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


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: www.ptwa.org/legislativeimpactday. 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.

Why I’m Optimistic that 2014 Will Be Our Year to Get Our Spinal Manipulation Bill Passed

I invite you to join us in Olympia for Legislative Impact Day on Thursday January 23rd. So why am I optimistic that 2014 will be our year to shine? We’ve done everything possible to get to an agreement with the Washington State Chiropractic Association. We’ve done everything asked of us by legislators. We negotiated, engaged actively in mediation and accepted compromise in good faith. Unfortunately, the chiropractor group wasn’t able to let go of their party line: mandating equivalent hours of chiropractic education and training. After eight months, professional mediators recognized the futility of continued dialog and declared an impasse.

            We’ve gone from simply striking the spinal manipulation prohibition language from our law to placing specific parameters around who can perform the procedure – making this the strictest PT spinal manipulation law in the nation. Even if you never intend to perform spinal manipulation in your practice, this core issue is important to you. No one profession holds a monopoly on a treatment technique. It’s bad for our patients and it’s bad for the economy. We’ve got the training, the safety record and the evidence to support our practice. Let consumers decide where they want to go for treatment.

Common Questions From PTWA Members:

1.     Why is this bill taking so long?

It’s often a difficult and lengthy process to remove prohibition language from a scope of practice law. We’ve spent the past six years negotiating and trying to reach agreement. Most of the time, opposing parties are eventually able to reach agreement about legislation and legislators prefer that outcome. We needed help, so legislators suggested a mediation process. Last October, when public policy mediators decided that we couldn’t come to an agreement, that was the end of the road. We made a number of concessions in this bill and can honestly show legislators that we did everything we could to reach agreement.

 2.      Why are we being so nice?

This is the strength of our reputation and the foundation of our political work. We seek opinions and ask for support from both sides of the aisle, from Republicans and Democrats. We’re known for our honesty and fairness. This is who we are and what we stand for.

It has nothing to do with being nice; rather it has everything to do with negotiating in good faith. This is not an issue that will be pushed through the Legislature; it’s one that legislators have insisted that we try to come to an agreement on with our opposition. 

 3.      It seems like all of our efforts are in vain.

Legislators asked us to use formal mediation to work out a compromise on bill language with the chiropractor group. After eight months of dedicated work, the neutral party professional policy mediators declared an impasse. After mediation ended, the chiropractor group sent their latest proposal to which we agreed to conditionally accept six out of nine of their specific provisions.

They steadfastly refuse to recognize our PT education and training model. We reject their unrelenting demand that physical therapists receive over 1,000 hours of chiropractic education and training in order to perform spinal manipulation.

We can say to legislators that we’ve done all we can do to get to common ground.

 4.      I have more important things to do.

We’re all volunteers with jobs and family commitments. I’m in awe of the time, money and energy spent by our members who take the day off to come to Olympia. Legislative Impact Day is our time to shine with our yellow umbrellas.

Our march to the Capital Campus sends a powerful message. Legislators love to meet with us face-to-face. They understand our issues. If you can’t be there in person, please be sure to contact your state Representatives and Senator and ask them for their vote on our bill. Email contact with your legislators takes very little time but the payoff is huge!

 5.      There are issues that matter more to me.

We represent such a broad range of practice: head to toe, newborn to elderly, eight specialty areas, etc. Even though one person can’t possibly practice all of what physical therapy encompasses, we know the importance of having all of the tools available in our PT tool kit.

The whole purpose behind LID is to speak to our legislators with one big voice about the practice issues of the current year and to help legislators put a face to a name. We need to ask our legislators to make the decision to allow physical therapists to provide the best evidence-based care to patients. This includes removing the prohibition on spinal manipulation from our practice act. In future years it could be something that hits closer to home for your practice. We’re all in this together.


