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What’s the difference between osteopathy, chiropractic and physiotherapy?

Now, this can get quite technical and when it comes to treatment they can appear very similar to the layperson but in fact the theoretical differences and therefore the differences in treatment approach can be quite different.

All three are based on physical therapy of the body; using hands on treatment to bring therapeutic relief for mostly musculoskeletal problems.  There is a lot of cross over in techniques used and obviously a lot of common theoretical ground.

I’m going to use as an example a patient presenting with low back pain.

As a general rule, physiotherapists tend to be the ones most closely associated with purely musculoskeletal therapy.  They usually have a diagnosis given to them by a doctor, possibly with a scan and tend to have a fairly systematic approach to treatment which is often less hands on and often more exercise based.  They will not usually take a complete case history and will not usually be able to diagnose non musculoskeletal problems.  Treatment will usually focus only on the affected body part (the lower back in this example) rather than looking at the rest of the body to see how that may be affecting it so in this case therapy is directed at the spine itself.   This is the physical therapy most closely associated with conventional medicine.  They would also often be associated with non-spinal conditions such as shoulder or knee problems.

Chiropractic theory holds that problems with the body are often due to misalignment of spinal vertebrae and treatment will nearly always involve spinal manipulation (‘clicking’), often of every part of the spine.  Treatments are usually shorter – 15 or 20 minutes and massage and other additional treatments are kept to a minimum.  Often patients are booked in for a series of treatments and typically need a greater number of them.  They can take a full medical case history and should be capable of diagnosing non musculoskeletal conditions.

In the case given, the chiropractor would try to relieve strain in the lower back by getting the whole spine moving through manipulation of every part from the neck down and would not normally treat non-spinal conditions nor look at lifestyle factors to the same depth as an osteopath.

Osteopaths tend to be the more ‘holistic’ of the three – that is the one which more readily consider other factors to the pain presentation than just the part which hurts.  A full medical case history would be taken and diagnosis made by the osteopath, whether the presenting problem is musculoskeletal or not.  Fully trained to be a primary healthcare provider, the osteopath would be able to refer the patient to another appropriate practitioner if required.

With treatment of the lower back in the case given, the osteopath may well be interested in seeing how the patient moves, and how the legs and pelvis affect spinal movement as well as the factors the other two practitioners consider.  Additionally other factors, such as diet, weight loss, stress or other lifestyle factors should be considered.

A typical osteopath should be more capable of tailoring the treatment appropriate to the individual using a wide range of techniques where suitable such as acupuncture, biomechanics or massage and are equally capable of treating both spinal and non-spinal conditions.

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