Saturday, February 2, 2008

Arelease from the APTA states the NATA (athletic trainers association) has filed a lawsuit against them for "anticompetitive" activities. The main point relates to MANUAL THERAPY, specifically rib and spinal manipulation. Now, as the few of you that read my posts know, I'm a big believer you don't need 4 years of hot air and philosophy to manipulate the spine, but you do need to have an excellent background in systems review, examination skills, and a wide knowledge of differential diagnoses. Chiros have this and PT's have this, but I don't see this with ATC education. And I choose a "masters" level education, which is the "new and improved" ATC degree, to highlight this.

I make no claim that I could effectively manage the day to day sports injury needs of a sports team or walk the sidelines of a game and provide the triage care that an athletic trainer can. However, ATC's are beginning to push their limited rehabilitation education into the realm of PT, and I guess DC. This is just another example of people wanting more than they are willing to go to school and get the education for. Heck, internally we even exclude PTA's from MT courses because IT IS OUTSIDE OF THEIR educated abilities. Here is the statement from the APTA:

APTA Responds to NATA Lawsuit

The National Athletic Trainers' Association (NATA) on February 1, 2008, filed a lawsuit against APTA and the Orthopaedic Section, APTA, Inc. in the U.S. District Court in Dallas. The complaint alleges that the APTA and the Section have violated the antitrust laws by seeking to deny athletic trainers (ATCs) access to the market for manual therapy and by coercing physical therapists to refrain from educating ATCs in certain techniques. APTA's counsel is currently reviewing the complaint. APTA believes that the NATA lawsuit is wholly without merit.

Physical Therapy can ONLY be provided by lisenced PHYSICAL THERAPISTS. Not by ATC's who wish themselves physical therapists.

For more fun reading, here are some additional links:
What is sad, is that we NEED ATC's. They are an integral part in the healthcare field. However, they are not physical therapists and yet they not only want to act like PT's their informational pamphlets boast about how ATC can be abused for economic gains being used as PT's by physicians and hospitals:

The value of certified athletic trainers isn’t limited to the
sports field. While ATCs have worked with orthopedists and in
rehabilitation clinics for the past 40 years, they can provide
a great deal of assistance – and additional revenue – to a
hospital, physician office or clinic, whether it be a large,
university-run complex or a small, private practice.
Then from a "FACT SHEET":
1. FACT: All athletic trainers have a bachelor’s degree from an accredited college
or university. Athletic trainers are health care professionals similar to physical,
occupational, speech, language and other therapists.
Sure, and I have a Doctorate degree similar to medical doctors then. What? It's not? Somebody better tell the NATA then.

To me, it seems the NATA may be trying to convince the lay public that they are in fact physical therapists with out having to go to physical therapy school. I hope you don't make the mistake of taking your grandfather s/p CVA or your mother with a diabetic ulcer, or your uncle who is trying to recover from a heart attack to a professional with out the educational background to effectively, and possibly, safely treat them.

It one thing to wave the magic wand (ultrasound) over someone and educate them in therapeutic exercise (which I believe ATC's surely do well) it's another thing to claim to be on par with THE experts in neuromusculoskeletal evaluation and rehabilitation.


Anonymous said...


I commend you for doing your homework before commenting on the educational qualifications of the ATC. Unlike the vast majority of physical therapists who oppose athletic trainers on almost all issues with little to no knowledge of the profession, educational preparation, qualifications and clinical proficiencies of the ATC, you have actually taken the time to investigate the profession and become educated.

I have to state that I disagree completely with your argument that ATC are unqualified to provide manual therapy to orthopedic patients. I also disagree that ATC are not trained in systems review.

While this may have been true a decade or more ago, the curriculums of athletic training programs have greatly expanded to include differential diagnosis and system review courses that do not involve the evaluation or treatment of orthopedic or sports injuries.

While I acknowledge that the program you selected appears to lack a manual therapy course, I would offer that, without course syllabi, we really have no idea of the didactic content of many of these courses. Instruction in manual therapy techniques is a requirement for accreditation for athletic training. The same can be said for an assessment course that includes a systems review of non-orthopedic conditions (in the case of Seton Hall this course is most likely titled General Medical Conditions).

Therefore, although it is not apparent from reviewing course titles, I assure you that students at Seton Hall and all other accredited Athletic Training Programs are receiving education in each of these content areas.

Finally, as a professor who holds each of these credentials and teaches both entry-level athletic training and entry-level physical therapy students, I can honestly state that in terms of their ability to perform an evaluation and differential diagnosis of both orthopedic and non-orthopedic dysfunction, I see absolutely no difference in abilities between graduates from the two programs in which I teach.

