Chiropractic, Osteopathy and Physiotherapy: define, compare and contrast

“There are a range of health care professions readily available to the community today. Three of them that are often compared include; Chiropractic, Osteopathy and Physiotherapy. It is important to understand the differences between and the purposes of each form of health care before commencing treatment with one of them.

Chiropractic is a form of complementary medicine based on the diagnosis and correction of misalignments and disorders of the musculoskeletal and nervous system. Chiropractors aim to improve the function of the bodily systems, through addressing neuromuscular pain with chiropractic adjustments and by eliminating any interference and discomfort that may be impairing the body’s ability to self heal to reach optimal health. Chiropractic originated in 1895 when DD (Full name here) Palmer, a local grocer with a keen interest in metaphysics, started as a magnetic healer until he put forward the principles of chiropractic, “I was a magnetic healer for nine years previous to discovering the principles which comprise the method know as chiropractic. During this period much of that which was necessary to complete the science was worked out. I had discovered that many diseases were associated with derangements of the stomach, kidneys and other organs...” (1) The word chiropractic literally means in Greek, “done by hand” (2) and public interest in the practice was generated when he “cured” a janitor of his deafness by manipulation of his neck. DD Palmer argued that all disease and infirmity is caused by a subluxated bone (95% of the time a spinal vertebrae)which disrupts the flow of innate intelligence. (3)

Physiotherapy is a healthcare profession that aims to help people affected by disability, deformity, illness or injury by manual therapy, heat treatment, hydrotherapy, exercise and movement. Physiotherapy aims to restore mobility and function whilst avoiding medicinal drugs and surgery. The origin of physiotherapy dates back to 1813 in Sweden when Per Henrik Ling, the “Father of gymnastics” founded the Royal Central Institute of Gymnastics as a centre for massage, manipulation and exercise for his gymnastics team.(4) In 1887, Sweden’s National board of health and welfare registered the treatment and recognition and utilization spread where in 1894 the Chartered Society of Physiotherapy was initiated. Not that much longer after, in 1913 the School of Physiotherapy opened at the University of Otago in New Zealand and the following year in 1914 Reed College in Portland, Oregon opened. At this time graduates from these institutions were called “Reconstruction aides” and in World War I physiotherapy, then referred to as rehabilitation therapy, was used to help injured soldiers and civilians. In 1921 the first research paper was published in the USA called, “The PT review,” and in the same year Mary McMillan founded The American Womens Physical Therapeutic Assosciation as the first physical therapy aide. (5)

Osteopathy utilizes stretching, manipulation of bones and muscles, soft tissue work and massage to address medical disorders and to promote optimal functioning of the body. Osteopathy is a therapeutic system based on embracing the unity of one’s structure (anatomy) and function (physiology). In 1874, Andrew Taylor Still, a medical doctor from Missouri put forward the concept that the health of one’s living anatomy determines the presence of disease or not. He delivered the concept that any slight anatomical deviation was the origin for disease. Dr. Still stated, “An osteopath reasons from his knowledge of anatomy. He compares the work of the abnormal body with the work of the normal body.” (6) He stated that optimal health is only made possible if all the body’s tissues and cells function together harmoniously. Dr. Still first practiced on himself, when he used the “rope swing treatment” to cure his headache. (7) Resting his head on suspended ropes and leaning back into them he limited the action of occipital nerves and allowed the flow of arterial blood through veins, thus alleviating the stress of the headache. He proved he could restore health by treating the body with his hands when he demonstrated on patients that he had the ability to change their physiology with his hands and cure the ailment. Dr. Still acknowledged the relationship of the mind, body, emotions and spirit and incorporated that into his medical practicing. Since there were no medicinal drugs or antibiotics, this was widely accepted by the though that nature’s ability to heal itself, with Dr. Still’s hands on technique as a catalyst, was most effective in gaining optimal health.

Chiropractic, Osteopathy and Physiotherapy all involve gathering an extensive patient history to examine in detail, diagnosing the presenting problem, planning a management strategy with protocols specific to the patient, treating problems associated with joints, muscles, bones, nerves and soft tissues by observing the function of the body as a whole, from the perspective of the presented complaint/area of discomfort. In terms of other similarities, the time spent studying to become both a Chiropractor, Osteopath and Physiotherapist are all relatively the same. They all involve a five-six year university/college course in which students study anatomy and other medical subjects, practicing different techniques and treatment methods and working through patient condition analyses to develop clinical reasoning skills and to learn how to construct management protocols under the supervision of experienced practitioners. (8) In fact, it is sometimes beneficial when Chiropractors and Osteopaths combine their knowledge and work collaboratively on a patient/issue, as during their individual studies they learn different ways to manipulate and mobilize joints/muscles etc. In terms of the lengths and types of treatments used by each profession the evident similarity is that all three use their hands when addressing the joint, muscle, etc. Chiropractors usually use skin on skin contact, however can also use techniques involving an activator. This activator technique is unique to the chiropractic profession. There are about twenty different types of techniques utilized by chiropractors, some including Coxflexion distraction (which is used to relieve pain through targeting compressed parts of the spine), Gonstead (which addresses pinched nerves induced by misalignments in the vertebrae), Extremity adjusting and Thompson technique (using the length of legs as a point of reference to identify misalignments and uses a “drop table”)(9) Although techniques throughout the professions differ and vary, the use of physical stretching or strengthening exercises, dietary and nutritional guidance, relaxation/de stressing techniques, use of heat packs, cryotherapy and disease prevention guidance are common practices used by all three professions.

