Chiropractic VS Physiotherapy

What’s the difference between a physiotherapist, a chiropractor, and an osteopath? and other commonly asked questions

This is a question we get asked all the time and one, which can produce widely different responses depending on your background. Below is our view, based, as ever, on the available evidence.

There are many similarities between the professions which include;

• we all treat musculoskeletal pain conditions;
• we all have protected titles, meaning that a therapist cannot call themselves an a Chiropractor, an Osteopath or a Physiotherapist, unless they have completed the relevant accredited course;
• we all have university based education.

Put simply, the main difference is in the philosophy of each profession. However, there are also fundamental differences in the approach we take with people.

Chiropractors will generally treat pain related problems using manipulation of the joints (adjustments), either of the spine or the limbs. Manipulation is a fast manual technique that takes the joints being treated to the end of their available range of motion. This is commonly viewed as a treatment with more risk to the individual that is not always necessary ( Both Physiotherapists and Osteopaths will use manipulation, but it is generally, not seen as a first option in treatment as it is in Chiropractic. Also, the chiropractic philosophy relies on the belief that the cause of back pain lies with subluxations, or certain joints being 'subluxed' (not to be confused with the medical definition of a subluxation, which is the incomplete or partial dislocation of surfaces within a joint). This belief is controversial, even within the chiropractic profession, as a ‘chiropractic subluxation' has never been shown to exist. If one had to define a Chiropractic subluxation, it could not be done within an objective scientific (evidence based) framework . In their defense Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic, has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on x-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static x-ray than a limp or headache or any other functional problem' (Wikipaedia, David Chapman-Smith (2000). "Principles and Goals of Chiropractic Care". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. NCMIC Group. pp. 160.ISBN 1-89273-402-8.) This stance may seem reasonable, but many chiropractors still endorse using static x-ray to identify the ‘chiropractic subluxations’. This obviously makes no sense when it is admitted that it is not visible on X-ray. Using X-ray in diagnosis of this sort has been condemned as dangerous, as it exposes individuals to levels of potentially carcinogenic radiation for no reason, as well as being of no use in the diagnosis of non-specific low back pain.

There are also issues regarding safety of chiropractic in the treatment of neck pain. Chiropractors are associated with more serious adverse reactions than other health professionals (E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice 64 (8): 1162–1165.). Whilst many Physiotherapists and Osteopaths will use manipulation of the cervical spine, Chiropractic treatments of the lower back may often involve neck manipulations. There is no evidence that manipulation of the cervical spine will have a positive effect on a person’s low back pain.

Although there is some evidence to suggest that chiropractic is as effective for low back pain as other mainstream treatments, Chiropractic has been labeled as quackery in relation to it’s claims regarding treatment of medical conditions such as asthma, ear ache, colic or sexual dysfunction (Trick or Treatment, Alternative medicine on trial S Singh, E Ernst 2008). This is simply because there is no evidence that it works for medical conditions, and there is no reasonable mechanism through which it should work, other than through placebo.

Osteopathy is also a manual therapy based treatment of the musculoskeletal system, and like Chiropractic, there are divisions of Osteopathy that believe in the treatment of non-musculoskeletal medical conditions such as respiratory or digestive conditions through mobilization / manipulation of the spine. The inappropriate use of manual therapy for these types of conditions has been covered above.

Generally, Osteopaths will use manual, hands on techniques to restore structural alignment with the aim to improve pain and function. They commonly do this with more gentle techniques than manipulation, but can manipulate. The osteopathic philosophy is based upon the belief that in order for the body to be healthy, all body tissues are required to move according to their function. The Osteopathic philosophy maintains that it movement exists and is balanced then good health will follow. This absence of movement is assessed through manual palpation. For the most part this philosophy seems fairly rational and logical. However, when looking at pain related problems, in the spine for instance, structural symmetry rates very poorly in whether someone recovers well or not. Outcome is dependant more on a person’s belief about their spine, (Grotle M, Brox JI, Veierød MB, Glomsrød B, Lønn JH, Vøllestad NK. Clinical course and prognostic factors in acute low back pain: patients consulting primary care for the first time. Spine. 2005;30:976). A focus on the quantity of movement as being the underlying cause of pain related problems neglects the influence of the mind and its huge influence on whether someone even experiences pain or not. This clearly contradicts the current view in the management of all pain related conditions.

In certain areas of Osteopathy, such as Cranio-sacral Osteopathy, this structural approach has developed beyond rational anatomical science, since these areas either do not move (Adult cranium) or are certainly not detectable by physical palpation (Sacro-iliac joint, van der Wurff P, Hagmeijer RH, Meyne W. Clinical tests of the sacroiliac joint. A systemic methodological review. Part 1: reliability. Manual Therapy 2000a;5(1):30–6; van der Wurff P, Meyne W, Hagmeijer RH. Clinical tests of the sacroiliac joint. A systematic methodological review. Part 2: validity. Manual Therapy 2000b;5(2):89–96). Unfortunately, this area of Osteopathy has made its way into some physiotherapy circles. It is our belief that this type of treatment has no place within a science based profession.