Physical Therapists Declare War on Chiropractic

You probably have experienced your share of skirmishes with your state's physical therapy association. In numerous ways, the physical therapists have sought to move from the referral only, mobilization-based position they have traditionally held in health care into a point-of-contact, all-things-musculoskeletal profession.

In an apparent effort to remove all doubt regarding its intentions, the American Physical Therapy Association (APTA) has filed with the court for intervener status in the American Chiropractic Association's (ACA's) HCFA lawsuit. In his two-page declaration submitted to the judge, APTA CEO Francis J. Mallon made it very clear that he believed physical therapists could do everything doctors of chiropractic do under Medicare, and more! (Please see "APTA Claims Rights to 'Correct a Subluxation'" in this issue.)

Perhaps most telling are Mr. Mallon's statements about the APTA's position on subluxation:

• "The use of the term 'subluxation' by chiropractors has evolved over time.
• "Physical therapists do not typically use the term subluxation, in part because the term is ambiguous and has a variety of different meanings.
• "No matter which of the definitions set out above is utilized, physical therapists can and do perform manual manipulations of the spine to correct a subluxation, where clinically indicated."

These comments are an obvious effort to rationalize the misappropriation of the correction of the subluxation by the physical therapy profession. While admitting that they don't use the term subluxation or really even know what it means, they still insist that know how to correct it.

This takes our profession into a nationwide battle that has been coming for some time. The medical profession initially attempted to "contain and eliminate" chiropractic. It didn't work, but it took over 13 years for chiropractic to win all of the court battles.

Now the physical therapists hope to contain and eclipse chiropractic by claiming to do all things musculoskeletal. Rather than being content to be a member of the health care team, the physical therapists hope to replace the chiropractic profession and are probably counting on the medical profession for support.

So what should our profession's reaction be? Is there something we can do to make it clear to the physical therapists that this will not be tolerated?

What would happen if :

• doctors of chiropractic took this into consideration when deciding whether to hire physical therapists in their clinics?
• the chiropractic licensing boards took action against those physical therapists who were manipulating patients in states where that practice was prohibited?
• the chiropractic licensing boards made sure that every consumer complaint against a physical therapist was made public and prosecuted to the furthest extent of the law?
• every state chiropractic association introduced legislation each year that would prohibit the use of manipulation by physical therapists? (Perhaps such legislation would take several years to pass, but it would help draw the line that distinguishes what doctors of chiropractic are trained to do, and in what area physical therapists lack competency.)

Perhaps there is even a better question to ask ourselves:

What would happen if the chiropractic profession did nothing?

Of all of the issues facing us, this is one we can all support.

The physical therapists have made their intentions clear. Our intentions need to be just as clear. To tolerate this activity is to condone it.