Can a Physical Therapist Do Spinal Manipulation? The Rules in Every State

Few practice acts answer this in so many words. Thirteen jurisdictions name manipulation in the PT act or the board's rules, thirteen name only mobilization, five say manual therapy, and eighteen use none of those words, which leaves the question to the board. Three draw a hard line at the spine: Arkansas and Tennessee rule spinal manipulation or spinal thrust out of physical therapy, and Florida sends it to chiropractors. Washington, Connecticut, Indiana, Wyoming and Oklahoma add training, an endorsement or a referral first. PTAs are barred from thrust or all joint mobilization in nine states.

This article goes through every state for PTs and PTAs: what the practice act calls it, any condition on spinal manipulation, what the PTA rule says, and the attorney general opinions and court decisions I could find on an official site. I'm an occupational therapist, not a PT, so I've stayed with what the rules say.

This isn't legal advice. I checked every rule on November 9, 2026, on the state's own legislature, code or board site. Your board's current rule is the one that counts.

The Short Answer

• Manipulation named: 13. Nine say it in the act itself (Connecticut, Delaware, Indiana, Louisiana, Maine, New Mexico, North Dakota, Washington, Wyoming) and four only in the board's rules (Hawaii, Iowa, North Carolina, Texas).
• Mobilization named, manipulation not: 13. Colorado, Illinois, Massachusetts, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New York, Pennsylvania, South Dakota, Utah and West Virginia.
• Manual therapy, neither word: 5. Arizona, Florida, Idaho, Kansas and Ohio.
• None of these words in the scope: 18. These acts list exercise, massage and physical agents, or describe treatment in general terms.
• Ruled out or carved off: 3. Arkansas excludes spinal manipulation and adjustment, Tennessee excludes spinal thrust past the normal range, and Florida's act leaves specific spinal manipulation to chiropractors.
• Extra steps before spinal manipulation: 5. Washington (endorsement), Connecticut (referral and training for Grade V), Indiana (referral), Wyoming (advanced training for Grade V) and Oklahoma (formal training, for anyone).
• Chiropractic words off limits: 6. Connecticut, Louisiana, Washington and Wisconsin bar the terms or the claim, and Illinois and Iowa exclude chiropractic technique or manipulation from PT scope.
• PTAs: a written limit in 9. Colorado, Hawaii, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Washington and Wyoming. Ohio's board says a PT may sometimes delegate low-grade mobilization.
• Attorney general opinions: 5, court decisions: 1. California, Nebraska and Tennessee opinions are against PTs doing spinal manipulation or Grade V, Wisconsin's draws a line at the chiropractic adjustment, South Carolina's declined to answer, and the Arkansas Supreme Court upheld a chiropractic board's fine against a PT in 2005.

Mobilization, Manipulation and Thrust: What the Words Mean in These Laws

Most acts don't define these words, and the ones that do draw the line in the same place: the joint's normal range of motion.

• Mobilization stays inside the range. Nebraska's act defines "mobilization or manual therapy" as skilled passive movements "throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation" (Neb. Rev. Stat. § 38-2910 (opens in a new tab)). Pennsylvania uses nearly the same words (63 P.S. § 1302 (opens in a new tab)).
• Spinal manipulation goes past it, with a thrust. Indiana: a PT "uses direct thrust to move a joint of the patient's spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity" (IC 25-27-1-1(8) (opens in a new tab)). Oklahoma: "a manual procedure that involves a directed thrust to move a spinal joint past the physiological range of motion, without exceeding the anatomical limit" (59 O.S. § 731.7 (opens in a new tab)).
• Two rules put a fast thrust inside mobilization. Arkansas's rule says mobilization includes "a small-amplitude/high-velocity therapeutic movement" (17 CAR § 175-101 (opens in a new tab)). Utah's says joint mobilization includes "a high-velocity low-amplitude (HVLA) therapeutic movement" (Utah Admin. Code R156-24b-102(7) (opens in a new tab)).

So where an act names only mobilization, read the definition before you read it as permission to thrust. Where it defines mobilization inside the normal range, as Nebraska and Pennsylvania do, a Grade V thrust is outside that word.

Every State at a Glance

"Not named" means the act's scope doesn't use manipulation, mobilization or manual therapy, and the quote shows what it does list. No specific rule means the act, the rules and the board's published statements have nothing more on the question. Neither one means allowed or banned. Each citation links to the official source I read.

