Other than the classic, “chiropractic? Er, isn’t that feet?”, normally accompanied with a distinct look of disdain, the most frequently asked question chiropractors come across is, “what’s the difference between a chiropractor and an osteopath?” In fact, only the other day I was having my haircut and got asked that very question.
Anyway, I digress. It’s not an easy question to answer, not just because there is now quite a large crossover in the UK, but also because it can stir up both heated and emotional debate between the two professions. However, due to the frequency we get asked this question, I feel it is important to address it and who better to answer it than a chiropractor or indeed an osteopath? I shall endeavour to be as factual and impartial as possible when writing this, but please be aware that I have studied chiropractic and therefore accept I may be inadvertently biased, but hopefully no more so than an osteopath would be.
Many of the main differences from a patient’s perspective are philosophical and date back to the origins of the professional entities. Both professions are often categorised as manipulative/manual therapies. Joint manipulation can be defined as the passive movement of a joint to achieve a therapeutic effect. This frequently involves the joints of the spine and is most commonly performed by hand. Indeed, the name “chiropractic” comes from the Greek word “chiropraktikos”, meaning “to practice by hand”. The popularity of manipulation has grown significantly over the past two decades as a wealth of high quality, independent studies have proven manipulation to be very safe and effective, most notably for treating low back pain.
It’s important to note that, although the founders of chiropractic and osteopathy have made spinal manipulative therapy widely available around the world today, they were not originated from thin air. Records of spinal manipulation reach back at least two and half millennia, being practiced by western physicians and surgeons alike. Indeed, as early as the fourth century BC, Hippocrates was using joint manipulation and traction techniques. However, in a century or two before both professions where born, orthodox medical practitioners seemed to abandon this type of therapy, leaving it as a folk speciality to uneducated bonesetters. The reasons for this are not fully understood, but it’s thought that this was due to the spread of diseases such as tuberculosis, which can severely weaken vertebrae and cause catastrophic fractures. It’s also understood that practitioners were very wary of any hands–on techniques due to fear of catching syphilis.
A Brief History of Chiropractic and Osteopathy
Both osteopathy and chiropractic have their origins in late 19th century Midwestern America. Osteopathy proceeded chiropractic by approximately 20 years. It was founded by Andrew Taylor Still in 1864 and Chiropractic was founded in 1895 by Daniel David Palmer. Both men were said to be prolific readers of anatomy and physiology.
Still had studied medicine with his father who was a physician since 1849. He attended the Kansas City School of Physicians and Surgeons immediately after the Civil War, but left before being formally awarded a diploma. It is of some interest to note that some American physicians could obtain a university degree in medicine by attending courses lasting only 3-6 months. To the average physician of Still’s era, a medical diploma had no practical value, as no formal training was required for a person to represent themselves as a “physician”, as no medical licensing laws existed until the 1870s and 1880s.
Still became disillusioned with medicine after losing three of his children to meningitis in 1864 and opened the American School of Osteopathy (ASO) in Kirksville, Missouri.
D.D. Palmer was a self educated healer who was born in Canada. It is rumoured D.D. Palmer visited Kirksville, Missouri, shortly after the ASO was founded and that he was treated by Still with his “new” technique and may even have spent time at his home. D.D. Palmer always fiercely denied this. There are records of heated debates between both Still and Palmer where they would meet at spiritualist meeting Camps in Iowa.
Still believed in two main principles. The first, ‘the rule of the artery is supreme,’ means that a healthy blood supply is likely to support a healthy bodily environment. Thus, osteopaths take circulation carefully into account when assessing patients. The second axiom, ‘structure governs function,’ concerns the fact that problems in the structure of the body, for example too much tension in certain muscles or the misalignment of a bone, can inhibit the natural function of multiple bodily systems.
Chiropractors, on the other hand, tend to focus on the spine and the alignment of vertebrae as the primary means to relieving pain and tension throughout the body. The spine consists of the vertebrae, which are bone segments that protect the spinal cord, and the individual nerve branches stemming from it. These nerve branches exit between the bones, conveying important messages between the brain and the rest of the body. Because the vertebrae shift and move with everyday activity, they can “misalign” and interfere with the nerve messages travelling among them. This interference causes problems, and frequently pain, throughout the body. This may be referred to by some practitioners as a “subluxation”.
