Saddle up for a little manip

Now if vets are manipulating horses, surely PTs should be manipulating humans. I can already hear the Animal PT SIG cheering, 'validation'. Perhaps PTs in Washington and Arkansas can keep up their skills a bit working with vets. Speaking of which, when will we see the practice acts of Arkansas and Washington revised (among other states that have problematic language issues)? There are always timing issues involved in politics, but at some level, there is no time like the present to shed our peace genes, raise cane, and take ownership of our profession for the betterment of our broken health care system.

John

Comments

[Louie Puentedura]

John, I couldn’t agree with you more. We are long overdue for “shedding our peace genes, raising cane and taking ownership of our profession for the betterment of our broken health care system”. We desperately need to "saddle up for manip".
The problem, in my opinion, is the apparent lack of leadership within our profession. Most of the State Physical Therapy Practice Acts are looking to the Federation of State Boards of Physical Therapy and specifically to the Model Practice Act (MPA Version 4) when revising their practice acts. And what does the MPA say? Of particular importance, is how the various States define “physical therapy” or the scope of PT practice within their regulations. The MPA provides model language for States to use in defining the practice of PT and includes the words “….manual therapy including soft tissue and joint mobilization/ manipulation,…” under Article 1.02, Paragraph D.2.
However, in their commentary section, they provide the following: “Because of political sensitivities over the term “manipulation,” it may occasionally be necessary to find an acceptable alternative that still authorizes, and in no way limits, the use of manipulative therapy procedures by physical therapists. An acceptable alternative is to retain in Paragraph D.2 the term “manual therapy” or “manual therapy techniques” (without using the term “manipulation”) and then further define “manual therapy” in statutes or rules. In 1998 the American Medical Association approved specific CPT coding for use by M.D. physicians and physical therapists for “manual therapy techniques.” This code also contains the terms “mobilization” and “manipulation” as part of the CPT code description.”
The MPA commentary appears to provide rather poor advice to State Boards on the matter of avoiding conflict with other professionals (primarily chiropractors) for the inclusion of the word “manipulation” within the practice act. I did an internet search of all 50 State Practice Acts and found that only 9 States include the word “manipulation” and in most of those states the term is used in a negative sense – as in, not allowed/ not permitted. This needs to be rectified. We need to more aggressively and positively define that we can and do, in fact, provide spinal joint manipulation when clinically appropriate.

[Louie Puentedua]

What a timely discussion!

After posting the above comment while at work (in between patients) I arrived home to receive the latest copy of Articulations, the AAOMPT Newsletter. On pages 5 and 6, there is an excellent article entitled "Chiropractors' Pursuit of PT Practice Restrictions: Public Protection or Restraint of Trade?" written by Gwen Simons, PT, JD, OCS, FAAOMPT. This is a must read for all who are interested in providing evidence-based manual therapy/ manipulation to their patient population.

This sentence from the article sums the issue up - "As Tennesse, Arkansas and other states have learned, negotiating language in statutory definitions is not the answer if it will be interpreted by an attorney general or a judge. PTs must continue to show the harm to consumers when qualified providers cannot practice their trade."

[Ken Mailly, PT]

John, et al,

I think we all need to realize that small groups of aggressive individuals can move large groups of followers, and defeat even larger groups of pacifistic and apathetic spectators. In other words, the minority CAN move the majority, but only if they commit to doing so. I am personally fed up with seeing and hearing our colleagues complain, then do nothing, or look for others to do something for them. This is why I have given up my clinical practice (because of what has happened to our practice) and devoted myself to advocacy. I love my profession & treating patients, but I loathe current practice.

The points being raised by both John and Gwen are valid and completely on target. When it comes to laws, regulations, and policy, wording means EVERYTHING. Despite this reality, many PTs seem to treat such discussions of advocacy on this subject, as nothing more than white noise. If we continue to wait for someone else to address our issues as a profession, we will be waiting a long time and ultimately for naught. Concerned PTs must force their representative bodies to address these issues, by any means necessary within the laws & bylaws applicable to doing so.

National organizations will never be terribly effective at addressing state-specific issues, because available resources can only be stretched so far. We will either have effective State advocacy, or we will find that our profession is slowly diminished, State by State.

As for me, I will not sit idly by and watch this happen in my State. How about the rest of you?

Sincerely,
Ken Mailly, PT
Mailly & Inglett Consulting, LLC
Executive Director & Professional Affairs Representative
NJ Society of Independent Physical Therapists