The States With a Specific Rule

Where the law puts conditions on spinal manipulation

• Washington: an endorsement. Physical therapy as defined leaves out "the use of spinal manipulation, or manipulative mobilization of the spine and its immediate articulations," except as the endorsement section allows (RCW 18.74.010(10) (opens in a new tab)). Spinal manipulation "includes spinal manipulation, spinal manipulative therapy, high velocity thrust maneuvers, and grade five mobilization of the spine and its immediate articulations." The endorsement takes at least a year of full-time orthopedic practice, then "Training in differential diagnosis of no less than one hundred hours," "Didactic and practical training related to the delivery of spinal manipulative procedures of no less than two hundred fifty hours," "Specific training in spinal diagnostic imaging of no less than one hundred fifty hours," and "At least three hundred hours of supervised clinical practical experience in spinal manipulative procedures." An endorsed PT may not "Practice or utilize chiropractic manipulative therapy in any form," may not delegate it, and must "complete at least ten hours of continuing education per continuing competency reporting period directly related to spinal manipulation" (RCW 18.74.190 (opens in a new tab)). PTs also "shall not advertise that they perform spinal manipulation, manipulative mobilization of the spine, chiropractic adjustment, spinal adjustment, maintenance or wellness manipulation, or chiropractic care of any kind" (RCW 18.74.085 (opens in a new tab)).
• Connecticut: a referral and training, for Grade V. "In any case in which a person seeking such treatment requires a Grade V spinal manipulation, such treatment shall only be performed (A) upon the oral or written referral of a person licensed in this state, or in a state having licensing requirements meeting the approval of the appropriate examining board in this state, to practice medicine and surgery, podiatry, naturopathy, chiropractic or dentistry," or an APRN or PA who may prescribe, and by a PT who also meets an education test and "holds a specialist certification in orthopedic physical therapy from the American Physical Therapy Association, or proof of completion of forty hours of course work in manual therapy, including Grade V spinal manipulation." Separately, no PT or PTA "may use the term “chiropractic adjustment” or “chiropractic manipulations” to indicate or imply the application of these techniques as part of the practice of physical therapy" (Conn. Gen. Stat. §§ 20-73(b)(2), 20-73c (opens in a new tab)).
• Indiana: a referral from someone who examined the patient. "A physical therapist may not perform spinal manipulation of the spinal column or the vertebral column unless: (1) the physical therapist is acting on the order or referral of a physician, an osteopathic physician, or a chiropractor; and (2) the referring physician, osteopathic physician, or chiropractor has examined the patient before issuing the order or referral" (IC 25-27-1-2.5(b) (opens in a new tab)). This holds even inside Indiana's 42 days of direct access.
• Wyoming: Grade V after advanced training. The act's manual therapy "includes mobilization and grades I through IV manipulation of joints and soft tissue but does not include grade V manipulations without completion of advanced training requirements as determined by the board" (W.S. § 33-25-101 (opens in a new tab)). The board's rule: "Qualification for grade V joint manipulation (high velocity, low amplitude thrust manipulation) requires hands-on practical evaluation and includes one or more of the following," and the list is a DPT program that taught thrust, an orthopedic or sports specialist certification, a manual therapy fellowship, or a post-entry-level thrust course (Wyo. Bd. of PT Rules ch. 7, § 2(a) (opens in a new tab)).
• Oklahoma: formal training, for everyone. This isn't in the PT act. It's a general healing-arts law: "No person shall perform spinal manipulation in this state until first being adequately trained in this procedure through formal education at an accredited college or school" (59 O.S. § 731.7 (opens in a new tab)).
• North Dakota: proof of competence. The act names manipulation and adds that "The board shall require each licensee to provide the board with evidence of competence regarding the various elements of manual therapy the licensee practices" (N.D.C.C. § 43-26.1-14(1) (opens in a new tab)).

