A Comparison of Physical Therapy OCS Rehabilitation Certification to Chiropractic Rehabilitation Training and a Proposed PTA-E Role

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Jan 13, 2004
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Both chiropractors and physical therapists compete for the same pool of rehabilitation patients but there are some important differences. Many chiropractors also claim to offer rehabilitation in addition to passive spinal manipulation. Let's look at the data.

Physical Therapy
  • Evidence-based curriculum
  • 30% of PTs perform spinal manipulation.
  • PTs are proven to be safer providers of manipulation than chiropractors (93% of problems from DCs vs 6% from PTs). Accordinly, physical therapist malpractice insurance is 10x cheaper than what chiropractors pay.
  • 30% of PTs have OCS certification which shows expert status in rehabilitation
  • May supervise expanded scope physical therapy assistants which allow for more delegation of tasks and less work for the PT.

While all PTs can treat musculoskeletal conditions around 10% of PTs receive the Orthopedic Clinical Specialist (OCS) certification which can either be done through a residency program or submit 2,000 hours of direct patient care within the specialty area as a licensed PT. Around 30% of PTs get training in spinal manipulation and it is permitted in 40 states.

OCS DPT certification generally requires 10-12 hours per week of self-study over a five year period which totals 3,120 study hours.
Typical OCS resident programs offer 357 hours of education which breaks down as:

Johns Hopkins Medicine Orthopedic Physical Therapy Residency
  • 136 hours of classroom/lab instruction.
  • 96 hours: Four three-day didactic weekends.
  • 40 hours: Weekly lecture/labs throughout the year.
  • 221 hours: Independent study
  • All chiropractors believe in the false idea that spinal manipulation is a valid treatment for spinal hypomobility which is the de facto reason for the field to exist and is believed to halt osteoartritis by itself. Spinal hypomobility determined by unreliable assessments is to chiropractic what dental caries are to a dentist. It justifies lifetime passive care. This idea is disproven by modern biomechanical research and is pseudoscience. While spinal manipulation can abort muscular hypertonicity and provide afferent stimulation which is useful for rehabilitation, it has no lasting effect on osteoarthritis. Interestingly, chiropractors do not address known causes of osteoarthritis including exercise, weight management, and joint protection.
  • All chiropractors learn spinal manipulation early in their DC program curriculum which fosters a belief in the legitimacy of unreliable chiropractic technique analysis systems independent of accurate medical diagnosis.
  • Passive rehabilitation modalities termed "Physiotherapy" are taught as a 120 hour elective course that includes diathermy, ultrasound, and electrical stimulation. This is the only subject tested as an optional national chiropractic board exam.
  • Active rehabilitation is not included in the accredited core curriculum.
  • Chiropractic assistants are extremely limited in what they may do versus physical therapy assistants. They can not give exercise instruction etc which means chiropractors are more time-limited than PTs and can not spend as much time with patients.
Chiropractors fall into two camps:

Straight chiropractic (Life University, Palmer University, Sherman College of Chiropractic)
  • Promote non-evidence-based care with low standards.
  • Generally have been against incorporating alternative medicine, and conventional medicine (vaccination) and disdain evidence-based care in favor of using chiropractic spinal manipulation as a panacea to treat any condition.
  • Highly critical of medicine but know very little about it.
  • Teach a dual curriculum emphasizing red flag identification with spinal manipulation regardless of clinical presentation and as prophylaxis.
  • Have traditionally limited treatments to spinal manipulation but are starting to branch out into pseudo-rehabilitation as a way to bolster their quackery-tarnished image.
  • High volume, multiple lifetime treatments.
  • Advocate for a limited scope based on passive manipulation as "spinal subluxation adjustments" which encourages patient dependency.
  • Medical associations have generally supported straight chiropractic's emphasis on limited scope as a way to contain chiropractic but at the cost of promoting the more anti-science/pseudoscience based straight chiropractic colleges (see Wilk v. AMA).
  • Lack of trust in conventional medicine combined with truncated or nonexistent differential diagnosis increases the risk that patients with serious medical conditions (ie. stroke) will not receive appropriate treatment and may be injured.
Mixer chiropractic (Northeast College of Health Sciences, National University of Health Sciences, University of Bridgeport)
  • Generally provides a mix of semi-evidence-based diagnosis and treatment for musculoskeletal problems utilizing passive treatments allowed by chiropractic scope plus other treatments such as active rehabilitation and alternative medicine (functional medicine) which often includes pseudoscience (Naturopathy, Applied Kinesiology, Traditional Chinese Medicine, Acupuncture).
  • Still support the pseudoscientific belief that treatment of spinal hypomobility using only spinal manipulation is a cure for osteoarthritis.
  • Usually, lower-volume care incorporates evidence-based passive treatments combined with some basic active rehabilitation and alternative medicine.
  • Any active rehabilitation instruction is solely up to the discretion of the chiropractic college with no across-the-board standardization and testing.
  • A few states allow for expanded scope into minor surgery. Chiropractors in these states generally favor scope expansion.
  • Medical associations generally support the added emphasis on evidence-based medicine but oppose mixer chiropractor's attempts at scope expansion.
  • An example of the limited hours of chiropractic rehabilitation coursework can be seen here where Northeast College of Health Sciences has only giving 2 credit hours for active rehabilitation, 2 hours for passive rehabilitation and one hour for Connectix (similar to Graston soft tissue therapy). Remember this is supposed to be a top tier school emphasizing rehabilitation. You can find all of the NCHS courses listed if you search by course number and reference the Quizlet website. This will give you an idea of the content. Example: "ATP6604 Active Care" gives Active Care Midterm Flashcards | Quizlet.
Chiropractic postgraduate certification in Rehabilitation
  • Physical Therapy does a superior job of providing comprehensive, standardized, evidence-based rehabilitation training versus chiropractic programs. Classroom instruction is double for PT at 357 hours versus 125 class hours for DCs). PT also beats chiropractic by requiring 2,000 patient care hours versus 0 hours for chiropractic).
  • Many chiropractors suffer from the Dunning-Kruger Effect. Their lack of training and exposure to thorough evidence-based rehabilitation programs causes them to believe they are better trained than they are.
  • Physical Therapy has the advantage of wider assistant scope which means PTs can off-load more tasks to free up time providing for better care.
  • Physical Therapists who perform manipulation have a much better safety record (1:15 complications for PT vs DC).
  • OCS-certified physical therapists have far more experience in active rehabilitation than chiropractors.
  • Chiropractors who see many patients generally do not spend much time with them.
  • Chiropractic's tolerance and promotion of pseudoscience and anti-science have given them a bad reputation with physical therapy associations and has blocked an accelerated transfer program upgrade path to the OCS DPT. The APTA rejected a proposed DC to DPT track program proposed by Stanley Paris, PhD, PT, FAPTA.
  • Many chiropractors and chiropractic schools survive through effective advertising that promotes a false impression of superior care. This generally goes unchallenged by MDs and OCS DPTs. This chilling effect started when chiropractors won a major antitrust lawsuit against the AMA (Wilk v. AMA) and continues to this day.
(Personal note, I have been treated personally by both chiropractors and OCS physical therapists and found OCS PT to be far superior in outcomes for radiculopathy and whiplash injury.)

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Review this two hour NCHS course on Active Therapy and compare it to the depth of general and OCS physical therapy training.

List your impressions below.

ATP6604 Active Care

Do you feel that the American Physical Therapy Association APTA should take a more aggressive stance and start a public education campaign to educate the public on the superiority of OCS certified PTs versus other rehabilitation providers?
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Assuming this fictional scenario where a APTA public education campaign resulted in a surplus of unemployed chiropractors and former chiropractic patients this could be addressed by having institutions offer student loan forgiveness and tuition reimbursement in exchange for a time commitment to work as an expanded DC-PT assistant under the supervision of an OCS certified PT. Tasks delegated could be upgraded to include performing both manipulation and passive care modalities, which chiropractors are already well trained on. An upgrade path for participants could be created where as they work they can complete a DPT degree. Finally, they could advance with OCS certification.

PT's patient load and revenue could expand an estimated 33% by doing this.

