Answers to Questions about Chiropractic:
Can Chiropractors and Physical
Therapists Work Together?

Samuel Homola, D.C.

Question

I am a physical therapist. Although not trained in the practice of spinal manipulation, I see its benefit when appropriately used by chiropractors. Tell me how you think that our professions can work together to promoting evidence-based treatment of our patients.

Answer

I am glad to see that some physical therapists are using manipulation along with mobilization techniques. Spinal manipulation should be a part of every physical therapist's treatment armamentarium. I would prefer that manipulative treatment be done by a physical therapist who is evidence-based and medically supervised than by a solo chiropractor who bases treatment upon the 19th-century subluxation theory.

As of 2002, all accredited physical therapy programs are required to offer degrees at the master's level and above, which will result in an increasing number of Doctor of Physical Therapy (DPT) degrees. Physical therapists are becoming more capable of serving as independent portal of entry practitioners. Thirty-five states already allow direct access to physical therapy services without a physician's referral—at least for the first month of treatment. Physical therapists should be able to perform basic spinal manipulation procedures.

Most chiropractors are very skillful in the use of spinal manipulation. At the present time, chiropractors do moire than 90% of the spinal manipulation performed in North America. The problem is finding a good chiropractor who uses spinal manipulation appropriately, limiting the use of such treatment to musculoskeletal problems. A few chiropractors have renounced the chiropractic vertebral subluxation theory. But such chiropractors are not easy to find.

Until chiropractic colleges uniformly graduate properly-limited, science-based chiropractors, or until spinal manipulation is readily available from physical therapists and physiatrists, it would be prudent limit one's use of chiropractors to those who are closely aligned with their medical communities. Hopefully, the future will provide us with more physical therapists who perform spinal manipulation as well as a larger number of chiropractors who have abandoned the vertebral subluxation theory, making it possible for physical therapists and chiropractors to work together under the same evidence-based guidelines. At the present time, there is little evidence that the chiropractic profession is making an effort to train chiropractors as specialists in the treatment of musculoskeletal problems—quite the contrary. In a move to seek recognition as an alternative method of primary care over the broad scope of health care, three major chiropractic colleges have embraced the alternative medicine trend by defining their schools as a "University of Health Sciences," including questionable alternative methods such as acupuncture and naturopathy.

If the chiropractic profession continues to present itself as an alternative healing method, it may be up to physical therapists and physiatrists to offer specialized spinal manipulative therapy as a treatment for selected neck and back problems. At the present time, chiropractors are promoting legislation designed to prevent physical therapists from manipulating the spine to correct a "subluxation," creating friction between chiropractors and physical therapists. A true medically-recognized subluxation is a partial dislocation that is often painful and easily detectable on x-ray examination, whereas a chiropractic subluxation is a metaphyiscal concept. Physical therapists do not want to manipulate chiropractic subluxations, but they should be allowed to manipulate the spine when it is appropriate to do so.

Chiropractors do not own spinal manipulation. It does not matter who does spinal manipulation as long as the procedure is used fora proper reason. There won't be any disagreement if well-trained practitioners base their treatment upon scientific guidelines in an evidence-based practice. But as long as chiropractors continue to define their practice as a method of adjusting subluxations to restore and maintain health, cooperation will be difficult if not impossible.

For further information on this topic, click here.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on May 2, 2002.