Which is better a Chiropractor or an Osteopath? Which one should I see?
As the son of a physiotherapist and as a UK Osteopath who has been qualified for over 20 years who has worked alongside and employed numerous healthcare professionals, I feel reasonably well qualified to answer this question. Although I wish to state at the outset, by virtue of my own training, my grass roots exposure to Osteopathy is more extensive than it is for chiropractic therapy.
Osteopathy and Chiropractic therapy have similar origins. Osteopathy was founded in America by Dr. Andrew Taylor Still in 1872, Chiropractic care was founded by Daniel David Palmer who was a student of Dr. Still in 1895.
Training is of a similar standard and length for both professions, typically four-years of full time undergraduate study that includes extensive training in human anatomy, physiology, and biomechanics with both practical and academic exams along the way before having to pass final exams in order to become a statutory registered and regulated healthcare professional with either the General Osteopathic Council or the General Chiropractic Council.
United Kingdom vs Other Countries
Training and registration is more similar for Chiropractic but varies more for Osteopathy. For example in the USA Osteopaths do part of their training alongside medical doctors, whereas in part of Europe Osteopathy is a post graduate course only open to Physiotherapists. In the UK Osteopathic training follows a more similar pathway to Chiropractic Training within teaching schools being independent of medical schools.
Main Differences Between Chiropractors and Osteopaths
One difference between chiropractors and osteopaths is in the philosophy of what they are taught in terms of what goes wrong and why. Chiropractors tend to focus primarily on the spine and are taught that misalignments in the spine can cause a range of health problems. Hence more emphasis in chiropractic training is placed on imaging techniques such as X-rays and at some schools MRI scans. Osteopaths, on the other hand, tend to take a wider approach and believe that spinal misalignments may not always be the problem, and that the body is a unified whole and that the musculoskeletal system is influences and is influenced by the body’s other systems.
Another difference between the two professions is their treatment techniques. For chiropractors the focus of their training is in spinal adjustments and joint manipulation (clicking). Whilst osteopaths also receive training in spinal adjustments and joint manipulation (similar to those taught to chiropractors) they also receive (more) training in other treatments such as soft tissue techniques.
Consequently, in private practice typical treatment sessions given by a chiropractor will principally or exclusively consist of spinal and or joint realignment techniques, whereas an osteopath will tend to use spinal and or joint manipulation together with massage style technique. Chiropractic treatments tend to be of a shorter duration but may be more frequent and Osteopathic treatments tend to be longer and more spread out.
Future Directions For the Chiropractic and Osteopathic Professions
Chiropractors in the UK, seems to me at least, to be on a more stable footing following a well trodden path, with present and future generations of chiropractors set to follow a similar path to those of the past. Osteopathy in the UK appears to be more in a state of flux. In the UK Osteopathy (as with Chiropractic) originate and evolved outside of the medical mainstream. Whereas Osteopathy was once firmly regarded and regarded itself as an “alternative (manual) therapy”, since the passing of the “Osteopaths Act” (in 1996), giving osteopaths protection of title, many influencers within the profession have increasingly pushed for acceptance via evidence based practice.
At the same time the profession has (so far) mostly resisted adopting some aspects aligned with main stream medicine and orthopaedics such as rights to prescribe medication and improving training and appreciation (at undergraduate level) for imaging techniques including ultrasound, X-ray, MRI imaging and SPECT CT. There may be various reasons for this, such as the debate and fear (shared by much of the Physiotherapy profession) surrounding MRI’s and X-rays throwing up too many false positives; I suspect though this is also in part due to fear of becoming too medicalised and losing touch some of Osteopathy’s traditional core values and philosophies, even though one of these, “structure governs function”, would to my mind at least mean Osteopaths should be craving the better understanding of their patients “structure” that MRI’s in particular can provide.
