Osteopath, Chiropractor or Physiotherapist?

What is the difference between an Osteopath, a Chiropractor and a Physiotherapist has to be the most frequently asked question when patients visit the practice and I will have an honest attempt at answering it.

In very simple terms and the treatment modality that concerns everyone is manipulation of the small joints in the spine. All physical therapists will manipulate but there is a subtle difference in how they go about it. This stems from what exactly the practitioner believes he is achieving when he or she elects to use this treatment modality.

A woman's world article summed it up quite well.

Chiropractors tend to use more force to open the small joints in the spine producing cracking sounds.

Osteopaths warm the joint up more with soft tissue, muscle energy techniques. They use a gentler manipulation that also produces cracking sounds.

Physiotherapists generally don't manipulate they use massage and electrotherapies and exercise advice.

Having said all that some chiropractors behave very much like osteopaths and vice versa and some physiotherapists have done post grad courses in manipulation. All will use soft tissue techniques, prescribe exercise and use electrotherapies. It really depends upon the individual practitioner and how they practice. The key for the patient is to find a practitioner who helps them achieve their reasonable treatment and health objectives.

A simple analogy that I use is a historical comparison with the Military services.

The Navy as the senior service, they were first then the Army and then the Airforce.

In terms of the physical therapy it would be Osteopathy we were here first the Chiropractors then Physoitherapists...please read on to understand historically the logic behind this.

Physical therapy has been with us since the time of Hippocrates and there are ancient Greek stone carvings depicting scenes of manual therapists at work.

Up until the 19th century there was little differentiation between medical practitioners; then in a small room in the University of Worcester UK, a small group of medical practitioners got together and formed the General Medical Council or GMC as we all know it.

This was done to protect the public from rogues and charlatans who would make all sorts of promises with out delivering very much. It brought the medical profession down and conscientious medical professional generated this format to bring the profession into shape. The medics were given the Medical Act 1858 from parliament and were then responsible for the profession ensuring academic institutions teaching medicine were up to scratch and medics practising medicine were appropriately qualified and followed logical practice governance to benefit their patients. This enabled the GMC to clear out the profession of all the deadwood. The aim being to establish the confidence of the public and most importantly do everything they could to ensure the public were safe from bad or dangerous practice.

At about this time in The USA there was a Military Surgeon Physician, Anatomist, Methodist preacher a philosopher named Andrew Taylor Still. He tragically lost 3 of his children to Viral Meningitis and his first wife to pneumonia. He was able to secure the services of the finest medical supervision of the time, but it was to no avail, and his family perished which devastated Still.

This drove him to re- examine the philosophy of Allopathy(to find pathology and to kill it or cut it out)/Orthordox medicine at that time which was a contentious thing to do but in the light of his experiences quite reasonable. He upset establishment medicine with his questioning of the accepted philosophies and principle of orthodox medicine at that time; not least from his own family who were all medics. His free thinking and ideas were contentious and challenging. The established medicine found all this self/clinical audit and reflection very uncomfortable, particularly when they would try to prosecute him for malpractice. Dr Still would always point to the mortality rates for his patients in comparison to his allopathic colleauges of the time. The prosecution case was always dismissed leaving the Allopaths red faced and furious. He returned to his studies and eventually came up with a number of principals that he based his natural non invasive health care philosophy on and that was:
  1. Profusion of tissue by blood and its good drainage were fundamental to tissue health."The rule of the artery is supreme" A.T. Still
  2. The structure of the body governs its function, Anatomy and physiology are recipricol.
  3. The body has the capacity to sustain a steady healthy state. Homeostasis 37 degrees celcius and 7.4 pH which is fundamental for the optimal function of physiology.
  4. The body is a self healing mechanism; the body has a capacity to heal itself. (Blood clotting and Immunity.)

This list has been refined and added to over the years but these 4 principles create the foundation of his philosophy. This philosophy was also underpinned by a devout faith and acceptance of the Almighty creator(God) of all things, he felt humbled and reasoned that if the almighty had created it... it must have purpose which was for us to reveal.

