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Let’s Talk…Californian Chiropractic Bill 381 appears “subluxed” and needs an “adjustment”

I recently came across a bill (SB 381) that was proposed on February 20th, in California, by Senator Yee (twitter @LelandYee —I am sure he would love to hear from his constituents).   The bill (seen below) proposes that any healthcare practitioner, excluding Chiropractors/MDs/DOs, can perform an adjustment or joint manipulation.   I was quite taken back by this proposal but believe it’s something we now need to openly discuss (according to my comment sections of previous posts and web analytics,  this blog has garnered the attention of prominent members of the American Physical Therapy Association and American Chiropractic Association and believe it’s time we openly “talk”).  Before progressing, I suspect there are several great forward thinking Chiropractors out there such as Dr. Shawn Thistle, Dr. Gregory Lehman, etc.  This post is not to degrade them.  The intention is to open up some much needed scientific (not pseudoscientific) dialogue.   So let me begin…and get real…

1. Why is this bill necessary?  I would suspect that a bill like this would be necessary if it were determined that healthcare practitioners were providing unsafe or unnecessary joint manipulations.  I am quite in-tune with the emergence of manual therapy literature  and I am unfamiliar with any research that indicates that Physical Therapist’s are unsafe with joint manipulation or provide joint manipulation which is unnecessary.   On the contrary, as a profession we have identified those who have benefited from joint manipulation (clinical prediction rules)[1], determined prognostic indicators of who has the best outcome when they have an initial within/between session change to joint manipulation [2] and lead the scientific community in research that attempts to identify what is happening with joint manipulation.   If anyone can provide support to the contrary, please leave me a citation in the comment box below.

2. The terms adjustment and manipulation are not synonymous.  Sorry, but they aren’t.    “Reference to subluxations in medical literature is often presented as support for the practice of chiropractic as a method of adjusting vertebral subluxations to “restore and maintain health.” [3]  The issue with this concept is that while it may be accepted by many chiropractors, it is not well- supported in qualitative or quantitative  literature.   I recommend those who are unfamiliar with this concept to read by this well-done review by Harriet Hall, MD.

3.  I would say the chiropractic lobbyists who proposed this bill,  can HAVE the terms “Joint Manipulation and Adjustment”.  The APTA needs to grow a pair and own the terms “Neurophysiological Manipulation” and “Neurophysiological Mobilization”.  Trademark these.  And trademark them now!!!!!!!!!  It appears that the benefits from manipulation have very little effect on the joint and likely have more effects with neurophysiological tissues.   You can push on bones all day long, but we must have an effect on the body-self neuromatrix to get a result…In other words,  we do these techniques  to 1. reduce pain or 2. get something to move, correct?  So let’s reason…can joints feel?  Well, without nerves, no.  And without nerves, can tissues move in a functional way?  Well, without nerves, no.  So, the results on improved movement are most plausibly due to alterations made in the somatosensory and motor homunculus (provide me a more plausible scientific argument and I’ll consider).     So if we “own” NEUROPHYSIOLOGICAL MANIPULATIONS AND MOBILIZATIONs”, then chiropractors can do “JOINT MANIPULATIONS or ADJUSTMENTS” all day long, but cannot perform them for pain relief or altered movement patterns.  If you disagree, I refer you to an article in published in Physical Therapy ahead of print entitled: “ Immediate Effects of Region-Specific and NonRegion-Specific SpinalManipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Clinical Trial.”[4].                   Thoughts? 

So all of this stated, let’s begin a discussion.  A scientific discussion.  This is a completely unnecessary bill and the chiropractors are continuing to fight an unnecessary turf-war.  If you comment in my box and make a “wild” claim without a “reference”, it is open to be deleted.  Leave cognitive dissonance at the door and tell me why this bill is or is not necessary.  

1. Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine 2002: 27; 2835-2843.

2. Cook CE, Showalter C, et al. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?Manual Therapy (2012), doi:10.1016/j.math.2012.02.020

3. http://www.sciencebasedmedicine.org/index.php/chiropractic-vertebral-subluxations-science-vs-pseudoscience/

4. Oliveira RF, Liebano RE, Costa L. Immediate effects of region-specific and non-region-specific manipulative therapy in patients with chronic low back pain: A randomized controlled trial. Physical Therapy  Published online February 21, 2013; doi: 10.2522/ptj.20120256.