The Biopsychosocial aspect of pain management in particular has become very much on trend. Whilst in many respects these are a positive things, they risks pushing out some of the classical more subjective and bespoke hands-on treatment approaches that might be well suited to certain individual patients but which might not necessarily carry over to large patient populations that, on paper, appear to be presenting with the same set of criteria. As has been the case with physiotherapy in recent decades, which had its origins in remedial massage* (now currently back on the NICE guidelines*), Osteopathy risks going through a similar personality crisis as it tries to become more mainstream; this risks becoming increasingly “hands-off” which in my opinion would be a real shame for a profession with such strong roots in manual therapy.
Variation Within Professions
When taking into account all the above, much like just because we all pass a standardised driving test it does not mean we all drive the same, the reality is that a patient might get a very different experience visiting one osteopath vs another osteopath or one chiropractor vs another chiropractor. Whilst some osteopaths or chiropractors will be heavily focused on joint manipulation and or firm soft tissue massage (more likely in the case of osteopaths vs chiropractors)), others will do very little or this, or may only practice very gentle “cranio-sacral” techniques (or Mc Timoney Chiropractic).
Which is better a Chiropractor or an Osteopath? Which one should I see? Which one is right for you?
With similar lengths and standards of undergraduate training both professions can be regarded as of equal status. One must also bear in mind that post graduate training often overlaps, osteopaths and chiropractors may attend the same post-graduate training courses in things such as medical acupuncture, electro and mechanical therapies (for example shock wave therapy or spinal decompression therapy) to supplement their manual therapy skills.
it’s important to do your research and choose a healthcare professional who is licensed, experienced, and well-regarded in their field. The question(s) you should be asking are: who in my local area has a good reputation, and provides an approach I am comfortable with, and or has a special interest in the problem I have (for example if you have a spinal disc problem it would make sense to see a local osteopath or chiropractor who sees lots of such cases, and or taken on board extra training or equipment relevant to this area, looking at their marketing / website will likely tell you)
Our Osteopaths (at Spine Plus)
My attitude has always been that whilst my primary training and official registration is as an Osteopath, first and foremost I am an orthopaedic therapist in the broadest sense of the word, i.e. a therapist that deals with patients presenting with musculoskeletal pain and dysfunction; and that most importantly my patients received the most effective care and advice that I can give them provided this is within my scope of education and practice which will be determined by both my undergraduate training (in Osteopathy) but also by my post graduate training and continued professional development which has included shadowing surgeons and radiologists from the Royal National Orthopaedic Hospital for over a decade. My aim is to be able to combine the knowledge of an orthopaedic surgeon, with the best hands on skills and techniques in joint manipulation (adjustments) and remedial massage, together with the best corrective exercise advice as might be expected of an elite personal trainer / physio, and whatever the best technologies in electrotherapy has to offer. This is something I have tried to instil in all the Osteopaths who work at Spine Plus’ Clinics, where in addition to “osteopathy” our osteopaths:
- Offer medical acupuncture, shock wave therapy, TECAR Therapy & IDD Spinal Decompression
- Receive post graduate training in spinal MRI interpretation
- Are qualified clinical Pilates from the Australian Physiotherapy & Pilates Institute
Chiropractors and osteopaths are both healthcare professionals who specialise in treating musculoskeletal disorders, there are some generalisations that can be made, Chiropractors will be more likely to make use of X-rays and focus on spinal / joint realignment, whereas an osteopath will be more likely to take wider scope of philosophy and combine spinal / joint manipulation with soft tissue massage techniques thereby resulting in longer (less frequent) appointments. However, there is a wide variety in how individual therapists practice (particularly within osteopathy).
If you are in the London area and looking for a multi-disciplinary approach that combines the best of traditional hands on manipulation and remdial massage with other effective therapies and modern technologies (including ultrasound & MRI scan analysis) and electrotherapies (medical acupuncture, shock wave therapy, TECAR Therapy & IDD Spinal Decompression)– then contact us to make an appointment book with one of our Osteopaths at Spine Plus.