Scope of Practice – Michigan
January 31, 2004
PLEASE SEE: “SOTO-USA Spinal-Cranial-TMJ Position Paper” which was sent to Dr. Donna Craft to submit to the Attorney General’s Office to explain the relationship between the spine and cranium/TMJ. Pending response from Attorney General’s’ office and Michigan Board of Chiropractic.
_________________________________State of Michigan
DEPARTMENT OF COMMUNITY HEALTH
Bureau of Health Professionals
611 W Ottawa • P.O. Box 30670 • Lansing, Michigan 48909-8170
www.michigan.gov • (517) 335-0918
December 10, 2003
Charles L. Blum, D.C.
1752 Ocean Park Boulevard
Santa Monica, California 90405
Dear Dr. Blum:
Recently we received correspondence from you with questions regarding the scope of practice of chiropractors in the state of Michigan as it relates to the ability to perform “Temporomandibular Joint (TMJ) Evaluation and/or Treatment” or “Craniopathy”.
As you are aware, the practice of chiropractic is defined in section 16401(1)(b)(i) of the Michigan Public Health code as practice pertaining to “diagnosis, including spinal analysis, to determine the existence of spinal subluxations or misalignments that produce nerve interference”. Subsection (b)(ii) of this section further defines the practice of chiropractic as “a chiropractic adjustment of spinal subluxations or misalignments and related bones and tissues for the establishment of neural integrity…” You have questioned whether “related bones and tissues” can be construed to include TMJ and cranial bones.
Because the scope of chiropractic is statutorily defined, the question whether a given activity is within the scope of chiropractic is one of statutory construction that is within the jurisdiction of the courts and not the Board of Chiropractic. Two decisions, Attorney General v Beno from the Michigan Supreme Court and Hofmann vs. Auto Club Insurance Association from the Michigan Court of Appeals, address the scope of chiropractic. While neither decision speaks specifically to practice as it relates to TMJ or craniopathy, it should be noted that the courts have narrowly defined chiropractic scope and diagnosis.
Enclosed for your information are copies of these decision.
Should you have further questions or concerns regarding this matter, please feel free to contact me.
Sincerely,
Diane R. Lewis, Manager
Policy Administration
Health Licensing Division
(517) 335-1752
MICHIGAN BOARD OF CHIROPRACTIC
Bureau of Health Services, Board Support
Department of Consumer and Industry Services
611 W. Ottawa (zip 48933)
P.O. Box 30670
Lansing, MI 48909
December 3, 2003
Donna Craft, DC
Chairperson, Michigan Board of Chiropractic
332 North Main Street
Brooklyn, MI 49230
FAX: 517-592-4087
Dear Dr. Craft,
Thank you so much for getting back to me yesterday. I called you because I received a phone message from someone at the Michigan Board of Chiropractic who informed me that the issue regarding TMJ and Craniopathy was discussed and that they were both considered not in the scope of practice of chiropractors in Michigan. I do not have the person’s name or phone number at this moment but they informed me that this was based on case law and that a letter would be forwarded to me shortly.
I would greatly appreciate your help in any way because I find the decision interesting since:
1. All chiropractic colleges in their diagnosis classes and also related to treatment in the clinics, teach TMJ diagnosis and some form of treatment.
2. At least in two colleges, Southern California College of Chiropractic and Logan College of Chiropractic, craniopathy is part of undergraduate education.
3. The majority of chiropractic colleges have had TMJ and cranial related classes taught through their post-graduated programs for many years.
4. Craniopathy was developed by Nephi Cottam, DC in the 1920s and chiropractic has actively been teaching TMJ and craniopathy procedures since the 1960s. According to NBCE’s Job Analysis 2000, [http://www.chiroweb.com/archives/18/14/23.html] as of 1998 there were 37.3% of chiropractors used cranial techniques up from 1991 which was at 27.2%. It is anticipated that as of 2003 there is even a greater number of chiropractors using this method of care.
5. While the various states might have qualifying statements so far all of the other states (even District of Columbia) consider TMJ and Craniopathy to be within the scope of practice of chiropractors in their state.
Sincerely,
Charles L. Blum, DC
_______________________________________________________
November 6, 2003
MICHIGAN BOARD OF CHIROPRACTIC
Bureau of Health Services, Board Support
Department of Consumer and Industry Services
611 W. Ottawa (zip 48933)
P.O. Box 30670
Lansing, MI 48909
FAX: (517) 241-3082
Thank you so much but what I need is a statement from the Michigan Chiropractic Board of Examiners, which notes their position on TMJ and Cranial Therapeutic treatment by chiropractors. The administrative rules and/or codes are not clear and some statement is necessary for clarity.
While the Michigan Chiropractic Council at 517-485-1649 or the Michigan Chiropractic Society at 517-367-2225 might have a position on this it is not pertinent to what our organization needs from the Michigan Chiropractic Board of Examiners.
See my enclosed questions in bold and brackets:
DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES
DIRECTOR’S OFFICE
CHIROPRACTIC
(By authority conferred on the director of the department of consumer and industry services by section 16145 of 1978 PA 368, and Executive Reorganization Order No. 1996-2, being MCL 333.16145 and 445.2001)
R 338.12001 Definitions.