Where the law rules it out

• Arkansas. The PT act's manual therapy includes mobilization "but excluding spinal manipulation and adjustment" (Ark. Code § 17-93-102(7)(B)(i)(c) (opens in a new tab)). The chiropractic act says "It is unlawful for any person other than a physician licensed to practice chiropractic," or a medical physician, "to perform spinal mobilizations, spinal adjustments, or spinal manipulations as those terms are defined in § 17-81-102," and in the next breath that it doesn't "limit or restrict the authority of a licensed physical therapist to practice physical therapy" (Ark. Code § 17-81-303(c), chiropractic board's copy (opens in a new tab)). In Teston v. Arkansas State Board of Chiropractic Examiners, 361 Ark. 300 (2005), the Arkansas Supreme Court affirmed a chiropractic board order that a PT had practiced chiropractic without a license, fined $5,000 for each violation, $10,000 in all (opinion (opens in a new tab)).
• Tennessee. Since 2007 the act has said: "The scope of practice of physical therapy shall not include the performance of treatment where the physical therapist or physical therapist assistant uses direct thrust to move a joint of the patient’s spine beyond its normal range of motion without exceeding the limits of anatomical integrity" (2007 Pub. Ch. 423, § 1 (opens in a new tab)). It was enacted as § 63-13-109(b)(2). A 2023 act amends the same referral text at § 63-13-104(b)(1) and doesn't touch (b)(2), so the 2007 words appear to stand at § 63-13-104(b)(2); the official code is only on Lexis, so I couldn't read the current section itself. The attorney general's opinion that spring reached the same end by another road: "No person licensed under Title 63, Professions of the Healing Arts, including licensed physical therapists, may perform a spinal manipulation or spinal adjustment," as the chiropractic act defines it, without meeting that act's training standard of 400 classroom hours and 800 supervised clinical hours (Op. Tenn. Att'y Gen. No. 07-55 (opens in a new tab)).
• Florida. "The practice of physical therapy does not authorize a physical therapy practitioner to practice chiropractic medicine as defined in chapter 460, including specific spinal manipulation, or acupuncture as defined in chapter 457. For the performance of specific chiropractic spinal manipulation, a physical therapist shall refer the patient to a health care practitioner licensed under chapter 460" (Fla. Stat. § 486.021(11)(c) (opens in a new tab)). The chiropractic act adds: "No person other than a licensed chiropractic physician may render chiropractic services, chiropractic adjustments, or chiropractic manipulations" (Fla. Stat. § 460.403(9)(a) (opens in a new tab)).
• Nebraska, by attorney general opinion. The act names "mobilization or manual therapy" and defines it within the normal range. In 2009 the attorney general wrote that physical therapists in Nebraska "may not perform any type of manual therapy, mobilization manipulation or joint manipulation which carries the joint beyond the normal physiological range of motion." The opinion notes that the 2006 bill "originally included the term manipulation but opposition to inclusion of that language arose during floor debate and the term was removed" (Op. Neb. Att'y Gen. No. 09005 (opens in a new tab)).
• Nevada and Pennsylvania, by definition. Nevada's act covers "the mobilization of joints by the use of therapeutic exercise without chiropractic adjustment" (NRS 640.024 (opens in a new tab)). Pennsylvania's mobilization is movement "throughout the normal physiological range of motion" (63 P.S. § 1302 (opens in a new tab)). Neither names manipulation.

Chiropractic words

Some states don't say what a PT may do with the spine but do say what a PT may not call it.

• Louisiana: "Physical therapists may not profess to provide 'spinal manipulation' or 'spinal adjustment' or use these terms for advertising purposes" (La. R.S. 37:2423(D) (opens in a new tab)). Its act names "passive manipulation," and the board's rule defines that as "manipulation or movement of muscular tissue or joints other than by the spontaneous function of the body or active effort on the part of a patient" (La. Admin. Code tit. 46, pt. LIV, § 123 (opens in a new tab)).
• Wisconsin: "A physical therapist may not claim that any manipulation service that he or she provides is in any manner a chiropractic adjustment that is employed to correct a spinal subluxation" (Wis. Stat. § 448.522 (opens in a new tab)). The attorney general's 2001 opinion: "Although neither a physical therapist nor a massage therapist may lawfully perform a chiropractic adjustment unless licensed as a chiropractor, not every form of therapeutic touch involving the neck, back, joints or connective tissues constitutes a chiropractic adjustment" (OAG 1-01 (opens in a new tab)).
• Iowa: a PT license "does not authorize the licensee to practice operative surgery or osteopathic or chiropractic manipulation," while the board's rule lists "Manual therapy, including soft-tissue and joint mobilization and manipulation" (Iowa Code § 148A.5 (opens in a new tab); Iowa Admin. Code r. 481—800.1 (opens in a new tab)). The act doesn't say where PT manipulation ends and chiropractic manipulation begins.
• Illinois: physical therapy "does not include practicing radiology, electrosurgery, acupuncture, chiropractic technique or providing a determination of a differential diagnosis" (225 ILCS 90/1 (opens in a new tab)).
• Connecticut and Washington, above, bar the terms in their own words.

PTAs

Nine states write a limit aimed at PTAs. Where a state rules spinal manipulation out of physical therapy, as Arkansas and Florida do, it is out for PTAs too.

