September 2007

Tennessee AG rules against PTs

Tennessee's Attorney General, Robert E. Cooper, Jr., has issued an opinion that prohibits physical therapists in that state from performing spinal manipulation. Saying that spinal adjustments and spinal manipulation are specifically chiropractic forms of care, the AG noted that, "while the physical therapy scope of practice might include performing manual therapy techniques on a patient's spine, or using physical agents and modalities on a patient's spine, nevertheless, a licensed physical therapist may not perform or hold himself or herself out as performing 'spinal manipulation.'"

Cooper's decision was based on an analysis of Tennessee's statutes regulating chiropractic as well as other health care providers. According to his written opinion, state law defines "spinal manipulation" and "spinal adjustment" as interchangeable terms that identify a "method of skillful and beneficial treatment where a person uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity."

The law prohibits any licensed provider from performing spinal manipulation or spinal adjustment without having received the pre‑requisite training in those areas. PTs and other non‑medical or chiropractic providers do not receive such training and therefore cannot offer manipulation or adjustments. If they do, they can be charged with the "unlawful practice of chiropractic," which is grounds for suspension or revocation of their license.

The opinion noted that under Tennessee laws, anyone providing spinal manipulation or adjustments must meet the following criteria:

(a) Training must be performed in chiropractic institutions or institutions that specialize in spinal manipulative therapy. Spinal manipulation is a highly skilled maneuver that requires adequate training. Four hundred (400) hours of classroom instruction and eight hundred (800) hours of supervised clinical training are considered a minimum level of education to properly administer the techniques.

(b) Spinal manipulation must be performed by hand or with the use of instruments such as Activator, Grostic, Pettibon, or Sweat instrumentation.

(c) Manipulation moves the spinal segments beyond their normal range of motion for the correction of nerve interference and articular dysfunction, but without exceeding the limits of anatomical integrity.

(d) A chiropractic diagnosis is necessary to properly establish the indications and contraindications before the administration of the spinal manipulation procedure.

The state differentiates clearly between the chiropractic profession and physical therapy.

For chiropractors, the adjustment, manipulation, or treatment "shall be directed toward restoring and maintaining the normal neuromuscular and musculoskeletal function and health of the patient," and a doctor of chiropractic "will also make appropriate health referrals for conditions that may not be treated by physical agent modalities and manipulative therapies."

The practice of physical therapy is defined as including, among other things, "examining, evaluating and testing individuals with mechanical, physiological and developmental impairments, functional limitations, and disability or other health and movement‑related conditions in order to determine a physical therapy treatment diagnosis, prognosis, a plan of therapeutic intervention, and to assess the ongoing effect of intervention."

Despite some similarities, the AG emphasized that "clearly the practice of chiropractic and the practice of physical therapy are two separate and distinct health care professions, each operating under different boards, each with separate licensure requirements."