Osteo, Chiro or Physio: Whats the best?
Updated: Aug 8, 2021
Choosing a healthcare provider from a crowded market can be a bewildering experience and can add to the anxiety and suffering from a painful condition.
Im an Osteopath. The most common questions we get asked as Osteopaths are "What is an Osteopath?" Why would you need to see one, instead of the more numerous Physiotherapists or Chiropractors. If you are a consumer, its an advantage to understand what an Osteopath is and what makes them different. This blog is an attempt to help you be informed and choose right.
What is Osteopathy?
In Australia, Osteopaths are university trained and government regulated health professionals who focus on the body and body related issues. We are trained to professionally assess and diagnose musculoskeletal issues and to provide various forms of treatment for it, often manual therapy (massage, assisted stretching and mobilisation) but increasingly also other therapies like exercise prescription, advice and ergonomic instructions and other related therapies. We are also trained to recognise non-musculoskeletal issues and refer them off appropriately. We can order diagnostic scans, provide workplace injury certification and treatment under insurance schemes like work-cover and traffic accident insurance schemes.
Why Osteopathy, and not Physio or Chiro?
Believe it or not, I would never assert you should just go to an Osteopath over a Physio or Chiro. I want you to go see someone who is good at helping people recover from injury, and all 3 professions have those. They also have not-so-good providers and downright hacks. To make matters more complex, some therapists are brilliant with knees, but not so with backs. Some are fantastic with headaches, but not with tendons. The modern therapy word is ever changing too, so the best therapies for certain conditions will shift significantly within a few years. So you also have to keep up with advances and not fall behind.
Traditionally, Osteopaths have tended to focus more on complex interplay of psychological, social and physical factors in the onset of an issue and weave those insights into treatment of medical conditions. As such we still see more complex issues, but we can do treatment for the garden variety, common and painful issues as well.
But Whats the Difference?
The best way to really understand the difference is to understand the history of the three professions (here is a great research article on that for the nerds). Osteopathy is the oldest of the three and emerged out of the medical profession in the 1860's. It was born out of reaction to some of the shittier therapies that were being performed on sick people (mercury therapy, bleeding sick people etc- there were a LOT of bad therapies in the 1860s) The founder was a man called A.T. Still, who was a physician. His wife and 3 kids died from spinal meningitis, after which he concluded that orthodox medicine was pretty crap- and fair enough. As such Osteopathy still has a bit of an anti-establishment streak, but nowadays plenty consider themselves proud members of a medical system that has much better treatment options for sick kids than mercury and bleeding therapies.
Chiropractic was a splinter school from Osteopathy, with Daniel David Palmer, the founder of Chiropractic having studied Osteopathy. He took the concepts in a slightly different direction. Traditionally Chiropractors were more focused on manipulation of subluxations for treatments for a wide range of conditions. On average, I would say a chiropractor still practices a more manipulative based therapy today. That means more cracks.
Physiotherapy was came out of nursing for war victims in the 19th century, with the need for a seperate profession being recognised with rehabilitation for maimed soldiers driving improvements with massage and gymnastic therapies, all coming under the banner of the new profession. As such physiotherapists today still have some clinical hospital rotations towards the end of their education and are more entwined with the medical profession. They used to be crap, using things like heat lamps and therapeutic ultrasound (which it pretty much an elaborate placebo) - but with huge growth in universities offering physio over the last 40 years and a bunch of prominent serious academics they are responsible for most of the quality research at the moment, and most physios are now just as capable with their hands on treatment now as Osteos and Chiros.
How do you find someone who is good?
So instead of what type of therapist to see, I think the better question is how do you find someone who is good- That is the challenge. You can ask around for a word of mouth referral or google someone nearby and look at reviews. University qualifications and experience in multiple settings (sports/hospital/different countries/academia) help cover a lot of bases. But ultimately there is still a leap of faith when you come to make a booking. When you are dealing with a therapist, Here are some things I would look for:
The most important skill of any therapist worth-their-salt is listening. It takes a lot of commitment to really hear what the patient is trying to tell you, and not what you want to hear sometimes. You should feel like they believe you at all times and dont belittle your experience. A good therapist should not be rushed and have a good dose of empathy.
Being popular is generally a sign that the therapist is good, although sometimes it can mean they are a good salesman and not the best therapist. It also probably means they have experience.
Unfortunately I think you should look for someone who has some life experience. Im not saying new grads are bad, they are quite often better versed in up-to-date research than older practitioners, but for most complex issues a little life experience helps immensely.
Finally and most importantly: results. It's surprising how long a person will stay with a therapist who makes them feel better, but doesn't help them sort out an issue for good. Make sure that you feel improvement - in reduced pain or better function - after a series of appointments. There are a few exceptions where a cure is not a realistic outcome (degenerative arthritis, some forms of chronic pain and other chronic conditions) but for most musculoskeletal problems we should be aiming at cure, and if this is not possible the therapist should be able to articulate to you why not. Make them work.
Eddie Clark is an Osteopath with over 17 years experience. He practices in Sydney Australia.