Physical Therapy and Chiropractic: Unraveling the confusion
- By Mike Howard
Hardcore PT: Chiro’s are a bunch of manipulative manipulators with back-cracking fetishes who are grounded in pseudo-science and vitalism.
Hardcore Chiro: PT’s are a bunch of narrow-minded allopathic puppets that are experts in placing hotpacks on patients while they iron them (ultrasound).
Discuss…
Right out of the shoot, this isn’t a one-vs-the-other argument. Rather it is an honest look at the professions of Physical Therapy and Chiropractic. It will look at the advantages, the flaws, and the opinions that relate to the fitness industry.
I’m hoping to tease out the best of both professions based on research, and my own experiences to help the fitness pro and enthusiast alike to make more informed decisions. I also want to start a massive fight between PT’s and DC’s….yeah!
Eliminating the Blanket Statement-ry
My opening scenario outlines the extreme opinion when it comes to both the PT and the Chiropractic profession, with reality settling somewhere in the middle. Here are some thoughts to consider when looking at both areas.
- There are both great physio’s and great chiro’s, as well as poor ones.
- We must look at the practitioner, rather than the discipline, when making a broad-based opinion on the profession.
- We must look at whether an intervention is evidence-based, rather than whether it is “chiropractic or PT” or on a broader scale, “allopathic” vs. “alternative”.
The line in the sand becomes even more blurry when discussing interventions. There are on-going legal issues regarding scope of practice and which profession may or may not do what. This is confounded by state and provincially-governed laws. Here is some clarification:
- DC’s don’t just “crack backs.”
- PT’s can and in many cases do “crack backs.”
- Manipulation is the “bread and butter” treatment used by chiropractors, while PT’s tend to use manipulation as an adjunct treatment.
- In many states, Chiro’s are able to perform rehabilitation services to their patients.
Without getting into a drawn-out discussion on education, suffice to say there is a good deal of overlap between PT and Chiro schools. The difference in terms of scope is small.
PT’s are trained in stroke rehabilitation, cardiorespiratory, rehabilitation, and post op orthopaedic rehabilitation.
Chiro’s have better training in radiology and diagnosis.
The Favorable aspects of Chiropractic
- Chiropractic treatment tends to have a high satisfaction rating amongst patients. This could be a function of its efficacy but may also be due to patient relationship and dialogue. Either way, PT’s could probably learn something from chiro’s in terms of communication and perhaps take a look at acute pain management – an area where Chiro’s seem to have an edge (some of these thoughts are anecdotal).
- Chiropractic treatments are generally effective for acute (and in some cases) chronic nueromusculoskeletal issues. There is also some evidence that manipulations are beneficial for migraine headaches. It should be noted, however that many trials prove inconclusive when it comes to chiropractic efficacy.
Flaws of Chriopractic
Again, I will reiterate the fact that I am talking about “ChriopracTORS” vs. ChiropracTIC”. As previously mentioned, I believe that there are very good ChiropracTORS out there. I believe, however that there are many aspects of ChriropraTIC that need to be addressed and/or exposed.
Here are some of the less desirable aspects of certain scopes of Chiropractic
1. Everybody is a candidate for manipulation: There is an undeniable trend in Chiropractic towards manipulating everybody – even hypermobile or osteoporotic individuals and children.
2. The subluxation factor: Many DC’s believe and convince patients that subluxations (when vertebrae are out of position) are a primary cause of disease and dis-ease and need to be treated. Most PT’s believe chiropractic subluxations to be a diagnostic apparition – a ruse to keep patients waling through the door to treat an invisible disease.
3. Treating diseases: There is a significant cross section of Chiro’s who claim that they can treat a wide variety of medical issues through their treatments. There is no convincing evidence that chiropractic makes your “organs function better” nor has it ever been shown to manage diabetes, asthma, blood pressure or menstrual pain better than a control group of a different intervention or sham manipulation.
4. Selling products, cleanses and Nutritional counseling beyond their scope: Many DC’s pad their pocketbooks by selling herbal remedies, providing nutritional counseling or by providing other services in which they are not fully qualified to do.
5. The Lifetime patient: Many DC’s will recommend “maintenance” adjustments whereby patients are encouraged to come in for frequent adjustments to continue to be “healthy”. The aforementioned “subluxation” argument is usually cited as the rationale for continued treatment.
6. Treating children: Selling parents on treating their children is a dubious tactic that some DC use. There is no substantive evidence that chiropractic improves the outcome of colic, nor does it cure bedwetting or digestive issues.
What about neck manipulation and strokes?
This area is a topic in and of itself so I won’t delve too deeply into it. In summary, the risk of stroke through cervical manipulation is very small. I can’t provide a risk/benefit commentary as I’m intimately familiar with the literature.
My off-the-cuff opinion?
Chiropractic is generally safe and the risk of stroke, although real – is likely overblown by overzealous MD’s and PT’s.
Getting the best of both worlds – a summary
- Like any profession, the practitioner is only as good as he/she’s dedication to continuing education and mastery of their profession and dedication to helping patients.
- Choose or refer practitioners that strive to stay on the cutting edge of science and those that exercise themselves and have a deep understanding of movement.
- PT doesn’t have the same stigma attached to it as does chiropractic, although PT’s could do a better job overall with patient care and satisfaction. Part of this disconnect may be because Chiro’s don’t have much in the way of a medical-based referral system.
- Look for a PT that is certified in manipulative therapy and that is “hands on” vs. modality-based. Find one with specializations related to the dysfunction or condition that you are your referral is struggling with.
- Steer clear of PT’s who treat only based on algorithms and formulas and who relies too much on modalities and cookie-cutter exercises.
- Choose a DC that is evidence-based and one with an interest in having patients “leave the nest” rather than create a dependence.
- Steer clear of “subluxationist” chiro’s and anyone who sells supplements or herbal remedies.
- Ask around, do your homework and find the best practitioner to suit your needs.
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Mike Howard is a Vancouver, British Columbia-based personal trainer, writer and educator – specializing in fat loss and corrective exercise. He is a regular contributor to Diet Blog (www.diet-blog.com) and has been published in several other local and national publications. Mike has also taught personal training certification courses and is a continuing education provider for trainers. For more information visit www.coreconceptswellness.com
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References:
1. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.
2. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Med. 1974;31:59-64.
3. Triano JJ, McGregor M, Hondras MA, et al. Manipulative therapy versus education programs in chronic low back pain. Spine. 1995;20:948-955.
4. Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021-1029.
5. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131-137.
6. Olafsdottir E, Forshei S, Fluge G, et al. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. 2001;84:138-141
7. Hondras MA, Long CR, Brennan PC. Spinal manipulative therapy versus a low force mimic maneuver for women with primary dysmenorrhea: a randomized, observer-blinded, clinical trial. Pain. 1999;81:105-114.
8. Reed WR, Beavers S, Reddy SK, et al. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther. 1994;17:596-60
9. Kukurin GW. Chronic pediatric asthma and chiropractic spinal manipulation. A prospective clinical series and randomized clinical pilot study. J Manipulative Physiol Ther. 2002;25:540-541.
10. Walsh MJ, Polus BI. A randomized, placebo-controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative Physiol Ther. 1999;22:582-585.
11. Goertz CH, Grimm RH, Svendsen K, et al. Treatment of hypertension with alternative therapies (THAT) study: a randomized clinical trial. J Hypertens. 2002;20:2063-2068.
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