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Physical Therapy vs. Chiropractic

Discussion in 'Clinicians [ RN / NP / PA ]' started by PublicHealth, May 6, 2004.

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  1. PublicHealth

    PublicHealth Removed

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    You knew this topic was coming...anyone care to elaborate on what makes each profession distinct? As I understand it, there is somewhat of a "turf war" going on between these two professions. Is the DPT degree going to push physical therapists into gatekeeper roles like chiropractors?
  2. SashaDPT

    SashaDPT Member

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    Although I would not call it a turf war, there is slight misunderstanding in general public regarding the difference between a DC and a DPT. From my understanding, DC?s concentrate on treating musculoskeletal and systemic disorders though a controlled manipulation of the vertebral column. As for PT?s, it is primarily a rehabilitation oriented profession, although treating back injuries is one of its biggest recognitions. DC?s have been practicing autonomously for a while, and PT?s are just trying to break into the open market, with the obvious problem of sharing a piece of the reimbursement pie.
  3. BackTalk

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    I agree with Sasha. I don't think it's the DPT or DC that needs to worry about each other but we need to worry more about massage therapists and athletic trainers taking more and more of the pie. The thing about chiropractic is most of the public will always associate the spine or back and manipulation with chiropractic. For us, this is a good thing because we are great at treating and it's our stock of the trade. I don't think any profession will ever be able to take that away from us:D . It's similar to when people think rehab or rehabilitation, they think of a physical therapist. We both have a lot to offer and there are more than enough patients out there to keep both of us busy.
  4. freddydpt

    freddydpt

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    Ok, you knew this question was coming too...

    Should physical therapists be allowed to perform manipulations (high velocity, low amplitude thrusts aka. grade 5 mobs).

    I would like to see MDs and DOs answer this question as well as PTs and DCs.

    Thanks!
  5. SashaDPT

    SashaDPT Member

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    In honest reality, many already do so, but just name it modified grade 4. The effectiveness of such a method is another question.
  6. BackTalk

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    With proper training a PT or DPT should be allowed to perform manipulations similar to what a chiropractor performs. Just like those DC?s who perform sophisticated rehabilitation (that have taken additional training).
  7. stwei

    stwei Senior Member

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    So what is the difference between a physiatrist, an osteopath, dpt, and a chiropractor? Don't they all learn about accessory manipulation techniques?
  8. DOctorJay

    DOctorJay formerly PTjay

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    physiatrist = physician (MD or DO) who has completed residency in physical medicine and rehabilitation
    osteopath = physician (DO) who has an education similar to that of an MD plus OMT
    dpt = a physical therapist trained at the doctorate level
    chiropractor = trains mostly in manipulation of the spine and how to treat without meds

    (extremely basic descriptions, all which could be expanded upon tremendously)

    osteopath, dpt, chiro all learn about manipulation - a physiatrist may or may not have learned about it depending most on whether or not they were DO or MD first.

    -J
  9. freddydpt

    freddydpt

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    stwei,

    You are right. Many of the techniques overlap in basic training. There are only so many ways the body can be manipulated and all are licensed to do the techniques. The depth and breadth of the skills of the practitioner depend on where they went to school.

    For example, from what I can gather, joint mobilization by a physical therapist is the same as articulation by an osteopath. And "Thrust" techniques by a DO are the same as "grade 5 joint mobilization" by a PT. Muscle energy techniques seem to be used by all the professions mentioned.

    As far has physiatry goes, I once spoke to a physiatrist at HMS who told me that he did NOT learn joint mobs or manipulation. He only learned concepts of rather than hands on practice and application. This is different than PT, DO, and DC schools where you spend 15+ hours a week in lab practicing these skills on each other.
  10. DocWagner

    DocWagner Senior Member

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    First of all...no one says "osteopath" ;)

    I would say that OMT covered every manual technique in PT school, and then some. HVLA and muscle energy is the MEAT of OMT, while PT programs are far more heavily influenced by Therapeutic Exercise techniques...something NOT taught in any OMT class.
    Do I think PT's could perform manipulations...well, monkeys could do it honestly, it is just that it will be very much ALL consuming. Once you learn it, you don't want to use a whole lot else. That will essentially take away the diversity of being a PT...
    Manipulations NEED to be practiced early on...daily. If you aren't committed, there is no weekend course that will make you comfortable. You need a good year of learning.
  11. SashaDPT

    SashaDPT Member

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    What you are forgetting is that besides grade 5 mobilization, there are other grades of intensity for each specific function. Mobilization/manipulation is a useful tool to treat an acute patient. What separates a DPT from the rest is the ability to use exercise physiology and kinesiology to treat movement and function disorders. Given that some sports medicine physicians and some orthopedic surgeons may also understand osteokinematics and arthrokinematics, it is the PT who has the ability to correct through exercise, neuromuscular re-ed and manual therapy.
  12. DocWagner

    DocWagner Senior Member

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    There are ALOT of instructors in exercise (yoga, personal trainers, ATC's, even independent writers) that believe PT's aren't the only ones who understand Thera EX (see personal improvement section in any bookstore). I personally would like to believe that to be the case, but even after my own experience as a PT...I am not convinced. I personally hope that PT does not place itself in a difficult position of irrelevance (sp?) by making academic requirements while having low reimbursement and allowing OTHER professionals to do the exact same thing (a similar position to chiropractic...yet they have incorporated some fringe practices that DO have a market place).
    PT is in an interesting place in its history...slowly becoming very similar to a DC, but losing many of its fundamentals (soft tissue, myofascial, muscle energy). I look forward to the developments!
  13. MacGyver

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    Chiropractic and OMT is mostly quackery. Please show me the randomized, double blinded, placebo controlled clinical trials for OMT and chiro therapy.

    Chiro is good for only 2 things: back pain and headaches. other than that, its worthless.
  14. DocWagner

    DocWagner Senior Member

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    OMT has a WIDE meaning (from massage to manipulation) and certainl has limitations on how it can be tested. And I think that is part of the point. If DPT's or PT's regard their exercise knowledge as superior based upon biomechanical training...then why is there so many "success stories" in other lesser educated practitioners.
    It is a powerful question when one challenges the efficacy of an art that is practices as a science.
  15. freddydpt

    freddydpt

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    I think it's really more the combination of the knowledge of biomechanics, therex and manual therapy all applied to inpatient and outpatient settings that makes PT special. Who else does Neuro rehab?