Rule 1. As used in these rules:
(a) “Adjustment apparatus” means a tool or device used to apply a mechanical force to correct a subluxation or misalignment of the vertebral column or related bones and tissues for the establishment of neural integrity.
(b) “Analytical instruments” means instruments which monitor the body’s physiology for the purpose of determining subluxated or misaligned vertebrae or related bones and tissues.
[QUESTION: Since these rules acknowledge a chiropractor’s ability to treat “related bones and tissues for the establishment of neural integrity,” would this include the temporomandibular joint (TMJ) and cranial bones?]
Michigan Public Health Codes
Act 368 of 1978
333.16401 Definitions; principles of construction.
Sec. 16401.
(1) As used in this part:
(b) “Practice of chiropractic” means that discipline within the healing arts which deals with the human nervous system and its relationship to the spinal column and its interrelationship with other body systems. Practice of chiropractic includes the following:
ii) A chiropractic adjustment of spinal subluxations or misalignments and related bones and tissues for the establishment of neural integrity utilizing the inherent recuperative powers of the body for restoration and maintenance of health.
[QUESTION: Again here in the Public Health Codes for Michigan regarding chiropractic they mention “related bones and tissues for the establishment of neural integrity.” Can related bones be construed to mean the TMJ and cranial bones?]
Your help with these questions will be infinitely helpful.
Thank you,
Charles L. Blum, DC, CSCP
September 4, 2003
Email from Michigan Board of Chiropractic
“If all you need is the scope of practice for chiro you can obtain that on our website. You can go to www.michigan.gov/healthlicense. On the left side of the screen will be listed all of the health professions we regulate. Click on chiro. Then scroll down to about the middle of the screen til you see a box headed license information. Inside that box will be a link for administrative rules. Click on that and a separate window will pop up listing all of the professions. Click on chiro again and it will give you the rules for chiro. Back on the main page on the right side of the screen you will see a link that says public health code. Click on that and it will take you to the Michigan legislature website. In the search box type chiropractic and it will take you to the section of the public health code for chiro. The scope of practice should be included in the rules and health code. If what you need to know is not in either of those, I suggest you call the Michigan Chiropractic Council at 517-485-1649 or the Michigan Chiropractic Society at 517-367-2225.
Bureau of Health Services
Board Support
(517)335-0038″
March 3, 2003
MICHIGAN BOARD OF CHIROPRACTIC
Department of Consumer and Industry Services
611 W. Ottawa (zip 48933)
P.O. Box 30670
Lansing, MI 48909
FAX: (517) 241-3082
My name is Charles Blum and I represent a chiropractic teaching and research organization entitled, “Sacro Occipital Technique Organization (SOTO) – USA.” We have a website which can be viewed at: http://www.soto-usa.org.
We are attempting to gather information about your state’s scope of practice for chiropractors as it specifically might relate to our teaching programs. We want to make sure that we respect your state board’s position with regards to teaching any seminars in your state.
In an article, Lamm LC, Pfannenschmidt K, Chiropractic Scope of Practice: What the Law Allows – Update 1999, Journal of the Neuromusculoskeletal System, Fall 1999; 7(3): 102-6, your board was not listed as one queried regarding whether chiropractors in your state are allowed to perform “Temporomandibular Joint (TMJ) Evaluation and/or Treatment” or “Craniopathy.”
At this time are chiropractors in your state allowed to perform: “Craniopathy” or “Cranial manipulative therapy” or “Temporomandibular Joint (TMJ) Evaluation and/or Treatment?” If so can you please share this information with me?
Your response will be greatly appreciated, as it will allow us to update our files and share this with other chiropractors. If you need more information about the relationship of the chiropractic profession and the cranial manipulative therapies or chiropractic management of TMJ dysfunction, please let me know. (see attached list of some articles)
Sincerely,
Charles L. Blum, DC
Articles Relating to the Relationship of Chiropractic and “Cranial Manipulative Therapy” or “Craniopathy”
Pederick FO, “Developments in the Cranial Field”, Chiropractic Journal of Australia, Mar 2000;30(1):13-23.
Blum, CL, “Cranial Therapeutic Treatment of Down’s Syndrome” Chiropractic Technique”, May 1999; 11(2): 66-76.
Blum, CL, “Spinal/Cranial Manipulative Therapy and Tinnitus: A Case History,” Chiropractic Technique, Nov 1998; 10(4): 163-8.
Blum, CL, Curl, DD, “The Relationship Between Sacro-Occipital Technique and Sphenobasilar Balance. Part One: the Key Continuities,” Chiropractic Technique, Aug 1998, Vol. 10, No. 3, Pp. 95-100.
Blum, CL, Curl, DD, “The Relationship Between Sacro-Occipital Technique and Sphenobasilar Balance. Part Two: Sphenobasilar Strain Stacking,” Chiropractic Technique, Aug 1998; 10(3): 101-107.
Connelly, DM, Rasmussen, SA, “The Effect of Cranial Adjusting on Hypertension: a Case Report,” Chiropractic Technique, May 1998; 10(2): 75-78.
