Physio vs Chiro

This is a question I get asked all of the time, “what's the difference between physio & chiro?”, “what do you think of chiropractors?”, etc.

My answer is always the same, “what do you think the difference is?”. Such an annoying answer, but one that tells me a lot about the individual and leads into a deeper discussion.

Generally, the answer they gave me is something like, “chiros treat the spine”, “chiros only ‘crack’ joints”, “I saw a chiro once...” etc.

To be honest, they don’t know what the difference is, and I think to some extent the wider healthcare profession, and even the professionals in these categories fail to really know the difference.

Thinking skeleton

These are the two definitions from the World Health Organisation (WHO):

Physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments.

Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system, and the effects of these disorders on general health.

So is it clear what the difference is? Absolutely not.

I have trawled through the Canadian Chiropractic Association and the Canadian Physiotherapy Association website to see what they have to say, and the terms chiropractor and physiotherapist could be interchangeable on both pages and I would be a tough time knowing. The common phrases are

  1. Scientific, evidence-based treatments

  2. Relieve pain

  3. Promote an active and healthy lifestyle

  4. assess, diagnose and treat neuromusculoskeletal conditions

So still no clearer to what the difference is.

This then opened up a wormhole, and I got deep into blogs and different clinic websites, trying to differentiate the two. Unfortunately, I would say, the deeper you get into the internet, the worse it looks for chiropractors...sorry guys! These are some common phrases I picked up on.

  • “Pseudoscientific”,

  • “homeopathy for orthopedics”,

  • “treatment based on the alignment of the spine”

I even read a website that talks about adjusting the spines of newborn babies to relieve birth trauma (head in hands emoji).

I know a lot of chiros, they are all disappointed to hear these things said and written about their profession and is not what their training is based on. Chiropractic is going through an identity change and it is tough to read. The WHO and the governing college of chiropractors, seem to have a different opinion than a lot of the internet on what chiropractic is. I know which source I will listen to.

This stems from history and the origins of the profession. This origin of chiropractic comes from its history. In 1895, a gentleman named Daniel David Palmer “adjusted” the neck of a deaf janitor and claimed to restore his hearing… Spinal manipulation had been used for thousands of years before this point, but DD Palmer used his knowledge of anatomy to apply this technique in the treatment of many disorders, and opened the first chiropractic school a few years later. Fortunately, a lot has changed since then and the schools now teach scientific backed principles. In Canada it is a Doctor of Chiropractic degree, I always find this interesting as it is not the same for the rest of the world. In New Zealand, it is an undergraduate bachelors degree.

Physiotherapy on the other hand, reads quite easily on the internet to the naked eye. However, for someone trained in the profession, there are also a lot of disappointing descriptions to read out there. The most disappointing for me are

  • “Promote healing by use of machines”

  • “Use heat as treatment to relieve pain”

Physiotherapy is also going through an identity change, just not as drastic as chiropractic. We are moving away from the use of electrotherapy and heat, to align ourselves better with the research and stick with our education, exercise, and manual therapy skills. Again, The WHO and the Physiotherapy colleges describe the profession as scientific-based health professionals, but this gets lost on the internet and we go back to being professionals who apply heat to people... Not very scientific if you ask me!

The history of Physiotherapy is less dramatic. It is generally believed that Hippocrates was the first practitioner of physical therapy using massage, manual therapy, and hydrotherapy to treat people in 460BC. In the 1800s, the use of manipulation and exercise were combined by the father of Swedish Gymnastics to treat gymnasts, and the profession really snowballed from there. Interestingly, spinal manipulation has been a part of physiotherapy treatment since inception. This is not something most people are aware of.

So that is a lot of general information with no answer. What is the difference? Who should you go and see?

For me, there is no noticeable difference in the way that we assess, treat, and manage our clients. Or I should say, there SHOULD be no noticeable difference. Both professions are “evidence-based” health professionals treating the musculoskeletal system. This means they base their assessment and treatment on the highest quality and most recent research. If both are doing that, how can they be different? They may look different on the outside, but the principles are the same. It is OK to teach exercises differently, use different manual techniques, and provide different strategies for self-management. It is like a mechanic using a different tool to service an engine, or an artist using canvas instead of paper. You will get these differences within the same profession as well as between. If you have 5 different physios and 5 different chiros look at a client, you can have 10 different treatment ideas, but the underlying principles of pain education, health promotion, and restoring function are the same.

I honestly think that if you watched a treatment session by “good” therapist, you would struggle to know if they were a physio or chiro without being told in advance.

Now don’t get me wrong. There are good and bad therapists in both professions. Ones that don’t update their knowledge, skill, and practice, with the latest research and understanding. There are those that care more about billings and making money, and that influences their practice. This is not unique to chiro or physio, or any profession. So really I should say there is no noticeable difference between a GOOD physio or chiro.

As a physiotherapist, I do a lot of continuing education courses. I can go to one of these on a weekend, and sit there with a personal trainer, a kinesiologist, a physio, a chiro, an osteopath, the list goes on and on. The initial training and schooling is different, but the ongoing education is exactly the same. In my opinion (for what it is worth) we could easily move towards a model of healthcare that gets rid of these titles and we merge to become “rehab professionals” or “musculoskeletal therapists” or something similar. This will never happen, money, politics, history, stubbornness are all too important!

In towns like Collingwood, there are lots of physiotherapists and lots of chiropractors. It can get confusing if you need to see one.

So who should you go and see for your condition?

This is easy. Go and see someone that helps! If you have had chiro before and it was useful. Go and see the chiro. If you have had physio before and it was useful, go and see the physio. If you have had neither, ask a friend or a family member who helped them with their knee pain, or back pain etc, and go and see them. It is important to have a strong relationship with your therapist, and they need to be someone you trust. If this is not the case, that does not mean that profession won’t help you, try another one. We all have people that we don’t “click” with. When this happens between clinician and client, it is tough to get positive clinical outcomes. So change it up, see another professional if you don't think it is working! The only thing that matters is that you trust them to help you get better, and they are honest with you about the process.

If anyone tells you that one profession is "better" at treating a certain condition or body part, I would question their knowledge and understanding- especially if they are one of these professionals!

Don’t get caught up on who is going to do what exactly, and how is that better than this etc. There is no one technique that is superior, otherwise, everyone would be doing it! See a professional who is going to be honest, give you the time that you need, that you are able to connect with, and that provides you with tools and understanding on how to improve your condition and reach your goals :)

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