Author: Eric Robertson

For those of you who are not power blog readers, I may first need to introduce you to the Respectful Insolence blog, written by Orac.  It’s one of the best, so subscribe.

Orac has made mention again of over-zealous chiropractors, characterizing them as "physical therapists with delusions of grandeur who don’t know their limitations."  He, along with Panda Bear, MD, is quick to point out the gaping holes in the science behind the whole subluxation concept.  Yes, that’s the concept which forms the core of chiropractic medical care.  In this case, Panda Bear, MD is concerned about the new pediatric focus in chiropractic care:

"Would you take your child to a Physical Therapist for routine health maintenance, well child checks, or even something as serious as asthma? Of course not. And no Physical Therapist would touch your child in this capacity for the same reason I don’t perform abdominal surgery, namely that it is well outside of my training and my legitimate scope of practice."

Limitation, problems with subluxation science…seems like something I’ve heard before.  Indeed I have.  Please reference Peter Huijbregts’ Journal of Manual and Manipulative Therapy editorial manifesto:

"Chiropractic Legal Challenges to Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground?"

Also check out the continuation of this conversation in the subsequent responses to the editorial (one of which was penned by yours truly).

Agreed, Orac and Panda Bear, MD.  Stealth medicine at its best here.  But perhaps the world does not realize how truly vulnerable the physical therapy profession is to these attacks.  It’s a simple case of "my lobby is bigger than yours."

For those non-physical therapists reading this, it may be timely to point out that what IS in our scope of practice is all sorts of manipulative therapy.  That’s right, the specialization area of Orthopaedic Manual Physical Therapy is one where the physical therapist is equipped with both the tools to manipulate the spine or peripheral joints AND develop a comprehensive, integrated program of neuromuscular modalities for orthopaedic conditions.  Check out the AAOMPT for more info on this area of physical therapist practice.

ERIC

I posted a while back on Stephania Bell’s ESPN Fantasy Blogging gig.  Well, she’s going strong and recently wrote up a winner in her breakdown of the LCL injury to Viking’s running back Adrian Peterson.  If you’re into fantasy sports or if you want to learn some "fun with biology" regarding your lateral collateral ligament, this column should be a regular read.

The broad and ever-growing appeal that Stephania is creating, not to mention Physical Therapy branding, is simply priceless for the profession.  Often, it only takes one door to open before the masses push through.  What does that mean?  Well, I could imagine several well-written physical therapists leveraging Stephania’s role at ESPN to quickly become the medical translators of choice in popular media outlets.

ERIC

Hey NPA Think Tank readers:  I’m back from my blogging hiatus and ready to roll.  My apologies for the unexpected lapse in my postings…

Here’s some video entertainment fresh from Texas State University.  As you enjoy it, consider Evidence in Motion’s hint of a "Best of" video contest.  Could be scary!

I got the chance to spend this past weekend at the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).  The event was excellent and my hat is off the the planners from AAOMPT who put together a seamless conference packed with incredibly useful programming, leaders in the field, pleasant receptions, and some awesome research platforms.

One of the more interesting moments occurred during the business meeting when a motion pass a position statement against referral-for-profit arrangements was passed without so much as a quip of debate.  This, from a group who then proceeded to debate the appropriate use of the word "Evidence" vs. "Research" for more than 20 minutes!  To me, this speaks to the ethical and rigorous standards the AAOMPT and its members are known to hold itself to.

This year’s conference marked the addition of a Student Association into the AAOMPT family (AAOMPT-SA).  The
students who attended were well received and played a very significant role in the conference.  Congratulations to them and to those students interested…join up!  The networking and career growth that can occur from a conference like this is great.

Next year, we’re off to Seattle, Oct 29 – Nov 2.  Convention center and all, it will be big time!

Images from Liz Sonnenberg

Some days it seems I need to search high and low for good blog fodder.  On other days, the story seems to write itself.

Yesterday became one of those days when I clicked on the NEJM RSS feed in my reader.  An article about the care and treatment of hip OA by Dr. Nancy Lane, was one of the new articles in this month’s issue of the New England Journal of Medicine.  The editors obviously thought highly of the piece, because they attached continuing education credits for reading it if you were to take the following quiz.  I was excited to see the medical community take a step toward reconciling their lack of musculoskeletal competence, however small, with this article. 

The piece started off normally, with examination and interpretation of findings, but as the article progressed to treatment I found something sorely lacking. The physician writing the piece kind of skipped right over any details about a physical therapy intervention for this patient.  Recommended were meds, an education program, and an aquatic exercise program.  It wasn’t until the final conclusions that the term "physical therapy" actually makes an appearance and the term "joint mobilizations" was absent altogether.  Dr. Lane did include acupuncture and "periodic telephone-support interventions by lay personnel" as treatments with supportive evidence, however.

A recent editorial in JOSPT (Journal of Orthopaedic and Sports Physical Therapy) thinks quite differently about how to treat an arthritic hip.  In "First-Line Interventions for Hip Pain: Is It Surgery, Drugs, or Us?" Wainner and Whitman discuss exactly the patient population which the NEJM article presents.  Their editorial outlines a variety of compelling evidence about the under-utilized, yet effective role physical therapists play with this patient population.

I’m not surprised that the Dr. Lane presumably had not read their editorial.  After all, what motivation does a physician have to keep up with PT literature?  Especially when they are so busy working as a consultant:

"Dr. Lane reports receiving consulting and lecture fees from Eli Lilly,
Merck, Procter & Gamble, Wyeth, and Roche and grant support from
Procter & Gamble, Amgen, and Rinat Neuroscience."

Which is another story in itself!

Hey, everyone’s got to make a living right?  Regardless of who pays who and for what, the bottom line is that there is a standing lack of respect for Physical Therapy literature.  Perhaps we speak "gibberish" to the docs, perhaps they don’t have the construct to understand manual therapy interventions, perhaps it is more of an institutionalized opinion among physicians that contributes to this oversight.  Whatever the cause, I can only presume that more good evidence, from our group to theirs, can only help our cause. 

Until then, I’m thinking of sending Dr. Lane an e-mail to let her know about how effective physical therapists can be with this patient population. 

ERIC