What is the difference between a physiotherapist, a sports therapist or a chiropractor?

To begin with it is important to understand that all of the above professions treat musculoskeletal conditions and each clinician is what is called an “autonomous practitioner”. This means that if the professional can justify a treatment method in a patient’s case then they can apply this treatment technique. Therefore, all clinicians treat patients with different techniques, even clinicians in the same profession will manage patients differently. This occurs because musculoskeletal medicine is not an exact science and research is constantly evolving and showing new ways to treat issues. This being said, generally, each profession uses a different skillset to base their foundation upon and this is different for physiotherapists, chiropractors, etc.

Chiropractor

Chiropractors generally rely on spinal manipulative techniques to achieve results. Spinal manipulative therapy involves taking a spinal joint to the end of its range of motion and then, forcefully manipulating that joint past its range of motion. This normally results in a “cracking” noise and a sensation of release.

Spinal manipulative therapy does have a reasonable evidence base of its usefulness in treating lower back pain, thoracic spine pain, shoulder pain, etc. Spinal manipulation works through many different avenues but its effects are mostly on the brain and spinal cord where pain is processed. However, chiropractors have been known to attempt to treat non musculoskeletal conditions with manipulation, such as colic in infants which is not grounded in any kind of scientific reasoning. Additionally, although applying an appropriate technique for an appropriate problem, some chiropractors are under the impression that the manipulative therapy fixes slight subluxations (bones out of place), this is also not grounded in science. Generally chiropractors rely on manual therapy as opposed to exercises.

Osteopath

Osteopathy generally involves a more holistic view of musculoskeletal conditions, taking into account the whole body as opposed to chiropractors who are more “joint focused”. Therefore osteopaths will generally practice using lots of different techniques whereas chiropractors will focus on spinal manipulative therapy. As with chiropractors, osteopaths generally focus on manual (hands on) therapy, not exercises.

Physiotherapist

As a physio, I always have thought of myself as more of a scientist than a therapist. However, I have still met physios who would describe their practice as an art form. Physiotherapy has no agenda, it does not have a dogma. Physiotherapy is an ever evolving practice which changes as the evidence shifts for certain techniques or exercises. Generally musculoskeletal physiotherapists will use mostly exercise therapy to achieve targets but will mix in manual therapy when there is a reason for it. In private practice (as in Joints and Points) manual therapy is a large part of what we do with nearly all of our patients.

Sports therapist

Sports therapists are much the same as physiotherapists but they focus on sports whereas physiotherapy is more of a varied profession with most of my peers working in hospital ward settings.

Summary

Any practitioner can apply evidence to treat a current condition. Therefore it is important to think about the quality of the practitioner, not the profession. To end with there is an old joke about chiropractors and physios:

How many chiropractors does it take to change a lightbulb? One but it will take weekly sessions over the course of six months.

How many physios does it take to change a lightbulb? Two, it takes one to put the lightbulb in and the other to tell the first physio to do this for three sets of 12, twice a day.

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