What is the difference between Physiotherapy, Osteopathy and Chiropractic?

Who is better to see?

A Physiotherapist, Osteopath or aChiropractor - a question I get asked a lot!

The very short answer is: The human body is the same whether you see anyone of these fine professionals. Joints crack the same way, muscles get pushed and poked the same way and exercises have the same physiological effect. It really comes down to the individual practitioner, the patients expectation and the problem itself.  Is one better than the other? No. I view a good practitoner as someone who is continually learning and willing to challenge their own beliefs and practices. 

Is My Pelvis Wonky?

The longer answer:

Id like to think you could go to any one of these professions and have the same outcome.  Of course, there are differences and people will have had good, indifferent and awful experiences.  The most likely situation is that you have had a friend recommend seeing someone and this is what drives 75% of our business at Core Body Clinic.  I think it is alwys good to read about the clinic you are going to and asking, is it right for you and your problem?  I will try to explain below what differences exist bwtween the three.  Id like to say three things that totally seperate them but its much more complicated than that and especially when you consider that I (Adrian) completed an MSc in Manual Therapy with my research on Spinal Manipulation and Spinal Adjustments.  I use spinal manipulation a lot in my day to day clinic.  However, not all physiotherapists can perform this very skilled technique. 

At Core Body Clinic, we assess everyone that comes through the door.  We find out what is wrong and we may request further tests working closely with the GP or directly through private pathways. We will use an array of techniques including: Manual therapy, acupuncture, injection therapy, ultrasound scanning, taping, rehabilitation and exercise therapy.  However, not all physiotherapy clinics will be the same.  There are differences within the profession of physiotherapy making this question a complicated one that needs a good 5 minutes reading to explain.  

Which one should I see?

I used to work with a Chiropractor called Ben, and I recall patients saying:

“er….so what’s the difference between you guys? You both crack my back and provide rehab!?”

It was a fair question and because me and Ben worked so closely and shared common philosophies, it wasn’t a surprise to have that question asked.

I’ve had other people tell me “I had physio once…..it didn’t work!” or they tell me “Osteo didn’t help!” – I always find this odd because the three have more in common than differences.  Furthermore, the three are professions and not treatment techniques.  If you went to an NHS physio you may be given a sheet of paper……but this isn’t what the 100 year old profession is all about.

My Back Is OUT!

So, what is the difference between Physios, Osteo and Chiro?

Well, the biggest difference is where they all started.  Physiotherapy was created in the early 1900s by a group of nurses to bridge a gap in healthcare.  We know rehab existed before this with literature dating back to the mid to late 1800s.  Physiotherapists (or remedial gymnasts as they were called then) helped people who had been in hospital after an illness, perhaps acutely ill.  They needed rehab and at the time, it just was not available.  If you have an injury you need rehab.  With back pain, your muscles weaken, movement deteriorates – you need rehab.  Hence, physiotherapy became a profession.  Because of its unique position in healthcare, it has become a central part through all disciplines of healthcare:  Cardiac, neuro, orthopaedics, paediatrics, respiratory, surgery, musculoskeletal, women’s and men’s health, burns and plastics, intensive care, mental health, sports medicine, injection therapy, sonography, surgery (?did I miss anything?).  Physiotherapists now work up to Consultant level, prescribe medicines, order and read imaging (Xray and MRI) and hold clinics where independent decisions are made.  It has had to evolve into a highly specialist profession working alongside specialist doctors and surgeons – so, we cant say “ I had physio once” and leave it there because it’s too diverse.  At Core Body Clinic, we are musculoskeletal physiotherapists and therefore we are trained in hands on manual and manipulative therapy, massage therapy, dry needling, diagnostic ultrasound and inject.  We also treat male and female health (incontinence and sexual dysfunction) and help people who are recovering from Cancer.  

I only got given exercises!

Osteopathy began in the late 1800s by Andrew Still, a doctor frustrated by the harm that medicine at that time was causing.  It was still in its infancy and was largely barbaric with a high mortality rate.  He found a physical way to help the body heal by using palpation, manual therapy and theories such as blood and cranio-sacral flow.  From here Osteopathy found its way through healthcare as a more holistic and alternative therapy.  However, with need to constantly change and the advent of evidence-based practice, the profession has developed, like physiotherapy, with an array of roles and diversity.  Like physiotherapists, they use hands on techniques and provide exercises.  Some Osteopaths work in the NHS alongside physios and doctors.  This is where the only difference between the two is in the name.  At Core Body Clinic, our physiotherapists use spinal manipulation.  If you trained 20 years ago (like me – yikes!) you would have been taught spinal manual therapy and adjustments at University.  Now, it’s typically a post-graduate course so not all physiotherapists will manipulate the spine.  Some physiotherapists also train in cranio-sacral therapy but it is not a typical training pathway. So, in short there are sometimes huge differences and other times the professions might look the same.

Chiropractic was created In the late 1800’s by a healer named Daniel Palmer who believed a deaf care-taker would benefit by having his neck manipulated.  Palmer performed the manipulation bone crunching technique to the man’s neck…….and he could hear! .

Chiropractic was very much an alternative to medicine with early Chiropractors believing you could cure anything with spinal manipulation.  Over time, Chiropractic has gone through many developments and evidence has driven a shift away from the original beliefs that the spine becomes subluxed and all pain and illness stem from this.  Like Physiotherapists and Osteopaths, Chiropractors now work in frontline community care and provide treatment for an array of conditons, not just backs.  

Spinal manual therapy is very effective for pain in the spine and at Core Body Clinic our physiotherapists use it a lot.  We know it has a place and we also acknowledge its limitations too.  

The bone crunching scares me!

Chiropractors, like physiotherapists, treat lower back pain and have generally gained recognition in society as the people to go to with back pain.  I think you will find many excellent Chiropractors, Osteopaths and Physiotherapists who are equally excellent at treating back pain.  I would suggest 90% of Chiropractors might use manipulation for lower back pain…….75% of physiotherapists and anywhere between 80 – 90% for Osteopaths (this is just my guess).  As a matter of fact, the NICE guidelines for back pain advise the use of hands on therapy in addition to exercise.  However, it does not recommend it on its own.  Evidence backs the use of manipulation provided it is part of the package of care that is primarily focussed on exercise.  What we must remember is that evidence does not mean 100% of people responded.  Therefore, differences between people and their experiences of back pain and said treatments will vary.  People we see at Core Body Clinic Physiotherapy may have been to see a Chiropractor or Osteopath already.  Equally, patients may present at an Osteopaths having just been handed an exercise sheet by a physio. I 

I always find the biggest differences are within the professions and therefore the individual practitioners.  If you have seen one of the three specialities and not got on, don’t think that it is the profession as a whole, rather the individual clinician.