AAOMPT Position Statements

AAOMPT Position Statement Opposing Use of Degenerative Disc Disease as Diagnostic Term

Motion: To discontinue the use of the term degenerative disc disease and the inaccurate implication of a causal relationship between age-related changes in the disc and patient symptoms.

Rationale: Degenerative disc disease is a commonly used term to diagnose an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column changes shape and size. These changes are a normal process of aging and not linked to a disease. The use of the term ‘disease’ in the diagnosis is not in the patient’s best interest because it misinforms patients, may lead to unnecessary treatment and can worsen the prognosis. Patients often react to the label ‘degenerative disc disease’ by losing hope because it sounds like a serious disorder. Patients often think only invasive treatments such as injections, medications, and/or surgery can be used to treat the “ internal disease of the disc.” Because of this thought process, they often seek more invasive and higher-risk treatments. They avoid beneficial physical activity for fear that exercise and movement will worsen their condition or potentially lead to chronic pain. Patients sometimes assume that they will need long-term medication to control the pain from their “disc disease.” Studies show that these changes are commonly present in persons without low back pain.

The majority of spinal pain is self-limiting and can be managed appropriately without the need for medications or risky procedures (injection, surgery, etc.). For those individuals who do need care, AAOMPT supports and encourages early physical therapy interventions with known effectiveness instead of high-risk procedures and medication, and strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease. Orthopedic Manual Physical Therapists are frontline providers for patients with low back pain who can provide early evidence-based low risk noninvasive care that empowers the patient to successfully manage their back pain.

Dry Needling:

POSITION: It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist practice.

SUPPORT STATEMENT: Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.

Ultrasound Imaging

POSITION: It is the Position of the AAOMPT that ultrasound imaging is within the scope of physical therapist practice.

SUPPORT STATEMENT: Ultrasound imaging is an evidence-based tool used by physical therapists to evaluate, diagnose, and treat altered muscle and related soft-tissue morphology and behavior during physical tasks consistent with the scope of practice of physical therapists. Ultrasound imaging is used to assist in the application of therapeutic interventions aimed at improving neuromuscular function. Physical Therapists are well trained to utilize ultrasound imaging to augment muscular assessment and rehabilitation strategies. This includes providing feedback to the patient and physical therapist to improve clinical outcomes. Additionally, ultrasound imaging is used in basic, applied, and clinical rehabilitative research to inform clinical practice to help support the practice of physical therapy.

Referral for Profit

POSITION: The American Academy of Orthopaedic Manual Physical Therapists opposes the ownership of Physical Therapy services by Physicians and any other referral for profit model that presents a conflict of interest for financial gain as a result of making the referral.

SUPPORT STATEMENT: The Academy believes that the consumer of Physical Therapy services is best served when they are able to access a Physical Therapist who has the best skills for their condition based on clinical expertise and physical therapists can exercise their best clinical judgment when free of accepting referrals from referral sources with a potential conflict of interest or potential for financial gain as a result of making the referral.

Lifelong Learning

POSITION: The American Academy of Orthopedic Manual Physical Therapists supports the concepts of continued competence, lifelong learning, and ongoing professional development as identified in APTA Vision Statement for Physical Therapy 2020 (Vision 2020), the Standards of Practice for Physical Therapy, and the Code of Ethics.

SUPPORT STATEMENT: This position refers to the APTA PROFESSIONAL DEVELOPMENT, LIFELONG LEARNING, AND CONTINUED COMPETENCE IN PHYSICAL THERAPY HOD P05-07-14-14(Program 65) [Position]* This position statement correlates with the mission of AAOMPT and directly relates to the basis of the Fellow renewal process in AAOMPT. Adoption of this position statement would clearly inform members of the lifelong learning philosophy developed within the renewal process for fellows. This position statement will guide the development of curriculum models and promote guidance in visionary developments in manual therapy education.

Evidence Based Practice

POSITION: To promote improved quality of care and patient/client outcomes, the American Academy of Orthopaedic Manual Physical Therapists supports and promotes the development and utilization of evidence-based practice that includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient/client management, practice management, and health policy decision making.

Procedures Performed Exclusively by a Physical Therapist

POSITION: The physical therapist’s scope of practice as defined by the American Physical Therapy Association Guide to Physical Therapist Practice includes interventions performed by physical therapists. These interventions include procedures performed exclusively by physical therapists and selected interventions that can be performed by the physical therapist assistant under the direction and supervision of the physical therapist. Interventions that require immediate and continuous examination and evaluation throughout the intervention are performed exclusively by the physical therapist. Such procedural interventions within the scope of physical therapist practice that are performed exclusively by the physical therapist include, but are not limited to, spinal and peripheral joint mobilization/manipulation, which are components of manual therapy, and sharp selective debridement, which is a component of wound management.

Teaching Continuing Education

POSITION: Physical therapists and physical therapist assistants conducting clinical continuing education courses are obligated to identify target audiences and indicate in the printed, lecture, and advertising materials that course content is not intended for use by participants outside the scope of their license or regulation.

Furthermore, they should make it clear when teaching elements of physical therapist patient/client management that subsequent use of those elements is physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist, in accordance with Association policies, positions, guidelines, standards, and the Code of Ethics.

In the interest of public safety, physical therapists, and physical therapist assistants should not conduct clinical continuing education courses that teach elements of physical therapist patient/client management to individuals who are not licensed or otherwise regulated, except as they are involved in a specific plan of care, and in accordance with Association policies, positions, guidelines, standards, and the Code of Ethics.