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  • Writer's pictureRodger Duckworth

What is the Difference between a Physiotherapist, an Osteopath & Chiropractor?

Updated: Sep 6, 2022

It’s not simple! But I shall try my best to explain.

I have always been of the view that we should not be disparaging of our fellow manual therapy and bodywork colleagues despite a common professional rivalry. There are good and bad accountants, good and bad physio’s and good and bad osteopaths. There are also differing views and perspectives all of which have validity.

I recall being an undergraduate student over 20 years ago and hearing students and lecturers laughing at the idea held by chiropractors that the health of the body and organs could be influenced by manipulation of the spine. I recall feeling inside at that time – why not? Of course now we are, as physiotherapists and osteopaths, accepting this view and know the anatomical connections of the organs to the outer skeleton and also how the nervous system exiting the spine is supplying the organs. We should be careful not to knock things! Have some humility and less arrogance in medicine – in all things.

The easiest way to describe the difference between the professions is to look at our training.

Physiotherapists spend their training in all aspects of hospital medicine – musculo-skeletal outpatients (back, neck, joint pain and surgery etc), neurology(stroke patients, MS, Parkinson’s etc), respiratory medicine, cardiac medicine, amputees and vascular care, mental health, burns and plastic surgery, paediatrics, women’s health (obstetrics and gynaecology)and many other areas of medicine.

We graduate very much as a jack of all trades then spend 2 years as a junior rotational physiotherapist deepening our understanding and experience in these areas. Rather like a junior doctor rotates through the different specialisms within the hospital. Then we can chose to specialise in a particular area and train further in our chosen specialism. Key areas of study are in manual therapy, biomechanics, electrotherapy, exercise therapy, rehabilitation and psychology.

Osteopaths train in using manual therapy to treat the spine and peripheral joints. Their entire training is in this so they are very good at it right from graduation. Indeed I often say to people “If you go to a newly qualified physio or a newly qualified osteo with back pain you will almost certainly receive better care from the osteopath.”

Chiropractors are trained in manual therapy for the body as a whole and often study the general health of the body and the organs in relation to the spine and the skeleton and nervous system. Some consider the energy of the person. They tend as a rule to use more forceful manipulations – the cracks an crunches but physiotherapists and osteopaths use these forceful manipulations too – perhaps less often though if I am to generalise.

However, a few years down the line I think the definitions blur. Certainly my own clinical growth and experience has taken me into many areas including cranial osteopathy, visceral manipulation and energy medicine and I spend most of my time looking at the general wellbeing and health of an individual in relation to what they might be presenting with.

For example the patient attending with back pain after years of abdominal issues. I believe that the breadth of training in general medicine helps physiotherapists have a broader perspective on the overall picture of our patients. Osteopathic peers of mine often recommend patients to me as they are less happy retraining muscle groups to support the spine for example.

Physiotherapists are the only one of the three disciplines who have worked in hospitals and seen the whole spectrum of patients. Experience counts for so much. You know something when you have seen it. Having seen patients after spinal surgery, ill patients with tumours and cancers and respiratory disease you recognise the signs quickly. You know the relationship of how one thing affects another. Of course I am biased because I am a physiotherapist although I respect my peers. My own approach is no longer constrained to my basic training – nor my colleagues.

In the end – it is “who” not “what”. Find someone you resonate with and who works for you and that is fine!

Phew: I hope that helped – clear as mud!


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Pasha Salnikov
Pasha Salnikov
07. des. 2023

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