What is the difference between a chiropractor, physiotherapist and osteopath?

There is a lot of variation in how all three practice. As a general rule, chiropractors work to correct illness and injury by restoring the body's ability to heal and maintain itself through a healthy nervous system. They do this by manipulating the spine to correct nervous system interference. Improved nerve system function means that the body is better equipped to fix itself. Chiropractic treatment usually involves gentle manipulation of the spine, corrective exercise, and often corrective nutrition.

The physiotherapists I work with focus more on the local area of injury. For instance, stabilizing the injury with tape, reducing pain with ice and ultrasound, and assisting rehabilitation with exercise and soft tissue therapies.

Although there are many similarities between osteopathy and chiropractic, osteopaths tend to work a little differently. For instance, they don't usually use X-ray to assess the spine and their emphasis is typically more on muscle and joints than on the nervous system. Osteopaths in my experience include a lot of soft tissue therapy, such as massage, in their treatments, as well a more generalized mobilizing of the spine.

Hi,

As Dr. Powderly said above, there is a large variation between professions, and also between practice styles within a profession. An example of this is the use of soft tissue therapies which are generally associated with physiotheapy, but which chiropractors are also trained to use. Some chiropractors, such as myself, employ these technques a fair amount (I have also completed a course in dry needling which is similar to acupuncture) to treat localised injury in conjunction with adjustments for neurological benefit; while others prefer to treat primarily with spinal adjustments to enhance nervous system function.

There are also various niches within a profession, for example, one physiotherapist may work primarily with athletes, and specialise in treatment modalities which will be best suited to this; while anothe physiotherapist may work with the elderly and, as I'm sure you can appreciate, the same treatments might not be suitable here.

It is best to talk to your specific health professional and see if you are comfortable with their treatment style. We all realise that patients will have preferences toward one thing or another, or their particular condition will respond differently to different treatment schedules. You needn't fear we will be upset or insulted if you change practitioner!

Hope this helps.

- Dr. A

The World Federation of Chiropractic defines Chiropractic as a system of healthcare concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. With a view to the outcome of individual wellness, the chiropractor helps each individual understand more about helping themselves with diet, exercise, lifestyle and educates them of their own body’s innate healing capacities.

Maybe we could call upon some of the Physiotherapists and Osteopaths within Healthshare to give a definition on their profession?

That is always a question I get asked by a lot of my patients. We do treat similar conditions, though our methods do change quite a lot. A chiropractor will generally be quite spine-orientated; they use a lot of adjustments, cracking of the joints, and tend to concentrate around the spine to treat other musculoskeletal problems. A physiotherapist will treat musculoskeletal problems, but will treat those problems at the site of the pain, generally; if you got a sore shoulder, they will just mainly work on that sore point of your shoulder. As an osteopath, we incorporate a few chiropractic and a few physiotherapy-type techniques, and we tend to treat a bit more holistically.

Again, I will use the example of the sore shoulder. If you had a sore shoulder and you saw an osteopath, I would do a little bit of work on your sore shoulder, but I would also look at other areas that may be contributing to that pain. Rather than just treating the symptoms or the pain that you have, an osteopath will look at what the actual cause is. We will try and do treatments that help the cause of the problem, which in turn will help those symptoms reduce.

All great snwers so far. Once again i agree we all may use similar ways to treat. I think it is important though to emphasise physios do not just treat the local area site. When treating something such as shoulder pain a physio will do a full assessment and look at all the areas and biomecahnics (how the body moves) to determine why the injury occurred, what needs to be done to settle the pain or inflammation and then what strategies need to be put in place to correct and prevent reccurence.

Styles can vary between hands on treatment, electrotherapy, manipulation and exercise based rehab. The big focus though is always achieving self management and independence of the patient so that there is not a continuing reliance on the therapist.

Good answer Jason. Physiotherapists definately do not just treat the local area - in the case of the shoulder injury, physiotherapists will look at the local area and the pathology, stage of pathology at the local area, but also look at whether the shoulder is actually the source of pain - often it will be a referral from the neck for example.  As Jason pointed out, as well at making a diagnosis regarding the presentating problem, physiotherapists will look at other causative factors such your sporting technique/posture/neuromuscular control and so forth and address these areas so prevent recurrance of injury (or from injury ocurring in the first instance).  

The treatment will be reflective of the assessment findings and how the physiotherapists has prioritised those assessment findings for the individual patient and will include local areas, referral areas, caustive factors and so forth and techniques may include joint mobilisation, joint manipulation, massage, trigger point therapy, dry needling, taping and bracing, electrotherapy, neural mobilisation, posture correction, movement correction, neuromuscular control training, stretching, education, ergonomic correction and so on and so forth.

Always a big part of Physiotherapy treatment, is getting the patient actively involved in their treatment and allowing the patient to become independant.  Physiotherapists want to get you better, so you don't have to keep coming back forever - we may do a check of exercises once every few months if necessary, but this is more about ensuring that you are able to look after yourself.

Physiotherapists don't just work in the sports and musculoskeletal areas, but in fact work in almost all areas of medicine - so you will see physiotherapists working on cardiac wards, on respiratory wards, with developmental issues in babies and the list goes on.  This is a very important distinction because in the training for physiotherapy you look at the entire body and all the systems of the body and how these all interact.  I'm a sports physiotherapist - but I use things I learnt about the rehabilitation of stroke patients, the development of infants and respiratory conditions every day.

Physiotherapists have also been very active in research and place enormous emphasis on evidence based practice.

I agree with the Physios above. There is a lot of confusion with regards to what each health professional does and which type of treatment may be beneficial. For example if someone has a tooth problem they are likely to see a dentist or a cardiologist for heart problem  or a neurologist/neurosurgeon for brain and associated issues.

However with respect to musculoskeletal problems, members of the community may often be confused as a low back pain could be treated with some massage, chiropractic adjustments or osteopathy. Who does a better job depends on the therapist's skills and awareness of their limitations. I believe Physiotherapists are more closely associated with the medical fraternity and have a deep understanding of the actual anatomy, physiology and pathology of human body.

 It is for this high level of knowledge and skill that you will find Physiotherapists employed in various aspects of health care. Physiotherapists work in ICUs in hospital for post-operative care to Out Patient Departments for various orthopaedic and post-operative problems. They are also employed in specialised rehab centres for stroke and brain injury and vestibular rehabilitation (dizzines and balance issues) or pulmonary rehab (COPD: asthama, emphysema, etc.) Physiotherapists can help with elite sportsperson's training and injury management to your ‘run-of-the mill’ sore neck and headaches or specialised Occupational Rehabilitation. And last but not the least, with aged and disability care.

There are sub-divisions within the Physiotherapy field as briefly outlined above. Each practitioner may employ a different treatment approach based on the patient presentation and therapist's Clinical Reasoning and experience in dealing with specific field/conditions. 

Within physiotherapy, there is a range of techniques and methods that are used. 

After many years of seeing people suffer I decided to focus my expertise on the McKenzie Method.  What this means is that I typically see people 3-4 times and my goal is always to show you how to stop that pain from coming back.  You are shown specific pain relieving exercises, importantly what exercises and movements that you have to avoid and how to improve your posture.

For more information about the McKenzie Method, “google it ” and you will find more details.

It's a great question and agree with a lot of my learned colleugues above. In regards to differences between the professions they are becoming less and less. An evidence based physio, chiro or osteo are likely to perform a similar multimodal approach to an injury.

As the professions develop and the evidence evolves I'd opine that within 20 or 30 years or so you'd be likely so an amalgamation of the 3 professions.