Furthermore, given the choice to be evaluated and treated for an orthopedic condition by either group of graduates, I would, without a second thought, select the entry-level athletic training professional. The depth of their knowledge regarding the evaluation, differential diagnosis, treatment and rehabilitation of orthopedic conditions is far superior to that of most physical therapists.

Additionally, students in the entry-level athletic training program receive a far more extensive education in terms of therapeutic exercise, therapeutic modality selection and application, orthopedic assessment (including a full course of evaluation and treatment of the spine) and diagnostic imaging than the PT students at the same institution.

To be fair, the breadth of knowledge that the PT students possess in terms of non-orthopedic conditions (neurological, cardiopulmonary, integumentary, etc.) is far superior to that of the entry-level athletic training students.

This is only one example from one University in the country, but I think it illustrates the need to allow each profession to practice according to their educational competencies and professional qualifications and not according to title alone.

While I wholeheartedly agree that physical therapy should be provided only by licensed physical therapists (not ATC, DC, OT or MD), I would remind you that joint mobilization is a treatment technique provided by a wide variety of qualified practitioners. Joint mobilization is not physical therapy.

I applaud you for taking the time to become more educated on the matter. I wish more physical therapists would follow your lead. However, I would caution you that until you walk in each professional's shoes (as a student and/or an educator), you should reserve judgment on exactly who is qualified to deliver various treatment interventions.

James Scifers, DScPT, PT, SCS, LAT, ATC

Anonymous said...

Who excludes PTA's from manual therapy courses? PTA's can LEGALLY perform jt. mobs in most states, and many state chapters of the APTA host manual therapy courses that PTA's are allowed to attend (Montana and Colorado are both doing so at their spring conferences this year, Wisconsin and Virginia did so Fall 2007).

Anonymous said...

I am a High School Athletic Trainer in the state of Maryland where we are presently trying to become a lincensed profession. Right now anyone can "claim" they are an Certified Athletic Trainer (ATC) and do my job and would not be breaking any laws. I AM SO TIRED OF HAVING TO JUSTIFIY MYSELF AS A COMPETENT ALLIED HEALTH PROFESSIONAL WHO CAN NOT ONLY PREVENT, EVALUATE, AND TREAT INJUIES BUT ALSO REHABLITATE THEM. I would agree with Jay that ATCs are excellent at rehabilitation of orthopedic injuries. I came from an accredited program in which Jay taught and we received many hours of instruction on the correct techniques of theraputic exercise. Why can't we all get along and allow our individual skills shine for the betterment of our patients and athletes, because I think most of us got into ths profession to help people. We need to stop the war of words and realize that we (ATCs and PTs) have similar, but differing skill sets that can be used to help a wide range of patients and athletes.

Erik Fabriziani, MEd, ATC

Anonymous said...

Maunal Therapy...

I have approached many athletic trainers regarding this "so-called" controversy regarding the employment in thier "practice."

As so many are aware, they have laid claim to utilizing "manual therapy" as part of their "clinical scope."

These subjects don't bother me; what does bother me is that when I ask them to describe to me what exactly is "maunal therapy" in their "clinical scope."

Most athletic trainers I've talked with tell me what is described as MUSCLE ENERGY TECHNIQUES, and not JOINT MOBILIZATION TECHNIQUES.

Furthermore, when I assess & treat "their" athletes with "MAUNUAL PHYSICAL THERAPY TECHNIUQES" who were not seemingly responding to stretching or contract-relax, the athletes miraculously respond with significant and marked functional improvement.

When I ask these trainers why they didn't utilize the concepts, that I was trained in, they are dumbfounded and take offense as "their patients" become ever-so leary of returning to them for "rehabilitation" or "treatment," thus deminishing their patient compliance.

Trainers are threatened by that which the do not know about "manual therapy."

They are infact highly skilled in "emergent care" for the athlete. There is absolutely no question about that.

They are surprisingly good in the administration of therapeutic exercise.

But make no mistake...physical therapists are the ONLY EXPERTS in EXERCISE PRESCRIPTION and MANUAL THERAPY.


If you want to bill out for a physical therapy code- get a physical therapy degree and a physical therapy license.

If I want to stabilize a fractured spine on a football field, I will go get my ATC!

Anonymous said...

How is it that either profession claims that they can provide manual therapy. Well let me tell you, I'm a MASSAGE THERAPIST. It doesn't get any more manual than that. I'm also an athletic training student who decided to get an AT degree to be able to provide the best care for my patients. No one is the sole expert in manual therapy. If rights should be given to someone then give it to the licenced and certified Massage therapist who went to school longer than a two week course to say they are now an expert in manual therapy.

Anonymous said...

Massage Therapist + ATC...So you can massage that injured football player as he is being carted off the field?? ATC + Massage Therapist does not equal PT. Still cannot manipulate the spine or extremities (Grade 5).

Post a Comment