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Chiropractor, Osteopath or Physiotherapist?

Who To See

Difference in Treatment: Chiro, Physio, Osteo

This is a question I’m sure that all chiropractors, osteopaths and physiotherapists have encounterd from patients at sometime in their practices: “What is the difference between a chiropractor and an osteopath or physiotherapist“.

Well since it is a common question patients might ask whichever practitioner is treating them I thought I might try help answer the question for you today. 

Chiropractor/Osteopath/Physiotherapist

Here are some of the points to compare each profession with.

We are all Manual Medicine

All three; chiropractor, osteopath & physiotherapist, use manual medicine to treat a person. This means they will use predominantly hands-on techniques or external electrical therapeutic machines like ultrasound, interferential therapy or low level laser therapy .

Different Treatment Techniques

Chiropractors tend to use quick thrust, short lever spinal manipulation techniques. Chiropractors like to term this, an adjustment. This means to click your lower back the would place their hands on that spot where movement is needed. Osteopaths and certain physiotherapist trained in post-graduate manipulation techniques will do the same.

Osteopaths will also use long lever techniques and be able to perform cranial osteopathy techniques. Crainial osteopathy is unique in that some osteopaths will treat various conditions by working on the cranial sutures (joints).

Physiotherapists tend to use their hands to work mainly on soft tissues like muscle, ligaments and tendons using various techniques to treat things like muscle trigger points. They are also likely to utilise electrical treatment tools like ultrasound. Chiro’s and osteo’s are also trained to use these electrical treatment devices.

Chiropractors might also use what are termed low force techniques with an instrument spinal manipulation tool like the activator. The aim is still to provide the quick thrust movement with a lower force than used with a hands on manipulation. You won’t hear the typical joint clicking sound with this type of manipulation.

Prescribing Home Exercise Rehabilitation

All three professions will provide rehabilitation education to do at home. With manual medicine treatment success it is not only what the healthcare professional does to you, but what you do to yourself.

Poor movements and posture repeated will slow down healing and recovery. Different types of exercises are prescribed to help improve your overall posture and movement habit to help your body heal.

Using Dry-Needling and Acupuncture needles

In the UK, the dry-needling technique is becoming a very popular technique to treat muscle trigger points instead of using massage. PLease understand that there is a difference between dry-needling and traditional Chinese acupuncture. Dry-needling technique uses acupuncture needles in order to get into the muscle knot (trigger point). In UK training colleges and universities, this is a post-graduate course or CPD course that any chiropractor, osteopath or physiotherapist can learn. My basic understanding is acupuncture needles are placed on acupuncture points. An acupuncturist is not just looking for muscle knots which is why for a headache they might put a needle some where far away from your head.

X-Rays/MRI scans and Blood Tests

UK trained chiropractors are taught both how to take x-rays and use an x-ray machine (radiography) and how to read and interpret x-rays for diagnosis (radiology). Some chiropractors will have a x-ray room in their clinics to take an x-ray of your neck or low back without referring you out for one.

I’m not quite sure and can’t see in various UK course outlines if UK trained physiotherapists spend a specified time studying how to use an x-ray machine and then how to interpret the x-ray films. I know physio’s do refer out for x-ray’s.

UK trained osteopaths are taught radiography set-up positions and then how to interpret x-ray findings for the diagnosis. They can refer out for further imaging studies.

I believe all three can refer for further specialised diagnostic imaging, like an MRI scan of your spine. Some may order blood tests for further help with differential diagnosis of various conditions. These diagnostic tests would be a private option for the patient and not performed through the NHS.

NHS

You definitely can see a physiotherapist for treatment on the NHS or you can pay for private physiotherapy treatment.

Very few chiropractors are on the NHS and osteopaths. Both professions tend to be private healthcare treatment paid for by cash by the patient or some health insurance companies. You would need to first ask your local GP if there is an option in their surgery to see a chiropractor or osteopath paid for by the NHS.

Prescribing Medicine

Neither a, chiropractor, osteopath or physiotherapist has prescribing rights for scripted medications. To get painkillers and anti-inflammatory medicines you will need to speak to your local pharmacist for over the counter medication or a medical doctor for prescription only medication.

So Who Do You See?

Yes this is a tough question for a patient.

I personally believe that each practitioner does a bit of treatment work like the other do, to a degree. However each professional has traditional specialities. What I mean by this is that chiropractors and osteopaths spend a lot of time practising joint manipulation. Osteopaths are also exposed to cranial manipulation which chiropractors are not in Chiropractic colleges.

Understand that each chiropractor, osteopath and physiotherapist will take their formal education degree training and apply the knowledge gained in their own way. Most will develop a special interest over time. This might be a specific treatment technique or treating a particular condition. For example, you might consult with different chiropractors and experience different manipulation treatments using: diversified technique, Gonstead technique, Thompson drop technique, Activator method etc…

Some other decision making questions to help you decide who should treat you might be:

  • Go on word of mouth recommendations from friends or family who have been treated.
  • If it is straight after or within weeks of surgery then a physiotherapist might be the best.
  • If money is a problem and you want it “free”, then physio is likely your only option. Maybe your local GP can get you Chiropractic or Osteopathy treatment on the NHS but you’d need to ask them.
  • Speak first to your local osteopath or chiropractor about your problem. Call up a local clinic and ask them if they could help your situation.

Like I said earlier this is a grey question and not always a black and white answer. It can be very hard to say in words the exact difference between all three professions. For example I have had people say when they have seen me for low back pain treatment that is was very different to what they got at a physio. I have people say they have experienced physio, chiro or osteo treatment now they can compare them because of they way they were treated. Either way, all three are based on non-surgical treatment options (conservative care) to try get you better. Whichever one you decide to go with I hope you feel better. You can also ask the three government regulatory bodies: General Chiropractic Council , General Osteopathic Council or Health Professions Council UK for an answer to what’s the difference.

Image Credit: Some rights reserved by Orin Zebest

  • Hi Jeremy, I meant no disregard to the difference in the skill of x-rays findings interpretation and diagnosis (radiology) between chiro’s and osteo’s. My original understanding from when I started studying Chiropractic in the UK in 2000 was that UK chiropractors were trained how to physically use the x-ray machine, patient set-ups and how to develop the films, before digital x-rays, Whereas that wasn’t the case in the UK Osteopathic institutes at that time. I did some research on the course outline at the European School of Osteopathy and see that some radiography and radiology is taught. I have updated the x-ray question section to, hopefully, clear up that answer.

    I would like to learn from you, as an osteopath, if you were taught as a student how to adjust the exposure settings (Kv mA) on a x-ray unit for different patients sizes, did you then have to take actual x-rays and then perform film development afterwards before interpreting the films? I think this is where the age old confusion is between chiro’s and osteo’s. I do understand the diagnostic and referral-out part is the same. Like you said, just want to get my facts right. I have friends who are osteo’s and physio’s and value their input on cases. Always good to bounce ideas off each other.

  • disqus_bCErHgOd5N

    if osteopaths do not include x-ray diagnosis in their training why did I spend two years as part of my osteopathic training learning radiology. And why do I refer patients for x-ray, MRI and CT scans? Please get your facts straight jeremymkenton@aol.com

  • Thanks. I didn’t know US DC’s couldn’t get licenses for dry needling. I do know the scope of practice can differ quite a bit between each state. I see your practices are in California, nice place to be I’m sure.

  • Anonymous

    Great Post Doc. I don’t think we have an option here in the USA to get a licence for Dry Needling Acupunture.