As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future.
February 2003: Chiropractic Board Fines PT for Performing Spinal Manipulation
In what is believed to be the first case of its kind in state history, an Arkansas physical therapist has been fined $10,000 by the state board of chiropractic examiners for allegedly performing spinal manipulation on two people, including a private investigator posing as a patient. Should the board's ruling stand, it would be the first time a PT has been disciplined by a chiropractic board in Arkansas and could start a political battle between physical therapists and doctors of chiropractic over scope of practice.
In December, the Arkansas State Board of Chiropractic Examiners ruled that Michael Teston used a chiropractic technique on a woman who claimed she was hurt by the technique. Teston has appealed the board's decision on the grounds he was practicing within the limits of his license, an assertion backed by the Arkansas Board of Physical Therapy (ABPT).
The issue stems from the vagueness of the state's Physical Therapy Act. Under Arkansas law, physical therapists are allowed to manipulate joints, but not the spine. They may also perform "mobilization," but are specifically prohibited from performing "spinal manipulation" or an "adjustment." Unfortunately, the Physical Therapy Act fails to provide definitions of the terms adjustment and spinal manipulation. However, the Arkansas Chiropractic Practice Act defines both terms: "Spinal manipulation and adjustment mean the skillful or dexterous treatment whereby a corrective force or passive movement of the joint is made to realign vertebrae or articulations to their normal juxtaposition."
In documents obtained by Dynamic Chiropractic, the woman who accused Teston of spinal manipulation went to his office in Little Rock from January to April 2002, after being involved in a car accident. In testimony delivered to the chiropractic board, the patient claimed Teston "popped" the cervical, thoracic and lumbar regions of her spine. The board also heard descriptions of the body positions involved, and the amount of pressure applied by Teston during treatment.
Each manipulation counted as a violation of Arkansas law with a penalty of up to $5,000, resulting in the $10,000 fine. Teston, a physical therapist for two decades, told the board the maneuvers he performed are common among physical therapists. He also disagreed with the board's ruling, saying that "pops" can occur from either manipulation or mobilization.
As the Teston case shows, there is little doubt that in many states, physical therapists are encroaching on the practice rights of chiropractors. The Arkansas State Board of Chiropractic Examiners has been proactive in this matter and has taken steps to discourage physical therapists from performing procedures that could fall into the chiropractic scope of practice. Other state boards are encouraged to follow Arkansas lead to ensure that the chiropractic profession is protected and that the ability to perform spinal manipulation and adjustments stays in the hands of doctors of chiropractic.
May 2003: Chiropractic on the Front Line in Baghdad
The sun descends on the horizon 10 miles south of Baghdad; a chiropractor wearing protective gear is performing an adjustment on a fellow Marine when gunfire erupts - adjustment over. It is the end of another day for Lieutenant Colonel Mark Losack, DC, stationed with more than 150 fellow troops as part of Operation Iraqi Freedom.
Lt. Col. Losack was sent to Iraq for his military experience first and his chiropractic expertise second, although both have been utilized during the conflict. Dr. Losack was called to active duty on Nov. 1, 2002, and deployed to the Persian Gulf region aboard the U.S.S. Boxer (LHD-4), arriving in Kuwait March 1. He was assigned to the Division Forward Combat Operations Center, with Task Force Tripoli, tied in with the 7th Marine Regiment. As a result of his deployment, Dr. Losack temporarily closed his thriving practice in Oceanside, Calif.
Although Dr. Losack made the change from treating civilians in his practice to those in his unit with relative ease, his first day on the front line was an eventful one. "I hung out my shingle, and before I knew it, I had treated over 25 patients in the first 21-and-a-half hours. I stopped counting at 25. I discovered later that three to four MRE ["meals, ready-to-eat"] boxes work well as an adjusting table. Judging from my posture, I would hurt myself doing 50 or more patients per day like this, but it works."
Dr. Losack made it clear he is a lieutenant colonel first, taking part in infantry operations, and a licensed DC second, treating on the front lines. "I believe chiropractors commissioned in the military have a tremendous opportunity; you know more than you think you do." He also cautioned: "Practice in the military is not for shrinking violets. You have to be able to weigh in during the decision-making process; and once that decision is made, carry it out on your own."
As he concluded his transmission from Tikrit, Iraq, on the palace grounds of its deposed leader, Dr. Losack expressed his gratitude to Dr. Reed Phillips, president of his alma mater, Southern California University of Health Sciences (SCUHS). "My sincere thanks to you and the faculty for imparting your knowledge to me. The bureaucrats [who] say we aren't needed in front-line units haven't spent much time on the front line. I have; I know."
June 2003: Study Finds Manual Therapy Is the "Most Effective Treatment" for Neck Pain
Although not as prevalent as back pain, neck pain is a common presentation in clinical practice. An estimated 10 percent to 15 percent of the general population suffers from neck pain and/or stiffness at any given time. Neck pain can be caused by a variety of factors including stress, accidents, compressed nerves, disease; and degenerative changes in the discs that comprise the upper spine. While neck pain usually isn't life-threatening, it can cause a great deal of discomfort and dramatically impact quality of life.
Among the most popular therapies for neck pain are manual therapy (including mobilization and manipulation), physiotherapy (usually performed by physical therapists) and pain-relief medications, which often are prescribed by medical doctors. A study in the April 26 issue of the British Medical Journal compared the efficacy and cost-effectiveness of these forms of care and concluded that manual therapy is "more effective and less costly for treating neck pain" than either physiotherapy or care provided by a general practitioner.
