I want to take a second to discuss the whole “MD referral” for PT versus Chiropractic issue. There is actually quite a bit to talk about here and a lot of my clients ask me questions like how do I tell an MD whether to use chiropractic or PT or blah, blah, blah.
So, here is the issue. Number one, the chiropractic education is far superior to physical therapy. They have absolutely no biomechanical training whatsoever and their education is very broad because sometimes, they get work with stroke patients, sometimes they get work with pediatric patients; there is a whole variety of different specialties within PT. Even if they are a DPT, which is a doctor of physical therapy, their education is very broad which obviously means it is not as specific. As far as “adjusting” or spinal manipulation goes, we may be even a little bit closer to osteopaths however, we still get a lot more than they get, and it is just based on hours of curriculum. So, this is what I tell an MD when it comes to physical therapy:
- Physical therapists are not case managers. They provide a simple, PRESCRIBED and directed therapy within a well-defined clinical timeframe and that is it. When the patient has reached the endpoint in that therapy or they have reached maximum medical improvement, there is no case management for the long term, the patient is released from care. That is usually a big part of the opioid epidemic and chronic spine pain syndromes because there are people with biomechanical spine problems that are still in pain, however, physical therapy does not manage those cases, PTs are directed by the MD.
- The physical therapist still has to work under the direction of a medical doctor, that could be a medical primary or that could be medical specialist. Either way, the chief decision maker on what is happening with that patient is the medical doctor. So, when we look at primary care, we see a prolonged timeframe relating to diagnosis. They do not order advanced imaging typically, they will order physical therapy, and then generally do some over-the-counter style medications. So, the patient goes a very long time without any biomechanical analysis. To the medical specialist on the other hand, managing biomechanical spine pain is a burden. They are essentially becoming a case manager which distracts them from doing their “procedure” [surgery or injection]. Remember, medicine has become a procedure-driven profession. Anything that has to do with case management is a time and money waster and a lot of MDs realize that. That is WHAT CHIROPRACTOR DO – manage spine cases and refer for medical management when necessary, but WE ARE INDEPENDENT.
- PTs do not provide a biomechanical diagnosis. They will exercise and stretch muscle but other than that, that is really the endpoint where chiropractic excels, it is in our ability to diagnose and assess biomechanical spine problems. Where are the MDs getting a biomechanical diagnosis? Not from the PT and certainly not from the MD that is overseeing the PT.
So, in summary, as far as chiropractic and PT are concerned, there are three reasons that the MD should use the chiropractor as opposed to the physical therapist for spine related issues;
1: Case management of biomechanical spine issues
2: Chiropractors work independently, therefore, we can order MRIs, NCVs, and many other objective tests.
3:We provide an outlet for primary care and medical specialists allowing them to focus on the particular procedures they are performing. Primary Care- “chronic disease management’ [AKA Heart Disease and Diabetes], Pain Management [AKA Epidurals and Facet Injections], Surgeons [AKA Surgery]
I hope that helps.