    As far as the success stories of lesser educated practitioners... well let's face it... exercise has global benefits to any lazy person with pain. You get them moving and they start to feel better all of a sudden. Did they need a PT... no... they needed a good kick in the a$$ to get off the couch.

    To the poster regarding the efficacy of OMT, how exactly would you blind a patient as to whether or not there is manual therapy delivered?
  16. BackTalk

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    Chiropractic and OMT is mostly quackery. Please show me the randomized, double blinded, placebo controlled clinical trials for OMT and chiro therapy. Chiro is good for only 2 things: back pain and headaches. other than that, its worthless.

    I can't speak for OMT but CMT isn't all quackery. As you say "Chiro is good for only 2 things: back pain and headaches". I'm glad that you at least give us that. I would add neck pain and also, extremity problems as we are not limited to the spine.

    I assume you are talking about research concerning chiropractic manipulation and organic problems. I really do not have any research for you. Then again, I do not make claims that chiropractic is a cure-all either.
  17. Skialta

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    DocWagner, you hit the nail on the head, I have many of the same feelings about PT. I really feel that almost 75% of PT is psychological, it is motivating the patient and giving the patient confidence in your judgement and your skills. Personality really has a lot to do with it. I don't know what to think about the future of PT, I really think the profession gave up a lot by not doing as much wound care, cardiac rehab and pulmonary rehab, those were niches that were PT at one time. It will be interesting to see what happens.
  18. SashaDPT

    SashaDPT Member

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    The profession may be headed in two separate directions. One, an autonomous practice resembling chiropractics in many ways. Two, physician owned practice where a PT becomes a secondary service provider, much like a personal trainer to all of the MD rejects. Skialta is absolutely right to say that PT?s are foolish to abandon the very niche of PT practice. Yet, one must differentiate self from the crowd, and that is hard to do when you provide so many services, each of which may be substituted by a lesser trained technician. Physical Therapy is a rehab specialty, and in rehab, I mean neuromusculoskeletal rehabilitation from the pathologies encompassed in the above fields.
  19. ScottDoc

    ScottDoc Member

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    The difference between DC and MD/DO - DC is NOT a real doctor. I was a DC, but got the heck out of that mess. I will say that there is a lot of 'good' in the profession and some very effective DC's. BUT, most of it is filled with 'get-rich-schemes' and creative marketing that I would call questionable at best. Dc's can only diagnose musc/skel conditions. Although many try to Dx other conditions I would NEVER trust a Dx from a DC unless it is HA or Back Pain or a sports injury. That is b/c we do not get training in DDx.

    DC's,PT's, Massage Tx, Herbal Healers, Accup, and Homeopaths are all fighting for the same piece of the pie and it is not big enough.

    I loved the patient contact and practicing based on clinical science and judgement. However, for most DC's to make money they must believe a theory based on an unproven premise - the vertebral subluxation. This premise requires continual Tx to the tune of 50-60 visits and is very expensive. The DC must SELL this concept to the patient and most train with a mangement company to learn how to do it. I for one said No Way! I refused that technique and therefore saw a very quiet practice and at the same time a very one-sided participation in the health of my patients.

    I am going back to med school to do it right.
  20. delicatefade

    delicatefade ASA Member

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    :laugh: hence...my sig block :laugh:
  21. delicatefade

    delicatefade ASA Member

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    Cadiopulmonary rehab at my hospital (a VA facility) has almost exclusively been taken over by the kinesiotherapists. Someone sure dropped the ball on that one.... :thumbdown:
  22. freddydpt

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    I've never heard of a kinesiotherapist... what is it they do?
  23. delicatefade

    delicatefade ASA Member

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    It's basically a profession that was created by the VA and for the most part, stays exclusive to the VA. They used to be called corrective therapists. They are a registered profession but not licensed. Their education is similar to PT but not as in depth. At my hospital, we (and they) usually describe them as "personal trainers for sick people" - they can use ther ex. and education but no modalities and I've not seen one yet that is trained in any manual therapy techniques. Our SCI patients go to "work out" in the KT gym, leaving PT's with the functional rehab, W/C prescriptions, home evaluations, etc. They also do all the acute orthopedic rehab at my VA (hips, knees). Someone (unfortunately, I suspect it was partly the fault of a professor of mine at MCV) dropped the ball big time in pretty much handing over outpatient cardiopulmonary rehab to the KT's. This includes pulmonary function tests, EKG monitoring, etc. Granted, they are KT's with dual graduate level degrees in exercise physiology with certification but there are several PT's at my hospital who would love to do that job.
  24. PublicHealth

    PublicHealth Removed

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    Thank you for sharing your story. Can you elaborate on what you mean by "effective DCs?" Are you talking about the DCs who don't use "get rich" schemes and who treat musculoskeletal conditions that do not respond to drugs or surgery? I am curious to know how to identify DCs who do not try to cheat their patients by selling them on vertebral subluxations.
  25. sjohnson1

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    Kinesiotherapists have a very limited education. Most have just a B.S. Some may do an M.S. program in Kinesiology. There are a fair number in the midwest. They register and become "RKT" . They are similar to PT's in that they use exercise as a modality. But that is about it. Here is a brief description.....from http://hhs.utoledo.edu/kinesiology/kinesiotherapy_program.html

    Kinesiotherapy
    Students completing the concentration in Kinesiotherapy learn to apply medically prescribed therapeutic exercises in the treatment of patients with both physical and psychological illnesses. Kinesiotherapists use many types of exercise to enhance the strength, flexibility, and neuromuscular coordination of the patients that they treat. Psychiatric patients are treated by resocialization activities and exercise which are specifically oriented toward the accomplishment of psychiatric objectives. The Department operates its own Kinesiotherapy Clinic, where students have an opportunity to develop their clinical skills with actual patients, while working under the supervision of Registered Kinesiotherapists. The program is fully accredited by CAAHEP and the American Kinesiotherapy Association, and graduates of the program are eligible to sit for the national AKTA registration examination. Graduates are employed in public and private hospitals and clinics, rehabilitation centers, VA hospitals, public schools, colleges and universities, and private industry.
  26. delicatefade

    delicatefade ASA Member

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    Some of the kinesiotherapists at my hospital (especially in TBI) have the most slack jobs I have ever seen and make more money than I do.
  27. ScottDoc