BILL NUMBER: SB 381	INTRODUCED
	BILL TEXT

INTRODUCED BY   Senator Yee

                        FEBRUARY 20, 2013

   An act to add Section 734 to the Business and Professions Code,
relating to chiropractic practice.

	LEGISLATIVE COUNSEL'S DIGEST

   SB 381, as introduced, Yee. Healing arts: chiropractic practice.
   Existing law, the Chiropractic Act, enacted by an initiative
measure, provides for the licensure and regulation of chiropractors
by the State Board of Chiropractic Examiners. Under the act, a
license authorizes its holder to practice chiropractic as taught in
chiropractic schools or colleges but does not authorize its holder to
practice medicine, surgery, osteopathy, dentistry, or optometry.
   Existing law provides for the licensure and regulation of
physicians and surgeons and osteopathic physicians and surgeons by
the Medical Board of California and the Osteopathic Medical Board of
California, respectively.
   This bill would prohibit a health care practitioner from
performing a joint manipulation or joint adjustment, as defined,
unless he or she is a licensed chiropractor, physician and surgeon,
or osteopathic physician and surgeon. The bill would provide that a
health care practitioner who performs a joint manipulation or joint
adjustment in violation of these provisions engages in the unlawful
practice of chiropractic, which shall constitute, among other things,
good cause for the revocation or suspension of the health care
practitioner's license, as specified.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 734 is added to the Business and Professions
Code, to read:
   734.  (a) Notwithstanding any other law, a health care
practitioner subject to regulation pursuant to this division shall
not be authorized to perform a joint manipulation or joint adjustment
except for the following individuals:
   (1) A chiropractor licensed by the State Board of Chiropractic
Examiners.
   (2) A physician and surgeon licensed by the Medical Board of
California.
   (3) An osteopathic physician and surgeon licensed by the
Osteopathic Medical Board of California.
   (b) A health care practitioner who performs a joint manipulation
or joint adjustment in violation of this section engages in the
unlawful practice of chiropractic, which shall constitute good cause
for the revocation or suspension of the health care practitioner's
license, or any other disciplinary action deemed appropriate by the
health care practitioner's licensing board.
   (c) For purposes of this section, "joint manipulation" and "joint
adjustment" are synonymous terms that describe a method of skillful
and beneficial treatment where a person uses a direct thrust to move
the joint of a patient beyond its normal range of motion, but without
exceeding the limits of anatomical integrity, as taught in
chiropractic schools or colleges.
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37 replies »

  1. Joe, an amazing argument and post. We truly appreciate the support you and the rest of the PT community is giving us over here on the west coast. I’m taking neurophysiological manipulation/mobilization to the bank.

    Always Evolve,

    Mike

    • Mike, if you are interested in neurophysiological manipulation/mobilization than attend Chiropractic College than pass board examination so that you can perform it safely

  2. PTs should share the ablity to maipulate. I am chiropractic student in California and see issues like this bill and other stupidity as detrimental to patients. I also prefer the term manipulation, as used by therest of the medical world, as opposed to ‘adjusting’ as used by the majority of chiropractors. It is not magic nor a religious experience. It is a viable manual therapy technique.

    Additionally, are we not all in this to help people using the best available evidence for appropriate therapies? That answer should be ‘yes’ and this bill should be scrapped.

  3. It’s sad that this is still going on, and of course you know I’m on your side in terms of neurophysiologic effects with all manual therapies. However, even owning these terms would not do anything to protect our practice act as to a legislator, or someone like Dunning who was sued, it would just be semantics, even if it’s the truth.

  4. Stories like this should encourage all PTs to join the APTA and become active. I don’t always agree with the APTA’s actions (or lack of) but they are our main defense against attacks like these. The chiros seem to have a much stronger PAC than we do. I am amazed at the battles they take on.http://www.sciencebasedmedicine.org/index.php/legislative-alchemy-chiropractic-2013/ So if you are not an APTA member you should join and we should all consider donating time and money to the cause.

