It’s difficult to differentiate between physiotherapists, chiropractors, and osteopaths. All of these professions deal with similar issues in a referred or primary contact capacity and all of these professions approach these problems in subtly different ways. Quite bluntly, private Allied Health is made up of a number of different professions all eating from the same pie, and who all want as big a slice of that pie as is possible. How big of the slice of the pie they get depends on how much of the slice of the pie they address and how well they hold on to that slice.
Articles describing the difference between physiotherapy, chiropracty and osteopathy divide the three professions into three broad categories: physiotherapists deal with soft tissue injuries through rehabilitation and exercise, chiropractors deal with injuries and disorders through management of spinal and joint alignment, and osteopaths take a “holistic” approach to management and consider the whole patient. I disagree with these delineations on three separate bases.
Firstly, no profession can claim that they address the patient in a more holistic manner than another. Holistic patient management boils down to considering the patient as a person, and considering the way in which their lives, jobs, activities and personal history can affect the course of their presenting problem. Holistic patient management isn’t something that belongs to one profession but something that is a basic requirement of working in health, regardless of it being in a community or private context. To say that one profession is inherently more holistic than another is wrong firstly because all health professions are supposed to be considerate of the patient as a whole, and disingenuous because to say one profession is more holistic than another is to suggest that those other professions are less holistic, less considerate of the patient context, and potentially less effective as a consequence.
Similarly, physiotherapists, chiropractors, osteopaths and the like all need to interpret injuries within the context of either functional deficit or functional alteration. As part of this interpretation, joint alignment and function is always considered. Just like being “holistic,” to say one profession expresses more of a bias towards or takes more consideration of spinal and joint alignment is incorrect because, again, assessing spinal and joint alignment is a part of the initial assessment of the patient. If someone comes in with knee pain, back pain, shoulder pain, or pain of any kind, joint and limb function is always assessed as part of the initial intake.
Lastly, there is no profession that can claim to promote health without rehabilitating its patients following injury or illness. Rehabilitation is the process through which an individual is brought from a state of disability or ability deficit to a state of better ability and function. No Allied Health profession can claim to be better or worse or consider this a more or less important part of the process because assessment, resolution, and rehabilitation are the three key pillars of professional practice. In summary, the three broad arguments used to differentiate these professions are disingenuous because they seek to magnify delineations to the point of philosophical or practical relevance where no such relevance exists.
So why is there so much confusion regarding the difference between these professions, and so much breath spent on differentiating them? Remember how I said that everyone’s eating from the same pie? That’s why. Physiotherapists, osteopaths, and chiropractors working in the private sphere are all competing for the contact hours and appointment dollars of people with the same problems. So if people have the same problems and your professions approach these problems with the same, evidence-based approaches, why do these differences exist? The answer is that when a profession differentiates itself, it can market itself based on that differentiation and capture more of that market. Physiotherapists, Osteopaths and Chiropractors are engaged in an ongoing race of reputation and identity in a dynamic and competitive marketplace of illness, and everyone wants to be the person who treats the largest number of sick people. This problem isn’t just confined to the differences between the professions, but also how they’re titled.
Previously, physiotherapy, chiropracty and osteopathy required bachelors’ level education. It was once possible to get into the profession with a bachelor of applied science and have the same legal right to practice as someone with a master’s or a doctorate today. As time went on, the minimum standard of accreditation has increased. Physiotherapy which was previously a bachelor’s degree has become elevated to a master’s minimum and now a doctorate-level qualification if taken at Melbourne Uni. Similarly, Chiropractors have a Doctorate level qualification and present themselves using that appellation. The issue is similar for osteopaths. There is a broader discussion about egalitarianism and fair access to professions that offer class mobility but that’s another discussion for another time.
Simply, we can return to the original question.
Is there a difference between physiotherapy, chiropracty, and osteopathy? Yes, there are differences between these professions. These differences relate to the titling that professionals can use as defined under state and federal legislation, and subsequent titling as pertains to specialisation. This legislation also specifies what constitutes each profession's appropriate scope of practice, and what they can and can't do. As may have been implied by the above paragraphs, the relative fields of practice of Physiotherapy, Chiropracty and Osteopathy are similar enough that if you were going to arrange them on a Venn diagram you'd probably end up with a tricolored circle.
Are these differences meaningful? No. A patient presenting with pain who wants to be seen will see the professional who can attend to them soonest, offer the most effective service, and who can provide the best plan of treatment. There is functionally no difference between physiotherapists, chiropractors or osteopaths because ultimately, the differences between these professions are so small as to be meaningless in terms of what can be offered in clinic. In spite of this, physiotherapy remains the most highly-recommended service by GPs and practitioners, so you as the patient may need to exercise discretion in your choice of care provider.
Why are these differences played up in dialogue? Most likely so that professionals can differentiate themselves through marketing and build a brand on offering a particular kind of service.
Does this matter to you as the patient? No. Ultimately, your choice of professional should depend on three factors. First, can they solve your immediate problem? Second, if you need additional treatment, do they have a plan? Third and final, do they help you in the way that you want to be helped, by offering a supportive, accessible, flexible and effective relationship that empowers you to do more with your life?
If you can answer yes to all three of those questions, then you’ve found your professional. Beyond that, the difference doesn’t matter.
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