    ScottDoc Member

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    "Effective" DC's know who they are. In my experience it is about 20% of the profession. An effective DC can easily point to the clinical rationale for patient treatment through clinical reasoning and scientific study. They also defend themselves without becoming militant or attacking medicine. Effective DC's wish to work in conjunction with medical providers because they know they are effective and thier patient management speaks for itself. The same cannot be said of the 80% of quacks.
    Typically, back pain and headaches respond well. Even some extremity conditions. But that is about it. Many DC's will use a get-rich scheme like this: they identify an imaginary subluxation (the problem with this is that there are several ways to identify subluxations and most are not repeatable and every DC finds something different as far as the location). However, it is the subluxation that is used to scare patients into care. The DC tells them "that subluxation here (pointing to T2) is putting pressure on that nerve going to your heart. That nerve is telling your heart to beat. But if the information for the heart is being supressed then the heart will not know to beat! That could lead to heart problems in the future! DO YOU WANT THAT! I sure don't! I know you are not sick now and that the area of your back is not painful - but that is the danger of the subluxation. BTW unfortunately your insurance will not cover this care. They care more about keeping your money that saving your life. But don't worry, if you pay cash for care we offer 20% off for upfront payment. That will be $2300 for 50 visits over the next year. Let's get you started."
    This is the script for an "ineffective" DC. They are not doing anything for the patient, except for ripping them off. It is very EASY to ID these clowns - visit the office and if you see anything on the walls or in the brochures you've never heard of then walk out. This DC WILL steal your patient by turning them against you - another trick taught by management companies. Another way is to try one in town and see how many treatments your patients are undergoing- if you see more than 10 without clear rationale, WALK! Keep in mind that they are not treating musculoskeletal conditions after 10 visits or so (except as in serious injuries) - they are treating internal diseases. They actually treat the subluxation that is cutting off "nerve energy" and tell patients that without nerve energy (or life energy) the organs conected to those nerves will eventually die and so will they! But it is not said in those words - it is carefully crafted.

    One more point. VERY FEW honest DC's are wealthy. I knew docs taking home 700K per year! But not an honest thing was going on in the practice. They usually had low paid associates (20-30K/year) hustling patients into the practice from malls, fairs and health calsses. All pts were usually examined by the "DR" and then passed to the associate. Then that is where the ripping off game started. These people make a load, but that is it. Honest DC's cannot make a lot of money for the most part because of the low numbers of patients available and the typical patient spends about $300-400 in the office.


    I'd be happy to answer more questions......
  28. BackTalk

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    The difference between DC and MD/DO - DC is NOT a real doctor.

    I disagree. DC's are real doctors who treat real patients just as dentists, podiatrists and optometrists do.

    Dc's can only diagnose musc/skel conditions. Although many try to Dx other conditions I would NEVER trust a Dx from a DC unless it is HA or Back Pain or a sports injury. That is b/c we do not get training in DDx.

    Where did you go to school? DC's are trained in DDX and trained to DX outside the NMS realm. Why would you trust a DC in the diagnosis of headaches, which has a large differential and or back pain if DC's have no DDX training? Your mouth is talking faster than your brain is thinking.

    DC's,PT's, Massage Tx, Herbal Healers, Accup, and Homeopaths are all fighting for the same piece of the pie and it is not big enough.

    I agree that our scopes all overlap. Keep in mind that MD's and DO's are fighting for the same piece of pie too.

    However, for most DC's to make money they must believe a theory based on an unproven premise - the vertebral subluxation.

    Not true. You do not have to believe in subluxations to make it as a chiropractor. I do not believe or treat mysterious subluxations and am doing fine as a chiropractor. I do agree that the premise is unproven.

    This premise requires continual Tx to the tune of 50-60 visits and is very expensive. The DC must SELL this concept to the patient and most train with a mangement company to learn how to do it.

    You are talking a "straight chiropractic". I agree with you that these scumbags take this approach.

    Effective" DC's know who they are. In my experience it is about 20% of the profession. An effective DC can easily point to the clinical rationale for patient treatment through clinical reasoning and scientific study. They also defend themselves without becoming militant or attacking medicine. Effective DC's wish to work in conjunction with medical providers because they know they are effective and thier patient management speaks for itself. The same cannot be said of the 80% of quacks.

    I agree 100%!

    Typically, back pain and headaches respond well. Even some extremity conditions. But that is about it. Many DC's will use a get-rich scheme like this: they identify an imaginary subluxation (the problem with this is that there are several ways to identify subluxations and most are not repeatable and every DC finds something different as far as the location). However, it is the subluxation that is used to scare patients into care. The DC tells them "that subluxation here (pointing to T2) is putting pressure on that nerve going to your heart. That nerve is telling your heart to beat. But if the information for the heart is being supressed then the heart will not know to beat! That could lead to heart problems in the future! DO YOU WANT THAT! I sure don't! I know you are not sick now and that the area of your back is not painful - but that is the danger of the subluxation. BTW unfortunately your insurance will not cover this care. They care more about keeping your money that saving your life. But don't worry, if you pay cash for care we offer 20% off for upfront payment. That will be $2300 for 50 visits over the next year. Let's get you started."

    Yep! That's what they do. Let's just remember we're not all like that. Sounds like a script right from CJ Mertz's mouth.

    Keep in mind that they are not treating musculoskeletal conditions after 10 visits or so (except as in serious injuries) - they are treating internal diseases.

    The straight chiropractic does not treat diseases. All they treat is the subluxation. Some say they treat nothing and just remove nerve interference by correcting subluxation. Don't get me wrong as they're chiropractors who claim they treat the disease by removing the subluxation but these are not the true straight chiropractors and are probably more dangerous than a straight quack job. As far as 10 visits goes, there is no set formula that correlates the number of treatments with the condition. You can't determine how many treatments a patient needs as all patients are individuals. One patient may require 10 treatments while another requires 25 for the same condition.

    One more point. VERY FEW honest DC's are wealthy.

    I disagree. There are plenty of ethical chiropractors out there that make plenty of money without selling hocus pocus subluxation quackery.