• Thrust or high-velocity work barred:
  • Colorado: "Physical therapist assistants may not perform joint mobilization, unless the supervising physical therapist has determined that the physical therapist assistant has the necessary degree of education, training and skill for safe patient care. Entry-level education is inadequate; additional formal continuing education (psychomotor and didactic) is required to perform joint mobilization. Thrust, high-velocity techniques are not within the scope of the physical therapist assistants’ practice" (4 CCR 732-1, Rule 1.5(B)(1)(a)(3) (opens in a new tab)).
  • Hawaii: "A physical therapist assistant may perform manual therapy, excluding thrust joint mobilization and spinal and peripheral joint mobilization or manipulation" (Haw. Code R. § 16-110-5(2) (opens in a new tab)). That leaves out spinal and peripheral joint mobilization too.
  • Oregon: a PTA "shall not: ... Perform high velocity manipulation of the spine or peripheral joints" (OAR 848-015-0030 (opens in a new tab)).
  • Utah: "A licensed physical therapist assistant or a physical therapy aide may not: ... perform high-velocity thrust joint mobilization" (Utah Code § 58-24b-402(2) (opens in a new tab)).
  • Wyoming: a PTA "shall not: ... Perform high velocity manipulation of the spine or peripheral joints" (Wyo. Bd. of PT Rules ch. 7, § 5(c) (opens in a new tab)).
  • Tennessee: the statute's thrust exclusion names "the physical therapist or physical therapist assistant" (2007 Pub. Ch. 423 (opens in a new tab)).
  • Washington: an endorsed PT may not "Delegate spinal manipulation" (RCW 18.74.190 (opens in a new tab)).
• All joint mobilization kept for the PT:
  • Pennsylvania: "A physical therapist may not assign or delegate to physical therapist assistants or supportive personnel functions which require the formal education or training and the skill and knowledge of a licensed physical therapist, including the following functions," and the list includes "(7) Mobilization" (49 Pa. Code § 40.53(b) (opens in a new tab)).
  • South Dakota: "The following physical therapy services, however, shall only be performed by a physical therapist," including "(5) Joint assessment and mobilization" (SDCL 36-10-35.7 (opens in a new tab)).
• A board saying some is fine: Ohio's board says "Ohio law does not specifically refer to whether or not a physical therapist assistant may utilize manual therapy techniques," and that "there may be some cases in which a physical therapist could safely delegate several treatments of low-grade (grades one or two) mobilization to a physical therapist assistant" (Ohio OTPTAT Board, PT scope of practice FAQ (opens in a new tab)). That is the board's reading, not a rule.

In home health this lands on the schedule. If the plan of care calls for thrust, Grade V or joint mobilization in one of these states, that part of the visit belongs to the PT, so don't hand it to a PTA visit. Our guide to ordering PT and PTA visits covers the rest of the sequence.

Attorney general opinions and court decisions

Five attorney general opinions and one court decision are on official sites:

• California: "A physical therapist may not directly manipulate or adjust the spine or any other bony structure" (AG Op. No. 75-282 (opens in a new tab)). The PT board posts it next to a 1980 Department of Consumer Affairs legal opinion, No. 80-18, which says joint mobilization by a PT is within the scope of § 2620 and is not chiropractic (PTBC legal opinions (opens in a new tab)). The scan of that letter is too poor to quote word for word.
• Nebraska (2009): no Grade V, and nothing past the normal range. See above.
• Tennessee (2007): no spinal manipulation without the chiropractic training standard. See above.
• Wisconsin (2001): no chiropractic adjustment, but not every hands-on technique is one. See above.
• South Carolina (2009): asked whether "adjustment" and "manipulation" by a PT are the practice of medicine, the office said it "is not in a position to provide a response to your inquiry inasmuch as any response would necessitate a review of facts" (AG letter of Apr. 30, 2009 (opens in a new tab)).
• Arkansas (2005, court): the Teston decision. See above.

Secondary sources also describe opinions or decisions in Alabama, Kansas, Maryland, Nevada and New Hampshire. I couldn't find an official copy of any of them that answers this question, so I've left them out of the table.

If You Want to Add Spinal Manipulation to Your Practice

None of this is legal advice. It is what the rules above have in common, put as steps.

