What are the differences between an Osteopath, a Chiropractor and a Physiotherapist?

Without a doubt this is the most often asked question in nearly every osteopathic clinic in the UK. In fairness, it’s also one of the hardest to answer in an honest and unbiased way. The first thing to say, is that in my long career, I have never found any of my fellow practitioners, no matter what discipline, who didn’t have their patients’ best interests at heart. We all have a common goal of improving our patients’ health and wellbeing.

While there are quite a few things that are similar, there are some things that are different and my explanation in clinic covers these three areas: the history, the philosophy and the technical approaches. Below is the longer version, but if you want my abridged and not so dry version, just go down to How’d you like your Spaghetti Bolognese?

So first of all, a brief history lesson. In order of inception, an American medical doctor founded osteopathy in 1872. His name was Andrew Taylor Still and it was he that laid down the philosophy that most modern day osteopaths follow. His was a fairly radical approach to medicine at the time, which was still pretty primitive in the main. Some of the treatments of the day included blood letting, mercury treatments and whoop! whoop! drugs like opium. His was a more naturopathic approach, with three primary tenets:

1. Structure governs function
2. The body contains its own medicine chest
3. The rule of the artery is supreme

Whilst I am somewhat paraphrasing these statements, at the time these were very insightful observations. A T Still realised the importance of the reciprocal nature of our structure and our function, and that a disturbance in one resulted in a disturbance in the other. e.g. if you break your leg (altered structure), you can’t walk (altered function).

Conversely, if you continually overload your liver with alcohol (altered function), you will develop cirrhosis of the liver (altered structure). He also recognised what we now refer to as the immune system and the importance of good nerve and blood supplies to all parts of the body.

A T Still established osteopathic colleges and many hospitals and this is where we see the first connection of osteopathy and chiropractic. Daniel David Palmer, the founder of chiropractic, studied under Still before developing his ideas, setting up his first chiropractic colleges several years later, in 1897. Palmer’s philosophy acknowledged the relationship between structure and function but felt that the role of the spine and the corresponding nervous system was of the utmost importance in health and thus concentrated on these relationships.

Physiotherapy can trace its origins back to 1813 and Per Henrik Ling “The father of Swedish gymnastics” but didn’t really become prominent in the UK until after the First World War. It was then a combination of trained masseuses and medical gymnastic practitioners. Many injured servicemen were convalescing in hospitals etc. around the world. It was noted that having these servicemen carry out simple exercises, their recovery rate was far quicker than if they were left in bed most of the day. In UK this led to physiotherapist courses being established in the military and, by the time the NHS was established, Physiotherapy had become a distinct discipline of its own and was part of mainstream medicine.

So from here, hopefully, you can see that different philosophies developed. In a nutshell, osteopathy tended to concentrate on a somewhat integrative approach, looking at the body as a whole. Chiropractic likewise, but with a greater emphasis on the spinal relationship to the nervous system and Physiotherapy on a more rehabilitative exercise-based system, to restore function.

All of these disciplines aim to restore health, but philosophically speaking, they do approach the patient in a different way.

When it comes to technical approaches, it’s more a case of what the perception of patients see their practitioners doing. Osteopaths would generally be seen to use more articulation (wiggling and waggling) of the body, whereas chiropractors are known for the use of techniques that “click” the joints, especially those in the spine. Physiotherapists are generally known for providing exercise regimes and rehabilitative exercises to patients. Remember these are generalities and each practitioner will work in their own way.

How’d you like your Spaghetti Bolognese?
So here’s my abridged version of the differences. Answer me this! If I put a set of ingredients in front of you, say: tomatoes, onions, garlic, beef mince, spaghetti and a few herbs… What have you got?

Well some would say that this is Spag Bol, right?

Well, yes and no. You have all the ingredients for a Spag Bol, but it’s not until you mix them together, in selected quantities and following some sort of order and then cook them, that we have our Spag Bol.

So what determines the quantities and the order in which we make our Spag Bol? It’s going to be down to the Chef’s training, which school and which instructor they trained under. The end result should be a great Spag Bol, but will vary on the Chef that is preparing it and how they learnt to cook it!

The same can be said of the three physical therapies we are discussing. The end goals are the same, but the way we get there will vary depending on the school we went to and the philosophy it followed. We will use a lot of the same techniques (ingredients) but may put them together in a slightly different order and in differing amounts. Hopefully we all get the same end results, but like Spag Bol, some people will prefer one Chef to another.

So how’d you like yours?