    I knew docs taking home 700K per year! But not an honest thing was going on in the practice.

    I know of doctors who have multimillion dollar practices and practice in an ethical manner.

    Honest DC's cannot make a lot of money for the most part because of the low numbers of patients available and the typical patient spends about $300-400 in the office.

    Not true. Again, there are many ethical chiropractors in the 6 figure club including me and there are ones who are in the 7 figure club. I agree with much of what you said but disagree that you have to be dishonest to make it in chiropractic. To me it sounds like you are an ethical chiropractor who never "made it" and therefore think that the only way to make it is to be dishonest and dupe patients.
  29. delicatefade

    delicatefade ASA Member

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    Ever read any history of common medical practices in the 1800's???? They weren't doing too well either.
  30. delicatefade

    delicatefade ASA Member

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    I see where you're coming from. I guess I'll I'm saying is that you're painting with a pretty broad brush. There are plenty of DC's who realize the nonsense of some of their founder's claims and have chosen to move on. There are plenty of DO's who realize the error of some of their founder's claims and have chosen to move on. There are plenty of MD's who have moved on from the unscientific practices of the past.

    I'm no supporter of chiropractic. But if you're going to judge them, at least judge them on current issues, not their founder's ideas.
  31. ScottDoc

    ScottDoc Member

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    BackTalk-

    I also agree with what you say. It was not my intention to suggest ALL well-to-do DC's are not ethical. But the majority are. I still stand by this assertion.

    Also, just because a DC can Dx outside of the NMS realm doesn't mean that you are a real doctor--- because there is not a damn thing you can do for them except refer them out. That is what I don't get about DC's who get 'diplomate' status in neuro, family practice or nutrition--- it is useless.

    You are right, I am an ex-dc! I do not hold anything against the ethical DC's and I hope to have a good relationship with some when I am (God willing) an MD or DO. I want to be able to do it all for my patients and as a DC it was not possible- I did get pretty good at referring though. I just got disgusted with all the problems in the profession and was very unhappy. I did build a good practice in 2 years (almost all cash) but decided to leave b/c I was not giving my all - there was no heart. I had pondered the thought for along time and had to make a move to be happy. I just saw so much dishonesty in DC's (present company not included). Also, a high level of fighting ACA, ICA, WCA. Who is right/wrong. Straight vs. mixer. Also a huge contingent of DUMB DC's. For me the final straw was when I was at a cont. ed session. The first day in the middle of the day I counted 6 people sleeping in the auditorium. One guy was snoring so loud I had to wake him up! I know one should rise above; and I am by going to MD or DO school. I saw so much degrading of the profession too- Mall screenings and County Fairs do not paint a pretty picture. And in some areas there are so many DC's they are like white on rice. For example last year I went to a county fair near St. Paul, MN and in the exhibition area there were 7 different offices doing screenings. It made me sick! How does that help the profession? But what really got to me was the number of consultants. They were not true consultants for business. The only real reason DC's joined were to be told how to "FIND" more new patients- clever marketing. Also, when every publication is full of articles and ads by consultants selling themselves that represents a problem. The problem is also represented clearly when these same publication are full of ads from companies selling something that will "flood" thier office with new patients. This problem is basically chiro is a luxury and it is viewed as such. There are too many DC's and other competitors (plus medical providers too) that the market cannot sustain growth. Many DC's are hurting out there and I decided that before it got bad I would make my decision to leave.

    BackTalk, I do wish you luck. But, will you be in jeopardy if the hospital down the street starts to offer manipulation? We know the difference, but patients do not. I hope they don't equate the two and head off to the hospital an bypass your office on the way.
  32. BackTalk

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    medicalstudent9, Give me a break. Chirobase? :sleep: That site is totally bias. The chance of having a stroke or death is very very low when the procedure is done by someone trained to do it (chiropractor). Accidents do happen, and it is unfortunately it happened with that young lady. Chiropractic has been shown to be effective for headaches.

    What about all those people who die from medical care every year?
  33. russellb

    russellb Senior Member

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    medicalstudent9, Give me a break. Chirobase? That site is totally bias.

    BT---you have to keep in mind that chirobase is not meant to be 'balanced', per se. It's meant to be a skeptical take on the profession:

    http://www.chirobase.org/00AboutChirobase/mission.html

    It's biased, but I think that a lot of the info is good. The people criticised on that site are really the same people that you and Scott Doc are criticising. If you navigate through the site carefully, I have a feeling that you'll agree with more of it than you expected.

    The chance of having a stroke or death is very very low when the procedure is done by someone trained to do it (chiropractor). Accidents do happen, and it is unfortunately it happened with that young lady.

    I agree with you that the risks are very low. There are 2 things to consider, though :

    1) The evidence regarding benefit for neck manipulation is a bit weak. As such, the risks are known to some degree, but the benefits are not really well eastablished from a strictly scientific point of view. As larger scale studies emerge regarding the benefits of neck manipulation, then this point may be out the window. However, if it is not shown to be of greater benefit than other manual therapies (whose risks may be even more miniscule), then there may come a time when it is discarded (in evidenced based circles, anyhow) in favour of other equally effective and safer alternatives.

    2) Some of the straight types recommend routine manipulation from cradle to grave. So, while the risk of 1 neck manipulation is low, the risk of several hundred to several thousand during a lifetime would actually be unacceptably high. The risk of stroke is estimated at about 1/ 1 000 000-2 000 000 treatments. The accuracy of this # is debatable as it is only recently that serious investigation into the issue has begun, but we'll use these numbers as a starting point. Someone who receives routine manipulations startng at a young age might receive 500-1000 in a lifetime (ballpark figure). That person's lifetime risk of manipulation induced stroke would now be in the 1/1000-5000 range. That's actually a high risk for a major complication related to conservative treatment, especially considering that lack of evidence supporting maintenance manipulations.

    Chiropractic has been shown to be effective for headaches.

    Maybe, but the evidence isn't clear:

    Cephalalgia. 2002 Oct;22(8):617-23

    The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials.

    Astin JA, Ernst E.

    California Pacific Medical Center Research Institute, USA. [email protected].

