Physiotherapy, chiropractic and osteopathy: What's the difference?

If you’ve ever had a sore back, neck or knee, there’s a good chance you sought some kind of treatment for it — most likely from a physiotherapist, chiropractor or osteopath.

The distinction between the three can be extremely confusing at the best of times.

Without knowing too much, it can seem these allied health professionals practise much the same thing: non-invasive, drug-free, manual techniques, which aim to improve physical health and wellbeing.

But scratch the surface and you’ll find claims and counter-claims about which method is most likely to work for you.

So who and what do you believe? We take a closer look at each profession to find what they do and how their approach differs.

Physiotherapy

Physiotherapists specialise in the diagnosis, management and prevention of movement disorders.

The aim of physiotherapy is to rehabilitate and improve a person’s ability to move and function, and physios use their expertise in anatomy and physiology to assess and treat people with a range of health conditions.

While physios are mostly known for their treatment of sporting injuries and neck and back pain, they also work with premature babies, people recovering from stroke, those with brain or spinal cord damage, and people with conditions like Parkinson’s disease, arthritis, osteoporosis and cystic fibrosis.

Physios use a combination of manual therapy, movement training and physical and electro-physical agents. According to the Australian Physiotherapy Association, a physio “helps repair damage, reduce stiffness and pain, increase mobility and improve quality of life”.

Physiotherapy is an evidence-based clinical health science, and practitioners are required to use treatments only if their effectiveness has been demonstrated in scientific research. But as Dr Andrew Leaver, Senior Lecturer in Physiotherapy at the University of Sydney, points out, evidence-based practice is “not a black and white proposition”.

“True evidence-based practice is using the best available evidence that you have, and the best available evidence for any intervention is sometimes not that good,” Dr Leaver said.

“We don’t have robust clinical trials that prove the efficacy of every single thing that we do, but neither does any profession — a lot of medicine is not backed up by robust randomised controlled trials.”

Dr Leaver says physios use the best available evidence, apply “clinical reasoning and wisdom” and take into account the patient’s individual needs.

As part of physiotherapy, a practitioner will often prescribe a personal exercise program tailored to meet your body’s specific needs.

There is no charge to visit a physiotherapist in a public hospital (a GP’s referral is needed for outpatient visits) but waiting lists can be as long as several months, the number of visits may be limited, and there are fewer services in rural areas.

For private physios, no referral is needed. An initial consultation is likely to cost about $80.

In Australia, physiotherapists must complete at the very minimum a bachelor degree (usually four years) in physiotherapy, however many practicing physios have a masters or professional doctorate.

All physiotherapists must be registered with the Australian Health Practitioner Registration Agency.

Chiropractic

Chiropractors’ core focus is the diagnosis, correction and prevention of disorders of the musculoskeletal system (spine, pelvis, muscles, ligaments and joints).

Chiropractic is nearly always associated with spinal and neck manipulations, but it involves a combination of hands-on care, physical therapy modalities (ultrasounds) and exercise.

Despite chiropractic’s surging popularity, its proven benefit is fairly limited. The only really strong, often-cited evidence is for lower back pain — and a review of spinal manipulation found that it could alleviate back pain, but that it was no more effective than other common therapies, such as exercise therapy.

When it comes to back pain, however, Dr Leaver says this same critique could be levelled at physiotherapy and osteopathy, given the same mobilisation and manipulation techniques are employed across all three disciplines.

“We draw from the same pool of evidence … and you can oversimply things but equating a single intervention (such as spinal manipulation) with the name of one profession,” Dr Leaver said.

In recent times, the chiropractic profession has come under fire for promoting and practising unsubstantiated therapies that have not been subjected to rigorous scientific testing.

While some chiropractors claim to “treat” non-musculoskeletal conditions, such as infantile colic, bed wetting, asthma, ADHD, autistic spectrum disorders, period pain, ear infections and high blood pressure, there is no evidence to support these claims.

Critics argue these claims have the potential to be dangerously misleading.

The notion that spinal adjustment can improve or rectify a host of health conditions is based on a belief held by some chiropractors that misalignments (or “subluxations”) in the spine can impair nervous system function, leading to all kinds of human ailments.

By locating and “correcting” these misalignments, some chiropractors believe they can unblock so-called nerve flow and eliminate disease, infection and childhood illness.

This premise does not fit within current scientific understanding of disease (or how to eradicate it).

It is important to note, however, that many chiropractors reject this approach.

“The more evidence-based chiropractors are really limiting their scope of practice to muscular-skeletal conditions and specialising in the spine,” Dr Leaver said.

The chiropractic profession has also attracted criticism for the promotion of anti-vaccination views, and just last year, The Royal Australian College of General Practitioners discouraged its Fellows from referring to chiropractors.

Chiros work in private practice and do not require a referral. Expect to pay $100 on average for an initial consultation and between $60 and $80 for subsequent consultations.

A chiropractic degree takes five years to complete, and practitioners are regulated by the Chiropractic Board of Australia, which is part of the Australian Health Practitioner Registration Agency.

Osteopathy

Osteopaths work on the premise that posture, injury, or negative lifestyle patterns compromise anatomical structure and lead to poor health. As practitioners, they look at the relationship between the structure of the body and the way in functions.

According to Osteopathy Australia, practitioners “focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit”.

For example, if you see an osteo for a sore knee, they may also take a look at your ankle, pelvis and back. The practitioner might also ask about your medical history, as well as factors that don’t appear to be directly related to your current injury.

Like physios and chiros, osteos diagnose and treat injury using non-invasive, manual techniques; orthopaedic and neurological testing, soft tissue manipulation, massage, stretching muscle groups and spinal adjustments. They may also recommend exercises and dietary modifications.

Similar to chiropractic, osteopathy’s proven benefit is fairly limited; there is scarce high-quality research investigating the effectiveness of its “holistic” approach.

There is some evidence for its treatment of lower back pain, typically through spinal manipulation and manual techniques, but the benefits appear to be modest.

“With back pain, one of the things to stress is that we don’t have a cure for it — nobody does,” Dr Leaver said.

“A good osteopath will work under an evidence-based paradigm and use interventions on the basis of their proven efficacy.”

Patients of osteopaths commonly include those with back and neck pain, sciatica, headaches, joint pain, work-related and repetitive strain injuries and sports-related injuries.

Osteopaths work in private practice and do not require a referral. They typically charge $100 for an initial consultation, which is likely to last between 40 and 60 minutes.

An osteopathy degree takes five years to complete, and practitioners must be registered by law with the Australian Health Practitioner Registration Agency.

Finding the right practitioner

Whether you see a physiotherapist, chiropractor or osteopath, Dr Leaver says the most important thing is that you find a practitioner who “operates under an evidence-based paradigm”.

“So physiotherapy is not a treatment — it’s the person who provides the treatment. And similarly, chiropractic is not a treatment — it’s the person who provides the treatment.”

What you want to avoid, he says, is somebody who makes false promises of a cure and takes too much credit for natural recovery.

“You want to see someone who empowers you look after your own body, and to look after yourself, who teaches you good strategies for dealing with day-to-day pain,” Dr Leaver said.

“You don’t want to be seeing somebody who is holding out a false promise of a cure with lots of interventional treatment — so somebody who does lots of things to you, rather than teaches you to do things for yourself.”

Seeking medical advice

It’s important to remember that neither physiotherapists, chiropractors nor osteopaths are doctors — and medical advice should always be sought from a qualified medical practitioner.

If you’d like to visit an allied health professional but aren’t sure who would be the best fit, it’s wise to first consult your GP.

This post originally appeared on ABC News.