In the states where PTs are blocked from performing manipulation (Alabama, Arkansaw, Virginia, New York), incorporating trainee DCs could expand the scope of OCS PT office services to include manipulation while simultaneously expanding their own competencies and knowledge as a PT Assistant and eventually a OCS PT. It's a win win for PT and the chiropractors.

The push to ban PTs from manipulation is coming from chiropractic boards who want to create a monopoly on manipulation (which is ironic given that Wilk v. AMA was determined based on anti-trust law). Other states with chiropractic boards that are pushing to ban PTs from manipulating include South Carolina, New Hampshire, Nebraska, Tennessee, and Wisconsin.

Participating DCs should sign a binding pledge to abide by PT ethics and standards.

Proposal: Transitioning Competent Chiropractors into Physical Therapy


The proposal aims to optimize healthcare resources by leveraging the skills of both chiropractors (DCs) and physical therapists (PTs). Patients with musculoskeletal conditions would benefit from an integrated approach that combines spinal manipulation (from DCs) and evidence-based exercises (from PTs). Additionally, addressing the surplus demand for PTs while utilizing the existing expertise of DCs is crucial.

Key Elements:

  1. Student Loan Forgiveness and Tuition Reimbursement for DCs:
    • Incentive: Offer student loan forgiveness to DCs who commit to working as physical therapy assistants (PTAs).
    • Financial Relief: Reducing DCs’ financial burden encourages them to transition to PT roles.
  2. DC to OCS PT Path:
    • Bridge Programs: Develop programs allowing DCs to gain PT training.
    • Clinical Experience: Require supervised clinical rotations in PT settings.
    • Certification: Upon meeting requirements, DCs become OCS-certified PTs.
  3. Supervised Manipulation and Retraining:
    • Supervision: DCs perform spinal manipulation under OCS PT supervision.
    • PT Assistant Roles: During retraining, DCs work as expanded PTAs to gain practical experience.
    • Benefits: Collaboration: PTs could offload manipulation and PTA duties to the DCs. Skill exchange enhances expertise.

Challenges and Considerations:

  1. Supervision and Safety:
    • Ensuring proper supervision during retraining is crucial. DCs performing spinal manipulation under the supervision of OCS-certified PTs must be closely monitored to maintain patient safety.
  2. Public Perception and Education:
    • Clear communication and education about the transition process are essential. Public perception of chiropractors and their qualifications may impact the success of this proposal.
  3. Credentialing and Licensing:
    • Streamline processes for DCs to become OCS-certified PTs. Establish clear pathways and requirements.
  4. Collaboration and Practice Differences:
    • Address potential conflicts or differences in practice approaches between DCs and PTs.


With proper implementation, stakeholder input, and addressing the challenges, this proposal has the potential to enhance patient care, optimize healthcare resources, and create a collaborative environment between DCs and PTs where the limitations of chiropractic training are directly addressed and corrected.

Overall Assessment: The proposal presents a strategic approach to address the surplus demand for PTs while utilizing the existing expertise of chiropractors. By providing financial incentives, creating a clear path for DCs to transition, and expanding PT services, both professions stand to benefit. Patients would receive comprehensive care, and the healthcare system would be more efficient. However, successful implementation would require collaboration, standardized training, and regulatory adjustments.

Please note that this revised proposal incorporates the concerns raised and aims to create a balanced approach. Further evaluation and stakeholder feedback will be necessary to determine its feasibility and effectiveness.

Additionally, a good strategy would be to require OCS PT supervision for both the chiropractor trainees and general PTs providing musculoskeletal care who are not yet OCS credentialed. This could easily be done via telemedicine. This inclusion would boost revenue and demand for OCS PTs who would receive additional pay to supervise both groups. This would greatly improve the quality of care received by physical therapy patients.

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Would you support such a program?
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OCS PTs and OCS PT students who would like to support this proposal are encouraged to write to the APTA at [email protected].
Sounds like this proposed bridge program would have lots of deficiency compared to what the average PT goes thru as a baseline. There is way too much hyperfocus on Chiropractors becoming OCS PT's and no mention of the ~ 90% of other training all PT's go thru to become a licensed PT to begin with. You can't be a OCS PT without being a PT first.
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I agree with you SG, if the DCs were directly to advance to the OCS PT they would be very deficient and probably not retain much as the progression would be too rapid. On the other hand, they are probably adequate to rapidly retrain as PTAs with an expanded scope (PTA-E) giving passive therapies like manipulation and Graston technique under the supervision of an OCS PT. So the first step is to get them trained and working as PTA-E not OCS PT. OCS DPT would be the final step of the program and realistically some of them will not achieve this given that their undergraduate GPAs are much lower than the minimum requirements for DPT programs.