    To carry out a systematic review of the literature examining the effectiveness of spinal manipulation for the treatment of headache disorders, computerized literature searches were carried out in Medline, Embase, Amed and CISCOM. Studies were included only if they were randomized trials of (any type of) spinal manipulation for (any type of) headache in human patients in which spinal manipulation was compared either to no treatment, usual medical care, a 'sham' intervention, or to some other active treatment. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control/comparison, direction and nature of the outcome(s). Methodological quality of the trials was also assessed using the Jadad scale. Eight trials were identified that met our inclusion criteria. Three examined tension-type headaches, three migraine, one 'cervicogenic' headache, and one 'spondylogenic' chronic headache. In two studies, patients receiving spinal manipulation showed comparable improvements in migraine and tension headaches compared to drug treatment. In the 4 studies employing some 'sham' interventions (e.g. laser light therapy), results were less conclusive with 2 studies showing a benefit for manipulation and 2 studies failing to find such an effect. Considerable methodological limitations were observed in most trials, the principal one being inadequate control for nonspecific (placebo) effects. Despite claims that spinal manipulation is an effective treatment for headache, the data available to date do not support such definitive conclusions. It is unclear to what extent the observed treatment effects can be explained by manipulation or by nonspecific factors (e.g. of personal attention, patient expectation). Whether manipulation produces any long-term changes in these conditions is also uncertain. Future studies should address these two crucial questions and overcome the methodological limitations of previous trials.


    Clin J Pain. 2004 Jan-Feb;20(1):8-12.

    Manual therapies for pain control: chiropractic and massage.

    Ernst E.

    Peninsula Medical School, and Department of Complementary Medicine, School of Sport and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK. [email protected]

    OBJECTIVES: To evaluate the effectiveness of chiropractic and massage therapy for the reduction of any type of pain. METHODS: Systematic reviews of chiropractic and massage as a means of pain control were located and evaluated. RESULTS: Six systematic reviews were found, 4 of chiropractic and 2 of massage therapy. Promising evidence emerged from some of these reviews but neither for chiropractic nor for massage was there fully convincing evidence for effectiveness in controlling musculoskeletal or other pain. DISCUSSION: The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.



    Dr. Ernst is pretty well published in numerous areas of CAM and is definitely not someone who is antagonistic towards CAM.

    What about all those people who die from medical care every year?

    You're correct, but you're only telling one side of the story. The other side of the story is the risk/benefit analysis. If if a particular treatment were to hasten the death of 3 patients for every 27 patients whose death it significantly delays, then the treatment would still be of value. Critics of the treatment would say, "This treatment is awful and barbaric -- it kills 10% of the recipients!!" But the critical obeserver would quickly point out that it saves 90%.

    Those who distrust medicine (I know that you are very rational and reasonable BT----I'm not singling you out with this statement, nor am I implying that you are distrustful of other health care providers, except LMT's, perhaps :D ) are very quick to point out the downside in the form of how many people are killed or injured by medical treatment. Those same people are often unwilling to accept that the numbers whose lives are improved by those same treatments is considerably higher.
  34. BackTalk

    BackTalk Removed

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    But the majority are. I still stand by this assertion.

    This is probably true. I remember awhile back I was sent a packet from the ACA on how I practice. It was a study but I never have seen the results. I am not an ACA member and I think they were trying to interview all DC's so they could get a good idea on how this profession is thinking. My point is this may help us get a better idea on how many quacks we are really dealing with.

    Also, just because a DC can Dx outside of the NMS realm doesn't mean that you are a real doctor--- because there is not a damn thing you can do for them except refer them out. That is what I don't get about DC's who get 'diplomate' status in neuro, family practice or nutrition--- it is useless.

    I think you feel one must be a MD or DO to be a "real doctor". Drugs are not always the answer and many things other than medication can be used to treat many conditions. Why did I order that lipid profile? So I can see how high your cholesterol is and tell you that it's too high and you need to lay off the Big Mac's. It is an easy solution. Would you prefer we hook them up with some Lipitor and just tell them to take two if they decide to have some Big Macs? You need to address the problem which is, most of the time, the patient's diet. People do not have high cholesterol because their body is running low on Lipitor.

    I can do that without being a "real doctor". That is just one example. Sure there are tests out there that we really do not need to order as we have no means of treating the condition they were designed to detect. The diplomate programs are designed to increase your knowledge. Are far as making more money, well yeah then they're probably worthless.

    You are right, I am an ex-dc! I do not hold anything against the ethical DC's and I hope to have a good relationship with some when I am (God willing) an MD or DO. I want to be able to do it all for my patients and as a DC it was not possible- I did get pretty good at referring though.

    That is good. It's better to go get an MD than it is to try to be an MD with a DC degree.

    I just got disgusted with all the problems in the profession and was very unhappy. I did build a good practice in 2 years (almost all cash) but decided to leave b/c I was not giving my all - there was no heart. I had pondered the thought for along time and had to make a move to be happy.

    This profession is the most whacked out profession on the planet. You have to be kinda weird to want to be a chiropractor with all the craziness it entails. I like being a chiropractor and like being my own boss, I'm happy. If you are not then I too would do something else. It is very hard to be an ethical chiropractor with a cash practice. I now understand your frustrations.

    I just saw so much dishonesty in DC's (present company not included). Also, a high level of fighting ACA, ICA, WCA. Who is right/wrong. Straight vs. mixer. Also a huge contingent of DUMB DC's. For me the final straw was when I was at a cont. ed session. The first day in the middle of the day I counted 6 people sleeping in the auditorium. One guy was snoring so loud I had to wake him up! I know one should rise above; and I am by going to MD or DO school.

    I agree that a lot of DC students are lazy. "Why do I need to learn this? I'm not taking blood pressure or ordering tests when I practice, I'm just allowing the innate intelligence of the body to express itself". Now those are the quacks. I went to Logan and the school has a good reputation, even so, we had some quack jobs. The guys you see listening, taking notes and asking questions are the ones who will succeed. We had a program where you could go do rounds with the medical interns at the local hospital. It was an excellent program yet most of the DC's involved spent their time in the cafeteria. Total losers! I think they finally discontinued the program.

    I saw so much degrading of the profession too- Mall screenings and County Fairs do not paint a pretty picture. And in some areas there are so many DC's they are like white on rice. For example last year I went to a county fair near St. Paul, MN and in the exhibition area there were 7 different offices doing screenings. It made me sick!

