The last two weeks have just been weird. We have had the deaths of several prominent figures, including my Aunt Helen. Death creates an “opportunity” for reflection by the “survivors.” Survivors are those who have lain witness to the life and times of the deceased. Charles Magistro, PT, DPT (hon), DrSci (hon), FAPTA, you were a tireless advocate and leader in the physical therapy profession. Prince, you were an incredible musician. Aunt Helen, you had an incredible sense of joy. Legacies can provide positive or negative inspiration messages. I don’t think it is ever too early to start thinking about how you want to be remembered. What is your legacy? How do you want to be remembered? I would hope your legacy is truly a positive event.

Envisioning your legacy will help inspire your work. I wish you all the inspiration to have part of your legacy to be and be known as a great physical therapy professional. I wish for those affected by a recent loss to find some inspiration from those who have gone before us.

Erik Moen
PTWA President

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.

PTA SIG Roundtable at Fall Conference and November Video Conference to Feature Discussions on New RCs Adopted at House of Delegates

During APTA’s House of Delegates in June, two RCs passed that affect PTAs. RC 14 allows a PTA to directly supervise a PTA student and RC 3 opens the door for PTs to dictate physical therapy care to health care practitioners other than PTAs. There is still much to be decided regarding the details of RC 3, so keep your ears open. The PTWA PTA SIG has scheduled two meetings to discuss the details of these decisions. The first will take place at PTWA Fall Conference at the Greater Tacoma Convention & Trade Center during the SIG Roundtable Discussions on Saturday, October 29 from 7:30 to 8:30 a.m. Breakfast is included for conference registrants and may be purchased on site for non-registrants. The second will be another statewide video conference on November 2, 2011. Future announcements will be made but both meetings will require PTA SIG membership, which costs $10 for APTA members, $20 for nonmembers.

Lisa McCann, PTA
PTWA PTA Student Liaison to the Board of Directors

Contact sigs@ptwa.org if you have any questions.

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

Rep. Adam Smith Holding Town Hall Meeting Aug. 25

Rep. Adam Smith invites 9th District constituents to a budget town hall meeting Aug. 25 at 7 p.m. Consider attending this meeting. 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 meeting. 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

What: Town Hall discussion on the national budget, debt reduction, and economic recovery
When: 7 p.m., August 25th, 2011
Where: Burien City Council Chambers
400 SW 152nd St., in Burien Town Square
Council Chambers are on ground floor of City Hall/Library building.
Space is limited and attendees are encouraged to RSVP, please call 253-593-6600 or email rsvpsmith@mail.house.gov.

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