Osteopathy, physiotherapy and chiropractic are three similar yet distinct disciplines offering treatment for musculoskeletal conditions. Whilst similar it can be difficult to know which of these approaches is best suited to an individual’s needs.
Each discipline has its own rationale for the different techniques and approaches used, with each approaching the human body from a slightly different perspective. All practitioners aim to improve mobility, optimise function, reduce pain and ultimately improve the patient’s overall well-being.
For someone looking to begin a career in manual therapy, it can be tricky to decide on which path to take. Helping people with physical issues like back pain and helping people recover from an injury can be a hugely fulfilling career. Understanding the difference between osteopathy, physiotherapy and chiropractic care is important when thinking about the type of conditions and patients you may wish to help. Equally one must consider the working environments you may see yourself in be that a hospital, community centre, people’s homes or even private practice.
At the core of osteopathy is the belief that the wellbeing of an individual depends on how the bones, muscles, ligaments, and internal structures of the body work together. It’s a treatment which applies the practitioner’s in-depth knowledge of anatomy with gentle hands-on techniques to improve function and therefore ultimately reduce pain. Like physiotherapists, osteopaths are now recognised as Allied Health Professionals (AHPs) with NHS England, as of 2017.
Osteopaths are very patient centred and look to understand a patient’s unique combination of symptoms, medical history, job and lifestyle. Following a thorough case history and physical assessment, they aim to formulate a diagnosis that focuses on the cause of the patient’s pain rather than just treating the site of the pain. They help treat a wider range of musculo-skeletal conditions than one would imagine including some functional problems, such as circulatory issues and digestive system disorders. Osteopaths spend longer with patients which allows them time to listen and to really understand their patient’s perspective of their problem; their fears, concerns, goals and expectations of treatment. This holistic approach addresses the mechanical aspects of the anatomy as well as the psychological making it a more global approach.
Osteopaths often provide guidance on posture and exercises that will aid recovery and promote flexibility, to prevent symptoms from reappearing. They also typically work alongside other health professionals such as doctors, nurses and midwives, or alternative medical practitioners, to complement their treatments and create a holistic recovery plan. The training is four years, full time, leading to a recognised qualification, either a BSc or Integrated Masters, allowing them to apply for professional registration with the General Osteopathic Council (GOsC).
There are several ways to qualify as an osteopath depending on your situation. You can either apply for a 4 year full time Master of Osteopathy (MOst) or a 4 year full time modified attendance BSc (Hons) Osteopathy .
The definition of a physiotherapist is someone who helps to restore movement and function in patients as close to normal as possible after they’ve been affected by an injury, illness or from a developmental issue or disability. Physiotherapists may assist patients with neurological conditions, those recovering from surgery and those with cardiovascular or respiratory conditions. As Allied Health Professionals within the NHS, physiotherapists may work within multi-disciplinary teams and with other AHPs such as occupational therapists and podiatrists. They may work alone with patients or sometimes in pairs, for example when helping people to walk again after suffering a stroke.
Physiotherapy is primarily offered within the NHS and patients are usually referred by their GP. Physiotherapists occasionally use hands on soft tissues techniques to relax tight muscles and to enhance mobility. They typically work with the affected area. So, if you have a knee injury, a physiotherapist will target their treatment around that area exclusively. They are trained with an emphasis on exercise-based pain management and generally provide patients with a set routine of strengthening and flexibility exercises depending on their pain and condition. They may often use adjunctive treatments such as dry needling (similar to acupuncture) and therapeutic ultrasound.
Physiotherapists too have an in-depth knowledge of anatomy and physiology and spend much of their three year degree course on placements in various clinical settings. This helps them to build up a broad knowledge and assists them with decisions about which area to specialise in, for example, working exclusively with cardiac patients.
Chiropractic stems from the early beginnings of osteopathy. Chiropractors tend to work with spinal dysfunctions or ‘subluxations’ on the understanding that spinal malalignment may affect local nerve supplies to the various structures and organs of the body. This impeded nerve supply is thought to be responsible for a number of musculo-skeletal conditions and visceral complaints. Similar to osteopaths their palpation skills are honed to be detect joint dysfunctions which they then look to correct, sometimes called ‘adjustments’, using short, quick manoeuvres which produce a ‘click’ to improve the mobility of a specific area. They also provide treatments that deal with the impact these disorders can have on general wellbeing and the nervous system.
Chiropractors use a variety of techniques to treat and prevent pain and improve mobility, including hands-on manipulation of the spine and joints, and offering advice on self-help and therapeutic exercises. They may also use heat, ice, ultrasound and dry needling to provide pain relief.
Stereotypically, chiropractors have specific knowledge of neck and back pain, but when treating patients, they will take the entire physical and emotional wellbeing into account. The training is four years long with a qualification that leads to registration with the General Chiropractic Council (GCC).
Ultimately, the main difference between these three disciplines is the treatment rationale of each specialism. While all profess to treat musculo-skeletal conditions and and the various areas of the body, the approach is different with each practitioner. Treatment may also be dictated by the type of injury and the symptom picture that the patients presents with.
Patient preference and previous experience will also play a part. For example, some people may not like the idea of their joints being clicked, which may rule out practitioners that manipulate joints. Some may prefer a more a gentle approach where muscles are softened, and joint tensions gently released and others may just want to be supervised with exercise regimes.
Whichever practitioner a patient decides to go to for their musculo-skeletal complaints, they must ensure they are registered professionals with their respective regulatory bodies.