In the study, 183 adults were randomly selected to receive manual therapy, physiotherapy (PT) or care from a general practitioner (GP) for six weeks. All of the patients suffered neck pain for a minimum of two weeks; 66 percent had received some form of treatment for the condition prior to enrolling in the study. Manual therapy consisted of a variety of interventions, including hands-on techniques such as low-velocity spinal mobilization, a technique the authors noted is utilized frequently by doctors of chiropractic. Spinal manipulation was not provided, however. Treatment sessions lasted 45 minutes, once per week for a maximum of six sessions.
Manual therapy was considered "the most effective treatment" in the study. After seven weeks, recovery rates in the manual-therapy group were 68 percent, compared to 51 percent and 36 percent in the PT and GP groups, respectively. Differences in recovery rates remained statistically significant at the 26-week mark, and were still superior for manual therapy at 52 weeks.
In addition, manual therapy patients reported less time lost at work due to neck pain. Patients in the manual-therapy group missed an average of 1.3 days (from paid work) and 5.4 hours (from unpaid work) because of neck pain in the year after being treated. Patients under the care of a general practitioner missed an average of 10.4 days (from paid work) and 15.7 hours (from unpaid work).
While manual therapy succeeded in providing greater relief of neck pain in physical terms, the most striking differences between treatments were seen in the area of cost-effectiveness. Manual therapy was easily the least expensive form of care; on average, the total direct costs of treating neck pain with manual therapy for one year were $137-$283 less per patient compared to PT or GP care. When direct and indirect costs were factored together, the difference was even greater. The average total cost of treating a person with neck pain for one year using manual therapy was $514. Treating a patient over the same time with physiotherapy cost $1,492, while GP care cost $1,586.
June 2003: New Study Finds Unity in Chiropractic
Published by the Institute for Social Research at Ohio Northern University, a new probability survey discloses overwhelming agreement within the chiropractic profession on key issues such as the vertebral subluxation, the adjustment and the appropriateness of a broad array of clinical services. How Chiropractors Think and Practice: The Survey of North American Chiropractors contradicts the long-standing stereotype that doctors of chiropractic are divided into rival camps. The hardcover report is based on responses from 687 DCs. The randomized survey netted a robust response rate of 63.3 percent, giving the results an estimated maximum sampling error of plus or minus 4 percent.
The only issue on which chiropractors were closely divided involved limited prescription rights. A slight majority (54.3 percent) favored allowing DCs to write prescriptions for over-the-counter medicines. A slight majority (51.2 percent) opposed writing prescriptions for musculoskeletal medicines (muscle relaxants, corticosteriods, etc.). However, the respondents were overwhelmingly opposed (88.6 percent) to the idea of writing prescriptions for all medicines, including controlled substances.
Asked to individually rate themselves on a nine-point philosophy scale, ranging from "broad scope" to "focused scope," approximately half the respondents chose the middle-scope label. While 46 percent of the respondents designated themselves as middle scope, 34 percent selected the broad-scope label and 19 percent preferred the focused-scope identification.
In contrast to the stereotype that chiropractors are divided into rival camps that think and practice in divergent ways, the report showed evidence of broad unity among practitioners. Majorities from each of the broad-scope, middle-scope and focused-scope groups were in agreement on the following eight concepts:
- the appropriateness of a wide spectrum of conservative clinical services;
- the term vertebral subluxation complex;
- subluxation as a significant contributing factor in a majority of visceral ailments;
- the adjustment as a treatment procedure for musculoskeletal and selected visceral conditions;
- the differential diagnosis;
- the notion of maintenance/wellness care;
- teaching patients a relationship between spinal subluxation and visceral health; and
- counseling patients on stress reduction and ergonomics.
This groundbreaking survey was underwritten in part by Dynamic Chiropractic; the graphics and typography for the report were underwritten in part by Foot Levelers, Inc.; and the printing was underwritten in part by the Palmer Colleges and the Palmer Center for Chiropractic Research. It likely will impact the direction of the profession for at least the next decade and should be required reading for every chiropractic leader in the country.
September 2003: Chiropractic Best for Chronic Spine Pain
A randomized, controlled clinical trial just published in Spine reveals that chiropractic manipulation is superior to both drugs and acupuncture in the treatment of chronic spinal pain (people with pain lasting more than 13 weeks). The study, conducted at a multidisciplinary spinal pain outpatient unit in an Australian public hospital, involved 115 patients randomly assigned to receive one of three interventions: medication, needle acupuncture or chiropractic manipulation.
Patients randomized to the acupuncture or spinal manipulation group were given an initial physical examination by the treating clinician to determine which form of acupuncture needle placement and needling would take place or what type of spinal manipulation would be performed, respectively. Patients randomized to the medication group were given Celebrex, unless they had used it previously. The next drug of choice was Vioxx, followed by paracetamol (acetaminophen) up to 4 g/day. Doses were left to the physicians' discretion. Chiropractors administered "high-velocity, low-amplitude" manipulations. Patients were given two treatments per week.
While a number of patients didn't finish the study due to noncompliance or treatment changes, the statistical significance of the results was maintained for most outcomes. At the end of the study, the group receiving manipulation experienced the most recovered patients (nine) compared with three for the acupuncture group and only two for the medication group. This was significant, considering the nature of chronic spine pain.
Patient assessments for the three groups also indicated superiority for chiropractic manipulation for all tests except the VAS for neck pain. This superiority is demonstrated in the percentage of improvement that patients in each of the three groups experienced as measured by the assessment tools. One of the study's most remarkable findings was that patients in the manipulation group reported a 47 percent improvement on the SF-36 questionnaire, compared to only 15 percent for the acupuncture group and 18 percent for the medication group. This finding is all the more significant because the SF-36 does not measure back pain, per se, but gives a perception of the level of overall health.
Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email
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