I often get asked what is the difference between physiotherapy, osteopathy and chiropractic so I thought I would try and explain the differences. I am a trained physiotherapist so know this profession inside out, however my comments about osteopathy and chiropractic are based more on my own personal experience of having treatment by and working alongside these different professionals.
People incorrectly assume that osteopaths and chiropractors only treat spines, where as physiotherapists treat other parts of the body with rehabilitation. This is simply not the case. All three professions are trained to be able to treat problems of the muscles, tendons, ligaments and joints anywhere in the body. As health professionals our aim is to get your musculoskeletal problem better however we are trained slightly differently and may go about it in a different way using different explanations and rationale.
What we do well
I think that physiotherapy and osteopathy are the most similar of the three. We both will use hands on treatment such as joint mobilisation, soft tissue work and perhaps even tape, acupuncture or ultrasound to get your injury better. Some osteopaths might be trained in something called cranial osteopathy or visceral manipulation, which is quite different to physiotherapy or more orthodox osteopathy.
Beyond these core skills physiotherapist specialise in post surgical or post trauma rehabilitation as they will have worked in hospitals. Physiotherapists also give patients home exercises to self manage their problems. Osteopaths specialise more in joint manipulation and spinal and postural alignment.
Of the 3 professions chiropractors are slightly different and focus more on the spine often performing X-rays in the initial appointment. They will use joint manipulation to correct spinal alignment and free nerve movement in order to get your injury better. Chiropractors would generally use more frequent and shorter duration sessions to get your injury better.
The criticisms of the professions
Physiotherapists are trained to work in the NHS so our training focuses on empowering patients to manage their problems through exercise.
Unfortunately, there are huge waiting list in the NHS and finite resources of therapists. It is more cost-effective to treat people once or twice then either to refer them into a group exercise class or educate them to self manage with a home exercise programme.
The main criticism I hear from patients who have NHS physiotherapy is that the physiotherapists don’t do hands on treatment any more and there is a reputation of patients just being given exercises and discharge.
There is a big drive in the NHS on something called evidence based practice and the evidence is showing that home exercise is a very powerful way of managing health problems, therefore patients are given exercises. However, I believe that hands-on treatment is also very powerful and there is research to suggest that it is very useful. In private practice physiotherapy you will get hands on treatment.
Osteopaths and chiropractors will go straight out into private practice, usually setting up their own businesses or working in other therapists businesses. The main criticism here is that they are business focused rather than patient focused. I have heard stories from patients who have seen chiropractors and have been told they need 20 treatment sessions over the next three months to get their problem better. There is the suggestion of unnecessary over treatment here and educating the patient that they need to regularly see the therapist in order to get better.
I have seen a number of patients that have come to me saying they have seen an osteopath or a chiropractor and it didn’t work for them. I’m sure people have seen a physiotherapist and said it doesn’t work for them preferring osteopathy or chiropractic. I think these criticisms are really down to human interaction not the individual professions. Ultimately a good therapist is a good therapist regardless of their profession and their aim will be to get you better. Perhaps the patient just didn’t connect with their therapist or they didn’t quite have their expectations met.
I think this is key – patient expectation and beliefs. If you believe that a chiropractor will click your spine back in place and this will make your back pain better, then a chiropractor is who you should see. If you feel you need acupuncture and a core stability exercises programme to get your back pain better than a physiotherapist may be better.
I hope this helps clear up the differences in the professions and reduce some of the confusion and misconceptions around what we do to get people better.