A couple weeks ago I found myself sitting at a small breakfast table with 2 past Presidents of the American Chiropractic Association (ACA) and some current ACA board members. For anyone who knows me well, this is a very unexpected place to find me – I am acutely aware of and involved in the many legal battles that have taken place between Chiros and PTs over the years. Now that I’ve had some time to reflect on the whole experience meeting with Chiropractors, I’d like to share it.
With the scene set, I must pause for a second and write a little about my writing process. At the beginning of a typical post, I have an idea and I start writing. Sometimes I don’t know where I’ll end up, other times I do, but I never know what the middle of the piece will look like. This time, I know I will end with a message of hope and collaboration between professions that have often been adversaries over a few decades. I only tell you this in order to convince you to read to the end. I can’t imagine I won’t disparage some Chiropractors along the way, it might get ugly – just stick with me, the end is positive.
There’s a local Chiropractor, who as with any other practitioner in a small town, I share some patients. She and I have never really met each other, but we’ve been in the same room enough times that we know who each other are. We share some great friends in common. Because of the people she is friends with, I can’t imagine that she is not a good person – but as a professional…. uhg. Her clients routinely come in believing they have “had Physical Therapy before”. I was shy at first when patients would come in telling me they already had Physical Therapy, but now I plainly reply, “You have not had Physical Therapy. She is a Chiropractor, you have had Chiropractic, not Physical Therapy”.
This single Chiropractor is emblematic of my relationship with the Chiropractic profession over the years.
My introduction to back pain was through an injury I suffered wrestling in high school. I originally went to see a Chiropractor who was the father of a soccer teammate. After my first Chiropractic treatments, I was hooked. Manual Spinal Manipulation feels good… but it didn’t fix what would eventually turn out to be a spondylolysis, a.k.a. decapitated scotty dog, a.k.a. fracture in my L5 spinous process. Chiropractic adjustment felt good, I loved it, but it wasn’t curing my spinal fracture. I eventually would wear a lumbar brace for 9 months, take some less-than-recommended time off sports, and get a short course of Physical Therapy that I hardly remember.
Fast forward several years, and I’m at Northeastern University in a pre-PT program bringing in Chiropractors to talk to our class so we can understand their profession, as well as ours. I was that guy. I was the guy who brought Chiropractors into school so we can all learn from each other and practice in a happy collaborative world of bliss.
Chiropractors ruined my positive attitude about them – there is no one to blame but them. I got involved in APTA in Massachusetts, then the states I lived in as a travel PT, and then nationally. One constant persisted across my experience – Chiropractors suing PTs across the country over pointless turf battles. The lawsuits centered mainly around two topics, PTs performing manipulations and PT Direct Access (without a Physician or Chiropractic referral). These lawsuits were not based on patient safety, they were only based on a perceived threat to Chiropractors’ bottom-line. These lawsuits developed a long, dense history of contention between the two professions that eventually led to last month’s Interprofessional Collaborative Spine Conference (ICSC) to start healing some wounds.
The ICSC brought together PTs, Chiropractors, and Osteopaths to discuss manual spine treatments.
The structure for the conference was essentially this: For two days, panelists presented topics, then opened up to audience questions for further discussion. The presenters and audience were largely leaders in PT and Chiropractic, (and Osteopathy). The questions were engaging and on-point – the presenters were the best-of-the-best in our fields. There was zero contentious discussion that was had. In fact, I found the formal content of the conference pretty underwhelming.
The good news is, there was a lot of time scheduled for social interaction and networking. This is how I found myself having breakfast with Chiropractic’s heavy hitters. The very individuals I have grown accustomed to battling against in state legislation over-and-over again, I was having a polite breakfast with, exchanging stories of insurance interference in our practices, and exchanging business cards. I think I behaved myself, and the conversations were enlightening for me.
The time in between the sessions was invaluable for me. It allowed for open, cordial conversation about a variety of topics. We talked about our education, our practice, our research training, and our common interests. It added to my understanding of the loooong histories that make the Physical Therapists, Chiropractors, and Osteopaths what they are today. Our current-day practices are deeply entrenched in the histories of our professional origins over the last 100 years and long before.
After digesting the conference for a couple weeks, I now more strongly than ever believe that the Physical Therapists have the higher ground on whose practice is more evidence-based. I hope that the Chiros and DO’s walked away saying to themselves, “Whoa, did you hear that content from the PT presenters?” That was definitely my reaction. But, more likely than not, their reaction, like mine, was something reinforcing their own practice beliefs. But, maybe they are onto something too. Chiropractors have a very effective model in making people feel good (if only for a little while). They don’t allow themselves to feel overly limited in doing exactly what the science dictates, they just manipulate and know it makes a lot of people feel good. They do have a point.
I could go on. And on. And on about how I believe PT is more superior in research based practice, that’s our training… but that’s not the point. They clearly have something good going on with the way they practice too. We will not align Physical Therapist and Chiropractic practices for a very long time – our histories are too different.
There was a great common thread of conversation that reflects the impetus for this conference. Research does, indisputably show, that patient interaction with a Physical Therapist, a Chiropractor, or an Osteopath decreases prescription medications, imaging, surgery, and, most importantly, cost. One phrase I heard in conversation at the ICSC that has continued to run through my head is, “A rising tide lifts all ships.” So true. Despite our different individual histories, and our many battles against each other, if we can unite to improve access to manual therapists before surgeons, we will save our patients from pain and from the cost of undue medications, radiographs, and surgeries.
I have learned that everything we think we have different with Chiropractors is justified. But we have one major thing in common – either of our treatments decreases more invasive and expensive alternatives. That is something worth burying the hatchet and uniting over.