Chiropractic Scope of Practice in Minnesota

Regulatory framework

The entire regulatory structure is based on the legal framework of Minnesota Statutes, primarily Chapter 148, and the administrative rules of the Minnesota Board of Chiropractic Examiners (MBCE). These detailed rules are found in the Minnesota Rules, Chapter 2500 ¹. The statutes provide the broad legislative mandate and core definitions. The rules, promulgated by the MBCE, offer detailed implementation and procedural requirements. The MBCE is the state agency responsible for licensing, regulating, and disciplining chiropractors. Its purpose is to protect the public interest ². The MBCE's task is to protect the public interest. It does so by establishing standards for licensure and practice and by enforcing the laws and rules governing the profession. The rules also dictate specific standards for record keeping ³, professional conduct ⁴, and advertising.⁵ The sole legislative purpose for Florida's statutes on chiropractic medicine is to ensure every chiropractic physician meets minimum requirements for safe practice and to prohibit those who present a danger to public health from practicing. ⁶.

Core scope of practice

As outlined in statute, the core of the practice involves analyzing interference with normal nerve transmission and expression and correcting this interference with a chiropractic adjustment ⁷. This principle aligns with the profession's historical foundations, which were established by developers like D.⁸ D. Palmer. This dual authority to diagnose and to adjust forms the central pillar of a chiropractor's scope of practice and distinguishes it from other manual therapies.

Diagnosis and analysis

The diagnostic process is a prerequisite for any therapeutic intervention and involves a thorough evaluation of the patient's condition. Chiropractors are authorized to use all necessary and accepted diagnostic procedures to analyze a patient's condition, with the exception of those that are explicitly outside the scope of practice ⁷. The identification of this complex or other abnormal articulations through the diagnostic process provides the clinical rationale for applying the cornerstone of chiropractic therapy, the adjustment.⁹

Radiographic imaging, or X-ray, is a principal diagnostic tool for chiropractors in Minnesota ¹. The use of X-rays in chiropractic, historically termed 'spinography,' has been a component of the profession since its early development.¹⁰ It was viewed as a way to visualize spinal structures for precise analysis.¹¹ A 2013 literature review, sponsored in part by the Council on Chiropractic Guidelines and Practice Parameters, concluded that the evidence was of mixed quality but unfavorable for using surface electromyography and skin temperature measurement to identify the specific location for applying spinal manipulation. ¹². These diagnostic procedures are not for the diagnosis of disease. Instead, they serve as a critical component of differential diagnosis and help to identify contraindications to care or uncover underlying factors contributing to a patient's neuromusculoskeletal complaints ¹.

The chiropractic adjustment

The therapeutic act of correcting these diagnosed dysfunctions is referred to as 'adjustment' or 'manipulation.' The adjustment itself is typically a high-velocity, low-amplitude thrust directed at a specific joint. This technique has been refined over generations since the profession's early development.

Adjunctive procedures

The Minnesota scope includes a range of diagnostic and therapeutic procedures beyond the adjustment. The scope also explicitly permits the use of adjunctive therapies, including heat, cold, water, exercise, supports, and nutritional counseling ¹³. These therapies are not considered primary treatments but are employed to complement and support the effects of the chiropractic adjustment ¹².

Physiotherapy

The range of physiotherapy modalities is specific. It is limited to the use of light, sound, and electricity for therapeutic purposes ⁷. The authorization for 'light' allows for low-level laser therapy (photobiomodulation), 'sound' permits the use of therapeutic ultrasound, and 'electricity' covers various electrotherapies such as transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) ⁷. Rules governing the application of these modalities were published in the Minnesota State Register on April 22, 1991 ¹⁴. To employ these adjunctive procedures, a chiropractor must demonstrate and maintain competency. A chiropractor establishes initial qualification by graduating from a Council on Chiropractic Education accredited college. The curriculum for such a college includes rigorous training in physiotherapy protocols and application ³.

Nutritional counseling

This legislative inclusion reflects a core tenet of chiropractic philosophy. This philosophy has historically emphasized a holistic approach to health that includes diet and lifestyle, a principle dating back to the profession's founders. This authority extends to the recommendation and sale of dietary supplements, such as vitamins, minerals, and herbal products.

Procedures requiring special registration

Some therapeutic procedures that are otherwise outside the primary scope of practice may be performed by chiropractors who obtain additional registration.

One prominent example is acupuncture. Under Minnesota law, chiropractors who complete additional training and registration can perform acupuncture ¹⁵.

