Guest Post: A Manipulation Win for Washington State?!? | Modern Manual Therapy Blog

Guest Post: A Manipulation Win for Washington State?!?

Thanks to blog reader and excellent manual therapist, Dr. Sally Moores, DPT for contributing this blog post on Washington's "new" manipulation law.

When I first moved to Washington State, I was shocked to learn that Physical Therapists weren’t legally allowed to practice spinal manipulation.  Though not my entire skill set, manipulations were an integral part of my treatment plans prior to moving to WashingtonPracticing in Washington State, however, my only recourse was to refer patients who needed a manipulation to a chiropractor I trusted. 

I was excited to learn a few weeks ago that a bill to remove the prohibition on physical therapy spinal manipulation in Washington State passed the State Senate.  All that is needed now is a signature from the Governor and we Physical Therapists are good to go… sort of.

Physical Therapists in Washington State gave up the right to perform spinal manipulation in the 80’s in order to obtain Direct Access.   In 1999, the Department of Health recommended that this treatment be added back into our scope of practice and in 2009, the PTWA began legislation to remove this restrictive language in the state practice act.  This past February, a bill was successfully passed by the Washington State senate and now awaits Governor Inslee’s approval.

The passing of this bill is a huge victory for Physical Therapists in Washington State, as well as for healthcare consumers, allowing for more quality providers capable of providing spinal manipulation.  My excitement was dampened however, after researching the finer points of the bill and learning of the requirements that are necessary to physically practice manipulation as a Physical Therapist in this state.

Physical Therapists in Washington State who seek to perform spinal manipulation as part of their practice will need a special endorsement by the Board of Physical Therapy which is not in and of itself unreasonable.  A similar requirement currently exists for those who want to perform sharp debridement or needle electromyography.  Realistically speaking, however, obtaining the spinal manipulation endorsement may be slightly more challenging.

Here are the requirements I would have to meet:

To formally apply for the endorsement, a Physical Therapist will need to have one-year of full time orthopedic post-graduate practice experience with a specific number of training hours in differential diagnosis, didactic and practical experienced relating to the delivery of spinal manipulation procedures and knowledge of spinal diagnostic imaging.  I’ve got the post-graduate experience covered and at this point, I’m fairly sure all DPT programs must comply with the training hour requirements in order to be a fully accredited program.

Here’s the kicker.  I’d also need 300 hours of supervised clinical practical experience, including:
·         150 hours under close supervision with the supervisor in the room and who personally diagnoses the condition and authorizes the treatment procedure
·         150 hours under director supervision where the supervisor is continuously on-site

This supervised experience must be completed within 18-months of the above educational requirements and the supervisor has to be a Physical Therapist holding an endorsement (there are none yet), a chiropractor (they didn’t want this bill to pass) or an osteopathic physician.  As a Physical Therapist with a busy practice who has been out of school for 12+years, the clinical practical requirements just might get the better of me.  Furthermore, the law also prohibits PT’s from advertising that they perform spinal manipulation or from billing a health carrier for spinal manipulation codes.

I know that the PTWA has worked endlessly on this bill, but given these restrictions I am forced to question why they accepted it in its current form.  In her blog post announcing the passing of the bill, Dr. Elaine Armantrout, PT, DSc, ECS, and PTWA President states, 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.”  So unfortunately, while we have made great strides towards removing a major restriction from our practice, it appears as if we may still have a significant amount of work ahead of us to fully realize the benefits of this bill passing.

To conclude, Physical Therapists in Washington State have been afforded a great opportunity through the efforts of the PTWA toward the passage of a bill allowing us to perform spinal manipulations.   Logistically, it would appear that a number of hurdles still need to be addressed before we can truly put this bill into everyday practice.    As a collective field, it is our responsibility to ensure that clearing these hurdles occurs in a timely and efficient manner, ultimately allowing us to provide the best possible care and treatment for our patients.  

Thanks Sally! How exciting and then frustrating that must have been after your research! Perhaps PTs like myself who were trained by Laurie Hartman, DO and had fellowships that included mentors who were trained by Philip Greenman, DO will be able to help. Anyone else out there in Washington have any thoughts on this?

Keeping it Eclectic...


  1. That stinks. To borrow a line from Real Genius "Well then I'm happy and sad for you."

    I'm waiting for an Attorney General ruling on dry needling in NJ to start taking some dry needling classes. Meanwhile accupuncturists in NJ can prescribe exercise and perform massage/"bodywork" without further education.

  2. I, too am a PT in Washington State with 20+ years of experience. I also started my professional practice out of state and was dismayed to discover that WA does not allow PT's to manipulate when I arrived here 15 years ago. I echo Sally's eloquent and measured frustration with the PTWA's "compromises" to get the bill passed - they folded. It's a non-starter for most of us already practicing and, as I am on the downhill slide of my career, I'm not sure if I'm willing to spend the time and money just to get certified under the current format. It will also be quite prohibitive for new grads to find someone to mentor them in-clinic for 300 hours. It would certainly be nice to have that additional tool in my intervention bag but after 15 years of practicing under the no-manipulation cloud, I have developed lots of other ways to get the results I need and if I get some cavitation in the process, great. I am disappointed in my state professional organization. They have essentially negated all the years of hard work lots of folks have put in to changing this discriminatory and restrictive law. I have always been okay with DC's operating in professional grey areas related to rehab, e.g. teaching "therapeutic exercise", as I have been confident in my expertise and that of other PT's that I believe elevates us above the rest of the physical healthcare crowd. PT's and DC's seem to coexist quite nicely in other states and I have learned a lot from the DC's who are secure enough in their practice not to worry about what the other pro's are doing and who share their clinical expertise with others. I hope that PTWA keeps chipping away at this issue and can eventually get more a more reasonable and less restrictive bill passed but my confidence is not least in my professional lifetime.

  3. Thanks for sharing this Sally. I knew there were issues out west with SMT but wow! This is not a successful arrangement for PTs or patients who could benefit from this modality.

    I agree with Max and you Sally. I don't know who has the time and money to mentor under someone for the mentioned about of hours! Do you think many PTs will even do it?? Will the benefit of those training hours outweigh one type of manual approach?

    I thought we had it bad in NC (can't perform SMT unless on MD order).


  4. I can't imagine either a new grad will be able to invest or a clinic owner will want to. So limited! Makes yours look unlimited!

  5. Well said Max. But already on the downside of your career? It's only been twenty years!

  6. Waiting for that on NY as well. Don't think there's been any movement tho

  7. It's my second career, Erson...I spent 15+ years as a professional ski bum. Didn't graduate from PT school until I was 35. That being said, I've found the last 3 professional years to be the most rewarding thanks to all the recent paradigm shifting from folks like Butler, Mosely, and Cook. Keep it eclectic!

  8. Great choice as a "second" career Max! I had a student who was 38 when he interned with me, much happier than his life as an business, and IT guy. Everyone thought he was younger than me tho!