Osteopaths tend to practice in longer sessions with a larger variety of techniques involving gentle skin on skin massage,(I thought they used soft tissue etc etc?) they also utilize muscle manipulation, similarly to Chiropractors, however in a lot less patients. In contrast to Physiotherapy and Chiropractic, Osteopaths generally approach the body as a whole. That is to say that although they treat all kinds of isolated joint or muscular pain, they take a holistic approach to the issue by addressing the body, lifestyle, diet, physical activity, allergies and the nature of daily work related activities in order to better understand the requirements and potential stresses on the body, and possibly use as information to create preventative measure for future problems.(10) Through the use of a combination of techniques (like pressure point finding, stretching, massage and manipulation) on the tendons, ligaments, joints and muscles Osteopaths provide immediate and long term relief by promoting mobility and flexibility to restore the body’s balance and overall health.

Physiotherapy is a treatment that is more area specific, in contrast to Osteopathy A similarity between Osteopath and Physiotherapy is the use of the palpation of the soft tissue and muscles to address and relieve pain and to enhance and promote mobility. Often used to rehabilitate injuries, muscles and joints, Physiotherapy uses a variety and combination of certain techniques (some that neither Osteopathy or Chiropractic use) such as; aquatic exercise therapy, hydrotherapy, joint mobilization procedures, muscle energy techniques, massage and stretching, strengthening exercises and high velocity/low amplitude thrusting. (11) Treatment is usually rehabilitation and exercise oriented. The use of ultrasounds in the injury/complaint analyses occurs much more often in Physiotherapy than in Chiropractic or Osteopathy. Physiotherapists often address an (most often an injury for rehabilitation) injury first by means of an ultrasound to identity the exact ligamentous/muscular damage, before creating a rehabilitation plan based on exercises.

The work environment of all three professions does to an extent differ. While Chiropractors and Osteopaths often work in clinics, or in their own practices, with their own clientele. Physiotherapists work under New South Wales Health, in health care systems and communities. Physiotherapists work in many wards of hospitals and can choose a field of specialisation, for example; pediatrics, neurologic, geriatric, orthopaedic, cardiopulmonary, clinical electrophysiology and sports physiotherapy. Physiotherapists are often involved with patients who have experienced serious trauma (often from serious car or workplace accidents) and spent time in the emergency room or in the intensive care unit to analyze and plan rehabilitation steps.

Chiropractic, Osteopathy and Physiotherapy are three different professions in today’s modern context, however they do share a variety of similar aims, techniques and beliefs. These similarities of the three practices are because they are ultimately striving to allow their patients to reach optimal health.”

References:

1. Palmer DD (Ed.): The Chiropractic 1897a (Jan); Number 17 (Palmer College Archives
Very helpful source in investigating the history of Chiropractic with a strong focus on DD Palmer.

2. Keating JC. The embryology of chiropractic thought. European Journal of Chiropractic 1991 (Dec); 39(3): 75-89
This source was of high importance in terms of researching the premise of Chiropractic.
3. Jones RJ. "...To relieve suffering humanity." National Chiropractic Journal 1948 (Mar); 18(3):7, 64, 66
A journal that was helpful in discovering more about innate energy and what it means.
4. The Manipulative Therapies, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116959/#!po=95.0000, BMJ. Oct 30, 1999; 319(7218): 1176–1179.
This article helped me to better understand the history of Physiotherapy and the important figures involved in its evolution.

5. Chapman Smith D, ed. Clinical trials, science and physical therapy. The PT Report, 1987. 1:1 to 6.
A close analysis of the PT report, provided me with clear information of the first practices of Physiotherapy and the first practionners.

6. Booth ER. History of osteopathy and twentieth-century medical practice. Memorial Edition. Cincinnati OH: Caxton Press, 1924
A great resource for learning of the history and origin of Osteopathy, very clear and helpful.
7.Osteopathic medicine, http://journals.lww.com/academicmedicine/Fulltext/2009/06000/Foreword__Osteopathic_Medicine_and_Medical.12.aspx, 2002
This journal was helpful in fully understanding the practices and meanings behind the Osteopathic premises.
8. Wolk S. Chiropractic’s clinical efficacy: the evolving role of researching. Am Chiro Assoc J 1988.
This resource was of great use when analyzing the role of Chiropractic and the common aims of each Practionner.
9. Coulehan JL. Adjustment, the hands and healing. Culture Med 1985
A resource that discusses multiple techniques carried out in the Chiropractic world.
10. Norris, P. (2001), How ‘we’ are different from ‘them’: occupational boundary maintenance in the treatment of musculo-skeletal problems. Sociology of Health & Illness, 23: 24–43. doi: 10.1111/1467-9566.00239
A fantastic resource for investigating the differing workplaces of each profession and their treatment types.
11. Letters to editor. Br Med J 1990: Physiotherapy. 2:18 to 22.
This resource was fantastic in researching the different techniques of physiotherapy.