1. Read your state's row, then the definition. If your act names only mobilization, check whether it defines mobilization inside the normal range, as Nebraska and Pennsylvania do.
2. Look for a gate. Washington needs an endorsement, Connecticut and Indiana a referral, Wyoming and Oklahoma training. Get it in place before the first patient.
3. Keep your records of training. North Dakota and Wyoming ask for evidence of competence. Even where no rule asks, your course certificates are what you'd show a board.
4. Watch the words. Don't call it a chiropractic adjustment or advertise spinal adjustment, and in Louisiana don't advertise spinal manipulation at all.
5. Check the PTA rule before you delegate. Thrust is off limits for PTAs in many states, and Pennsylvania and South Dakota keep all joint mobilization for the PT.
6. Practicing on a compact privilege? The remote state's scope applies there. Our PT Compact guide shows which states are in.
7. When in doubt, ask the board. The licensure compact tool links each state's PT board.

Key Takeaways

• Most acts don't use the word manipulation. 13 jurisdictions name it, 13 name only mobilization, 5 say manual therapy, and 18 describe treatment in general terms.
• Arkansas and Tennessee rule spinal manipulation or spinal thrust out of physical therapy, and Florida sends specific spinal manipulation to chiropractors.
• Washington, Connecticut, Indiana, Wyoming and Oklahoma add an endorsement, a referral or training before spinal manipulation.
• PTAs face written limits in nine states, most often a ban on thrust or high-velocity manipulation.
• Attorney general opinions in California, Nebraska and Tennessee go against PT spinal manipulation; Wisconsin's draws the line at the chiropractic adjustment.
• This isn't legal advice. I checked these rules on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Can a physical therapist do spinal manipulation?

It depends on your state's words, and few acts answer it directly. 13 jurisdictions name manipulation in the PT act or the board's rules, 13 name only mobilization, 5 say manual therapy without either word, and 18 name none of them, which leaves the question to the board. Arkansas and Tennessee rule spinal manipulation or spinal thrust out of physical therapy, Florida sends specific spinal manipulation to chiropractors, and Washington allows it only with an endorsement.

Can a PTA perform spinal manipulation or joint mobilization?

Often not the thrust part. Nine states write a limit aimed at PTAs. Colorado, Hawaii, Oregon, Utah and Wyoming bar PTAs from thrust or high-velocity manipulation, and Hawaii also bars spinal and peripheral joint mobilization. Pennsylvania and South Dakota keep all joint mobilization for the PT. Tennessee's thrust exclusion names PTAs, and in Washington an endorsed PT may not delegate spinal manipulation. Colorado lets a PTA do joint mobilization only with extra formal training.

What is the difference between mobilization and manipulation in the practice acts?

Most acts don't define either word. Where they do, mobilization stays within the joint's normal range of motion, and spinal manipulation is a thrust that takes the joint past it. Nebraska and Pennsylvania define mobilization as movement throughout the normal physiological range of motion. Indiana, Oklahoma and Tennessee define spinal manipulation as a thrust beyond the normal range. Arkansas and Utah count a small-amplitude, high-velocity movement as mobilization.

Which states require extra training or a referral before a PT does spinal manipulation?

Five. Washington requires a spinal manipulation endorsement with hundreds of hours of training and supervised practice. Connecticut allows Grade V spinal manipulation only on referral and only by a PT who meets an education or experience test and has an orthopedic specialist certification or 40 hours of manual therapy coursework. Indiana requires the order or referral of a physician, osteopathic physician or chiropractor who has examined the patient. Wyoming requires board-set advanced training for Grade V. Oklahoma requires formal training for anyone who does spinal manipulation.

Can a physical therapist call it a chiropractic adjustment?

No, in several states that is written down. Connecticut bars PTs and PTAs from using the terms chiropractic adjustment or chiropractic manipulations. Washington bars PTs from advertising spinal manipulation or chiropractic adjustment. Louisiana bars PTs from professing to provide spinal manipulation or spinal adjustment. Wisconsin bars a PT from claiming a manipulation is a chiropractic adjustment to correct a spinal subluxation.

Sources

Every state's rule is linked in the table, to the state's legislature, its official administrative code publisher, its attorney general or its PT board. All were read on November 9, 2026. The documents cited outside the table:

• Arkansas: Ark. Code § 17-81-303(c) (opens in a new tab) (chiropractic act, board's 2021 compilation) and Teston v. Arkansas State Board of Chiropractic Examiners, 361 Ark. 300 (2005) (opens in a new tab).
• California: PTBC legal opinions page (opens in a new tab), with AG Opinion No. 75-282 and Legal Opinion No. 80-18.
• Florida: Fla. Stat. § 460.403 (opens in a new tab) (chiropractic act).
• Louisiana: La. Admin. Code tit. 46, pt. LIV (opens in a new tab), §§ 123 and 303.
• Washington: RCW 18.74.085 (opens in a new tab) (advertising).