Do I need to see a chiropractor, osteopath or physiotherapist?

by David Harvey, DC MChiro - November 5th 2020

This is something all manual therapists will have to answer at some point or another; I have certainly been asked this question a fair few times.

I was faced with this question initially when I was in secondary school — during my GCSE years I made the decision to study chiropractic at university. When I told my teacher, she asked me out of genuine interest:

“What is the difference between a chiropractor and an osteopath?”

Like many others, she was suffering from lower back pain at the time. In fact, 4 out of 5 adults in the UK will experience lower back pain at some point in their lifetime, according to research — that’s 80% of people!

This question was difficult to answer on the spot as a 15-year-old, but I would like to take this opportunity to provide some insight 12 years on, including studying at the Welsh Institute of Chiropractic, and 5 years of clinical experience, from that point.

With so many different professions, techniques and treatment modalities out there, it can often be difficult to know who to actually go and see for your specific problem, and when is the right time to do so. In this ‘Information age’ self-diagnosis and exercise prescription, based on a quick google or youtube search for your symptoms is not uncommon, but can be very misleading, and even dangerous in some cases. An outline of the similarities and differences between them will help you to make the right decision and get the service you need when you need it most.

To understand who to see and when you should see them, you must first be able to define each treatment modality individually, so that the similarities and differences between them are highlighted. If you are unsure, it is always best to seek professional advice.

What is Chiropractic?

Chiropractic is a healthcare system, based on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially those of the spinal column, which cause dysfunction by affecting the nerves, which control both muscles and organs.

The best way to understand the term is to define the word itself. The prefix “Chiro-“ comes from Greek origin, and literally means ‘of the hand or hands’; and “-practic“ refers to a certain practice or experience/skill.

So in other words, a chiropractor is somebody who uses their hands to help relieve problems with the bones, muscles and joints. This will usually involve some spinal manipulative therapy (SMT), in combination with soft tissue work (STW), such as stretching or massage.

BUT the defining characteristic of chiropractic, in contrast to other professions, lies in its philosophy. The aim of any treatment is to improve the function of the nervous system.

In the UK, Chiropractors are governed and regulated by the General Chiropractic Council (GCC). Chiropractors need to complete an approved chiropractic degree, register with the GCC and meet the requirements of ‘The Code’ in order to practise in the UK. These criteria are essential to ensure that, in line with other health professionals, chiropractors are treating patients safely and to a consistently high standard.

Chiropractic is not widely available on the NHS, but it is provided in some areas. You do not need to see your GP before making an appointment with a chiropractor, but it's best to seek some advice if you are unsure about what type of treatment may be best for you.

What is Osteopathy?

Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions. It works with the structure and function of the body and is based on the principle that the wellbeing of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.

Its name also derives from Ancient Greek, with “osteo-” referring to "bone". The suffix “-pathy” also comes from Greek, and relates to curative treatment of a specific kind.

Osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery. Osteopaths use touch, physical manipulation, stretching and massage to increase the mobility of joints, to relieve muscle tension, to enhance the blood and nerve supply to tissues, and to help your body’s own healing mechanisms. They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring.

All osteopaths in the UK are regulated by the General Osteopathic Council (GOsC).

Similarly, Osteopathy is not widely available on the NHS, nor is a GP referral required to see an Osteopath.

What is Physiotherapy?

Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, including the patient’s lifestyle. Physiotherapy aims to restore movement and function when someone is affected by an injury, illness or disability. It may also be used preventatively, in an attempt to reduce your risk of injury or illness in the future.

The term derives from Greek, with the word “Phusis” meaning nature, with the suffix “therapeia” meaning healing, however, the use of medicines, prescriptions, and injection therapy are within the scope of the UK physiotherapy profession.

Treatment sessions will typically involve some education/advice, movement/exercise, and some manual therapy (e.g. massage, mobilisation). Other techniques may also be utilised, such as dry needling, ultrasound, or transcutaneous electrical nerve stimulation (TENS).

To practise physiotherapy in the UK you must be registered with the Health and Care Professions Council (HCPC), the UK’s regulatory body for health and care professionals. Physiotherapy is available through the NHS or privately. To have physiotherapy on the NHS, you may need a referral from your GP.

It is not uncommon for clinics and practices to be multidisciplinary, meaning they have several academic disciplines or professional specialisations working under one roof. Even where this is not the case, if you were to see a clinician who believed your condition or problem was beyond the scope of what they are able to help with, they would be likely to refer you to somebody better suited to your needs.

Since there is such a crossover in the technique of these three professions as well as the conditions they are able to address, the decision of who to see should be more heavily influenced by the level of the individual practitioner, rather than the profession itself; a good practitioner in any field will trump a bad one, regardless of their discipline. If you have a friend or family who has had positive experiences with their practitioner, for example, this may be a good place to start — if they were able to get good results, it stands to reason that you would too.

For more information on chiropractic, osteopathy, or physiotherapy, visit the websites of the respective governing bodies:

https://www.gcc-uk.org/ (General Chiropractic Council)
https://www.osteopathy.org.uk/home/ (General Osteopathic Council)
https://www.csp.org.uk/ (The Chartered Society of Physiotherapy)

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