    I know what you're saying. We used to do the Working Woman's Survival Show which also had other doctors there such as eye doctors, dentists, plastic surgeons etc. Anyway, when we started there were like 4 other chiropractors doing it. Now there is 20-30 plus the damn college. Doing these things at county fairs is down right tacky. It fit in at the Working Woman's Survival Show as other doctors were there. It makes me sick too when I see a chiropractor at the local carnival doing spinal screenings.

    How does that help the profession? But what really got to me was the number of consultants. They were not true consultants for business. The only real reason DC's joined were to be told how to "FIND" more new patients- clever marketing.

    It's all about money. That's their only interest. It's not about patient care or anything like that. I think that today people are smarter. Many see that's it's a scams but unfortunately there are suckers and they get duped.

    BackTalk, I do wish you luck. But, will you be in jeopardy if the hospital down the street starts to offer manipulation?

    Good question. It won't be in jeopardy as PT's aren't licensed to perform manipulation in Illinois (I think this is where your question is leading). The Illinois Chiropractic Society is a very strong group so I don't see it happening anytime soon. The other thing is, when most people think of the back, back pain or the spine, they think "chiropractor". They do not think physical therapy of therapist. So I'm not too worried about the hospital down the road. That is not just yet. I think I can get through my career or close to it before that becomes a major issue. Plus I also do acupuncture, rehab services and am thinking of doing IME so I can nail the quacks when they try to bill the insurance company for 50 visits with a diagnosis or asthma or sinusitis. Plus I'll get paid for doing it.

    Are you from Minnesota? I lived there for about 10 years.

    Russ, I totally agree that the medical profession saves more lives than it harms or takes away. I guess what I was trying to get across was that chiropractic isn't perfect and neither is medicine. Accidents happen and sometimes it's just the way it is.

    Just got back from vacation talk to ya soon.....
  35. PublicHealth

    PublicHealth Removed

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    Great thread! Thank you, BackTalk, for your informative and balanced feedback regarding chiropractic. Would you mind sharing with the rest of us the manner in which you practice chiropractic? What types of patients do you treat? What types of services do you provide? The chiropractic profession desperately needs more people like you.
  36. BackTalk

    BackTalk Removed

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    Thanks PH for your warm compliments. I don't mind sharing how I practice chiropractic. Basically I look at chiropractic as a specialty (NMS) within the healthcare system, even though it's not fully accepted within the healthcare system (allopathic) it's my vision that someday it will be.

    The types of patients I treat are those in pain. That is 95% of the patients that venture into my office are in some sort of pain. Of the 95% I would say 85% of those patients have back or neck complaints. The remainders fall within the extremity category of carpal tunnel syndrome or perhaps rotator cuff syndrome or perhaps trochanteric bursitis and a host of other conditions that affect the extremities. 5% of my patient base is patients that venture into the area that had already seen a chiropractor on a regular basis or existing patients that just want to be adjusted to work out stiff and tired joints. They come in on their own free will as we do not have any mandatory "wellness or maintenance care programs". Some of those existing patients are chronic patients that come in every one to two months for a few adjustments just to feel loosened up or to also workout stiffness and soreness. Again, this is elective. We treat quite a few acute cases of back pain (sprain/strains) to patients that have disc bulges or protrusions and even herniation. I also treat patients who have scoliosis, not to straighten out the curve as you and I know it really can't be done once the child is fully grown. Anyway, it's to help restore motion and help balance the muscles that become chronically tight or hypertonic. We have quite a few cases of whiplash cases that are mostly work, MVA or sports related. I treat many cases of sciatica. I would say that most of the patients who venture into my office are those patients who are chronic and there symptoms are secondary to degenerative arthritis. I could go on and on describing the different back and neck conditions I treat but I will stop here. Also, I treat patients with headaches. Not sinus headaches but rather tension, which is the most common. I have also treated patients with severe migraines and have had good success. Not all, but usually most of these patients have some sort of positive response.

    My main service I provide is manipulation of the spine and extremities. I also offer acupuncture and will talk with patients about diet, exercise and nutrition from time to time. We also offer x-rays on site and perform onsite neurodiagnostics, including diagnostic US usually once per month. We have a room for rehab and also have various physical therapeutic modalities we use. I also do employment, transportation (DOT), school and sports physicals from time to time.
  37. PublicHealth

    PublicHealth Removed

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    Thank you, BackTalk.
  38. DrDrewpt

    DrDrewpt DrDrewPT

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    In general, I don't have a problem with chiropractors.

    What DOES get me hot is when a chiropractor KNOWS that a physical therapist is working with a patient, and then goes on to council the patient NOT to do the exercises or home program that was prescribed by the relative expert in rehabilitative exercise (eg. the PT). This has only happened to me a few times in my 10 years of practice, but it has happened with increasing frequency over the past year or so, and of late, it's been an increasing problem for my supervisor (who still treats patients).

    I would never tell a patient not to go back to their chiropractor --- even if said chiropractor was doing rotational manipulations to treat an HNP. At best I'd call the chiropractor and have a chat about how our treatments were countermanding each other and find a solution based upon understanding of professional equality and mutual respect.

    The current delusion of superiority on the part of many, many, DC's is one thing --- but the countermanding of the instructions of another clinical doctoring professional (especially, as in the case of a physical therapist prescribing therex --- clearly an area where even the BSPT has greater relative expertise than the chiropractor) without consultation --- is quite another.

    It is unprofessional. It is inappropriate. It is a far too common practice among DC's. The practice must stop, or we as PT's, DPT's in particular must become far more agressive in our patient education and marketing regarding the "hazzards of chiropractic."

    It's a shame really. We really should be able to get along better.

    Drew
  39. awdc

    awdc Senior Member

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    Speaking as a (former) chiropractor... chiropractors ARE their own worst enemy.
  40. busupshot83

    busupshot83 S.D.N. Vet

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    I disagree: a chiropractor is a doctor. The word doctor is defined as "anyone with a doctorate; not necessarily associated with practioners of medicine."

    Does a chiropractor have a doctorate? Yes.
    Is a chiropractor a real physician? No.
    Is a chiropractor a real doctor. Yes.
  41. physiatrist :confused:
    ^^^^^^^
    I looked it up the dictionary....
    It was that mean Physical therapist doctor?
    I don't understand..
  42. lawguil

    lawguil Senior Member

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    What are you talking about?