Chiropractors in Minnesota may also provide chiropractic care to animals. A critical stipulation for this practice is the requirement of a written referral from a licensed veterinarian before a chiropractor can provide care to an animal patient ¹⁶. A critical limitation on this practice is the requirement of a written referral from a licensed veterinarian before a chiropractor can provide care to an animal.

Limitations and excluded procedures

The scope of practice is also defined by its limitations. The foundational chiropractic practice act, Minnesota Statutes 148.01, explicitly excludes certain medical procedures from the scope of chiropractic practice. Chiropractors are prohibited from performing major surgery, providing obstetric care, and prescribing or administering legend drugs ⁷. A legend drug is defined by Minnesota Rules as any drug that is required by federal law to bear the statement 'Caution: Federal law prohibits dispensing without prescription' ¹².

The MBCE has also issued specific guidance on procedures at the edge of the scope. For example, it has stated that 'dry needling' is not part of the chiropractic scope in Minnesota, whereas chiropractors who become certified can perform acupuncture after meeting separate requirements set by the Minnesota Board of Chiropractic Examiners ¹⁵.

Needling therapies

The use of needling therapies by chiropractors is another area subject to specific board rules. A significant distinction is made between acupuncture and the practice of dry needling.

A notable example is the board's position on dry needling. Dry needling is a technique involving the insertion of a filiform needle into a trigger point to treat myofascial pain. Dry needling involves the insertion of fine needles into muscle tissue. The MBCE has determined that this procedure does not fall within the statutory definition of chiropractic in Minnesota and is therefore outside the scope of practice for licensed chiropractors in the state. In a position statement, the board has indicated that the state's practice act, Minnesota Statutes 148.01, does not authorize chiropractors to perform this procedure ⁷⁵. The board's position distinguishes dry needling from acupuncture. It is not considered a form of acupuncture and is therefore not covered by the registration that permits chiropractors to perform acupuncture. A chiropractor performing dry needling in the state is practicing outside the legal scope and could face disciplinary action from the MBCE.

Professional boundaries

Maintaining strict professional boundaries with patients is a critical component of the legal and ethical scope of practice. The importance of this boundary is reinforced through mandatory continuing education requirements. These requirements mandate that chiropractors complete coursework on professional boundaries as a condition of license renewal ³¹⁷. Professional boundaries also extend to advertising and public statements.

Sources

Minnesota Rules, Chapter 2500, Chiropractors' Licensing and Practice - https://www.revisor.mn.gov/rules/2500/
Texas Occupations Code, § 151.003 - https://statutes.capitol.texas.gov/Docs/OC/htm/OC.151.htm#151.003
Minnesota Statutes § 148.107 RECORD KEEPING - https://www.revisor.mn.gov/statutes/cite/148.107
Minnesota Board of Chiropractic Examiners, "Dry Needling" - https://mn.gov/boards/chiropractic-examiners/resources/current-issues.jsp#dryneedling
R. C. Schafer, Clinical malpractice (1983) - https://openlibrary.org/works/OL3085001W
The Florida Senate, 2022 - https://www.flsenate.gov/Laws/Statutes/2022/460.401
Minnesota Statutes 2023, 148.01, Subd. 1 - https://www.revisor.mn.gov/statutes/cite/148.01
David D. Palmer, Three generations: a history of chiropractic (1967) - https://openlibrary.org/works/OL6449150W
Ralph W. Stephenson, Chiropractic textbook (1927) - https://openlibrary.org/works/OL11214447W
Russell W. Gibbons, Chiropractic history (1977) - https://openlibrary.org/works/OL5541722W
M. B. Thompson, Chiropractic textbook (1927) - https://openlibrary.org/works/OL7690071W
Triano et al., 2013 - https://pubmed.ncbi.nlm.nih.gov/24152787/
Minnesota Administrative Rules, 2500.0100, Subp. 11 - https://www.revisor.mn.gov/rules/2500.0100/
Minnesota Rules, 2500.6000 - https://www.revisor.mn.gov/rules/2500.6000/
Minnesota Statutes § 148.01, 2023 - https://www.revisor.mn.gov/statutes/cite/148.01
AVMA Model Veterinary Practice Act, 2020 - https://www.avma.org/advocacy/state-local-issues/model-veterinary-practice-act
Minnesota Rules, 2500.7000 - https://www.revisor.mn.gov/rules/2500.7000/