a scary place.

 

[facetguy]

Unfortunately, he's an outlier in his profession. Just had an in-patient that went through a C4-C5 discectomy and fusion. C/O headaches and went to see a what I presume as an old school quack chiro. He was told that he had a c-spine subluxation and then proceeded with treatment. Pt. stated that he heard an unusually loud pop and asked if everything was okay. He informed the chiro that he had a funny sensation running down his arm. Was told it was normal and should go away and for him to go home and rest. Pt. went home and took a nap. Woke up minus sensation and strength in all four limbs. Wife called 9-11 and imaging showed a ruptured disc. Fortunately, the Sx went well and he was able to walk a few hundred feet w/o assistance before discharging home with family 2 days later.

This is only anecdotal, however, the more I have been exposed to the chiropractic profession, the more I question the clinical reasoning behind their treatments. I'm currently in acute inpatient clinical rounds.

I agree; this is only anecdotal. I've heard many unsavory tales of PT involvement over the years, but it doesn't change my view of PTs.

 

[Azimuthal]

I agree; this is only anecdotal. I've heard many unsavory tales of PT involvement over the years, but it doesn't change my view of PTs.

I admit, I'm more impressionable to these things because of what I have been exposed to (I don't put much weight in what I hear) and that my exposure is limited compared to yourself. I'm curious, however, to how many of your tales of PT involvement lead to emergency surgical intervention and/or were life threatening?

 

[markelmarcel]

I'm curious, however, to how many of your tales of PT involvement lead to emergency surgical intervention and/or were life threatening?

Nothing life threatening or emergent surgery inducing here, but a PT that I worked at one of my clinicals had several run-ins with people falling and breaking a bone in the clinic. Freak accident type stuff... which is probably what that chiro incident was...

 

[Fiveoboy11]

Fwiw, I have a patient right now who had a vertebral artery dissection and a cerebellar stroke. Mid thirties, normal height/wt, no PMH. He was seeing a chiropractor with c/o headaches and getting neck manipulations. Looks like i've seen a rare phenomenon!

 

[markelmarcel]

Fwiw, I have a patient right now who had a vertebral artery dissection and a cerebellar stroke. Mid thirties, normal height/wt, no PMH. He was seeing a chiropractor with c/o headaches and getting neck manipulations. Looks like i've seen a rare phenomenon!

That's nuts! Although, if someone came in and was c/o headaches or neck pain, I wouldn't think "Oh this person has a dissected vertebral artery", so I wonder if there were other red flags that the chiro missed? Very interesting case, and I'm not saying chiropractors are the best for anything, but sometimes I feel like everyone is super negative towards them. Just like every other profession there are good and bad.

 

[goyo1010]

A VBI insufficiency screen should ALWAYS preclude any type of cervical manipulation. Dunno what that chiro was thinking.

 

[facetguy]

A VBI insufficiency screen should ALWAYS preclude any type of cervical manipulation. Dunno what that chiro was thinking.

That sounds like you are making the assumption that those screening maneuvers are meaningful. They're not, per the literature. Now, your malpractice attorney might tell you to do them so it looks good, but don't fool yourself into thinking they are predicting much of anything.

 

[Bones26]

That sounds like you are making the assumption that those screening maneuvers are meaningful. They're not, per the literature. Now, your malpractice attorney might tell you to do them so it looks good, but don't fool yourself into thinking they are predicting much of anything.

I've heard from several manual therapists that some of the VBI tests are at least as risky and potentially harmful as basic, entry-level cervical mobilizations. They claimed that the only reason they're taught in school is because documentation of performing them could save your ass in a malpractice suit.

 

[Fiveoboy11]

I don't know that it is anyone's fault when a stroke due to manipulation occurs. Unpredictable, extremely rare. As a whole the benefit outweighs the risk. But definitely does happen and patients need to be informed and give consent before they're manipulated. And it should only be done when it is indicated. And it looks like there's a long way to go before any cost effective and realistic screen is helpful in predicting and preventing this type of thing.

Http://www.jospt.org/doi/pdf/10.2519/jospt.2009.2926?noFrame=true

http://www.jospt.org/doi/pdf/10.2519/jospt.2005.35.5.300?noFrame=true

 

[SuperKirby]

Someone once asked me if I needed a high school education to be a PT. I didn't even know how to start to respond to this inquiry.

A friend of mine (who is a Dental Assistant) thought my PT degree was a certificate. He's in the medical field and didn't even know. lol.

 

[SuperKirby]

Nothing life threatening or emergent surgery inducing here, but a PT that I worked at one of my clinicals had several run-ins with people falling and breaking a bone in the clinic. Freak accident type stuff... which is probably what that chiro incident was...

Comparing a fall in a clinic (freak accident) vs a CVA due to CSpine manipulation are two very different comparisons. One is just an "accident" where the practitioner was not careful and the other is a health intervention procedure taking place that is in question.

 

[goyo1010]

That sounds like you are making the assumption that those screening maneuvers are meaningful. They're not, per the literature. Now, your malpractice attorney might tell you to do them so it looks good, but don't fool yourself into thinking they are predicting much of anything.

I should qualify my initial statement to say "after considering S&S, test position, MOI, and presence of bony injury". But ALWAYS for legal reasons. My apologies. And true, there are studies that assert the inconclusiveness of VBI screens (poor diagnostic accuracy). If a patient with true VBI came to the clinic and I didn't bother to check for signs of VBI and manipulated their cervical spine, then the potential for an adverse event went up. The VBI screen does not only include the actual manipulative position, but also includes S&S consistent with VBI the patient may present with simple neck motion, e.g. nystagmus, dizziness, N/V, which then needs to be differentiated from vestibular etiology vs. vascular insults (VBI, TIA, cervical myelopathy 2/2 vascular ischemia, CAD, etc). I had a pt who came in with neck pain with no real MOI. No c/o dizziness, drop attacks, or any of that sort, but something bothered my about the etiology of her pain. So, I assessed her c-spine, but did VBI first just because it's on the front of my list. Took her to the test position, had her count back slowly from 10 and have her maintain her gaze on my nose. Suffice to say, she became dysarthric, and I observed nystagmus halfway through. I stopped the test immediately and reported to my CI. It isn't completely correct to say the screens are "meaningless".

