August 2007

Move over DCs ‑‑ here come the DPTs

by Dr. Terry A. Rondberg

By the year 2020, physical therapists will be doctors of physical therapy, "recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health."

That's what the American Physical Therapy Association (APTA) has set as the goal in its "Vision 2020" mission statement.

One of the services they will provide is spinal manipulation, a therapy many PTs claim as part of their rightful domain based on history as well as practice.

In an editorial published in the current issue of The Journal of Manual & Manipulative Therapy, (http://jmmtonline.com/current), Peter A. Huijbregts, a physical therapist who serves as the Journal's co‑editor, shares his in‑depth views of the competitive and often antagonistic relationship between his profession and ours.

Although his conclusions will infuriate many chiropractors, there can be no denying many of his statements. For instance, he sees clearly ‑‑ more clearly than many chiropractors ‑‑ that the chiropractic profession has painted itself into a corner.

As Mr. Huijbregts says, based on their education and scope of practice, chiropractors have a hard time justifying their claim to be primary care health practitioners. As Mr. Huijbregts puts it: "The limited set of therapies available within the chiropractic scope of practice is clearly poorly suited to providing primary care to the vast majority of health problems that present to a true primary care provider, problems that require interventions that are outside of this legally determined scope of chiropractic."

In many respects, he is correct. Chiropractic education does not qualify DCs to diagnose the thousands of conditions and ailments presented in their offices, nor does state law permit them to do so.

This is precisely why so many chiropractors have embraced the traditional, and unique, practice purpose of detection and correction of vertebral subluxation. This is the one area DCs "own" and it's also the service we offer that can do the most good to all people. If you do not believe that correcting subluxations is more helpful to a patient than prescribing drugs or surgery to treat a specific disease, then why in the world didn't you go to medical school instead of chiropractic college?

Ah, but there's the rub. Many DCs do not believe that correcting subluxations is important. Some even question the very concept of subluxations.

Mr. Huijbregts notes: "Some more scientifically oriented factions within the profession increasingly question their [traditional chiropractic principles] relevance to modern‑day chiropractic. Critiques range from pointing out the limited value of the ACC consensus statement when it comes to providing operational definitions for chiropractic research to a call for a skeptical evaluation of the subluxation construct in an attempt to separate dogma from science and even to a characterization of the subluxation construct as the Achilles heel of the profession."

The editorial also repeatedly claims that the physical therapy community has contributed more research on the effects of spinal manipulation than has chiropractic. In support of its premise, the article points to William Meeker, DC, director of research, Palmer Center for Chiropractic Research, who "underlined this threat that the chiropractic profession obviously perceives from physical therapists by warning his fellow chiropractors that they are in a race for 'professional ownership of manipulation' by specifically mentioning the recent physical therapy research on developing diagnostic classifications and clinical prediction rules as an indication that chiropractors are falling behind in the scientific validation of the use of manipulation."

With both professions racing after "professional ownership of manipulation," Mr. Huijbregts' conclusion is that physical therapy and chiropractic are, or shortly will be, "in a position of direct economic competition within the health care market."

We have two choices. We either continue the race and muddle our chiropractic identity even further or realize that the goal isn't worth the effort and that "winning" the race would be a Pyrrhic victory. What we would lose would be worth far more than what we would gain.

In his "Art of War," the Chinese general Sun‑Tzu said "It is best to win without fighting." We can do this by embracing the uniquely chiropractic concept of vertebral subluxation and by differentiating between spinal manipulation and chiropractic adjustment.

Future Doctors of Physical Therapy will be able to claim "ownership" of spinal manipulation, along with MDs, DOs, and any number of other practitioners who manage to stake a claim on that generic territory.

Only Doctors of Chiropractic can rightfully asset their right to provide subluxation correction to all people, regardless of the presence or absence of symptoms and without the need for differential diagnosis of disease entities. That is our exclusive domain and our true gift to humanity.

The first step is to make it clear that the chiropractic profession ‑‑ as a whole ‑‑ does NOT agree with that small but vocal internal faction who, as Mr. Huijbregts noted, considers the entire concept of the vertebral subluxation complex as the Achilles heel of chiropractic. These critics do NOT speak for us and should not present themselves as representatives of the profession.

The second step is to forcefully dispel the myth promulgated in the Huijbregts' editorial that the anti‑subluxation camp is the "more scientifically oriented faction." This is not true and RCS (Research & Clinical Science) is proving that.

No chiropractic college or research foundation is engaged in any research project with the depth and scope of the one being conducted by RCS. None is exploring the impact of vertebral subluxation on every aspect of physical, mental and emotional well‑being or the potential of chiropractic adjustments to elevate overall health and wellness. None has as many field researchers as RCS or is collecting data on as many volunteer subjects around the world. None is backed by the kind of International Scientific Advisory Panel, comprised of PhDs, MDs, DCs and other noted researchers.

RCS is, in short, the epitome of scientific research and is being run by and for chiropractors who hold that the primary purpose of chiropractic is to detect and correct vertebral subluxation. They are finding answers we have been searching for since DD first adjusted Harvey Lillard in 1895. They are compiling the scientific evidence we need if we are to continue providing the most important health benefits possible to our patients.

The fact that many RCS doctors are also seeing huge increases in their practice numbers as a direct result of their involvement in the program is an indication of how hungry people are to have access to true "health" care as opposed to the disease care provided by all other practitioners (including PTs). When volunteers learn about chiropractic during their participation in the research program, their eyes are opened to new and wondrous possibilities and they eagerly become patients.

Despite what both Mr. Huijbregts and Dr. William Meeker think, DCs are not in a race with PTs. Nor are we even in competition. As long as we maintain our separate and unique identity and conduct the research to show the incredible value of chiropractic care, we need not worry about what new drugs the MDs come up with, or that PTs are classified as "DPTs."

None of them will be doctors of chiropractic and none of them will be able to give patients the gift of subluxation correction. We will have won the war without fighting, and that's what I call true victory.

If you want to share in this victory, take part in the greatest adventure ever offered to DCs and become an RCS Authorized Clinical Investigator. To learn more, call me at 800‑909‑1354 or 480‑303‑1694.