It has come to my attention via the twittersphere that my job duties might change significantly in the coming months. This applies to all physical therapists in California. Recently, a state senator, more specifically Senator Leland Yee, has proposed a bill, CA SB 381, which, if passed, would not allow physical therapists in California to perform joint manipulations or joint adjustments. The chiropractors who are in support of this (and I have yet to interact with one who is not in support) are known for their ability to manipulate (it’s not just cracking and popping) the spine (and other joints) among many other therapeutic techniques. More to come on this.

The biggest problem with this bill is that it does not appropriately define what a joint manipulation or adjustment is, how they vary from joint mobilizations, or what grade(s) of such adjustments would be considered unlawful under the new law. (Not all adjustments are violent twists and jarring of joints producing cracks and pops.) If they are trying to make it illegal for me to do a grade-3 joint mobilization on an ankle, for example, this bill should be the laughing stock of ALL healthcare practitioners. This mobilization  is a frequently utilized, low-risk treatment technique that uses moderate pressure on the joint to achieve decreased pain, increased mobility and range of motion.

What other practitioners in California can perform joint adjustments/manipulations/mobilizations under the current law? Doctors of medicine and osteopathy, surgeons, chiropractors, occupational and physical therapists, YES.

And which of these practitioners will continue to be able to legally perform joint adjustments if the bill is passed? Everyone EXCEPT occupational and physical therapists.

What many people do not know is that physical therapists receive comprehensive training in joint manipulations/adjustments/mobilizations on the road to obtaining their master’s or doctoral degrees. (A minimum of master’s-level training in physical therapy is now required to gain licensure nationwide.) When I took my National Physical Therapy Examination I had to posses at least minimal clinical competency in the performance of joint manipulations, adjustments, mobilizations or whatever else they want to call them. Also, California’s Physical Therapy Practice Act states that regardless of what we are trained/allowed to do, if we as practitioners feel we no longer possess this minimal clinical competency in a certain area, it is unethical to perform such duties (do no harm), and this goes for all other healthcare professions as well.

And research supports physical therapists’ ability to perform these treatments safely and effectively:  Piece de resistance,

more info, even more info.

Yet physicians and surgeons, neither of whom has formal training for joint manipulations or adjustments in their curriculum, will continue to be allowed to perform these treatments under the proposed law. Does this make any sense?

Why is this bill even being brought forward? Either Senator Leland Yee had a life-changing experience for the better from a chiropractor, or for worse from a physical therapist…OR this is lobbying at its best. This might explain more: Long but interesting read. Or how about this bill just trying to take our own language away from us? Even though they are taking away the words manipulation or adjustment, we are still trained and schooled, accredited, and licensed to perform these manuevers under our own Practice Act. So why no do what Joe Brence says (says is putting it lightly) here, and let the chiropractors have these words and develop a language of our own. We’ll take Neurophysiological Joint Manipulations/Mobilizations, both of which are much more relevant terms than vague joint manipulations and adjustments. If you read Joe’s article, you will see that this is a touchy subject, because Joe doesn’t even practice in California, but it’s a very slippery slope once one Board starts dictating over another what the other can and cannot do.

Chiropractors are saying that this is a public safety issue, and that there must be rogue “healthcare practitioners” going around adjusting people’s necks and backs with resulting strokes and paralyzations. The research is out there folks, PTs are just reckless. That must be why my malpractice insurance costs a whopping (sarcasm) $170 a YEAR! Malpractice insurance for chiropractors, on the other hand, costs about $2,500/year. And we all know that physicians pay out the nose for malpractice insurance: My research placed this insurance in the range of $20,000 – $100,000/year for doctors in California.

So this bill is just for spinal adjustments, right? Have I been using the term “spinal” manipulations or adjustments throughout this post? Nope, it is for all joints, toes, ribs, elbows, you name it, we won’t be able to adjust it if this bill passes. The language of the bill is so vague, if you are referred to PT after your rotator cuff surgery and your protocol calls for grade 2/3 shoulder mobilization, we won’t be able to do it, and you will need to go to your local chiropractor who: 1) you were not referred to by your physician (nor do you need a referral), and 2) likely does not take your insurance.

It boils down to this: If you read and agree with that long but worthy read above, Chiropractors tend to get overlooked in the rehab profession because they do not have an identity of their own within the healthcare system. They are neither primary care physicians, nor the rehab specialists physicians most commonly refer their patients to. As a result, they are not covered by health insurance to the extent other providers in the field are, and they are forced to cast about in search of an identity, and, more importantly, a patient base. The long and short of it is…they’re trying to sell our California senators — via, might I point out, Senator Yee, who’s currently running a campaign for Secretary of State — a bill of goods that adds up to poaching patients from the very healthcare professionals who are most qualified to treat their needs. Personally, I cannot see why chiropractors are attempting to dictate to the physical therapists in California what they are trained to do and what they are not. Shouldn’t this bill come from our own governing body determining that what we are doing is within our own scope of practice?

I’m not saying chiropractors are bad. I know plenty of fantastic chiropractors, and I know plenty of bad physical therapists. In the world of rehabilitation, the cream rises to the top regardless of the letters behind their names. The point is that this bill is made up of falsehoods, vaguenss, and malarkey that is so restricting to a fully trained and licensed group of professionals that it would change the face of rehabilitation in this state forever (or until it’s overturned). What about the PT schools in California? Can they no longer teach joint mobilizations because that would be illegal, even though many of the graduates wouldn’t practice in this state? If so, these graduates would then not be qualified to perform these essential treatments, even in other states, because of minimal clinical competency restrictions.

I can’t wait for the American Butchers Association to say they are the only licensed professionals that can use knives at work and then see surgeons try to do their jobs. Below are some links to the full text of the bill (it’s short), and a pre-made document to fax to your local senator or even to Senator Yee.

Always evolve,

Mike

Full text of bill

Fact sheet/fax sheet (thanks @sturdy)

There is no need for this to happen http://www.chirofind.com/mpacms/dc/article.php?id=9048