Senate Republicans add to majority; PT wins Bellevue City Council seat

In the closely-watched Senate race in the 26th district, Representative Jan Angel has won the Senate seat vacated by now-Congressman Derek Kilmer.  Nathan Schlicher, a Democrat, was appointed to Kilmer’s seat last January and had to run this fall to finish the remainder of the term.  Senator-elect Angel won the election by a close margin of approximately 1500 votes and will have to run again next fall for a new four-year term. Her win gives the Senate Majority Coalition Caucus (MCC), currently comprised of 23 Republicans and two Democrats, an additional Republican member.  The MCC now holds a 26-23 majority in the Senate.

In other Senate election news, Senator Ed Murray will resign his senate seat soon as a result of his election as mayor of the City of Seattle.  His seatmate, Representative Jamie Pedersen, has expressed an interest to move to the Senate.

In the race for Bellevue City Council Position 6, physical therapist Lynne Robinson won her bid for a council position by over 62% of the vote.  Robinson received her Bachelor of Science in Physical Therapy from Northwestern University School of Medicine, and her DPT from Regis University.  She is in private practice in Bellevue. 

Melissa Johnson
PTWA Lobbyist

Advocacy Opportunity for 8th District Constituents

Congressman Dave Reichert invites constituents to Puyallup for a breakfast with special guest Senator John Boozman (R-AR) Saturday, August 27 at 8: 30 a.m. at the Elks Lodge314 27th Street Northeast, Puyallup. Cost is: $35 per person or $325 for a table.

 Consider attending this event. Bring along the position papers for our priority bills available to download and print at www.apta.org/advocacy. Approach the representative or staff before or after the event. Hand them the position papers and let them know you will be in touch!

The bills currently of concern to the physical therapy profession are:

HR 1546/S829 -The Medicare Access to Rehabilitation Services Act.
HR 1426/S 975 “The Physical Therapist – Student Loan Repayment Eligibility Act of 2011 HR 531 Access to Frontline Health Care Act.
HR 469-The Protecting Student Athletes from Concussions Act

To attend, Please R.S.V.P to Keith Schipper at 425-455-3283 or kschipper@davereichertforcongress.com.

Sharon McCallum, PT, DPT
PTWA Federal Affairs Liaison

Invite Legislators for a Clinic Visits

You may have seen PTWA Lobbyist Melissa Johnson’s article in the June PTWA Connections about arranging a clinic visit with your legislators. Here are some additional thoughts from PTWA Legistlative Committee Chair Robin, Schoenfeld, PT, OMT:

While the legislative session is over, the PTWA Legislative Committee would like to keep activity going in the home districts. Hosting legislators in clinics and work settings is a great way to inform them of who PTs are and what we do. This year we are calling on manual therapists in particular to make these contacts, given the continued efforts to pass PTWA’s spinal manipulation legislation. Two years ago, I was happy to have Rep. Reuven Carlyle, of the 36th District, at the MTI Physical Therapy Clinic in Magnolia. It was great to have him see the clinic and talk to him about manual therapy.

Over the next few months we should take advantage of the chance to get to know our legislators away from their busy office settings by inviting them for clinic visits. This affords us the opportunity to really explain who we are as constituents and PTs. The Legislative Committee and PTWA Lobbyist Melissa Johnson can help make the appointments and prepare you for your clinic visit.

Please let us know if you already had these visits planned by emailing the Legislative Committee at legislative@ptwa.org.  Thank you for your commitment to the ongoing legislative efforts, including that of lifting the ban on spinal manipulation.

Robin Schoenfeld, PT, OMT



PT Day on Capitol Hill

Attending the APTA’s PT 2011 in National Harbor, Md.? Register for PT Day on Capitol Hill!

Talk to our congressional representatives about student loans and the permanent repeal of the Medicare cap! Prep and briefing meeting will take place Wednesday, June 8, 2011, 4 to 6 p.m. PT Day on Capitol Hill takes place June 9, 9 a.m. to 1 p.m. Bus transportation to and from the conference provided, as well as CEU.

Join in for an inspiring day of advocacy along side PTWA delegation and other members. Registration required. To help APTA plan for adequate bus transportation register by May 11.

Visit apta.org/advocacy for all the details and check out this great video clip!

There are no educational sessions opposing our time on Capitol Hill and Capitol Hill day is free.

Questions? Email PTWA Federal Affairs Liaison Sharon McCallum.