Chiro Vs Osteo Vs Physio: A Difference Of Opinion

Two of the most common questions I get asked in the clinic is “What’s the difference between an Osteopath, a Physiotherapist, and a Chiropractor?” or “Which is better, Chiro, Physio or Osteopathy?” My opinions are formed over many years of experience.

My experience contains my biases. My biases are neither bad nor good, they just are! My experience then affects my opinions. This cycle is constantly repeated, and success or failure is a byproduct of this repeated cycle. I’m an Osteopath. I have a differing opinion on many things than a physio or a chiro. On some things, we share a similar opinion.

Whilst this article will contain some facts, it’s ultimately, like all things I say, my opinion. To me, one thing has made itself evidently true though. A great therapist and a bad therapist (yes there is such a thing) will generally always have a significant difference of opinion.

Chiropractic, Osteopathy & Physiotherapy. The three main regulated hands-on Allied health professions that deal with the whole body.

We, practitioners, care about how our professions are defined because it groups us together and we obviously want the best possible reputation. But the general public, Joe Average the patient, what you are really asking is, which one of these professions can best help me with my problem?

It’s a difficult question to answer in the treatment room, as you’re trying to focus on getting the person in front of you feeling better. Whilst I don’t want to make sweeping generalisations about the professions, I invariably have to. I’ll try and give you my answer to this question, in slightly more detail than what you may get from me in the clinic, in the hope that you actually care for that detail. But first, a small comment on healthcare and medicine that can add some context.

In reality, when it comes to Medicine, philosophy is king. In this age of information and Google, it’s all out there for everyone to access. There are no special practitioners with inside knowledge that you can’t access. There is, however, GOOD MEDICINE, and BAD MEDICINE. Those who practice good medicine with logical philosophy will build up a wealth of experience that will give them higher rates of success. Those who don’t will have lower rates of success. Those who are more successful will have a more valuable opinion.

To give you an example, one would think that a knee specialist would have a better treatment protocol of the knee than say… a successful massage therapist. I’ve conversed with a knee surgeon that practices good medicine. I’ve also conversed with a knee surgeon whom I consider a butcher. They all have studied much longer than the massage therapist, but one had a sound patient-centric philosophy, and the other didn’t. I would value the opinion of a successful massage therapist with a good philosophy over the butcher! I said earlier that great therapists will have different opinions than bad ones. Inversely, great therapists will generally arrive at the same conclusions as other great therapists.

When discussing the three main manual-therapy professions, I’ll first refer to the definition given by Allied Health Professionals Australia (AHPA), the national voice for those professions in Australia. I will then give some details on the traditional pathways of these professions, and some pros and cons for each.

Physiotherapists

Physiotherapy: (AHPA) “Physiotherapists are experts in the structure of the human body and its movement. They work with people of all ages to treat a broad range of health conditions including sports injuries and musculoskeletal conditions as well as chronic health conditions such as diabetes, obesity, osteoarthritis, and stroke. Physiotherapists are involved in the assessment, diagnosis, planning, and management of patient care. Physiotherapists work across a range of health settings including private practices, public and private hospitals, community health centres, residential aged care facilities and sports organisations.” 

Traditionally, physiotherapy education is generally grounded in evidence-based practice. This is reflected in a generally heavier slant towards electro-therapies such as ultrasound and TENS machine treatment, alongside exercise prescription. Whilst they do learn basic massage, their manual hands-on application is minimal.

• Pros:
  Physios provide great focus on exercise, movement, and rehabilitation in their education. They do great work in hospital settings with helping patients post-surgery, recovering from orthopedic injuries and stroke.
• Cons:
  They don’t have a defined philosophy that underpins their treatment approach, and very little hands-on focus on their education. Practitioners who have a wider range of treatment options available to them have generally had to go looking for that knowledge outside of their profession, especially when it comes to hands-on treatment.

Chiropractors

Chiropractic: (AHPA) “A chiropractor diagnoses and offers treatment for back pain and disorders of the musculoskeletal system. The treatment may include manipulation, massage or ergonomic advice. Chiropractors in Australia are a nationally registered and regulated healthcare profession. Chiropractors work in private practice.” 

Traditionally, Chiropractors have had an almost direct focus on the spine, with their main tool of treatment being spinal joint manipulation, based on the Subluxation Model (a joint that is out of alignment will cause nervous system disruption). Learning of soft tissue treatment is generally self-directed.

• Pros:
  Good Chiropractors are able to help people suffering from spinal pain and have become synonymous with spinal manipulation. If this is a treatment option for you, (and it may well be) spinal manipulative movement can help you get moving again.
• Cons:
  The Subluxation Model has been pretty much thrown in the toilet by modern science and imaging, and so with it, the core traditional philosophy of Chiropractic. To make up for this, they have had to do lots of self-directed learning to align their treatment with sound principles. Practically, however, this looks like some spinal manipulation and exercise mashed up together. How it’s applied will be down to the individual practitioner.

