Osteopathy, physiotherapy and chiropractic care: what's the difference?

(Or, a brief history of the manual therapies.)

I must admit, I’ve been avoiding writing this blog post.

One of the most common questions I am asked is ‘what is the difference between osteopathy, physiotherapy and chiropractic care?’, and my answer depends on a couple of things: how much detail the person asking the question wants, and how much time they have.

There are differences but, in saying that, there are also differences between practitioners in each profession, so it’s a difficult question to answer succinctly.

To get a better idea of how they differ, first you need to know a (brief) history of each of the professions.

Osteopathy was founded in the USA in 1892, by a doctor named Andrew Taylor Still. As a doctor, Dr Still grew wary of the medicine of the time, as he believed it often caused more harm than good. In the 1890s, we were still frequently treating patients using arsenic, castor oil, whiskey, opium and heroin, so he was probably right in many ways.

The last straw for Dr Still came when he was unable to save three of his children from spinal meningitis, and another from pneumonia, despite treating them to the best of his ability following the medical protocols of the day.

He decided that there must be a better way to find health, and osteopathy was born. At the time, osteopathy was deemed an “alternative” to conventional medical practices. Dr Still believed that by correcting any misalignments throughout the body, everything else was allowed to function better.

For instance, poor posture or breathing may affect blood flow through the arteries near by, or spinal compression or tightness may affect nerves going down the legs.

He saw this as a much less harmful way to improve health, and osteopathy was touted as being able to assist everything – including infection, gangrene, deafness and many others.

Physiotherapy was born a few years later; in Australia, that was 1906. At the time, massage therapists worked in hospitals to keep patients comfortable and to help prevent bedsores. These therapists teamed up with nurses around the time of the First World War due to the amount of injured soldiers returning from war. They needed to come up with ways of rehabilitating these injured soldiers, and physiotherapy was solidified in the Australian healthcare landscape.

Chiropractic care was invented when one of Dr Still’s students decided that the majority of disease in the body seems to stem from the spine and spinal nerves, thus manipulation of the spine could affect the rest of the body.

Today, we live in a very different world medically. The treatments we have at hand are amazing, and no longer cause more harm than good.

I believe that osteopathy has moved with the times; no longer do we claim to cure infections or deafness (antibiotics and ENT specialists are far more effective than any of us could ever be!), and we’re certainly no longer an “alternative” to conventional medicine. Rather, we are a “complementary” therapy that works with, not against, our doctors.

So, from a philosophic point of view, most osteopaths will still stick to some of the broader principles of treatment – including looking at the whole person rather than just a symptom and taking into account vascular health, nerve health, musculoskeletal health and mental health in order to assist with a complaint.

Most chiropractors will assess and treat the spine, before they move on to other things.

Most physiotherapists will include some kind of rehab in their treatment plans (exercises).

Having said that, we all do all of the above. I certainly assess spines, I certainly include rehab. I know physios who have more of a “whole body” emphasis than I do, and I know chiros who don’t often manipulate spines.

The reason there’s now so much overlap is that we have evidence to support what works and what doesn’t when assisting our patient’s musculoskeletal ailments. We all try and go for what we know works, so we’re all pinching a bit here and there from each other.

When choosing a practitioner, the main concern you should have is finding someone you trust and are comfortable with. The qualification is a consideration, but less so than it was 120 years ago.

About the Author:

Claire Richardson is a registered osteopath. To learn more about osteopathy or to find an osteopath in your local area, visit the Osteopathy Australia website.

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