  5. I agree with the post, and coming from a practicing DC in another state maybe I can shed some light on why bills like this are proposed. PTs and DCs will continue to butt heads and cause increasing competition in the marketplace as more chiros come over to the light of joint restriction and neurophysiology, simply because we will be using what works and dumping what doesn’t. In KY, where I practice, the PT board has a pretty large sway in terms of legislature. They own the term physical, so a DC can’t say they perform physical therapy, physcial manipulation, or physical anything. That IMO is taking things a bit to far. To perform a physcial modiality and call it physical therapy in the public’s mind is correct. Instead chiros are using the term physiotherapy, whoop de do, we sound like idiots.

    The turf war will continue to wage for some but IMO working together is a much better idea, look PTs do much better with vestibular training, work hardening and many other areas while DCs tend to do very well in patient diagnostics and management (in my area) compared to PTs, based upon additional training. I personally wouldn’t want to try to do post-surgical rehab but a PT would excel at it. In my opinion eventually DPTs vs DCs will end up being like the DO/MD debate, different schools of thought but the same driving goals and largely the same treatment options.

    • Thanks for the insight Casey. While I agree with the State of KY that chiropractors should not conduct “Physical Therapy”, I have no issue with chiro’s using the term “Physical” in-front of other words.

      We need to work together to resolve these ridiculous bills and lawsuits. Unfortunately, I am sure there was a large push by the CA Chiropractic board for this bill proposal (despite the majority of high-quality literature on manipulation being conducted and provided by PTs). We should allow “science” and “research” dictate best practice patterns; not lawsuits/legislation.

      • I wouldn’t worry about a large push by the board. Chiros are notoriously poorly organized (<5% belong to ANY professional organization) and even if California has a large number of chiros they still should be dwarfed in number by PTs and other allied health providers. A strong push by the PT board should eliminate this stupid bill.

  6. Casey,
    There is a big difference between protecting the brand of your profession and trying to prevent another profession from performing a particular treatment which they are trained in. Physical Therapy is a profession not a treatment intervention. I think every state chapter should protect the term “physical therapy” (limiting the use of “physical” may be going a bit far). I would never tell a patient that a thrust technique I performed was a “chiropractic manipulation” and I don’t expect other professionals to misuse the term Physical Therapy.

    • I understand protecting your brand and honestly the sponsors of this bill may be using this line of thought with their attempt to protect their ‘brand’ of manipulation, since that is the #1 thing that chiros are known for. I can’t speak for them but perhaps that is their line of thinking. As for physical therapy being a brand, I personally have difficulty with that since physical therapY is defined as “The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs” according to google. Vs physical therapISTS are the primary providers of such therapies. The generality of the term makes things difficult. Remember that we have to look at this as laypersons and not professionals. Just as manual therapy is not massage therapy but more than likely that is what the public would call it.

      • Casey – the definition according to google? You can do better than google!

        Physical therapy is performed by physical therapists. period. And physical therapy is much more than massage, heat, and exercise.

      • Physical therapy is by and large considered manual therapy as well as most modality applications. A chiropractor performing therapeutic exercise is not being a pt anymore than doing manipulation makes you a chiropractor.

  7. A quick search of Mr. Lee reveals he has a PhD in mental health. It would seem reasonable that he would be open to the evidence behind this bill if he was presented with it.

  8. I think this is a good article but disagree on two points. I disagree with the author stating that with research produced by DCs that the term adjustment is used more than manipulation. I believe chiropractic adjustment is used sometimes when the article is against “adjustments” even when some of the procedures were done by other professions. I believe when the efficacy of the procedure is being evaluated, or when high quality case studies are documented manipulation is used. The verbiage is mostly semantics at this point. Secondly, there is no possible way that PTs can “own” neurophysiological manipulation as a term. The mechanism of the effect of the manipulation on pain, inflammation, cytokines etc have been established for some time by MDs, DOs, DCs, and also PTs. I think the knowledge of this mechanism could be strengthened if we just work together on the matter and stop bickering on the “I do this and you do that” argument.

    • Chris,
      I wrote the article and am confused on your first disagreement. I never stated that the term adjustment is used more than manipulation in research produced by DCs. That stated, semantics are important here and the terms are not synonymous. The term adjustment is described by the World Chiropractic Alliance as “The goal of the chiropractic adjustment is to correct the spinal subluxations detected during the examination. To do that, the doctor applies pressure to the bone and “unlocks” it from its improper position. The bone will then be free to align itself correctly.” Unfortunately, it has been found that palpation of supposed spinal and pelvic abnormalities is quite unreliable. Furthermore, joints don’t just “lock” and “unlock”. The term manipulation is defined by the Guide to Physical Therapy practice as “a skilled passive movement to a joint and related soft tissues”. Manipulation, unlike Adjustment, is not built upon this belief of a “subluxation”—again, I refer to Dr. Halls piece.

