What's The Difference Between a Physiotherapist, Osteopath and Chiropractor? Part 2

I first met Nick at a course in Auckland a few years ago. Nick is an Osteopath and a certified personal trainer. He had come from Melbourne specially to attend this particular course. We struck up a conversation and have been keeping in touch here and there ever since. At the start of the year I managed to make the trip to Melbourne to visit his clinic and observe what he does and how he practices. We do share similar views and I was very grateful when he agreed to contribute to this series that I wanted to address. You can also check out some of his writings here. Without further ado, take it away Nick....


What is the difference between physio/osteo/chiro?

“An osteopath. That’s bones right?”

This is a really common response when people hear what I do for the first time, and they don’t know what an osteopath is.

Osteo stems from the Greek root for bone (osteon), while path stems from, the Greek root for, “responding to” (patheia).

It is believed that the name arose from founder AT Still’s observations that anatomically, everything is in relation to the bones.

So yes, osteopathy is about bones, but it also about everything else that is related to the bones, which is everything, including the person those bones carry around.

Developed in the late 1800s, osteopathy arose as an alternative to the medicine of the time. It was based on the premise that the body had everything it required to heal from injury or disease within it, and that by restoring the optimal structure, that health could be expressed again.

These days medicine is much better. We have developed pharmaceutical interventions, refined surgical procedures and can even view the activity of the brain on MRI!

As a result, osteopathy has evolved into a form of manual therapy based healthcare, with a particular focus on musculoskeletal conditions.

Given the history of osteopathy, there is a lot of variation in how osteopaths treat, based on their readings, understandings and interpretations of both the history and philosophy of osteopathy, and the current body of scientific evidence.

But, what is common to all osteopaths (or should be) is a holistic, patient centered approach that is governed by the main tenants of osteopathy:

1.       The body is a unit

2.       Structure and function are reciprocally interrelated

3.       The body has capacity for healing/self-repair

So how does that differ to chiropractic and physiotherapy? Couldn’t they equally apply those principles to their practice?

You’re right, they could, and go ones do.

To me, the main thing that separates osteopathy isn’t what we do, or even how we do it, it is simply the thinking.

Firstly, osteopaths take a very broad view, appreciating that everything is interconnected. This is why there are no specialisations.

For example, you can’t be specialise in the shoulder and neglect the rest of the body, which has an effect on the shoulder.

Secondly, osteopaths look for the why behind the what.

Using a sore shoulder again. Lets say you have bursitis.

Conventional wisdom is that if you have inflammation, you treat the inflammation.

A broader view is that something is causing the inflammation. So treat that something.

A broader view still, is that inflammation is an immune response, with local and systemic effects, so consider the entire immune system, along with that something that is causing the inflammation.

A broader view still is that inflammation occurs when the energy demands placed on cells exceed their capacity to produce energy, so consider the energy demands placed on the tissues, and the person, as well as the capacity for cells to respond to that demand.

Going back to bursitis, we would then ask what demands are being placed on this bursa?

For example: an increased mechanical demand due to compression by the supraspinatus tendon, which is secondary to decreased mobility at the neck, which has resulted from a period of sustained stress from a personal relationship.

We then can appreciate that sustained stress elevates both adrenalin and cortisol, which suppresses the immune system, breaks down body tissue and decreased appetite. So this person’s normal resilience was lowered as well.

So while there is a bursitis leading to the symptoms of shoulder pain, there is a lot more to it.

But, again, this way of thinking is still not exclusive to an osteopath.

The think this deeply and broadly requires a thorough understanding of the body from a biological, psychological, environmental and social point of view.

The knowledge then needs to be applied, and the experience of applying knowledge, observing cause and effect is then termed understanding.

This level of knowledge and understanding is common to good, or rather excellent health professionals across all disciplines.

So what is the difference between an osteopath, a physiotherapist and a chiropractor? A good one.