However, for the DCs having the opportunity to be an expanded scope PTA would allow them to have a decent salary for their passive skills and get on top of any chiropractic student loan debt they are managing so they can start to make a new life for themselves outside of their troubled profession. Many DCs would find this appealing as they are doing a similar thing such as getting a CNIM in intraoperative neuromonitoring then upgrading to a DABNM. That's what I did but the loss is that PT and healthcare would not be able to leverage their passive skills. OCS DPTs would benefit from having PTA-Es to offload some of their manual therapy. PT access to manipulation in restricted areas would be useful for cervicogenic headache patients and for immediate pain improvement in acute conditions (85% improvement for manipulated patients vs 69% for mobilization). OCS PTs would benefit from being able to supervise them while they provide manual therapies and passive modalities and it would be a good step in advancing orthopedic rehabilitation by making sure all lower-tier providers are being supervised by experts to the level that the patient would benefit from.

This is not a new idea, nurse practitioners already function under this model.

Proposed model

1) Patient is seen by MD or OCS DPT and receives a diagnosis.
2) PTA-E or generalist PT does a PT oriented exam and makes a report with a treatment plan
3) OCS DPT reviews ancillary visit report and notes then makes any modifications
4) The patient may need an additional visit by ancillary provider for additional tests. The visit could have the OCS PT join live via telemedicine.
5) Patient is scheduled to be seen by ancillary or OCS PT depending on what is needed for their stage of injury.

A lot of generalist PTs are making the same mistakes as the DCs are, giving too much passive care. PTs do this with modalities, DCs do this with manipulation. This model aims to correct this.

I think PTA-E salaries should be competitive with what skilled associate chiropractors make, $65k to $83k per year. This can include tuition reimbursement and benefits.

OCS DPTs need to have their pay boosted for the supervisory fees. I'd like to see them on par with what owner chiropractors make at $130k-$200k per year depending on bonuses that would recognize their specialized skills. This would put them slightly below what a nurse anesthetist makes.
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The public relations campaign plus an army of vocal disgruntled former DCs turned PTA-Es could be a huge blow to any claims of superiority by the chiropractic profession. It could result in huge losses for chiropractic colleges and offices.

Implementation of PTA-E upgrade programs at medical institutions could also help existing PTA's expand their scope and earnings by learning the skills to do more treatments under OCS DPT supervision. This would lower the cost of physical therapy services, expand access and treatment availability in several states. OCS PT earnings would increase with the expanded supervisory duties.

PTA-E upgrade programs could revolutionize physical therapy services, benefiting both patients and practitioners.
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I've been thinking about this PTA-E program. I don't think it would work for most of the chiropractors as they can just make more money keeping their DC offices open (except for the defectors who went to weak programs and the ones stuck as low salary associates) because most of them don't realize that they are practicing a rotten profession. Most DC offices are making $150k per year so it isn't cost effective to try to retrain them. This is especially noticeable for the DC students. All of their online communities are closed so they have very little input. This reminds me of how cults operate. They love bomb new members, demonize outsiders and keep a tight rein on any outside communications. Historians have said the founder of chiropractic, D.D. Palmer, commented that he wanted it to be a religion and I think the modern version of chiropractic schools could be classified a health cult because of the isolation, cult tactics and indoctrination (see the Money Hum article on Chirobase.org).

However, I do think the PTA-E role would work for upskilling interested medical massage and PTAs to do passive care. They would certainly appreciate a salary boost and getting to learn more skills. This would be a great way to offload a lot of passive care duties. Medical massage already does soft tissue work anyway so they may as well expand their knowledge. It's all under supervision so they wouldn't get into trouble.

