This is a question we are often asked. We have chosen to train and practice as osteopaths, but this does not mean that osteopathy is better than other systems of health care – it simply reflects our own choice.

Osteopaths, physiotherapists and chiropractors are all manual therapists principally involved in treating musculoskeletal dysfunctions or injuries. Practitioners from all these professions are very knowledgable about human structure and anatomy. No version of manual therapy is necessarily better than any other – there is no monopoly on wisdom and we take the view that we can all learn from each other. The common goal is to try and help the patient.

What follows is a thumbnail sketch of physiotherapy and chiropractic. A very brief outline cannot do justice to the years of tradition and practice that each represents. The situation is further complicated by two other factors. Firstly all our professions are changing in response to the need for evidence-based medicine; and secondly each individual practitioner will practice in their own individual way, and with a different interpretation of the overall tenets of each profession.

Physiotherapy

Physiotherapy is a science-based healthcare profession which sees human movement as central to the health and well-being of individuals. Physiotherapists (‘physios’) identify and maximise movement potential through health promotion, preventive healthcare, treatment and rehabilitation. The core skills used by physiotherapists include manual therapy, therapeutic exercise and advice and the application of electro-physical modalities. In the UK, all physiotherapists have to be registered with the Health Professions Council (HPC).

The profession was founded at the end of the nineteenth century by nurses who wanted to establish medical massage for patients to speed their recovery. In due course the Chartered Society of Massage and Medical Gymnastics was founded which became in 1944 The Chartered Society of Physiotherapy (CSP) (http://www.csp.org.uk).

CSP is the professional, educational and trade union body for the UK’s 48,000 chartered physiotherapists, physiotherapy students and assistants. Physiotherapists work in a wide variety of health settings such as intensive care, mental illness, stroke recovery, occupational health, and care of the elderly. About 70% of physiotherapists work within the National Health Service and the remainder work in private practice. Some large firms now employ physios and many are attached to gyms and fitness clubs.

The profession is now a graduate profession. There are now 37 universities in the UK, running 58 different programmes and the majority of courses are three-year full-time BSc programmes. ( Roberts, L (2008). Physiotherapy: an overview. Backcare http://www.backcare.org.uk/779-5128/Physiotherapy-an-overview.html )

Chiropractic

Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to mechanical dysfunction of the joints, particularly those of the spine, and their effects on the nervous system. Working on all joints of the body, but concentrating particularly on the spine, chiropractors use their hands to make specific adjustments designed to improve the function of the joints thus helping to relieve pain, muscle spasm and increasing the range of movement in a joint. Chiropractors frequently use diagnostic procedures, such as X-rays, MRI scans, blood tests, and urine tests.

The Canadian Daniel David Palmer developed chiropractic at the end of the nineteenth century. Chiropractic is legally regulated by the General Chiropractic Council (GCC). It is against the law for anyone to practice as a chiropractor if they are not on the GCC register. The British Chiropractic Association (BCA) is the largest and longest-standing association for chiropractors in the UK, founded in 1925 (http://www.chiropractic-uk.co.uk).

Chiropractic is a graduate profession. In the UK there are over 2,000 practising chiropractors. Most work as private health care providers, although some do provide services through the NHS (http://www.backcare.org.uk/CMS/files/603-chiropractic.pdf)

What are the differences?

All three professions – osteopathy, physiotherapy and chiropractic – treat similar patients and similar conditions. Not every practitioner practises in the same way, and each profession will encompass a wide range of different styles of practice. The following generalisations remain simply generalisations.

Both osteopaths and chiropractors are recognised in law as primary healthcare practitioners – which means they are diagnostic and not just remedial: they have a duty to ensure a patient is safe to be treated, and that their treatment is appropriate to the diagnosis they make. Physiotherapists are not primary healthcare practitioners: patients are treated following a physician’s referral and diagnosis, or are self-referred.

Chiropractors view most dysfunction as due to spinal misalignment. Osteopaths look at all the other areas of the body as well as the spine. Osteopaths and physios will tend to rely more on physical examination and will refer on to GPs and specialists for further tests such as X-rays or MRI scans. Chiropractors frequently use X-ray examination as a routine procedure.

Chiropractors emphasise influencing the nervous system by “adjustment” which is a manipulative thrust technique to the spinal vertebra, which may result in a “crack” or cavitation of the joint. Osteopaths commonly use thrust techniques, but also focus on the soft tissues with massage and stretching techniques. There are changes taking place within the professions, with a degree of convergence between them: many physios also perform manipulations; many osteopaths manipulate less or not at all. Osteopaths generally employ a wider range of manual techniques than the other two professions.

Physiotherapy is the only profession that is established within the NHS, for historical reasons. Physios frequently work in gyms or similar spaces and use stretching and strengthening of muscles and employ exercise as an important modality. Exercise and life style changes and stress management are seen as increasingly important by all three professions.

Chiropractors tend to see patients more frequently on the basis that a number of adjustments over a course of time are required for the spine to settle into its proper alignment. Osteopaths tend to spend more time than either of the other two professions with their hands on, palpating and working manually. Generally osteopaths spend more time with their patients, but see patients for fewer sessions.

Do the differences matter?

Our experience is that patients get better when there is a good relationship between the patient and the practitioner.

The actual techniques themselves, provided they are performed competently, seem to matter less. Practitioners learn from each other and from different professions and perhaps the best advice for patients is for them to try different therapies and find the one that works for them as individuals.