He took his principles and applied them via manual therapies, care for his patients, good nutrition and rest. Dr Still coined the term Osteopathy in 1885 and today in the USA the Andrew Taylor Still University of Osteopathic medicine is a thriving academic medical centre of education; that has been accepted by the Allopaths. I fear though North American Osteopaths with the right to prescribe may become too reliant on the injection of steroid and prescription of pain relief drugs at the expense of the manual aspects of manual techniques. Osteopathy has earned the right to ask for the right to prescribe but the profession has been rightly circumspect in advancing this right.

This is the first comparison we can make to highlight the difference and similarities between Chiropractics and Osteopathy. D. D Palmer was a beekeeper, teacher and grocery store owner and reader of medical journals. He practised Alternative therapies including Magnetic healing, and Spiritulism ( indeed Still initially described himself as a Magnetic healer and lightining bonesetter until 1885 when he used the name Osteopath). Palmer raised his profile when he claimed he relieved a deaf man of his deafness by cracking his back and another man of his heart condition via spinal adjustments.....very grand claims to make and very difficult to substantiate or repeat I am sure(but a tremendously powerful marketing tool). Palmer coined the term Chiropractor in 1890. He spent time in jail for practicing medicine without a licence, but started a college of chiropractors in 1892.

It is said that early chiropractics was very similar to osteopathy which may give some validity to the story Palmer may have been a student of Dr Still but never stayed to do the full course preferring to set up his own college with his son at exactly the same time that Still founded his college in Kirksville Missouri in 1892.

Dr Still was rigourous and driven even obsessed by his practice and insisted that his students had full command of at least 90% of Grays Anatomy Text book, before allowing them to enter the clinic where patients were treated. Still never taught technique but was insistent that his students apply their knowledge of anatomy. Dr Still would demonstrate treatment but not teach technique and this maybe why Palmer went off to do his own thing..........who knows? One of Still's first students was a chap called John Martin Littlejohn who then came to London and set up the British school of Osteopathy. He taught a chap named John Wernham whose protégé was Tom Dummer who brought the Paris School of Osteopathy to Maidstone in Kent which was the beginning of The European school of Osteopthy at Boxley my old college!

Our physiotherapy cousins were first introduced when 4 nurses working in London set up the first physical rehabilitation unit in a London Hospital. This was in 1892.

It took till 1993 for the osteopathic profession to galvanise and follow the process of lobbying Parliament supported by The Prince of Wales and Princess Royal and the late Princess Diana for us to secure the Osteopath Act 1993. The formation of the General Osteopathic Council who oversee the profession in the same way as the GMC was critical to this process being successful.

Osteopaths decided not to take up the title Dr so as not to confuse the General public and we did not want to be mistaken for GPs.

The process of validation of the Osteopathic profession is now used as a model for other profession wishing to seek Statutory regulation to follow, due to the rigour of the process.The Chiropractors indeed followed the Osteopaths lead shortly after this. The Chiropractors have decided to take up the title of Dr of Chiropractics.

The physios haven't as they predominantly are a subset specialisation of nursing and don't see the need to be a separate profession the only issue about this is that whilst physios seen through the NHS will be qualified Private Physios will not necessarily have to be, as the title Physotherapists is not a legally protected title. They do belong to a voluntary health professional council. Another crucial difference is that Physiotherapists are not trained to diagnose. Ultimately they will always defer to Medical doctors for diagnosis of musculoskeletal problems.

As time goes by and the provision of health care has evolved in this country the NHS a leviathan of a bureaucracy has emerged heavily promoted by the Politicians but consistently under funded; raising patient expectation and failing to deliver on number of levels. A beautiful ideal but unworkable in practice. The livelihood of very sophisticated business people and X - politicians who fill their coffers with giant pharmaceutical companies loot, rely on its very existence.

Meanwhile on the front line the best interest of the patient seems to have been relegated to the fringes of the process; as the underfunding and demographic pressures thwart even the most florid promises of our politicians. Post code NHS, Deaths as a result of neglect. An altruistic work force contractually gagged by insidious bureaucratic jargon and threats.

Osteopaths generally wish not to be involved in such a monster preferring to give candid, accurate advice and best treatment possible for their patients; including referral to medical colleagues when necessary. We have retained our freedom to speak honestly, openly and truthfully, we have demonstrated this in external audits of competence.