      Your second statement which eludes to the idea that the “mechanism” of the effect of the manipulation has been “established” for some time, is not quite accurate. We are continuing to learn what happens when we manipulate the spine. The “mechanisms”, under a modern understanding of the neuromatrix, appear to be neurophysiological, but we are still learning. My argument above it based upon the scientific plausability of this rationale.

      This stated, I do appreciate the discussion. Can any chiro’s, provide insight on why this bill is necessary?

      • Chris,

        The WCA is a pretty out there and small professional chiropractic organization. The ACA is much larger and the ICA as well. Citing a fringe group of old school thinkers doesn’t strengthen your point. The Mayo Clinic’s website, as well as many other parts across the web will refer to SMT and ‘adjustment’ as synonyms.

      • To the statement of, “Reference to subluxations in medical literature is often presented as support for the practice of chiropractic as a method of adjusting vertebral subluxations to “restore and maintain health.” This is not true if we look at the research out there. The blog that the link went to stated that the subluxation is the yoke of the profession, also not true. That it is difficult to find DCs that do not subscribe to subluxation theory, entirely not true. The blog that this article links to highly ignores the vast research of manipulation by chiropractic medicine, I suspect mainly as a tool, which I already mentioned that I detest. The article, although of good length for a blog, is very poorly done and should not garner respect from PTs. The WCA is not a respectable organization to reference the profession as a whole. So your point made that statement is moot. My second point holds true if a search of the research is performed. I would a agree that we are learning more every year. Although the “trademarking” of the term of the “neurophysiological manipulation” is absurb.

        Look, I am not in favor of this bill. I believe more effort should be placed upon increasing scope, establishing residencies, and opening opportunities for chiropractic physicians to practice that way that they have been trained for decades. (In reference to training, I mean schools like NUHS, Western States, etc.)

        I don’t mind PTs doing manipulations as DCs are doing as long as they have the same training and evaluation. The professions are much closer than these blogs purport, and I think we can learn from one another rather than attack and show false blanket statements. Agree?

  9. I agree this bill is ridiculous. First off, I would rather have a physical therapist performing a manipulation versus a “(2) A physician and surgeon licensed by the Medical Board of California”…..do they even receive proper training? At least a physical therapist is knowledgeable in manual therapy. Secondly, we work better together than apart. There is overlap in both fields, those who are fearful of losing their edge from either side are going to be left behind to begin with. It is an ignorant way of thinking and living. Striving for continued learning and education for the best possible results are what we need. As long as we start to see healthcare go the route of conservative treatment first before any other more expensive or extensive treatment I think there is progress. It just makes sense (in the right patient cases) to progress from least to most invasive.

    • Kathy,

      Your comment of “A physician and surgeon licensed by the Medical Board of California”…..do they even receive proper training?” leads me to believe that you don’t consider osteopathic manipulation on the same level as PT manipulation. Given the greater breath of educational scope and residency programs between the DO and PT programs how can you make such a logical jump? There are some fantastic DOs that perform manipulation quite regularly, most in physiatry practices but some in general/primary care. If you truly want to work together then don’t make such logic jumps. If we wanted to go down that road we could easily say that chiropractors have much more training in SMT than most PTs, but I don’t think there is a need for this divide.

      • Just a misunderstanding. I was pointing out the bill in which point #2 refers to physician and surgeon and then goes on to #3 which specifically states DO’s. I took #2 as meaning any general MD or surgeon could adjust as well (on top of PT’s, DC’s, DO’s). I would not mind getting adjusted or manipulated by either a DC, PT, or DO at all as they are all trained in the therapy. It just seemed that the #2 point included all doctors, regardless of specialty, whom obviously may or may not be not educated on the subject.

