Chiropractors, Osteopaths, Physiotherapists, GPs & Consultants

So What's the difference?

It's a good question, and the truth is that sadly there is as much difference between the ways individual chiropractors practice as there is between the individual professions themselves. More often than not it comes down to the skill and enthusiasm of the practitioner, and never more so than between Chiropractors, Osteopaths and Physiotherapists. Not much help when trying to choose.

Having said that, there are educational differences that often facilitate different approaches, and therefore, crude and vastly over simplified as this answer must be, hopefully it will go some way towards illumination.

Chiropractors & Osteopaths

Generally qualify with a 4 year BSc(Hons) or 5 year MSc(Chiro) / MSc(Ost) Masters degree. Both are recognised primary healthcare professionals, which means they are qualified to diagnose in a similar way to a GP, and then treat or refer based upon that diagnosis. You don't need a referral to see one. Chiropractors are qualified to take x-rays, and both Osteopaths and Chiropractors are qualified to read them, along with MRI scans and CT scans, which generally Physiotherapists and indeed GP's are not.

Both are qualified to manipulate joints, and spend at least 4 years of their full time education practicing and learning this skill. For Chiropractors the last year of college is in supervised clinical practice, and then there is a post graduate 5th or 6th year 'on the job' learning to gain their DC (Doctor of Chiropractic) qualification. Sometimes Physiotherapists and GPs attend courses in manipulation which obviously do not generally produce the same levels of manual skill that you would expect to find in either a Chiropractor or an Osteopath.

Both professions are fully qualified in soft tissue therapies, and injury rehabilitation, and are correspondingly best placed to diagnose and treat most neuromusculoskeletal (nerve, muscle, and joint) problems. More so than between any of the other professions, it is far more about the individual, their skill and they way they practice, than which professional title they hold.

Physiotherapist

Physiotherpy is enormously diverse, encapsulating such a wide arena of skills and specialisms, that definition is virtually impossible, tending to end up as a rambling and vague!

They generally qualify with a 3 year BSc(Hons) degree course, which includes around 1000 hours of clinical 'hands on' learning before qualification, and then a further 1 year on the job before they are eligible to apply for 'charted' status. There are many different courses available, each offering individually different modules that students can then individually pick and choose. The result is that rather than saying generically "physiotherapists are qualified to.......", the buzz phrase seems to be that they are qualified ".....within their own scope of practice".

Broadly however, Physiotherapy is also concerned with the treatment of neuromusculoskeletal complaints, (nerve muscle and joint problems), and also with Cardiovascular issues. They treat a range of issues across the board through Asthma, Multiple Sclerosis, Heart attack and Stroke rehabilitation to muscle problems and sports injuries.

There is of course diversity within all professions, however with the other professions here the statutory governing bodies regulate the content of the courses far more than with Physiotherapy. There may of course be a huge difference between how two chiropractors practice, however the basic education, qualifications and skill expectations are fundamentally defined.

As an aside, many Physiotherapists work within the NHS, where time, patient compliance, accountability and freedom to direct treatment is limited. This environment is arguably not well suited for either effective treatment or professional development, and therefore physiotherapy should probably not be judged upon a patients experience within the NHS. If you would like to know more about physiotherapy or indeed a particular physiotherapist, the Charted Society of Physiotherapists will be glad to help.

GP (General Practitioner)

It takes a long time to become a General Practitioner, initially a 5 or 6 year degree, followed by 4 (now 5) years 'on the job' learning before they are allowed to practice independently. We all tend to go there first with whatever problems we have, and indeed a GP is qualified to provide a general diagnosis upon an immense diversity of health issues. Because essentially their primary job is to identify everything from acne to heart disease, their detailed diagnostic skills and treatment arsenal are necessarily limited. In terms of nerve, muscle and joint problems, we expect far too much from them, and arguably they often take too much upon themselves. Once they have broadly defined the problem, the only treatment tools initially open to them are the prescription of anti-inflammatory tablets, painkillers, and a limited array of generic muscle stretches. If these don't solve the problem they are able to refer you through to a more specialised professional. More often than not that will tend historically to be a Physiotherapist, although (not always aware of it), they are equally able to refer you for Chiropractic, Osteopathy and Acupuncture through the Departments of Health's 'Musculoskeletal Services Framework'

Consultant

The title given to a senior doctor after they have completed a designated amount of specialist training in their chosen field. Consultants must first complete the same 5 or 6 year medical degree that a GP would, and then instead of going into a private GP practice, the doctor must remain within the hospital environment for a further 8 years on the job learning before becoming a consultant. Consultant's diagnostic skills are correspondingly more in depth than a GP for their chosen speciality.

In the UK however, Orthopaedic Consultants tend to be surgeons, and as a result, their remit will usually be to assess your problem with a view of whether to operate or not. They do not generally get involved with any non-surgical treatment, or rehabilitation either before or after surgery. As a result they are not well placed to guide rehabilitative treatment. Surgery is not by any means without risk, particularly when the spine is involved. It is therefore a last resort after exhausting the more conservative alternatives. For this reason Consultants do not treat or indeed operate, but simply refer the vast majority of patients they see to Chiropractors, Osteopaths, Physiotherapists or indeed for Pain management (anaesthetists).