I am often asked what the difference is between Physiotherapy, Osteopathy and Chiropractice. In all honesty, the more I find out about these seemingly separate disciplines, the more they seem to have in common! So here’s a not-so-brief summary of what we share and what perhaps sets us apart. I will do my best to be un-biased! Just remember, regardless of the therapist you go to, the key thing is whether they are good (or not so good) at what they do and how you feel as a result.
The roots of physiotherapy began with exercise, massage and hydro (water) therapy way back in the BCs, with physicians utilising these skills and knowledge of good movement and health to help patients. It was further developed in the early 20th century (no doubt with many stages in between!) by female masseuses working with injured soldiers during the wars who saw that just massage was not enough to restore the abilities of these men, much as it soothed them. Still today there is a focus on restoring and promoting quality and pain-free movement, indeed this seems to form the basis of numerous definitions of the profession. However, though the philosophy implies the whole body, not all (but hopefully most) physiotherapists approach the body as a whole, indeed in the NHS each ‘problem’ (even each knee!) is seen as a separate referral. Though this allows focus on a particular issue in the allotted time, it doesn’t allow to see the wider picture, though thankfully many private physiotherapists have the luxury of following their nose to the root cause of a problem, under their own jurisdiction.
They (we!) also have a range of skills that are adjuncts to this, such as acupuncture or joint manipulation, though not all physiotherapists have these techniques under their belts. Physiotherapists are not going to lie you on the plinth (massage bed) and just treat you, though of course in private clinics there is an enthusiasm to get ‘hands on’ and ease patients’ pain and restrictions. There is a strong emphasis on self-management and long-term recovery, and though there is a reputation for physios to “just give a sheet of exercises”, it should be clearly explained that rehabilitation is a process that needs to happen all the time, not just in the hour you are seeing your physio.
Physios also seem to have a reputations as Physio-Terrorists, but that is down to the individual therapist whether they are pushy or regimented. As a personal disclaimer, I am very much against making anyone squeal with pain while I’m treating them! Some people want that kind of motivation, others don’t, but ultimately physiotherapy aims to not just overcome the current symptoms but restore optimum function, so you need to find someone you can get on with as it can be a long process.
Finally, for what it’s worth, Physiotherapy is a profession, registered and regulated by the Health and Care Professions Council, which is a benchmark of minimum standards of quality and evidence-based practice.These, like any therapeutic discipline, are adhered to at the point of qualifying, but it is the responsibility of the therapist to further their knowledge and update their skills throughout their career, hence there are a huge range of physiotherapy specialisms such as respiratory, neurological or prosthetic, so you may be surprised where and when you come across physios as your life progresses.
For further detail on the history of Physiotherapy, read More Here
The world of modern Osteopathy began with Dr Stills in 1874, who after years of study crystallised the concept that physical wellbeing is inherently part of ‘medical’ wellbeing and that the body must be treated as a whole unit, not separate limbs and sections. He created osteopathic manipulative medicine (OMM), and during their 5 years of study Osteopaths cover not just muscles and bones but also common medications and reasonably ‘out there’ therapies such as cranio-sacral therapies. Before this time there was a practice of ‘bone-setting’ that just like today seemed to be a therapy that people went to not only when in pain but also as regular maintenance for their bodies.
Osteopaths have a reputation for cracking joints, but this is not an accurate description of what is actually going on (though admittedly it very much sounds like it!) and they can also use the same skills such as massage and acupuncture that physios do as adjuncts. I have had sessions with osteopaths myself as a patient and not been cracked at all! Nevertheless, they use this technique in the majority of sessions, especially as the research around what exactly it is doing and how it benefits the body gathers pace.
There is less emphasis on exercise therapy so you may have more frequent sessions with an Osteopath to gain benefit from your treatment. Bear in mind that you as a patient will need to be quite passive during treatment as many manipulations will involve the Osteopath getting in very close to you to ensure safety and efficacy in their techniques while moving you about, so make sure you are comfortable with this beforehand. A good Osteopath will be clear on what is expected before the appointment, as like physiotherapy you may well need to undress to an extent to allow a proper assessment. Again, it is very much down to the individual therapist and what works for you.
For further information on the history of Osteopathy, read More Here
Like Physiotherapy, Chiropractic (not Chiropractice, apparently) describes its origins way back with the Ancients, with Hippocrates himself encouraging study of the spine as a foundation for the rest of the body. The main Chiropractic movement as we know it today began in America, with students qualifying as Doctors of Chiropractic Medicine now the world over, though they are not to be mistaken for medical doctors. The key concept remains with spinal ‘dysfunction’ as the root of most physical problems, as each vertebral level is associated with a different organ or body part, and solving spinal problems should therefore relieve pain and dysfunction elsewhere in the body. They also see the body as a whole, with treatment aimed just as much at its positive effects on the nervous system as the musculo-skeletal system.
With spinal problems previously termed ‘subluxations’ (which in physio and in the medical world means a part of a bone being ripped off the main bone by trauma), Chiropractors are evolving their terminology in an increasing bid to become clearer about their practice and its benefits. Also practising acupuncture and massage as a precursor to ‘spinal adjustments’, it is mainly a passive procedure with spinal manipulations, like Osteopaths, forming the mainstay of treatment. It has a strong following of dedicated clients that return year after year, relying on this hands-on therapy to solve and keep long term problems at bay. Indeed, “chiropractic” is from the Greek words cheir (hand) and praxis (action), and means “done by hand.” However, I am told that increasingly patients are receiving advice on what they can do themselves to reduce symptoms themselves, though Chiro’s don’t seem to claim to be specialists in this.
There are some ethical controversies with the use of X-rays in Chiropractice, as X-rays hold their own risks and shouldn’t be prescribed lightly, but by no means all Chiros use this so don’t be scared off unnecessarily. There is also a dearth of specific research on Chiropractic techniques, though again don’t let this put you off as just like other therapies the experience and individual knowledge of the practitioner plays a large role and research evidence from other fields often applies across the board. The only thing that might alarm you slightly is the huge BANG noise that the bed makes during the manipulation, as many Chiros use a ‘drop’ bed that physically drops beneath you to aid the direction and depth of the manipuation. Osteos I have met have questioned whether this technique’s effects are entirely positive as they favour ‘low amplitude’ manipulations – but here I am straying into an area of speciality that I can’t claim to unravel for you, so it’s best ask your Chiro or Osteo to explain this directly. The Chiropractors I have met and visited have all had excellent knowledge and certainly have a loyal following of repeat customers. Just bear in mind that the appointments tend to be much shorter than Physios or Osteos (around 15-20 minutes), but with a price tag to match.
For further information on the history of Chiropratic, read More Here.