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

I find myself having to start off this editorial in a most unusual way: I believe I need to apologize in advance to all of you reading this editorial for producing what must be the longest editorial in the history of peer-reviewed literature. My only excuse is that this topic is near to my heart and that it is a complex issue that requires a few more pages to discuss.

Chiropractic: A Profession in Crisis
It has been well over a century since Dr. Daniel David Palmer in September of 1895 performed the first chiropractic adjustment on the thoracic spine of Harvey Lillard, the janitor of the Ryan Building in Davenport, IA, where Palmer had his magnetic healing practice, and thereby reportedly restored the man’s hearing1. Yet, even with such a considerable period since chiropractic’s founding, even to an outsider like myself it is obvious that the chiropractic profession is at a crossroads when it comes to defining its place in the current health care environment. Some prominent chiropractors even go so far as to say that the profession is in crisis2. They indicate that even after 112 years, the profession has not managed to defi ne itself to society in a way that is consistent, coherent, or defensible. Even within the profession, there is lack of consensus about the proper role of chiropractic. Are chiropractors subluxation correctors, primary care physicians, neuromusculoskeletal specialists, wellness practitioners, or holistic health specialists2.

Chiropractic initially earned—and to a large extent up to this day maintains—its unique place distinct from other healing systems as a result of three postulates originally proposed by Palmer2:

  1. There is a fundamental and important relationship between the spine and health that is mediated through the nervous system.
  2. Mechanical and functional disorders of the spine or subluxations can have a deleterious effect on health status.
  3. Correction of the spinal disorders by way of adjustments may restore health.

These postulates are easily recognized in the consensus defi nition adopted by the Association of Chiropractic Colleges (ACC) that describes the chiropractic subluxation as a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and that may influence organ system function and general health3. However, even though these three postulates are still held to be true today by a sizable portion of the chiropractic profession2, some more scientifically oriented factions within the profession increasingly question their relevance to modern-day chiropractic. Critiques range from pointing out the limited value of the ACC consensus statement when it comes to providing operational definitions for chiropractic research to a call for a sceptical evaluation of the subluxation construct in an attempt to separate dogma from science and even to a characterization of the subluxation construct as the Achilles heel of the profession4-6.

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