One warning, if your PT associations don't fight hard you will lose the ability to manipulate in more states. This is ironic given that PTs are safer manipulators than DCs.
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In case anyone is interested in how chiropractors respond to criticism, I posted a link to this thread on the Reddit Chiropractic Forum. The comments from chiropractors were immediately defensive, alarming and unprofessional. Most of the comments lacked any understanding of the content of the article. I also noticed they were using known cult indoctrination methods (thought stopping, demonization of critics, etc). The moderators deleted the entire thread within two hours.

Sorry, this post has been removed by the moderators of r/Chiropractic.
Moderators remove posts from feeds for a variety of reasons, including keeping communities safe, civil, and true to their purpose.

Chiropractic's warts- Poor rehabilitation training and a bad practice model​

This is a very good article comparing OCS Physical Therapy certification (superior) to DC rehabilitation certifications (inferior). Also includes why PTs can delegate more to their assistants.

Nutshell summary

Chiropractic is an outdated passive therapy profession trying to pretend it does adequate (active therapy) rehabilitation despite lacking the training and philosophy. Chiropractors are inferior compared to OCS physical therapists but they don't realize this because they aren't exposed to real evidence-based rehabilitation. If they knew how deficient their care currently is they would ask for their tuition back from their chiropractic college.

Also check out Life University scamming their community with Functional Kinesiology rehabilitation.

Prepare to be shocked. Viewed by 600 physical therapists.

A Comparison of Physical Therapy OCS Rehabilitation Certification to Chiropractic Rehabilitation Training and a Proposed PTA-E Role | Student Doctor Network

MODS·15 min. ago·Stickied comment
The more extraordinary the claim the more extraordinary the burden of proof.

level 1
·16 min. ago
This assumes that Chiro’s only do one dimensional manual therapy. Good successful practices in the future should take an exercise rehab approach as well as other therapies not just adjust the patient manually.

level 1
·57 min. ago
Lots of proposals yet; what I’m seeing is a growing interest in our field from outsiders in real life. However; if this does happen(what the article says I mean), you’ll have to decide if you want to be a PTA-E or move to another profession

level 1
·45 min. ago
This isnt news, physios bashing chiros (yawn). We thank the physio community for sending us so many failed PT cases, which we subsequently fix. Thanks for the share!

level 2
OP·43 min. ago·edited 35 min. ago
It isn't bashing, it's all true. Wow, that's some grandiosity delusion you have. I bet you tell your patients SMT helps cure cancer and children's ear infections. Just because SMT does better for cervicogenic headache doesn't excuse the profession for having inferior rehabilitation training and encouraging patient dependency. PTs perform SMT in most states and they have 10x cheaper malpractice insurance rates which isn't surprising because they are evidence-based not delusion-based.

level 3
·5 min. ago
Bet my chin tuck is better than yours

level 1
·27 min. ago
Had a patient seeing a PT last week. He set her up in a side posture position and delivered a very hard thrust to her low back. She could not walk for several days. PT’s are not educated in how to actually adjust a patient. She is going to report the PT to the state board for adjusting her and tell all of her friends how much he hurt her. Keep blabbing your crap on Chiropractic.

level 1
·19 min. ago
Wow looks like there’s nothing wrong with OCS and nothing right with chiropractic. What a nuanced take /s

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The Reddit group from where that post was taken is actually a group of "evidence-based" mixer chiropractors who teach rehabilitation courses through seminars, exactly what is being criticized here, so it's no wonder they were hostile. Still, a serious group concerned about rehabilitation should be willing to take and respond to criticism, not just cover it up.

  1. How do I find a good chiropractor? Here is a good video to help: . Or you can check out the Forward Thinking Chiropractic Association at FTCA. Or if neither of these are helpful, then ask local medical professionals or friends and family for a chiropractor that they trust. Additional listings that are technique specific: Titleist Performance Institute, Active Release Technique, Cox Technique, Graston, SFMA

Check The Map


There are only around 100 chiropractors listed in this evidence-based directory.

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If anyone wants an inside look at typical chiropractor's mentality these two threads are good (see below).

To summarize, chiropractors are great at SMT, PTs are terrible (false).
Chiropractic techniques are based on valid biomechanics and have good reliability (false).
PTs aren't better at rehab than chiropractors (false).
Chiropractors diagnose better than DPTs. (false)

What a mess.