Texas Chiropractors May Not Perform Needle Electromyography or Manipulation Under Anesthesia

Chiropractors in Texas are authorized by the state legislature to perform nonsurgical, non-incisive procedures including spinal adjustment and manipulation. Chiropractors who are not licensed medical doctors may not perform procedures that do not fall within this category.


Controversy arose between the medical and chiropractic communities concerning whether certain procedures fall into the permissive category. Specifically, needle electromyography (needle EMG) and manipulation under anesthesia (MUA) were challenged, as well as the diagnoses of various conditions. Needle EMG entails the insertion of needle electrodes into a patient's muscle and transmitting a small electric current as a means of evaluating nerve conductivity. MUA refers to a chiropractor's manipulation of the musculoskeletal system while the patient is under general anesthesia so as to facilitate a greater range of motion than if the patient was feeling pain or resisting.


Pursuant to a directive from the state legislature, the Texas Board of Chiropractic Examiners (TBCE) promulgated a “Scope of Practice” rule delineating which procedures, in its opinion, could legally be performed by chiropractors. This document authorized needle EMG, MUA and the diagnoses of musculoskeletal conditions. The Texas Medical Association (TMA) sued the TBCE seeking declarations that these provisions of the scope of practice rule were invalid because they exceeded the statutory scope of chiropractic and, therefore, constituted the unlawful practice of medicine. The trial court granted the TMA’s motion for summary judgment. The chiropractic association appealed.


The court of appeals held that needle EMG and MUA were outside the scope of authorized chiropractic procedures and affirmed the trial court summary judgment invalidating these procedures.


The court reversed and remanded for further proceedings that part of the summary judgment concerning the diagnosis of diseases and subluxation complexes. Because the scope-of-practice rule limits the diseases chiropractors may diagnose to biomechanical conditions of the spine or musculoskeletal system these diagnoses may be made by chiropractors. Subluxation complexes are unique to the practice of chiropractic so it would not be logical to prohibit chiropractors from diagnosing such conditions.


See: Texas Bd. of Chiropractic Examiners v. Texas Medical Ass'n, 2012 WL 1149289 (Tex.App.-Austin Apr 05, 2012) (not designated for publication).