Spinal Manipulation Bill Passed Unanimously by Senate; Heads to Governor Inslee for Signature

With great pleasure I’m announcing the passage of ESHB 2160, the bill to remove the prohibition on physical therapy spinal manipulation. The bill was voted and passed on the Senate floor today. It follows passage by the House on February 13th. The bill is now on its way to Governor Inslee to sign into law. The law will take effect on July 1, 2015. The Department of Health asked for this delayed start to allow time for rule making by the Board of Physical Therapy.

            This bill will allow physical therapists to obtain an endorsement on their license to perform spinal manipulation. The Board of Physical Therapy has the sole authority to grant the spinal manipulation endorsement similar to the two other endorsements for sharp debridement and needle electromyography. To obtain the endorsement the law states that a physical therapist needs to:

  • Have one year of full-time orthopedic postgraduate practice experience
  • Provide evidence in a manner acceptable to the Board additional requirements for specified hours of training in:
  1. Differential diagnosis
  2. Didactic and practical relating to the delivery of spinal manipulation procedures
  3. Spinal diagnostic imaging
  • 300 hours supervised clinical practical experience. The first 150 hours must be under close supervision where the supervisor is in the room and personally diagnoses the condition and authorizes the treatment procedures. The second 150 hours must be under direct supervision where the supervisor is continuously on-site and is available for assistance. This supervised experience must be completed within eighteen months of completing the education requirements a. through c. above. There are three categories to qualify to be a clinical supervisor:

1)      A physical therapist holding a spinal manipulation endorsement

2)      A chiropractor or osteopathic physician

3)      A physical therapist with an endorsement or advanced certification commensurate with the training requirements listed above. This would allow a physical therapist who meets these requirements to qualify as a clinical supervisor on Day 1.

The law prohibits advertising of spinal manipulation including chiropractic adjustments or chiropractic care of any kind, as well as maintenance or wellness manipulation, having spinal manipulation be the majority of practice, delegating spinal manipulation, billing a health carrier for spinal manipulation codes or using chiropractic manipulative therapy in any form. The law also requires 10 hours of continuing education related to spinal manipulation per reporting period, that the physical therapist make a reasonable effort to coordinate patient care if it’s known the patient is also being treated by a chiropractor for the same diagnosis and must consult with a healthcare provider who is authorized to perform spinal manipulation if spinal manipulative procedures are required beyond six treatments. The law defines spinal manipulation to include spinal manipulation, spinal manipulative therapy, high velocity thrust maneuvers and grade five mobilization of the spine and its immediate articulations. The law requires a report to the Legislature from the Board of Physical Therapy by November 15, 2019 on any disciplinary actions taken against physical therapists whose performance of spinal manipulation resulted in physical harm to the patient.

How did we get here? We accepted this highly restrictive bill language because the Washington State Chiropractic Association promised to be neutral and not oppose our bill. Legislators, tired and weary of this scope of practice issue, saw a deal was close and wouldn’t accept further amendments. If PTWA withdrew support of this substitute bill, the likelihood of reintroducing another bill anytime in the next ten years was nil. During the process, PTWA consulted and got advice from our lobbyist, the mediation team, the PTWA Legislative Committee and Board of Directors, PT educators, APTA staff, the APTA Orthopedic Section and legal counsel. The advice we received was to accept the bill substitution and amendment.

PTWA will submit comments and speak to the Board of PT during the rule- making process. We’re fielding many questions from members and plan to post a frequently asked questions page soon.

We began this journey in 1999 when the Department of Health recommended that spinal manipulation be added back into our scope of practice. We ran our first spinal manipulation bill in 2009. We’ve achieved a seemingly impossible feat by removing prohibitive language from law.

I thank you for your grassroots efforts and perseverance in seeing the big picture on how the spinal manipulation prohibition hurt all of us no matter what our practice setting. I’m humbled by all of your support and help. Thanks and keep in touch.


Elaine Armantrout
PTWA President