The Effects Of The Spinal Manipulation Prohibition On Physical Therapists' Decision To Practice In Washington State

Document Type

Conference Proceeding

Publication Date


Conference or Event

AAOMPT 2014 Conference


Physical Therapy


Background: For over 70 years, physical therapists have been educated and trained to practice manual therapy techniques, including spinal manipulation. Current research indicates that spinal manipulation is the most effective and successful treatment option for patients with acute low back pain, and is recommended by clinical practice guidelines for patients with mechanical neck pain. Additionally, manipulation has been proven safe and efficacious, exhibiting an estimated rate of serious side effects in only 1 in 100 million. Despite these facts, spinal manipulation by physical therapists continues to be prohibited by statute in Washington State. Purposes: 1. To demonstrate that the current prohibition of spinal manipulation is a factor in physical therapists’ decision to practice in the state of Washington upon graduation. 2. Identify the number of new physical therapists who have made the decision to relocate to a different state, or are planning to relocate, due to the spinal manipulation prohibition. Methods: Data was collected as a follow up to surveys conducted in 2008 and 2011, which asked DPT students in Washington State, the effect the spinal manipulation prohibition would have on their decision to practice in Washington State upon graduation. An online survey was sent to the graduating classes of 2009-2013 of the three physical therapy schools in Washington State, containing 7 multiple-choice questions relating to their current practice as physical therapists. Results: 227 licensed physical therapists responded to the survey (48% response rate); 159 (70%) currently practice in an orthopedic setting. Due to the prohibition on manipulation, 36 (23%) physical therapists now practice in a state other than Washington, with another 23 (15%) currently considering relocation if the prohibition is not lifted. Discussion -Conclusions: The prohibition on manipulation significantly impacts physical therapists’ decision to practice in Washington State upon graduation. This supports earlier conclusions drawn from the 2008 and 2011 student surveys.