Physical Therapy and Chiropractics: Commonality Through Competition

I was recently attending the Duke Mind-Body Medicine study group and heard the presentation of a local Chiropractor. He was attempting to inform the audience of what chiropractic is all about. This was his second presentation this year in the same vein. As he was presenting, I was very uncomfortable with the mode of presentation in that it attempted to build up his profession by discrediting my profession of Physical Therapy. I did not feel that this was in the proper spirit of the study group.

It is heartening but ironic that in the world of neuromusculoskeletal medicine, and other types of health care, out of competition there has evolved a commonality. Orthopaedic Physical Therapists, Osteopaths, Chiropractors and others seem to be speaking a more common language and describing what we do and see in more common terms. So it seems more and more apparent that much of the competition is about, money, turf , power and status rather than philosophical disagreements. (Kind of like the world religions, the true core is very similar, but the politics and power and dogma separate.)

This irony was apparent in the presentation of this Chiropractor. In attempting to describe what he, as a chiropractor does and make it acceptable, he seemed to have abandoned much of the traditional terminology and interpretation in chiropractic and adopted the terminology of Physical Therapy and mainstream medicine. For example he stated that he treats back problems, primarily joint dysfunction, by increasing joint play, range of motion and biomechanical motion of the joints rather than improving "alignment". Dysfunction, joint play, range of motion and biomechanical motion are terms that, to my knowledge, have evolved and been applied by Physical Therapists. He also stated that he does rehabilitation, that includes exercise. Exercise and self management/treatment has always been an integral part of Physical Therapy.

One of my primary treatment modalities is gentle joint, nervous system and soft tissue mobilization. This gentle hands on treatment in conjunction with exercise and education in self management. I have been trained to use "manipulations" and use them selectively. I find that the more gentle joint mobilization is very effective and that I don't have to use manipulations frequently. Physical Therapists can be accused of adopting manipulations and other techniques from other professions, and in some instances we have. Just as other professions borrow from us. But within the mainstream medical system in this country and in other countries, manipulation has remained a small part of the treatment options. Besides, I believe that orthopaedic practitioners have "the village bone setters" as our common ancestors.

The other thing that I found interesting and disturbing is that this person who presented and the Chiropractic community as a whole is jumping on the Agency for Health Care Policy and Research (AHCPR) findings that manipulation is effective in treating acute low back pain. They are using these findings to promote chiropractic. In fact, of the research articles that these recommendations are based upon, only a small percentage of the studies are chiropractic studies. In the majority of these studies, physical therapists and medical doctors are the practitioners involved in the treatment of acute low back pain. It is therefore a misleading interpretation that these guidelines endorse chiropractic treatment. These guidelines do not endorse any specific discipline. If they are interpreted to endorse specific professional approach, than it must be the discipline and training of the practitioners that were involved in the studies that the guidelines were based upon. One of the things we know is that semantics, publicity and use of the media can be used to promote almost any perspective.

I tried to convey my perspective without rancor, I'm not sure that I did a very good job of it. I don't like promoting one profession by disrespecting another. There is a small paradox here of being both heartened and annoyed at the trend of adopting similar semantics and approaches. I continue to tell those people that seek help from me that if they talk to seven different practitioners about their problem, they will probably get seven different (or now maybe more similar) answers and recommendations of what will help. It is not that one answer or interpretation is right and the others are wrong but that there are many ways of viewing how our bodies function and why things go dysfunctional. Sometimes it is your rapport, connection and confidence in the person that your are seeking help from as much as their specific discipline that makes the difference in your process of regaining health. You must have confidence in both their training and their intent to treat you with the utmost respect and compassion and help you as a mind/body/soul find healing.

Written by Krista J. Clark, PT


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