    "clearly an area where even a BSPT has greater relative experience than a chiropractor." :laugh: :laugh: :laugh: :laugh: :laugh:

    Are you suggesting that a DPT is more/better qualified than a BSPT? In case you didn't know, academically, your training is almost identical. The only difference is that if you’re a DPT you’re probably still entry-level and owe more than you'll ever make. :idea:

    PT is NOT a doctoring profession. They are a politicking profession trying for direct access and a bigger piece of the pie (DC's are not a doctoring profession either.).

    Clearly, the chiropractic profession is an un-inspiring profession, especially compared to PT, but please don't threaten the chiropractic community with patient education and marketing "about the hazards of chiropractic" when you have actually bought into the jargon of the APTA about PT being a doctoring profession. You do understand that the DPT is a joke right; it deserves no respect other than the fact that you’re a physical therapist just like a BSPT is a physical therapist and could kick your ass with knowledge and skill. L. :laugh:
  43. BackTalk

    BackTalk Removed

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    DC's ARE a doctoring profession.
  44. freddydpt

    freddydpt

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    So, what in your opinion defines a doctoring profession?
  45. lawguil

    lawguil Senior Member

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    The Doctor of Science degree (and the Doctor of Health Science - DHSc) is a well-recognized degree in Europe and to a lesser degree on the East Coast (Boston University was one of the first institutions to award the DSc). The DSc is designed for professional specialty areas such as Dentistry, Pharmacology, and Physical Therapy. The DSc degree's primary focus is on the practice of the profession. It tends to have depth and focus in the professional area, but not the breath one might see in a PhD. It is distinctive from an EdD or PsyD in that it builds on the entry level education of a profession and the subsequent post entry level clinical experience. Most DSc degrees are over 60 credits in length. Most have some significant terminal project such as a doctoral project or dissertation but less research (inquiry) credits than a PhD or EdD.
    Depending on the focus of the institution (research vs. teaching), the DSc degree is accepted in most academic institutions, but may not qualify an individual for a tenure tract position. It is generally regarded as an academic degree rather than a clinical degree.
    Issues to consider: The DSc degree may prepare an individual to teach in their content area, to provide expert mentoring and vision for their clinical field, and to conduct and participate in clinical research. If a state determines that only individuals with clinical doctorates can be addressed as Dr. in the clinic, the DSc may not qualify. This issue may require legal opinion.

    A Doctorate in Education is regarded similarly to a PhD in many institutions. Many academic institutions make a distinction between the EdD and PhD when offering both in the same program. They may regard the EdD as the practitioners degree and the PhD as the research degree. Generally, the distinction is in the number of required research (inquiry) credits units required. Often the PhD has a greater requirement for research credit units. However, Harvard, as an example, only offers an EdD for a doctorate in Education. The EdD is generally over 60 credit units, requires a qualifying exam (which may be less rigorous than a PhD), and a dissertation.
    The EdD is regarded by most academic institutions as an academic doctorate, qualifying the individual for a tenure tract position and by credential, positioning the individual for access to grant money. The EdD, when distinguished from the PhD is designed to create users of knowledge in specific practice areas.
    Issues to Consider: Most institutions view the EdD and PhD as synonymous with regards to salary, promotion, tenure, etc. It is not regarded as a strong research based degree when compared with the PhD. The EdD requires a significant time commitment and may include a residency requirement.

    The Doctor of Philosophy degree is the gold standard of academic degrees. The purpose of the PhD is to educate students to create new knowledge that is, to become scholars. The PhD often has a residency requirement that requires a student to engage in full-time studies on campus for a portion of their program. Non-traditional institutions (such as technology based programs) often do not require this residency requirement.
    The emphasis of the PhD is on designing, performing, analyzing, and writing of original research. The PhD is typically broad and may require courses not in the students’ content area. Generally, a PhD requires upwards of 72 credit units.
    The PhD is accepted at all academic institutions as the quintessential academic degree. The expectation is the individual will generate research.
    Issues to consider: The PhD generally requires the most time and is the most rigorous. Some may feel the PhD does not prepare an individual to work in any particular sector, but rather prepares them for academia. If the PhD (or minor) is not in Education, the degree may not include any education courses. The PhD may be considered not as useful in the clinical area.

    The DO, MD, DDS become worthy of the mighty “D” because of the extensive clinical training, intensity, and invasive autonomy of a physician. Viewing medical schools globally, they are probably more selective than any other educational program. The pre-requisites for medical school make sense and provide a foundation to construct a medical student. Further, referring to a physician as Dr is reflected in hundred and hundreds of years of history and by definition describes what it is they do.
    Issues to consider: The MD, DO, DDS is not accepted by most academic institution for tenure tract position, but may be qualified to teach in a specific content area (such as a medical school). As a general rule physicians aren’t known for generating quality research outside of specific clinical subjects.

    Now for the DPT, I’m not quite sure what to say. I’m sure that the DPT is an intense program, but physical therapy should be an intense entry level undergraduate program much like engineering. This would give students an opportunity to then do real graduate work and really allow the profession to diversity. Imagine an undergraduate degree in physical therapy and a master’s in kinesiology, exercise physiology, education or a DSc in Physical Therapy or Athletic Training. I can’t seem to recognize any material in a PT curriculum that requires undergraduate work for the program to build on. As you already know, PT was a bachelor’s degree for many years and there is nothing I can find that showed that the programs were not producing competent providers. If you follow the politics that are going on in all the states and nationally, PT is fighting for direct access and more autonomy. However, if you review the curriculum, the content of the courses hasn’t really changed. You can’t add a pharmacology course and more clinical training to qualify calling PT a doctoring profession. The “clinical doctorate” is being used as leverage for the APTA’s political agenda. It simply doesn’t work that way in academia (yes, I know that PT is a clinical degree). Currently, I do not know of any institution that has anything on the books that recognizes the DPT outside of the fact that it is a degree that they may or may not award simply because the APTA has mandated it as the future of entry level physical therapy

    This issue has been discusses a fair amount by PT’s and others in link below!

    http://forums.studentdoctor.net/showthread.php?t=153753
  46. freddydpt

    freddydpt

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    I agree, with the exception that Doctor was originally meant Teacher... so only according to our society and individuals perceptions, it describes what they do

    Is that your opinion or something you've heard as feedback from patients and clients of physical therapists, or actual physical therapists themselves.