Osteopath

Osteopathy: (AHPA) “An osteopath has a clinical focus on the way the body works, in strains or injuries and human movement. They provide direct manual therapy interventions including exercise prescription, needling, education and associated lifestyle advice to improve movement, reduce pain and manage and/or treat a range of physical impairments. Osteopaths mainly work in private practices but also work in a range of health settings including multidisciplinary medical/health clinics, rehabilitation clinics, aged care facilities, professional sports clubs, government, chronic pain management settings, and research institutes.”

Traditionally, Osteopathy has been very philosophy focused. It’s principles ask that the body be looked at as a total unit, with a heavy mechanical focus on the relationship between the structure and function of the body. Osteopaths rely on the self-healing mechanisms of the body and are bound to treat in this manner. Their education is very hands-on heavy, giving them access to a multitude of treatment options.

• Pros:
  A sound philosophy of treatment can almost always produce desirable results, given that it’s applied properly. Being tied to philosophy and principles tends to allow for greater access to areas “outside of the box.” This can be especially helpful when seeing conditions that everyone has seemingly had a crack at and no one has been able to solve. If this sounds like you, then an Osteopath may be your best bet.
• Cons:
  Their reliance on hands-on treatment application means their rehab and exercise prescription tradition has not been strong. Although there have been advances in education in recent years, this remains an area for improvement. Self-directed learning is still required here.

To the general public, it looks like the physio gives me exercises, the chiro cracks my spine, and the Osteo kinda does everything, but nothing in particular. And here is the dilemma these professions face. Physios and Chiros have attached themselves to something they do, whilst Osteopaths have attached themselves to a way they think. From a marketing perspective, it’s been much easier to advertise to the general public when you tell them what you do. It’s much harder to explain to someone how you think in a 30-second snippet.

Like I said earlier, in the real world, there is just good medicine and bad medicine. When something is heard loudly in the media, it’s usually about the bad practitioners. The good ones are just silently going about their business helping people. You’ll hear about the good ones through friends, family, and colleagues. Before the speedy internet age, all you had to be was great at what you do. If you mastered your skill and helped people, those people would rant and rave about you and you would be busy. In today’s internet age, you can be a relatively unskilled therapist and market yourself to get busy. That’s the power of Google!

How to pick a practitioner?

So here are my top four tips for finding a great practitioner:

Check out how long they’ve been practising. 

• Do they have a professional clinic, reception, a proper functioning business, all that stuff. If they’re professional and they’ve been doing it for a while, chances are they’ve put the same effort into their skillset. If they’re a younger practitioner, make sure they have been mentored by experienced colleagues.

They must empathise with you. 

• Do they understand your pain points? Or at least are they trying to. Do they have experience in the things that you’re seeking? If you’re a weekend-tennis tragic, have they asked you about this? Are they interested in your lifestyle and pressures? All these things that the research neglects, a great practitioner will use to figure out your problem and help you find a solution.

The best person to help you at the time.

• They must believe that they are the best possible person to help you at that point in time. Now obviously, everyone will think they are best poised to help you, and that’s great. They should have opinions and express those to you in a sound and logical manner. They should be able to answer your questions. If they can’t, they should be secure enough to say they can’t and go and do some learning for you. The point is, sniff out indecision and hesitation and run from it like the plague!

Results! That’s it.

• The results are KING. If the person you are looking for does not have a track history of getting results for their patients, then time to move on to the next candidate. That’s why word of mouth is still the best way to find the right fit for you.

In saying all of this, if you do find a great practitioner that is helping you, trust in them. See the value not only in that treatment that they are performing, but the years of education they have accumulated to bring you that result. They will get even better and more efficient at helping you as time progresses and they learn the intricacies of your body.

Throughout the process of writing this article, I’ve restricted myself in making the claim that out of the 3 professions, Osteopathy presents itself as a primary choice because of its logical philosophy that underpins everything it professes. This restriction is not my style and I find my skin crawling with ants of hesitation! So I’m about to relieve myself of this agitation and give you my opinion. Whilst some Physios and Chiros may arrive at a sound philosophy out of sheer perseverance of excellence, Osteopathy makes sure that sound philosophy is directly part of its educational process. Are there good Physios and Chiros out there? Yes, there are! I’ve worked with many. Are there some lazy Osteopaths out there? Sure, I’ve worked with a few of those too. 

But here’s the thing. What all the great practitioners have in common is that they are all great thinkers. They view the body as a united system. They view the real person as a total functional structure living in a world where gravity and the laws of physics don’t wait for the “researched evidence” to tell them what to do. And they then proceed to practice GOOD MEDICINE based on those assumptions. They are not lazy, they accumulate treatment techniques over time and apply them with confidence. Sounds awfully close to Osteopathy to me! All great practitioners move closer to Osteopathic philosophy as they get better. Even Osteopaths. That’s my opinion!