Physical Therapy, Manual Therapy, Manipulation and Chiropractic

People often ask “what the difference is between Physical Therapy and chiropractic?” When you get to the root of what most people want to know, it is “Can Physical Therapist’s perform manipulations?” The answer is yes. Manipulations are just one part of manual therapy techniques which are commonly used by physical therapists.

MANUAL THERAPY

According to the Guide to Physical Therapy Practice the definition of manual therapy is: “a continuum of skilled passive movements to the joints and or related soft tissues that are applied at varying speeds and amplitudes, including a small velocity and high amplitude therapeutic movement.”1

Put into plain English this means that Physical Therapist’s can move joints and soft tissue using varying techniques and speeds. This type of passive movement can range from slow rhythmic movements, all the way to fast movements that may cause an audible pop. While state laws differ, Idaho currently recognizes manipulations as part of physical therapy practice3.

HISTORY OF MANIPULATION

Physical Therapist’s have the education, expertise, and assessment processes to manipulate joints in the human body. Manipulation of muscles and joints was identified as part of physical therapy in the 1920′s when Mary McMillan, the first American Physical Therapy Association president, defined Physical Therapy6. Physical therapy was founded on movement analysis and the science of movement.

Physical therapy was governed by the American Medical Association from 1936 to 1977 and has since been governed by the Commission on Accreditation of Physical Therapy Education (CAPTE). Both of these organizations have supported physical therapists ability to mobilize and manipulate as part of our practice.

THEORIES OF CHIROPRACTORS AND PHYSICAL THERAPISTS

Physical Therapy and chiropractic have very different theories at their core. Since there are opposing theories, methods and approaches will also differ as well as educational training. Chiropractic is based on correcting subluxation in order to decrease interference with neural transmission2, while physical therapy is based in decreasing disability caused by an injury. This can range from learning to walk following a stroke, being able to drive your car without back pain after a back injury, or helping you get back on your feet after a knee surgery1. Physical therapy will progress you towards an increase in activity or efficiency, in that activity, which will allow you to perform at a higher level.

Another item that helps differentiate the two professions is follow-up care. Physical therapy continues to progress patients through muscle stability and strength4. Therapy establishes goals with predicted outcomes and time frames that account for the patient’s dysfunctions, conditions, disabilities, expectations and functional goals.

RESEARCH

Perhaps what continues to separate Physical Therapy manipulation and chiropractic is current research showing the benefits of manipulations performed by physical therapists. Therapists have recently produced the most research validating the effectiveness of physical therapist manipulation/manual therapy for low back pain and cervical pain. For example, Physical Therapists have developed what is called The Clinical Prediction Rule5,6. This is a series of questions and tests, that when asked to the patient, gives the therapist a percentage of success on how the patient will respond to a specific treatment.

CONCLUSION

You can always be sure that your body is in safe hands with a Physical Therapist. Physical Therapists are clearly taught how to assess in order to rule out serious medical complications as well. Not only are therapists constantly assessing your signs and symptoms during all sessions, therapists are also trained to refer to appropriate medical professionals when serious medical complications have been detected.

Physical Therapy and Chiropractic have both been founded in joint mobility and movements since their conception. Differences are found in the assessment process (theoretical) which carries over into differences in follow up care.

If you have any other questions about manual physical therapy and whether or not physical therapy would best suit your needs you can contact any of our Physical Therapists at any of our RehabAuthority locations.

RehabAuthority offers the physical therapy solutions such as back pain, shoulder pain and knee pain in Boise and throughout Idaho.

References:

  1. Guide to Physical therapy practice. American Physical Therapy association. 2009. Available at http://www.apta.org. Accessed July 2009.
  2. Chiropractic practice act. Idaho Bureau of Occupational Licensing. Available at https://secure.ibol.idaho.gov/IBOL/Home.aspx. Accessed June 2009.
  3. Idaho Physical therapy practice act. Idaho Bureau of Occupational Licensing. Available at https://secure.ibol.idaho.gov/IBOL/Home.aspx. Accessed June 2009
  4. King, P.et al. Manipulation Education Manual.2004.
  5. Childs, JD et al. Clinical Prediction Rule. 2008. Ann Intern Med. 2004 Dec 21;141(12):920-8. http://www.aaompt.org
  6. Position on Thrust Joint Manipulation Provided by Physical Therapists. APTA, February 2009.

PHYSICAL THERAPY IN BOISE:

Rehab Authority provides manipulation and manual physical therapy techniques across our many Boise area offices.