Monday, December 11, 2017

Misconceptions about the Chiropractic Profession

There are many misconceptions about the chiropractic profession and the scope of practice, particularly in Rhode Island.  It is important for the legal community to have a clear understanding of this topic as questions will arise during statements, deposition, and even a trial. 

To begin, chiropractors in Rhode Island are considered physicians and are allowed to perform all medical procedures with the exception of prescribing medications and major surgery.  As a chiropractic physician, I can order any tests such as MRI, CT scan, and x-rays without primary care involvement.  When there are procedures that may be questionable whether or not the chiropractor should perform, if it is not typically taught in an accredited college, often the question will be presented to the Board of Chiropractic Examiners.  The Board of Chiropractic Examiners is comprised of three chiropractic physicians, on which I currently serve as Chairman, two public members, all of whom act as an advisory board to the Department of Health.  The Board handles all disciplinary actions and decisions on licensure as well as public complaints.  Chiropractors are held to the same record-keeping and HIPAA requirements as medical doctors.  All records must contain a proper history and physical examination including orthopedic and neurological testing, and the diagnosis and prognosis should be stated.  All subsequent visits are usually in a SOAP note format:  Subjective or is what the patient is stating to be the chief complaint, Objective or the physical findings for that day, Assessment or how the patient is doing since last visit, and Plan/Treatment or the details of the treatment from that day, future treatment advised, and even a comment regarding the patient's disability status.  Records should be available to the patient in a reasonable amount of time and made available to the attorney with signed consent from the patient. 

Another topic that is commonly directed towards chiropractic therapy is “overtreatment.”  In most cases, we are typically treating sprain/strain injuries and according to the American Medical Association, sprain/strain injury can take between three and six months to heal.  Typical treatment involves three phases of care—acute, subacute, and rehabilitative.  In the acute phase, the goal is to reduce inflammation and muscle spasms, which in turn will consequently increase range of motion.  The subacute phase deals with restoring movement to the injured area and usually involves stretching, massage, manipulation, and light exercises.  This phase is usually one to two months of treatment.  Finally, the rehabilitative phase is intended to elongate and stretch the damaged muscles which usually involves exercise therapy and will reduce the chance for relapse and allow the patient to sustain the treatment that has been performed thus far and insure long-term success.  The response time to these phases of treatment can depend on a variety of factors such as the patient's age, underlying spinal or extremity conditions such as degenerative arthritis which will prolong the treatment time, and general health issues such as diabetes or rheumatoid arthritis which will certainly impede progress.  Furthermore, the patient is often under the care of another physician and/or still following recommendations given to them by a hospital, and whether or not they are using medications such as ibuprofen and muscle relaxers will also dictate their response to treatment time.  There are situations where chiropractic overtreatment does occur and in my opinion, chiropractors who only perform manipulation, use heat and modalities such as electric muscle stimulation throughout the entire length of treatment, and exceed approximately three to four months would be considered to be overtreating, and this is usually not a format that will provide a positive long-term outlook for the patient.  It should be noted that Estner Injury Centers follows a three-phase protocol strictly and over the course of the past 17 years of practice in Rhode Island has rarely encountered the question of overtreatment by insurance companies or other physicians and has rarely experienced patients returning due to relapse. 

 This post was proudly written for Lawyers Weekly Rhode Island publication. 

Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Providence, Pawtucket, Warwick and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
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