  10. Thanks Joe for opening this important discussion. I’m a PT, practicing in California and use thrust manipulation (Gr V mobilization in our State) regularly to patients that are appropriate based on their history and physical exam findings. it’s great to note that rational heads are prevailing in this thread thus far. This is what we need. I’ve always believe that PTs and Chiros should be working together not against. Each profession offer unique skills sets. It is frustrating to say the least however that legislation like this continue to pop out when the focus should be cost effective healthcare delivery given the waste happening in the our industry. Our chiro friends should understand why we strongly oppose this nonsense. They only need to look back in their own history when the medical profession was restricting their rights to practice.

    • I am a chiropractic physician and I agree with the above statement. (Given that the hours of PT study for HVLA manipulation matches the that chiropractic institutions.)

      • Why do chiropractors use the term “chiropractic physician”? Some physical therapists use the term “Doctor of physical therapy” in the same fashion and I find it a bit annoying. Just curious…

        Anyways, How many education hours do you suspect are needed for one to learn how to appropriately administer a HVLA? CAPTE does require a set number of hours in physical therapy education for accreditation, but is it truly that hard or skilled to learn how to manip a neck or back? I would argue that learning how to grade manual techniques along with the inductive development of altering an approach based upon a patient response is much more challenging. Thoughts?

      • Chiropractors are physicians in that they can manage all levels of care, just as any true PCP should be able to. Doctors of physical therapy carry a large educational scope and have earned the highest degree possible in their field. As such they should be referred to as doctor in any health care setting.

        Hours to learn smt aren’t as important as learning when to vs when not to perform the procedure. Skill takes time to build, that we can surely all agree.

  11. Hey Joe,
    Great post, love reading your content and even the comments following. This can be a very touchy subject and I think you brought it up in a very professional manner.

    I do like your thinking of neurophysiological mob/manip but would be tough to get this term protected. I deal on a daily basis finding chiro offices still advertising physical therapy (or physiotherapy) on their site or advertisements without a PT being employed. Term protection was enacted in VA in 2010 and even shown here on APTA’s site: http://www.apta.org/termprotection/

    Difficult to even define what we are or what we do as a whole, not just an intervention. Another subject I know but I think we can all share manipulation for the sake of the patients; the reason we got into a healthcare field.

    I’ll be interested to see what comes out of this bill. I am sure the Senator is tired of hearing from PTs by now 🙂

  12. Regarding PT vs MD/DO and musculoskeletal care…”physical therapists demonstrated higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and most physician specialists except for orthopaedists. Physical therapist students enrolled in educational programs conferring the doctoral degree achieved higher scores than their peers enrolled in programs conferring the master’s degree. Furthermore, licensed physical therapists who were board-certified achieved higher scores and passing rates than their colleagues who were not board-certified.” http://www.biomedcentral.com/1471-2474/6/32#sec8

  13. Great job on starting an excellent dialogue. However, I have concern with its direction.
    Your original premise is discuss who should or should not be allowed to manipulate the spine. This is a great question.
    Current legislation within Ontario (as an example) states that spinal manipulation, as defined by a high velocity low amplitude manipulation can be performed by a DC, MD or PT. Chiropractors inherently spend a great deal of time during their education learning various techniques and applications of spinal manipulation. There is a great deal of training and focus placed on this intervention, as there should be. Medical doctors on the other hand receive no manipulative training, yet are allowed to practice it should they desire.
    Over the past decade, given the increase in available evidence, physiotherapists have began utilizing this intervention in growing numbers. This blog post offers great insight into this.
    Restricting manipulation, as per Bill 381 proposes, to certain professions is archaic and against patient centred care. It is a foolish submission. Plain and simple.
    Manipulation should not be restricted to those that hold a certain title, but those that hold training and qualification within its practice. Like any intervention applied by hand (including injections and surgical procedures that require dexterity and accuracy) there is an art to its application. One can easily learn how to perform a rotational lumbar manipulation. But learning the subtle nuances and applying it to symptomatic patients is another matter. Learning alternative techniques or positioning becomes relevant. Knowing when NOT to perform a manipulation takes time. (In my opinion, learning manipulation over a two day work shop does not create qualified practitioners. But thats an entirely different discussion I suppose.) CPG’s have helped tremendously, but they are not applicable to everyone that walks through your door. They offer insight only.
    Joe, while I agree 100% with your primary argument, moving beyond this towards creating an entirely new term for the intervention is not the answer. In fact, this only muddies the waters and makes it even more confusing for patients.
    Case in point; In Ontario, an ND is not included in the original legislation. However, they can perform a naturopathic manipulation of the spine….in which they received training from chiropractors. This is a mild concern however compared to the growing trend of Osteopaths (an unregulated and very different profession in Canada than the United States) within Ontario and Quebec, whereby the education is classroom OR online based with optional technique seminars over a 1-2 year period. These practitioners cannot perform spinal manipulation, but they can perform an osteopathic manipulation. Their rationale may be different, but they are performing similar procedures with minimal training.
    A procedure is the same, no matter the name, if the parameters match. High Velocity, Low Amplitude, delivered to the spine – It is spinal manipulation. This is like renaming the low-level laser machine, ultrasound equipment or even cryotherapy to make it seem different and more effective than the one down the street.
    Also, creating an argument for the term adjustment versus manipulation has similar flaws. It is the same procedure. Only the paradigm and rationale surrounding its use differs.
    The end product of these arguments is indeed a turf war, but turf wars tend to be bilateral. In my opinion, our professions should be working together on this matter instead of segregating us into camps of ‘the chiropractors’ and ‘the physios.’ This is damaging for all, and confusing for patients, the public and legislators.
    Let us continue interprofessional collaboration. Let us work together to create a stronger research base. Let us build upon our own clinical niches and enjoy practice life without worrying about turf wars or treatment nomenclature. By doing this and ensuring research, suitable training and patient centred outcomes stand above the rest, we cannot fail.

