I get asked this question frequently. Osteopathy, Chiropractic and Physiotherapy study the alignment, movement and function of the body and treat injuries and various dysfunctions of bones, connective tissue, muscles and nerves.
Although the education of each discipline differs there is a great crossover in skill sets. All were founded around the beginning of the 19th Century. They all use a form of differential diagnosis to ascertain what the injury or problem is. They all use varying degrees of manual therapy.
Physios can either work in the public or private sector. Osteopathy is rare and hard to find but does exist in the public sector. Chiropractors only work in the private sector. For the purposes of this article, I will talk about therapists in private practice.
Ok, here goes, my humble attempt to explain the differences between these three highly effective and distinguished professions. I hasten to add that I have no bias to any one as you'll discover when you read on.
Physiotherapy
Physiotherapy was founded in the orthodox medical framework. Physios were originally aids to orthopaedic surgeons and practised under the supervision of medical doctors.
Physiotherapists train on an NHS funded 3 year degree course and study musculoskeletal (MSK), respiratory and neuro Physio. In the private sector Physios mostly specialise in MSK. Scientific research in Physiotherapy, like medicine, tends to be quantitative and largely subjective and double blind studies are entirely possible.
Physios may diagnose an injury through a series of orthopaedic tests for joint, muscle, connective tissue and nerve function. They may also palpate the muscle and connective tissues to feel for changes in tissue tension. Treatment may include ultrasound, hydrotherapy, some soft tissue and joint manipulation but the main form of treatment is rehabilitation exercise to correct and improve movement function.
Physios are often, though unfairly, thought of as only treating the area of concern. This may have been the case many years ago, but good Physios will look at the body as a whole and try to ascertain why an injury has occurred. However, it is still common for Physios to take an area such as the hip as their specialism particularly if they go on to do Masters and PhD studies.
Physiotherapy is generally thought of an acute form of treatment usually lasting 6-8 weeks, although there are always exceptions dependent on the injury. Physios are keen to get patients better as quickly as possible and may educate patients on how to self treat alongside their rehabilitation exercises.
In recent years Physios have also included psycho social and lifestyle factors in treatment particularly when treating for chronic pain and more complex conditions.
Osteopathy
Osteopathy is the study of the relationship between structure and function of the body. As its name suggests, the founder Andrew Taylor Still, believed all dysfunction originated in the bones.
Osteopathy was founded outside of the orthodox medical framework and was for many years considered a complementary form of treatment. However, in 1993 the UK Parliament passed the Osteopaths Act, and osteopathy gained the same formal recognition as medicine and dentistry.
Osteopaths study for 5 years and qualify with a Masters in Osteopathy. Scientific research for osteopathy tends to be qualitative and anecdotal as it is hard to run double blind placebo controlled studies blinding both the therapist and the patient.
Osteopaths are trained to look at the body in a global sense. For example, if you come in with a knee problem, an osteopath will look at the function and alignment of the whole body and may find that your problem is originating elsewhere. This is based on theories of compensation and adaptation to our work and living space, habits of posture and movement we develop and repetitive sports specific pattern. Osteopaths also look at the affect of other systems of the body such as hormonal and digestive when treating patients.
Some therapists choose to specialise in cranial osteopathy often administered to babies. It is the study and treatment of the cranial bones and the fluids contained within and how it affects the rest of the body.
Osteopathic assessment usually includes observation of posture and movement patterns and palpation of the soft tissues. Treatment is mostly soft tissue therapy based, although some joint manipulations may be used. Although osteopaths have an understanding of the importance of exercise as part of healing and recovery this is something that is learned post-qualification and is highly dependent on the individual therapist.
Osteopathy is a form of treatment that can last for a set period of time for an injury. In my experience, I often find patients use osteopathy as a form of regular maintenance and check up.
Chiropractic
Chiropractic was founded just a decade later than osteopathy by Daniel David Palmer. It is still officially considered a complementary medicine in the UK. Chiropractors study for 5 years resulting in a Masters degree and scientific research is conducted in a similar way to osteopathy.
The chiropractic philosophy is based on pain, injury and dysfunction of the body caused by nerve impingement from a malalignment in the spinal segments. A little explanation is needed here... The spine houses the spinal cord and at each segment of the spine it branches off into nerves that innervate the entire body, sending sensory, autonomic and motor (movement) messages between the brain and the body. It is believed that the cause of dysfunction lies in the compression or impingement of nerves at the level of the spine - often referred to as a sublux. Chiropractic focuses mainly on the joint manipulation of the neck and the spine, to realign the segments for optimal nerve function relieving symptoms, and improving function and movement.
Chiropractors are trained to read X-Ray's and may use this as a diagnostic tool in their practice. They may also check tissue tension around the spine and in the limbs. Some may employ soft tissues techniques but the main treatment modality of a chiropractor is joint manipulation. Again, like osteopaths they have an understanding of the importance of rehabilitative and some therapists may prescribe it as part of their treatment.
It is common for patients to routinely return to a chiropractor for a readjustment. But it is also entirely possible that patients only need one or two corrections for a specific problem also. Rehabilitative exercise helps hold a correction for longer.
They all sound pretty comprehensive! So how do you choose?
How to choose
It's not the title a practitioner works under that is important here, it is the individual practitioner themselves that really makes a difference. Like in every profession, you have those that are exceptional, those that are middling and hopefully not too many that are not good. It really is about finding a therapist that works for you as a patient. Each therapist, whatever their title, will find a way to work and treat in the manner that suits them. In many instances there may be a greater difference between two osteopaths than there is between an osteopath and a chiropractor.
I seek out therapists who are naturally curious and open minded and always want to learn more. I also think critical enquiry and discernment are valuable attributes in a therapist as well as a positive and upbeat yet caring bed side manner. Experience and qualifications are also of great importance.
In my opinion, a good therapist looks at the body globally, they have the ability to administer soft tissue therapy and joint manipulation as needed, and they can also advise on or refer to a specialist for rehabilitation exercise and other self-care practices to aid healing and recovery.
If you still need help with making a decision on what type of treatment to take for your specific injury feel free to contact me by emailing me at KT@precisionmovement.co.uk and we can have a little chat and hopefully I'll help you to find the right therapist for your condition or injury.