Seattle, Washington, October 29, 2008- Washington is one of only two states in the nation that prohibits physical therapists from performing spinal manipulation. Back and neck pain are two of the most common reasons patients seek medical care. The ability of physical therapists to perform spinal manipulation is supported by numerous high quality randomized clinical trials. This body of research, much of it developed by physical therapists, has demonstrated the proven efficacy of manual physical therapy interventions, to include mobilization AND manipulation, for patients with back and neck pain. Physical therapists have produced landmark research in the area of low back and neck pain which is recognized by national and international physician groups. This month’s issue of Spine, reports on the results of a randomized clinical trial, which demonstrated that patients with neck pain who received a physical therapy program of spinal manipulation and exercise had twice the improvement in symptoms compared to the current guideline group (Walker, 2008). Unfortunately, the current law prevents the citizens of the state of Washington from receiving physical therapy treatment that is evidence based, proven to be effective, and recommended in clinical practice guidelines.
Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapists, expressed confidence that, "Given the overwhelming evidence of the benefits of physical therapy I would expect that this limitation will soon change. It is time to bring health care in Washington into the 21st century.” Flynn continues, “The American Medical Association, the Department of Defense, the American Physical Therapy Association’s Scope of Practice, as well as 48 other states in our nation recognizes physical therapists’ ability to perform spinal manipulation. Furthermore, the American College of Physicians and the American Pain Society (Chou, 2007) have published clinical practice guidelines recommending manipulation by physical therapists as the only proven treatment for patients suffering with acute low back pain.“
It is my opinion that the chiropractic associations continue to push and agenda portraying "patient safety" as a reason to continue to prevent PT's in the state of Washington to manipulate. However, manipulation is taught to all PT's in our training, just as examination, evaluation, therapeutic exercise, and physical modalities skills are taught. "Safety" is a red herring covering-up for the real reason which is profits. Legislators in Washington need to hear from patients in particular about how this law is negatively affecting their health care potentially leading to chronic conditions and significantly increased costs.
Jason L. Harris
