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), determined prognostic indicators of who has the best outcome when they have an initial within/between session change to joint manipulation  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.”  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 Non‒Region-Specific SpinalManipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Clinical Trial.”. 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
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.