Perseverance Prevails in Texas

By Beth Clay

Texas Chiropractic Board of Examiners Wins Against the Texas Medical Board

February 4, 2021 (Falls Church, VA) The International Chiropractors Association (ICA) congratulates the Texas Board of Chiropractic Examiners (TBCE) and the Texas Chiropractic Association (TCA) on positive outcome of their decade long legal battle with the Texas Medical Association (TMA).  The case, which has been compared to the restraint of trade case lost by the American Medical Association (AMA) in 1987, revolved around whether or not the scope of practice for chiropractors, as it relates to the evaluation of the musculoskeletal system, includes a nervous system component.

This case centered around the Texas Medical Association claim that a chiropractic rule improperly defines “musculoskeletal system” to include “nerves” and that a rule defining “subluxation complex” as a “neuromusculoskeletal condition” was therefore invalid. This claim was upheld in the lower courts.

Even the AMA weighed in on this case in an Amicus Brief in which they claimed that The Board’s new rule defines the “musculoskeletal system” to include “nerves” and defines “subluxation complex” as a “neuromusculoskeletal condition” that might cause “neuro-physiological reflections” in the body…” and that “These rules are contrary to the plain language of the Chiropractic Act because Legislature did not include “nerves,” or “neuromusculoskeletal systems,” or “neuro-physiological reflections” or “neurology” in the Chiropractic Act.

In its petition to the Texas Supreme Court the Texas Board of Chiropractic Examiners argued that The Texas Medical Association uses the pretext of medical licensing to thwart competition from other licensed healthcare professionals. Medical licensing does not extend a monopoly to physicians who might prefer to advance their own interests through anticompetitive behavior. Nor does it authorize physicians to redefine core concepts of chiropractic.  … The Medical Association, however, made an end run around that legislative intent in an effort to suppress economic liberty. The Medical Association not only raises piecemeal attacks on various chiropractic practices but challenges definitional provisions to fundamentally alter what it means to be a chiropractor.

In its petition to the Texas Supreme Court the Texas Chiropractic Association argued that For their entire history, chiropractors have focused on the interaction between joints and nerves and also quoted the 1986 ICA Policy statement From 1986: The science of chiropractic deals with the relationship between the articulations of the skeleton and the nervous system and the role of this relationship in the restoration and maintenance of health and concluded with  the concept of subluxation is essential to chiropractic, just like oral health is essential to dentistry.

In an Amicus Brief the National Board of Chiropractic Examiners (NBCE) and the Federation of Chiropractic Licensing Boards (FCLB) advised the court that Every other state either explicitly or implicitly includes at least some treatment of the nervous system in their definitions of chiropractic practice, and no other state explicitly excludes all treatment of the nervous system in its definition of chiropractic practice. This brief included “Appendix A” which quoted excerpts from the

legislative language in the other 49 states that clearly demonstrate that Most states’ statutes or rules include explicit reference to nerves or a neurological component in defining the scope of chiropractic and that all implicitly include at least some treatment of the nervous system in the definition of the scope of chiropractic.

In its order of January 29, 2021, the Supreme Court of Texas acknowledged that This ten-year-old case is part of “a long history of professional, scientific, or economic antagonism between chiropractors and the medical community, and resultant disputes, spanning all three branches of government, regarding where any legal line between chiropractic and the practice of medicine is or should be.”

Furthermore, the Court correctly concluded that every act that a physician may do is not automatically the unlawful practice of medicine when done by a non-physician, and terminology in one field may overlap with that of another and then rendered the decision Applying the proper standard of review, we conclude that TMA has not carried its burden of demonstrating that the challenged provisions of Rule 78.1 contravene the specific text or the objectives of the Act. Accordingly, we reverse the judgment of the court of appeals in part and render judgment declaring that the challenged provisions are valid.

Dr. Stephen Welsh, ICA Interim Chairman of the Board stated “I applaud the Texas Board of Chiropractic Examiners for staying the course and continuing the battle all the way to the Texas Supreme Court. This case exemplifies the continued efforts in jurisdictions around the world to contain the growth of the chiropractic profession by diminishing the scope of chiropractic practice, by denying the impact of the chiropractic adjustment on the nervous system, and by attempting to limit chiropractic practice to uncomplicated neck pain and back pain.”

Dr. Welsh continued “Chiropractic is a profession not a modality to be incorporated into the practice of medicine.  Patients around the world should be free to select the health care provider of their choice, free from the discrimination inherent in most national, provincial and state and federal programs.”

For 95 years the ICA has been the only national/international organization of chiropractors dedicated to the promotion and preservation of chiropractic as a separate and distinct drug free profession focused on the adjustment of the subluxation for the purpose of restoring and maintaining health.

The full set of case materials may be viewed at the Texas Supreme Court website at:  Case Detail (


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