  14. Great article. I found it interesting that the bill states that manipulation & adjustment are synonymous & therefore anyone performing manipulation is practicing Chiropractic. However, the bill allows MDs & DOs to perform manipulation. Does this mean that MDs & DOs are now allowed to legally call themselves Chiropractors? I do not believe that Chiropractors realized that they just gave their profession to the MDs & DOs.

    Just a thought.

    • I think your logic here is slightly skewed. The bill would state that anyone other than MDs DOs and DCs that adjust or manipulate is practicing out of their scope. I don’t think MDs and DOs widely want to manipulate. Have you seen the reimbursement? 🙂 Again, I am not in favor of the bill, but would rather have correct scope of practice right than to fight PTs on the right to manipulate. Working together is best.

      • I believe that working together is the best option. However, it is difficult to work with a profession that continues to use semantics to limit other professions through legislative bills & litigation. Overall, the patient loses in this battle.

        The fact that they deemed manipulation as synonymous with adjustment and only Chiropractors can perform adjustments for subluxations is to limit other healthcare providers such as PTs & ATCs. If manipulation is Chiropractic, then all other health professions should be excluded in this bill as well. To include MDs & DOs in manipulation would mean that they are able to manipulate/adjust and therefore practice Chiropractic. Most MDs & DOs do not manipulate & they have a powerful PAC. That is why they were included in the bill and allowed to manipulate. This would avoid a turf war between Chiros and MDs & DOs.

        Again, I agree that working together is the best option for all health professions and more importantly for the patient.

      • Right. If this bill or bills like this didn’t exist, would semantics be an issue? No. Some DCs would do adjustments, some DCs would do manipulation, some PTs would do manipulation, some PTs would still be against manipulation. Would the procedure be that same for the most part? Yes. The semantics is for the purpose of the bill. The purpose that is antiquated. Lets think about the patient. PTs can do manipulation. DCs practice primary care natural medicine like they are trained. I’m all for it.

    • And that’s the greatest irony of this bill Eric and Chris. CA DC’s wants to restrict PT’s here in CA, who are educated, trained in and legally allowed to practice SMT/manual therapy; and yet DC’s seems OK with MD’s to manipulate when they are not educated and trained to practice SMT! I work with MD’s and have friends that are MD’s and I’ve asked about their SMT training and not surprising, they don’t! I can understand DO’s due to their HVLA training. Even then, most of them don’t practice SMT because they practice medicine and surgery. So what gives? Lastly, I echo Eric’s point about the difficulty of trying collaborative effort for our patient’s sake when DC’s are continuing to fight this silly battle. It will truly take like minded people in both parties to sit down for this to end. I agree with your last point Chris.

  15. It’s very obvious that it’s simply a turf war! MD’s, DO’s, DC’s, ND’s, OT’s, & PT’s currently do HVLA manipulations in CA, and in many other states, and should be allowed to continue doing so!

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