The seminar was conducted by a company called the University of St. Augustine for Health Sciences Institute of Physical Therapy, and was scheduled for five days in Little Rock. During the first two days, the students learned to palpate the spine looking for "positional faults." The third day began with a slide presentation on the history of spinal manipulation. According to Jana Busby Guillory, DC, one of the observers, the physiological effects of manipulation were described as "touch, induced movement, and the pop or snap."
After the slide presentation came the "manipulation lab," where physical therapist Olsen began demonstrating manipulation techniques on the participants. On witnessing this part of the program, the chiropractic observers contacted the Arkansas State Board of Chiropractic Examiners.
The Arkansas Board acted quickly, filing a motion with the local court for a temporary restraining order to stop the seminar. Unfortunately, the motion was denied. The reasons for denial, according to Chancellor Collins Kilgore, were:
"Although the court is sensitive to the Attorney General's concerns for the safety of the citizens, the Court does not believe that the threat is sufficient to overcome the Defendants' (University of St. Augustine Institute of Physical Therapy) constitutional due process protections and the right to be heard after notice of the State's complaints."The seminar has included two days of training. It appears to the the Court that if any damage is going to be done, it has probably already been done." (Emphasis ours: Imagine a judge declaring in a criminal case -- theft, assault, whatever -- that 'the damage has already been done, so let's just forget it.') "A review session is scheduled for tomorrow. The Court thinks that the chance of any harm is too remote to ignore the constitutional protections of the Defendants who haven't had notice to be here today."
The seminar continued, and the students were encouraged to practice their new techniques on their patients. At the conclusion, Olsen´
After the seminar, Olsen described the event and made this comment in Articulations, the newsletter of the American Academy of Orthopaedic Manual Physical Therapists:
"In reflecting on this experience, I feel that my civil and professional rights have been violated. I was unable to speak freely and unable to use the terminology I have always used to describe manual therapy procedures. We must fight back. Manipulation is defined by the University of St. Augustine as a "skilled passive movement to a joint." As such, it is part of the continuum of therapeutic exercise that physical therapists have been providing since our inception as a profession. The chiropractors do not own this term. We must fight to protect our right to use this important component of our practice as physical therapist and to freely call it what it is, manipulation. The University of St. Augustine will continue to offer manual therapy courses in the state of Arkansas. My experience in Arkansas should be a wake-up call of the importance to stay informed on legislative activities on the state and national level and to get involved with our professional organizations to assure that this does not continue to occur. Additionally, the physical therapy profession must stop negotiating away vital components of our practice for any reason."
In the same issue of the newsletter, Stanley Paris, PhD, PT, president of the University of St. Augustine made his comments:
"Chiropractic today is doing all it can, nationally, to secure manipulation of the spine as their exclusive territory. (PTs in) states from Washington to Arkansas and South Dakota have given up spinal manipulation. Missouri (PTs) has allowed the word to be removed from its practice act and Georgia (PTs) are prepared to trade it away for direct access. Should (PTs in) any state be able to give up on an essential element of patient care? When we receive patients for physical therapy we are expected to do our best for those patients. Manipulation is now a validated procedure, one we have fought for and won. Now if we trade it away for direct access, for any other "favor" or just let it happen out of neglect or lack of concern, we are seriously handicapping the future of our profession in areas of great need: back and neck pain and disability."The research in spinal care, especially that of the AHCPR (Agency for Health Care Policy and Research acute low back pain guidelines), validates the practice of 'manipulation.' The literature speaks of manipulation, not of mobilization. The medical and lay communities use the term manipulation. If we in Arkansas are not able to say we do manipulation then we are not able to say we meet the guidelines for low-back care and associate ourselves with the increasing acceptance of this practice.
"If we as a (physical therapy) profession had a vision statement such as our being the primary health care profession in all rehabilitative aspects of the neuromusculoskeletal system, then we would clearly know that we must retain manipulation (and other practices such as EMG) to meet this vision.
"As a result, chiropractors are needing to practice patient instruction, exercises and posture -- all in addition to manipulation in order to help make the patient independent instead of dependent. This brings them into competition with PT practice. Chiropractic has even redefined manipulation to make it a movement related rather than a position related therapy. As a result, they are fighting hard across the nation to reserve the spine as their exclusive territory. This clearly is not in the interest of patient care, and must therefore not be allowed to happen.
"The Institute has had a long and successful defense of practice. We won in Arkansas in 1981 when they (chiropractors) first tried to stop us. Out of ignorance they are trying again. Should they continue, I hope to gain as much adverse publicity against chiropractic for their efforts at limiting our ability to help patients as I possibly can. If we win and win big here, then we must make it count. If we lose then we must be prepared as to the consequences, which will mean expensive appeals and a concerted effort. Eventually we will, I am sure, prevail and the attention will help the profession by further raising our commitment to practice and to patient service as well as clearly establishing our lead in manipulation. Be assured that much of the research that supports manipulation has been written by and is of physical therapy not chiropractic manipulation. This the public will learn and so chiropractic's effort to have us cease and desist will backfire and hurt them dearly."
Stanley Paris has made the PT's position abundantly clear. If you're still unsure of his intentions, his company has 51 more seminars scheduled across the country through the end of the year. The seminars, as you see below, are designed to teach PTs how to manipulate:
- S1 - Introduction to Spinal Evaluation and Manipulation
- S2 - Advanced Evaluation and Manipulation of the Pelvic, Lumbar and Thoracic Spine
- S3 - Advanced Evaluation and Manipulation of Craniofacial, Cervical and Upper Thoracic Spine
- E1 - Extremity Evaluation and Manipulation
- MF1 - Myofascial Manipulation
While the battle still rages in Arkansas, it is only the beginning. If the chiropractic profession is going to maintain its position as the primary providers of manipulation, it will have to be ready and willing to defend that position again and again.
Sources
- Letters to the Editor. Articulations, May, 1998.
- Chiropractic vs manual physical therapy: what price direct access. Articulations. May, 1998.
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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