Pederick FO, “A Kaminski-type evaluation of cranial adjusting”, Chiropractic Technique, Feb 1997;9(1): 1-15.
Phillips CJ, Meyer JJ, Chiropractic Care, Including Craniosacral Therapy, During Pregnancy: A Static-Group Comparison of Obstetric Interventions during Labor and Delivery Journal of Manipulative and Physiological Therap 1995 Oct ;18(8): 525-9.
Pick, MG, “A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain,” Journal of Manipulative and Physiological Therapeutics, Mar-Apr 1994; 17(3): 168-73.
Pederick FO, “For Debate: Cranial Adjusting — An Overview”, Chiropractic Journal of Australia, Sept 1993; 23(3):106-12.
Blum, CL, Cranial “Therapeutic Approach to Cranial Nerve Entrapment Part II: Cranial Nerve VII,” ACA Journal of Chiropractic, Dec 1990; 27(12): 27-33.
Howatt, J, “Chiropractic: The Cranial Sacral Complex”, the Journal of Orthopaedic Medicine, 1988; (1) : 13-20.
Blum, CL, “Cranial Therapeutic Approach to Cranial Nerve Entrapment Part I: Cranial Nerves III, IV, and VI,” ACA Journal of Chiropractic, July 1988; 22(7): 63-7.
Blum, CL, “The Effect of Movement, Stress and Mechanoelectric Activity Within the Cranial Matrix,” International Journal of Orthodontics, Spring 1987; 25(1-2): 6-14.
Blum, CL, “Biodynamics of the Cranium: A Survey,” The Journal of Craniomandibular Practice, Mar/May 1985: 3(2):, 164-71.
Peterson, K.; A Review of Cranial Mobility, Sacral Mobility, and Cerebrospinal Fluid Journal of the Australian Chiropractic Association. 1982 Apr ; 12(3): 7-14.
Pick MG, Spinal-cranial morphology and physiology: A review of the relationships between osseous, meningeal and neuronal structures and their role in the cranio-sacral respiratory rhythms Association of Swiss Chiropractors Conference: BŸrgenstock Hotels and Resorts : September 18, 1998.
Phillips CJ, Chiropractic and Pediatrics Cranial Compression and Distraction: a Possible Implication in Otitis Media Proceedings of the 1994 International conference on Spinal Manipulation: Palm Springs, California Jun 10-11, 1994: 136-39.
Vail B, Evaluation and Cranial Treatment of the Pediatric Patient With Sagittal Suture Synostosis: A Case Report Proceedings Of The National Conference On Chiropractic 1993 Oct: 58-63.
Phillips C, Case Study: The Effect of Utilizing Spinal Manipulation and Craniosacral Therapy as the Treatment Approach for Attention Deficit-Hyperactivity Disorder Proceedings Of The National Conference On Chiropractic 1991 Nov: 57-74.
Shambaugh P, Pearlman RC, Hauck K, Changes in Brain Stem Evoked Response as a Result of Chiropractic Treatment, Proceeding of the 1991 International Conference on Spinal Manipulation, Apr 1991: 227-9.
Cottam C, MacGillivray Smith E, The Roots of Cranial Manipulation Nephi Cottam and “Craniopathy” Chiropractic History 1981 ; 1(1): 31-5.
Articles Relating to the Relationship of Chiropractic and the Temporomanibular Joint
Chinappi AS, Getzoff H, Chiropractic/Dental Cotreatment of Lumbosacral Pain with Temporomandibular Joint Involvement Journal of Manipulative and Physiological Therapeutics, Nov/Dec 1996; 19(9): 607-12.
Chinappi AS, Getzoff H, The dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction., Journal of Manipulative and Physiological Therapeutics, Sep 1995; 18(7): 476-81.
Chinappi AS, Getzoff H, A new management model for treating structural-based disorders, dental orthopedic and chiropractic co-treatment Journal of Manipulative and Physiological Therapeutics, 1994; 17: 614-9.
Gregory TM,. Temporomandibular Disorder Associated with Sacroiliac Sprain Journal of Manipulative and Physiological Therapeutics May 1993; 16(4): 256-65.
O’Reilly A, Pollard H, TMJ Pain and Chiropractic Adjustment – A Pilot Study Chiropractic Journal of Australia. 1996 Dec; 26(4): 125-9.
Alcantara J, Plaugher G, Klemp DD, Salem C, Chiropractic Care of a Patient With Temporomandibular Disorder and Atlas Subluxation treatment Journal of Manipulative and Physiological Therapeutics,. 2002 Jan; 25(1): 63-70.
Chiropractic Approaches to Temporomandibular Joint Dysfunction (TMD) Journal of The American Chiropractic Association. 2001 Apr; 38(4): 9-17.
Skaggs C, Liebenson C, Orofacial Pain Topics in Clinical Chiropractic. 2000 Jun; 7(2): 43-50.
Knutson G, Jacob M, Possible Manifestation of Temporomandibular Joint Dysfunction on Chiropractic Cervical X-Ray Studies treatment Journal of Manipulative and Physiological Therapeutics,1999 Jan; 22(1): 32-7.