President’s Plea: Call to Action

All hands on deck. This is your final call to attend Legislative Impact Day this Thursday, January 23rd in Olympia.  It’s critical to our PTWA mission to get this spinal manipulation bill passed. We need members to ask their legislators for their yes vote on our bill. See the PTWA website for details: Advance registration is closed but you may still attend and register onsite.

If you can’t attend, please contact your legislators on your own. APTA will send you an email that will provide a link to their Take Action Center where you will be able to easily send a message to each of your three legislators. Every voice counts. You may not need to practice spinal manipulation, but it’s a critical treatment technique needed in our PT tool kit for those who do. It’s our professional obligation to support all areas of physical therapy practice. Next time the issue could be related to your practice area.

The chiropractors had their legislative day last week. Below is a list of questions that you’re likely to hear.

What The Legislators Will Likely Ask You About the Spinal Manipulation Bill

  1. Why can’t you work out a compromise with the chiropractors?


Unfortunately, a compromise just isn’t possible. Professional public policy mediators couldn’t get us to a compromise and formally declared an impasse.

In good faith and after the end of negotiation/mediation, we presented our framework language as the basis for our bill to the primary sponsor, Rep. Laurie Jinkins. She used key elements from this framework and from the chiropractors’ latest proposal and incorporated the two into bill language. This bill reflects compromises from both parties. Although this is not the ideal bill language we wanted, we’re willing to accept it. We’re extremely grateful for Rep. Jinkins’ continued work on this bill.

2.      You can’t safely perform a spinal manipulation without an imaging study first.


It’s been established that taking an X-ray isn’t necessary prior to performing spinal manipulation. The Centers for Medicare and Medicaid determined that a physical examination is sufficient to determine whether or not a chiropractic adjustment is necessary.

      Standards exist that demonstrate when it’s appropriate to perform an X-ray or other imaging study. This is clearly defined in the literature. Not all spinal pain conditions warrant an X-ray or imaging study before a manipulative technique is performed. All physical therapists must evaluate the patient to decide if physical therapy treatment is appropriate or if a referral to another health care provider is necessary including when to recommend an X-ray or imaging study.

3.      Physical therapists can’t perform spinal manipulation in 48 states.


The law prohibits physical therapists from practicing spinal manipulation in two states: Arkansas and Washington. Physical therapists safely and legally practice spinal manipulation in the remaining 48 states by virtue of state law, rules, and attorneys’ general opinions, court opinions or by the definition of physical therapy in statute without specifying spinal manipulation.

4.      All providers of spinal manipulation must have the hours of training prescribed in the World Health Organization report.


PTWA has a statement from a WHO coauthor responsible for these guidelines indicating that they were intended to apply as a guide for chiropractors and chiropractic care as a whole. This report wasn’t intended to be used as a guideline describing the minimal competencies required to learn spinal manipulation techniques.

5.   There isn’t a need for additional providers offering spinal manipulation services.


There is a need. TriCare doesn’t cover chiropractic services outside of Madigan Army Medical Center or Bremerton Naval Hospital. Patients who don’t live near these areas must pay out of pocket to see a chiropractor. TriCare does cover physical therapy services, so our active duty men and women, their dependents and veterans would be able to receive spinal manipulation as a covered service.

It’s good for the economy when patients have a choice when seeking healthcare services. Passing this bill ensures that patients will get the best care possible by allowing physical therapists to use evidenced-based practice at the fullest extent of their professional training.

6.      Physical therapists have never showed where they have any specific training in spinal manipulation, whether in their doctorate program or in their advanced fellowships, and they continue to only offer an insufficient training threshold in order to get this bill.


PTWA shared information on the following key points:

– All accredited physical therapy school programs are mandated to ensure graduates have competency in performing spinal manipulation.

– A letter signed by the directors of our state’s three physical therapy schools declares that spinal manipulation is a core competency requirement for entry-level graduates.

– A summary document of where spinal manipulation is taught throughout the PT curriculum in all three state schools.

– Documentation on residency, board certification and fellowship training demonstrate acquisition of advanced knowledge, skills and abilities in orthopedic physical therapy that includes spinal manipulation techniques.

The fact is that spinal manipulation is taught differently to PT students than it is to chiropractic students; just because it’s different, doesn’t make it less education.

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