Thank you for writing the recent Editor's Message, “Jumping on the Manipulation Bandwagon” [September 2004]. I believe that it is very important for [DCs] to address the issue of physical therapists [PTs] performing spinal manipulation. Aside from the territorial aspects of not wanting nonchiropractic practitioners to invade our specialized domain, there is a huge problem in that nonDCs are incapable of providing the precise, effective, safe, and gentle adjustments that DCs provide.

I recently had lunch with a [PT], and we discussed spinal manipulation versus Grades I–IV mobilizations that PTs perform. She left the lunch meeting believing that she was capable of doing everything that I could do, even though this could not be the case. A huge problem is that until somebody experiences properly performed spinal manipulation by a DC, they oftentimes fail to appreciate the specialized expertise and competence that DCs possess.

Outsiders often fail to recognize that there is a tremendous amount of tactile sensation and anatomical and pathological knowledge that is required to properly perform spinal adjustments. For instance, should C2 be adjusted for a left rotation malposition? Or should C4 be adjusted for a loss of right lateral flexion? Or, should the left glenohumeral joint be adjusted for a loss of superior to inferior glide with abduction?

Taking a weekend seminar or an elective course in manipulation certainly cannot provide the expertise and competence that should be required. Therefore, we must continue to stand strong and speak out against any nonchiropractic practitioners that wish to utilize manipulation. Thank you for addressing this important issue.

Robert Brown, DC
Pain Relief Clinic
Pontiac, Ill

Regarding the September 2004 editorial, the chiropractic profession needs to consider several practical aspects of this issue.

First, [PTs] now receive doctorate-level degrees. This will likely change portal-of-entry access and almost certainly increase competitiveness in the neuromusculoskeletal marketplace. It remains to be seen if PTs and DCs will be reimbursed according to different fee schedules, as is the case with osteopathic manipulative treatment, which is generally reimbursed at a higher rate than CMT codes for chiropractic permit.

Second, many techniques originally pioneered by both the osteopathic and chiropractic professions are now standard repertoires for both [PTs] and licensed massage therapists, specifically, craniosacral therapy, visceral manipulation, and trigger-point therapy. Some view this as encroachment into their specialized profession. However, many DCs use ancillary physiotherapeutic modalities and rehabilitation protocols as adjuncts to the chiropractic adjustment of the spine. One low-force technique in particular (Positional Release Therapy)¹ has been developed jointly by a DC and PT, who were themselves heavily influenced by the osteopathic profession.

Third, spinal manipulation or mobilization techniques are not necessarily equivalent to the correction or reduction of vertebral subluxation. Practitioners outside of the chiropractic profession who claim to correct subluxation through a generic form of spinal manipulation or mobilization must demonstrate their training and competence in doing so. The Association of Chiropractic Colleges has stated: “Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation, [which] is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.”²   

The debate over who has the copyright on spinal care is not likely to be won strictly on the basis of semantics and credentials, but rather in clinical efficacy and results. Chapman-Smith³ observed that the field of functional pathology of the neuromusculoskeletal system, including its optimal diagnosis and management, is a complex specialty in its relative infancy that no one profession has mastered but that one will become recognized as having a leading presence and expertise in the next millennium. He continues, “Plainly, this will be the profession that is seen by the public and the health care system as the most knowledgeable and skillful. Learning from and incorporating the best of others is what the founders of chiropractic did.”

In practicality, it would seem doing this (as other professions have done vis-à-vis chiropractic) while building on the subluxation foundation of our forebears in the profession is a part of the natural evolution of the chiropractic profession.

Gerald Anzalone, DC
Hudson Valley Neck and Back Care
Peekskill, NY
janzalonedc@hotmail.com

References
1. D’Ambrogio KJ, Roth GB. Positional Release Therapy: Assessment and Treatment of Musculoskeletal Dysfunction. CV Mosby: St Louis, Mo; 1997.
2. Association of Chiropractic Colleges. Position Paper #1. 1996.
3. Chapman-Smith D. Low-force and soft-tissue techniques. The Chiropractic Report. 1998:12(5).

I just wanted to let you know how much I enjoy the Practice Profile section of Chiropractic Products magazine. I look forward to each issue specifically to read the Practice Profile. It is great to be able to see how other doctors are running and promoting their practices. It is not only interesting, but also shares new ideas and ways to promote success in practice. Just wanted to take a moment to give you some positive feedback and tell you to keep up the good work.

Greg Dutson, DC
North Idaho Spine Clinic
Sandpoint, Idaho