    By "Graduate work" I'm assuming you mean original research. For many years, before I was born, most undergraduate physical therapy programs required research theses as a part of the curriculum. Were they as extensive as PhD programs? No. As master's programs... yes.

    This system you mention for us to "imagine" has been in place for about 30+ years. Many physical therapists move on to graduate degrees in public health, exercise physiology, applied anatomy, subspecialties of PT ie. pediatrics, orthopedic manual therapy, neurological PT, etc. DSc's, DHSc's PhD's etc have existed as academic programs in physical therapy as well.


    Ok, so I have to admit that I wasn't angered about statements up until this point. Your arguments so far have been somewhat realistic, though skewed. However, this last comment regarding prerequisites not necessary makes me believe that the author has truly not delved into the requirements of a physical therapy curriculum nor the tasks involved in the physical therapy evaluation, examination, treatments or patient management.

    Prereqs for PT include the following (parentheses is the requisite of clinical skill and patient management):

    General Biology (understanding cell biology, bacteria, pro/eukaryotes, general laboratory research principles)
    Human Anatomy (usually covers material similar to an abbreviated microanatomy/gross anatomy course - lab includes Cat Dissection, brain, eye ball, etc for orientation of the human body)
    Human (systems) Physiology (cardiovascular/respiratory physiology is essential to know for Cardiopulmonary PT, neurophys for Neurological Physical therapy, renal/endocrine to understand basis of metabolic dysfunction - is patient medically stable to get out of bed?)
    Exercise Physiology (Therapeutic exercises for strengthening, aerobic capacities, adaptations to exercises, training principles, etc)
    General Chemistry - depending on the school, this can be General, Orgo and Biochem - much like Boston University (understanding acid/base in physiology, principles in ionic flow for nerve conduction, understanding enzyme principles for drug effects/interactions - yes PT's need to have basic understanding of drug effects to understand presenting signs and symptoms - why that sounds very similar to what a physician does.)
    General Psychology (therapeutic relationship, personality types, principles of reinforcement and behavioral treatments)
    Developmental Psychology (understanding the human across the lifespan used in pediatric, geriatric specialties as well as understanding what stage of life a person is in... this reflects their goals in therapy)
    Abnormal Psychology (sick people have comorbidities that present psychologically as well. It is important to recognize and refer for individuals with eating disorders, OCD, etc. These issues have implications for therapy and how you instruct or interact with patients. This is used in education theory classes in DPT curriculum)
    Physics (this should be self explanatory - physical forces govern the human body - physiology = physics and biology, functional anatomy and kinesiology is the application of biomechanical forces ie. lever arms etc in the human body)
    Math (algebra or calculus) - health care management courses explore accounting and business principles. One needs to have a working understanding of exploring and creating graphs to track progress.
    English Composition - technical writing is required for writing up case studies and research throughout the graduate program.



    While I agree the politics are a major driving force (and this is my opinion that differs from others in the profession), the truth is another major driving force is the change in health care climate. The content of curriculum has changed in response to an increased need for primary care. Primary care physicians are lacking in this country and are overburdened, underpayed. PT's are now trained to medically screen more efficiently (though I think this can be improved even more), health care management classes have been created to stimulate interest in greater autonomy, political activism, and awareness of the health care system in the US. Education theory and practice courses have been added to improve upon the teaching skills of the therapist in various settings including media, classroom, and adult learning courses. Pharmacology courses have been added to improve upon the PT's understanding of drug interactions and appropriate timing with therapy to maximize patient ability.

    You see what defines PT as a doctoring profession (and I'm not saying that it is or isn't) to those who feel PTs are doctors is the extensive education, clinical expertise in biomechanics, rehabilitation and functional improvement. In most cases, the patient has a greater relationship with the therapist than with the physician. Doctors care for patients, they examine, diagnose, evaluate, design a plan of care, treat, establish prognosis. Oddly enough, a physical therapist does all of those things, as well. Why there is such a disturbance among the health care professions to call a DPT doctor is absurd. It is in most part because of radical change (no one ever likes that) and lack of familiarity with PT education and the actual clinical tasks of a PT. Why are psychologists traditionally called Dr.? Studies have shown that master's educated therapists are just as effective. Physicians in other countries receive BSSM... bachelor's in medicine and surgery.

    Patients don't need a referral just to let them know they have a sprain... patients don't need a referral just to let them know they can't walk...
    They just need someone who can help them. A doctorally educated physical therapist is able to evaluate and treat, and appriopriately refer as necessary. Were BSPT's able to do the same? Probably. But professions change and health care has changed a lot in the last ten years. PT has adapted, and I think anything that ups the standards of education cannot ever be a bad thing for a patient.
  47. lawguil

    lawguil Senior Member

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  48. 4216DOT

    4216DOT New Member

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    I thought what you had to say about DC was interesting. I just graduated and may be returning like yourself. Have you taken the MCAT?
  49. PT or DO

    PT or DO

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    What wonderful discussion!

    For the past year I have been working on my prerequisites to apply for DPT school. My goal was to get my DPT and then attend a fellowship in either MA or CA to get trained in Manual Therapy. I want to be able to utilize my whole self, including my tactile abilities in the way that I diagnosis and provide rehabilitation.

    Then a couple weeks ago I learned about OMM and DOs. Since then I have been scouring the internet to learn more about the field and am trying to clearly identify differences in job possibilities, interaction with patients (one or two visits for diagnosis vs rehab), and the insurance coverage for DPT's and DO's.

    For example, lots of people are writing that the application of OMM is greatly declining among DO's and that it is difficult to tell any difference between the DO from a MD. This does not appeal to me.

    What does the job market look like for DO's who wish to develop OMM within their daily practice throughout their professional career?

    :)Thank you all for your candidness. It has been extremely helpful to read your opinions and I look forward to responses!
  50. Blue Dog

    Blue Dog Avec caféine. Gold Donor SDN Advisor

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    This question would be more appropriately answered in the Osteopathic Forum.

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