Talk:Physical therapy

The chiropractic and spinal manipulation part

Howard, you've got some good work and insight in the section on chiropractic and spinal manipulation and the controversy there, but being the front article for Physical therapy, do you think we need to even mention chiropractic or get into the whole spinal manipulation issue? It begs to question that we discuss all the issues with the various forms of exercise (passive, active, eccentric, etc.) with the pros and cons and who does which and what as well. However, an article on Spinal manipulation could certainly make the distinction between manipulation, mobilization, and adjustment... This article probably should be for describing Physical Therapy and what they do, which does include spinal manipulation, and what they do not do, which is prescribe medication.

As an aside, the things that Chiropractic and Physical Therapists do are similar and there is a lot of overlap, especially as the science is now being pursued to give us an idea of what works and what doesn't for which conditions. I don't think anyone argues that spinal manipulation is beneficial anymore; the argument is "for what?" It's just as beneficial for PTs as it is for Chiros. However, if you are performing manipulation to reduce adhesions, that's one thing, but if you are using it to create an autonomic response to affect the brain and nervous system and affect health, that's another. Obviously, whether you are a PT or Chiro, you are both going to have the same effect no matter what your objective. The other distinction is certainly the autonomous vs allied arrangement from a historical/political perspective. The question is which direction each profession is heading, both in opposite directions toward each other.. impact is inevitable. D. Matt Innis 21:55, 1 June 2010 (UTC)

Spinal manipulation indeed may be a very good idea, with some of the details here moving there. I do think, however, that something of the historical/political belongs here, and, indeed, perhaps in chiropractic. One DC/PT I saw thought the professions might someday merge, but he was thinking of effect: "PT is best for strength and chiropractic for flexibility." This may be the thinking, however, of very few people.Howard C. Berkowitz 23:08, 1 June 2010 (UTC)

You have to make the distinction about Chiropractic vs chiropractor and Physical Therapy vs physical therapist. Chiropractors use physical therapy as they see fit. Some chiropractors build their entire practice on strengthening and rehab, which is physical therapy at its best. However, in some states (North Carolina for instance), Physical Therapy legislation does not allow chiropractors to call it physical therapy. We therefore call it physiological therapeutics. So some chiropractors use similar protocols and basically use the same research and similar protocols when using stretching, strengthening and rehab.

Meanwhile, chiropractors used what we called spinal adjustments as a term to describe what we do during a visit. Part of most spinal adjustments was the procedure that resulted in the audible release or "pop" that most people associate with chiropractors (results from some HVLA maneuvers). Once the research validated its use for low back pain and neck pain and headaches, it became of interest to physical therapists as a form of treatment as well (they called their treatment 'mobilization' and it rarely was accompanied by the audible release). So the term spinal manipulation is used to describe that procedure.

The confusion comes when we try to replace spinal adjustment with spinal manipulation because spinal adjustments may include other things, including physical therapy. But the purpose of a spinal adjustment is to affect the physiological and neurological component (which most chiropractors claim there is) of spinal dysfunction.. or for that matter use the spine to affect physiological function - or treat conditions distal to the spine. This is a part of spinal manipulation that physical therapists and even some chiropractors refute and, although case studies exist, the research is scant.

But I don't think we want this article to be about those things.D. Matt Innis 15:15, 2 June 2010 (UTC)

I can't help but think, however, that either in cost control or in integrative medicine, the overlap will be increasingly visible. One issue mentioned by some of the PT's was that they don't use X-rays so the patient isn't exposed to radiation -- but if it is needed for diagnosis, who does it? The radiation argument is a very intense one in medicine, especially with the statistically demonstrable (but low) increased cancer risk of some of the CT techniques. It's a constant battle on one of my trauma surgery mailing lists if too much imaging, or the wrong kind of imaging, is being used. Howard C. Berkowitz 23:08, 1 June 2010 (UTC)

I agree, but not because chiropractic will become more mainstream, but because PTs will destigmatize what chiropractors do when they begin to do it. Unfortunately, there are conditions in the spine that contraindicate the use of spinal manipulation and the only way to rule them out is xray. I shudder when I think about anyone using spinal manipulation without knowledge of the condition of that spine. D. Matt Innis 15:15, 2 June 2010 (UTC)

As you'll see above, I'm making links out of some of your points, which are excellent; I'm not yet sure how it should be arranged. Is there, I wonder, some decent definition around that encompasses both "physical therapy" and "physiological therapeutics"? You know, I keep meaning to start an article on assassination, which isn't necessarily the same as silent killing, some techniques of which are extreme spinal manipulation.

No, I don't want this to be a political article. Still, CZ could contribute something about the collision of disciplines, including models, economics, history, politics, etc. At the moment, I'm cheered by the amount of interdisciplinary cooperation that took place in social capital.

Apropos imaging, as more and more work is done on musculoskeletal ultrasonography, it would be nice for DCs and PTs to make use of that non-ionizing technique. Do DC's do nerve conduction study and electromyography? --Howard C. Berkowitz 19:30, 2 June 2010 (UTC)