It is no secret there is more ongoing research, and ample evidence available for effectiveness of spinal manipulation for musculoskeletal pain in just the last few years.  I decided to look into it further.

The results of ‘spinal manipulation’ and ‘physical therapy’ in GoogleScholar and PubMed are enormous (over 4000 results).  I could not define it any different   So I decided to delve further into our literature, the peer-reviewed, scholarly and popular JOSPT.  Searching under keyword of ‘manipulation’ in JOSPT’s search engine on their website and individually looking at each year resulted in the following (year – number of results): 

1992 – 0

1993 – 1

1994 – 2

1995 – 0

1996 – 1

1997 – 0

1998 – 0

1999 – 1

2000 – 1

2001 – 1

2002 – 0

2003 – 3

2004 – 6

2005 – 7

2006 – 10

2007 – 5

2008 – 9

2009 – 8

2010 – 7

2011 – 6

2012 – 6 so far

Now don’t get me wrong, this is not a highly scientific investigation but big changes over last 20 years in just JOSPT.  A journal that provides scholarly articles in all realms of rehabilitation in orthopedics and sports physical therapy covering a diverse selection of  rehabilitation methods.  This is huge considering specific manual therapy journals have evolved over this same period of time; JMMT started in 1993 and Manual Therapy in 1995 (I believe this is correct as 1st issue I could research is 1995), as well as others. 

So how does this relate to PTs further separating from PTAs?  This can get dicey as each state’s practice acts are different.  I would recommend you look up your practice act to know if you are providing legal intervention. I know in Virginia, PTAs can legally do this if the PT delegates it to them under direction and supervision of the PT (and they feel comfortable allowing the PTA to do so).  However, I am close to the North Carolina border and PTA students who have come up to our clinic have been “hands-off approach” and legally cannot do any mobilization(s) to the spine.  Needless to say it can be confusing!

Before manipulation really came aboard, honestly the main difference is general treatment is ability to perform initial evaluation and make changes to the plan of care.  At some clinics, as soon as the patient is evaluated, the PTA treats until the end and may not need the PT.  

From my novice knowledge of changes in physical therapy education, I have heard more manipulation is being taught.  The usual 5% of PTs who manipulate may increase tremendously over the next few years.  Will patients choose to see the PT vs PTA in an outpatient setting as their results are better considering the spine is being addressed?  Will PTAs feel they are not providing optimal care because they cannot mobilize/manipulate (or even “touch!”) the spine? Now that treating the spine for other areas of pain is being proved efficaciously by more and more research, will this push the PTA profession further away?  How will the outpatient physical therapy clinic look in 10 years?  All PTs?

Not going to help that by 2016 though, all entry level programs have to be doctoral level in terms of PT education.  

What do you think?

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6 comments

  1. “Before manipulation really came aboard, honestly the main difference is general treatment is ability to perform initial evaluation and make changes to the plan of care. At some clinics, as soon as the patient is evaluated, the PTA treats until the end and may not need the PT. ”

    I side with Paris on this, evaluation IS the main difference and still is. Any spinal manip thrust or non-thrust can bring immediate changes to a clinical presentation and PTAs should not be doing them as they cannot evaluate the patient without guidance from a PT after these potential changes. The PTAs in Buffalo, NY schools are taught hands off when it comes to the spine as well. I’ve had some amazing PTAs in the past, with very good hands, but let’s not pretend that evaluation is any small thing. That is what makes us different from other providers, and PTAs.

    1. E,
      Thanks for the response. I was being somewhat sarcastic with the quoted statement above as this is what I have heard from others. I agree with you that evaluation, assessment, and just as important re-assessment is a clinical skill that PTs possess, or should possess.

  2. Thoughts about other professionals like ATC’s using spinal manipulation or OMT? ATC’s always have to make rapid changes and evaluate orthopedic and general medical conditions. Athlete need to compete at their highest level, no?

    1. James,
      Thanks for the response! Good question and I will try to answer it as best as I feel. It would be nice to get an ATC (maybe yourself) to comment back.
      I am not an ATC or have been through any type of their training but I would side that they should not perform manipulation. I am not saying manipulation belongs to us, chiropractors or osteopaths; as it doesn’t; and it shouldn’t. I would imagine we need to delve into the practice act of ATCs to find out what they can do legally. I do not know this.
      The realm of OMT is so vast that I feel ATCs can practice this as a tool to get an athlete better. Absolutely, I would like to know that they use OMT vs just relying on older methods of ultrasound, MH/CP, e-stim to get athletes at their highest level.

      Hv

  3. I know that manipulation is being taught this days but are they really relevant? touching the spine or manipulating the spine as you put is a subject that should be further researched. physical therapy has come a long way.

    1. Joy,
      To quickly respond, I would say the subject of spinal manipulation has been researched more in the past few years with more higher level evidence that it ever has. Yes, I do agree that any type of intervention should be continued research but the evidence is looking promising on its efficacy.

      Hv

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