Despite their differences, both philosophies were at odds with orthodox medical practices at the time. These involved procedures such as blood-letting which was said to sweep out the evil spirits and illnesses that took over the body.
Both osteopathy and chiropractic share a common philosophy on the following points:
• The body is a unit.
• Structure and function are interrelated.
• The body has an inherent ability to heal itself.
• When normal adaptability is disrupted, disease can ensue.
• The musculoskeletal system is central to the wellbeing of the organism.
• Preventive strategies are important to maintain wellbeing, including proper nutrition and exercise.
Despite Still’s disdain for orthodox medicine, by the 1960s, osteopathic medicine had become integrated into mainstream American medicine. The reliance on manipulative therapies has, since this time, fallen into less common usage. In fact, in the US, the main difference between seeing a medical doctor and an osteopathic doctor is the initials MD and DO at the end of their names. This has not been the case outside the US, where it has remained essentially a drug-free system based on manipulative techniques originally used by Still.
Chiropractic, on the other hand, has always maintained independence from medicine in the US and continues to do so. It’s now the third largest healthcare profession in the West after dentistry and medicine.
In the UK, both chiropractic and osteopathy are regulated by independent government bodies, namely The General Chiropractic Council (GCC) and The General Osteopathic Council (GOC), much the same way as Medicine is governed by The General Medical Council (GMC).
In order for an individual to call themselves a chiropractor or an osteopath, they must have attained a qualification which is recognised by the government. This is normally a full-time four-year degree course studied at recognised UK universities which have been assessed and have passed the rigorous evaluation by the GCC or GOC Educational Standards Committee.
Whilst both professions are able to refer for x-rays and MRI scans, chiropractors are also trained to take x-rays, indeed many chiropractic clinics have in-house x-ray facilities. The profession has been criticised in the past for using x-rays too frequently. However, this is no longer the case, as all x-rays must comply with the legislation under the Ionising Radiation (Medical Exposure) Regulations 2000.
Both professions can be accessed through the NHS, but at present this is very limited and dependent upon the individual Primary Care Trusts. Most major healthcare providers cover treatment by both professions.
What can I expect to find from differences in treatments?
This is very much a grey area and seemingly has been since the beginning of the professions. Although some chiropractors and osteopaths may disagree, I personally believe, from a patient perspective, that there may be little difference between the interventions received. In general terms, it’s often said that chiropractors manipulate more than osteopaths and that osteopaths perform more soft tissue work (massage) than chiropractors. However, in my experience, this depends very much on the individual practitioner, as I know at Bodymotion we regularly use a range of soft tissue techniques. I also have a good friend who is an osteopath who I’ve observed on several occasions and can say that he manipulates as much as I do. Whilst there appears to be a lot of crossover in techniques, there are differences, but I’m doubtful that many patients would be aware of these.
In addition to the four-year training programme, both healthcare professionals are required to attend further training courses, the choices of which may reflect the individual practitioners’ beliefs and philosophy. These can often have a direct impact on the way the individual practitioner assesses and treats their patients. At Bodymotion, for instance, we perform a one-hour initial assessment and have 30-minute treatment sessions. All our consultations are one-to-one. Our treatment plans are individually tailored and we therefore do not offer discounts on bulk booking treatments, but are on a pay-per-session basis. In addition to hands on treatment, we like to educate the patient and give postural and ergonomic advice as well, as structured rehabilitation exercise programmes. This is done to reduce recurrence and improve the long term wellbeing of the patient. This may not be the case with all chiropractic and, indeed, osteopathic clinics.
So which one should I choose? I know which one I would like to say, for obvious reasons, but I am afraid the honest answer is I don’t know. The best bit of advice I can give is that it is important for a patient to find a practice that fits his or her unique needs, regardless of the label.
So after reading all this information, you may ask, “well, what is the difference between a physiotherapist and a chiropractor?”… Well, that is another story!