And you're right. It's largely a legal issue. That same article by Childs et al. cited by Fiveboy: "...therapists who suggest that screening is futile and forgo screening potentially place themselves at legal risk should an adverse even occur..."

Interesting JOSPT article came out recently that found no significant changes in blood flow through the VA during manipulative positions. In healthy individuals. Not sure how ethical it would be to research it in individual with known pathology...

 

[facetguy]

I should qualify my initial statement to say "after considering S&S, test position, MOI, and presence of bony injury". But ALWAYS for legal reasons. My apologies. And true, there are studies that assert the inconclusiveness of VBI screens (poor diagnostic accuracy). If a patient with true VBI came to the clinic and I didn't bother to check for signs of VBI and manipulated their cervical spine, then the potential for an adverse event went up. The VBI screen does not only include the actual manipulative position, but also includes S&S consistent with VBI the patient may present with simple neck motion, e.g. nystagmus, dizziness, N/V, which then needs to be differentiated from vestibular etiology vs. vascular insults (VBI, TIA, cervical myelopathy 2/2 vascular ischemia, CAD, etc). I had a pt who came in with neck pain with no real MOI. No c/o dizziness, drop attacks, or any of that sort, but something bothered my about the etiology of her pain. So, I assessed her c-spine, but did VBI first just because it's on the front of my list. Took her to the test position, had her count back slowly from 10 and have her maintain her gaze on my nose. Suffice to say, she became dysarthric, and I observed nystagmus halfway through. I stopped the test immediately and reported to my CI. It isn't completely correct to say the screens are "meaningless".

And you're right. It's largely a legal issue. That same article by Childs et al. cited by Fiveboy: "...therapists who suggest that screening is futile and forgo screening potentially place themselves at legal risk should an adverse even occur..."

Interesting JOSPT article came out recently that found no significant changes in blood flow through the VA during manipulative positions. In healthy individuals. Not sure how ethical it would be to research it in individual with known pathology...

All good points. And there have been similar previous investigations regarding vertebral artery flow/tension (Herzog maybe? Don't have time to look it up now) with similar conclusions.

 

[Fiveoboy11]

I should qualify my initial statement to say "after considering S&S, test position, MOI, and presence of bony injury". But ALWAYS for legal reasons. My apologies. And true, there are studies that assert the inconclusiveness of VBI screens (poor diagnostic accuracy). If a patient with true VBI came to the clinic and I didn't bother to check for signs of VBI and manipulated their cervical spine, then the potential for an adverse event went up. The VBI screen does not only include the actual manipulative position, but also includes S&S consistent with VBI the patient may present with simple neck motion, e.g. nystagmus, dizziness, N/V, which then needs to be differentiated from vestibular etiology vs. vascular insults (VBI, TIA, cervical myelopathy 2/2 vascular ischemia, CAD, etc). I had a pt who came in with neck pain with no real MOI. No c/o dizziness, drop attacks, or any of that sort, but something bothered my about the etiology of her pain. So, I assessed her c-spine, but did VBI first just because it's on the front of my list. Took her to the test position, had her count back slowly from 10 and have her maintain her gaze on my nose. Suffice to say, she became dysarthric, and I observed nystagmus halfway through. I stopped the test immediately and reported to my CI. It isn't completely correct to say the screens are "meaningless".

And you're right. It's largely a legal issue. That same article by Childs et al. cited by Fiveboy: "...therapists who suggest that screening is futile and forgo screening potentially place themselves at legal risk should an adverse even occur..."

Interesting JOSPT article came out recently that found no significant changes in blood flow through the VA during manipulative positions. In healthy individuals. Not sure how ethical it would be to research it in individual with known pathology...

I'm impressed! What did you guys do with that patient?

 

[facetguy]

Continuing from my previous post, a few articles on vertebral artery strain, none of which is perfect but valuable nonetheless:
http://www.ncbi.nlm.nih.gov/pubmed/22483611
http://www.ncbi.nlm.nih.gov/pubmed/20534313
http://www.ncbi.nlm.nih.gov/pubmed/20114096
http://www.ncbi.nlm.nih.gov/pubmed/12381972

Interesting close call: http://www.ncbi.nlm.nih.gov/pubmed/16690388?dopt=Abstract


From this 2001 article by neurologist Scott Haldeman, MD, PhD, DC et al.: http://www.cmaj.ca/content/165/7/905.full
"The likelihood that a chiropractor will be made aware of an arterial dissection following cervical manipulation is approximately 1:8.06 million office visits, 1:5.85 million cervical manipulations, 1:1430 chiropractic practice years and 1:48 chiropractic practice careers. This is significantly less than the estimates of 1:500 000–1 million cervical manipulations calculated from surveys of neurologists.7,8,9 These data also confirm the conclusions of a recent review of the literature in which patients at risk for this complication could not be identified.10"

There has been an evolution in thinking with regard to stroke and cervical spine manipulation. Hopefully future studies will provide useful information and not simply sensationalize the matter.

 

[facetguy]

This study was published last month in JMPT. Used MRI to evaluate vertebral artery flow in various positions. All young, healthy male subjects.
http://www.ncbi.nlm.nih.gov/pubmed/24239451

"Conclusions: There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations."