One question that I get asked a lot is, “How do I know if I should see a chiropractor, a physio or an osteo?”

Do you know what? If I’m being perfectly honest with you, I’m a bit confused about how to answer this question. Yes, I can easily research and give you a ‘textbook’ definition of what chiropractors, physio’s and osteo’s (supposedly) do but times are changing. Many practitioners are being encouraged (both professionally and socially) to evolve and change their clinical service model/s to merely, “Keep up with the Joneses.”

I even went as far as calling an osteo clinic and writing to a physio to see if they could help me draw a definitive line in the sand between what chiropractors, physio’s and osteo’s do but I discovered that, overall, I can’t.

There’s a lot of common ground between what chiropractors, physio’s and osteo’s do because they can use similar (or the same) types of treatments to improve people’s muscle and joint (or musculoskeletal) function.

Consequently, it doesn’t surprise me that a lot of people are confused about what chiropractors, physiotherapists and osteopaths do. I’ve lost count of how many times I’ve heard people say statements like:

“I see my chiropractor because they give me a massage before they adjust me. I like that they give me home stretches to do, too,” or, “I go to see an osteo because I like that they do a bit of massage, dry needling, and joint manipulation,” or, “I see a physio because they give me a massage, they stretch my muscles and sometimes, they ‘crack’ my back. And then they give me all these exercises to do at home.”

Once, I had a person call me to ask if they could see a chiropractor and if so, they didn’t want any joint manipulation done on them – they just wanted a massage to help loosen their tight back muscles. I left the conversation feeling confused – I thought to myself, “But I’m a chiropractor – I adjust joints. Why didn’t they call a massage therapist?” To me, that’d be the same as someone going to a French restaurant and asking the chef to make them their best soufflé without using any eggs.

So, where’s all this public confusion about the three manual therapy services coming from? My theory is that because health science is rapidly evolving, many allied health practitioners are learning novel and innovative ways to improve their clinical competencies. This means that patients are being exposed to heaps of new, unexpected, and similar treatment services when they see either a chiropractor, a physio or an osteo. Consequently, you end up getting conversations between people like:

Person 1: “I just went and saw my chiropractor and they did some dry needling to help my back pain.”

Person 2: “Wait – my physio does dry needling. I thought that chiropractors just adjust joints?”

Person 3: “Hey – my osteo does dry needling, too.”

So, personally, I’ve observed that the type of service (and care) a patient gets is dependent on the treating practitioner’s personality traits (which includes their ethics) and influences (both professionally and socially), irrespective of whether they’re a chiropractor, a physio, or an osteo.

What’s the (professional) difference between a chiropractor, a physio and an osteo?

In Australia, chiropractors, physiotherapists, and osteopaths are registered allied health professionals and they’re specially trained to diagnose and treat musculoskeletal conditions, such as: back pain, neck pain, migraine, and headache.1

Chiropractic Treatment.

According to the ‘Australian Chiropractors Association’,2 there is a common misconception that chiropractic care involves a singular therapeutic technique – spinal manipulation (or a spinal adjustment). However, chiropractors use a patient centred, multi-modal model of care.

Most Australian chiropractors provide a therapeutic approach to care that incorporates a range of manual therapies, such as: spinal adjustment, joint mobilisation, soft tissue techniques (which includes electrotherapies), exercise prescription, rehabilitation, nutritional recommendations, and lifestyle advice. These have been shown to be of benefit to people with a range of musculoskeletal conditions.

When treating patients, chiropractors make an assessment and develop a treatment plan (in accordance with the needs of the patient) and provide advice on future management strategies.

Physiotherapy Treatment.

According to the ‘Australian Physiotherapy Association’,3 physiotherapists are trained to assess a patient’s condition, diagnose the problem, and help them understand what’s wrong. A physio’s treatment plan will consider a patient’s lifestyle, activities, and general health.

The following are common treatment methods use by physiotherapists:

Exercise programs to improve mobility and strengthen muscles. Joint manipulation and mobilisation to reduce pain and stiffness. Muscle re-education to improve control. Airway clearance techniques and breathing exercises. Soft tissue mobilisation (massage). Acupuncture and dry needling. Hydrotherapy. Assistance with use of aids, splints, crutches, walking sticks and wheelchairs to help people move around.

Physiotherapists work in all sectors of healthcare, such as: public hospitals, private practice, rehabilitation centres, sporting clubs, and community health centres.

Osteopathy Treatment.

According to ‘Osteopathy Australia’,4 osteopaths use a whole-body approach (which is often called the biopsychosocial approach) to consider the cause of a patient’s musculoskeletal injury or pain, and not just their symptoms. This means that osteo’s reflect on and manage the biological (body), psychological (mental) and social (environment) factors that may be affecting a patient’s health and wellbeing. It works on the principle that everything is connected.

Osteopathic treatment involves one or a combination of the following manual therapies:

Checking your musculoskeletal and nervous systems. Providing non-invasive manual therapy, when appropriate. Developing clinical exercise programs. Providing movement, postural and positioning advice. Providing ongoing support and educational advice about lifestyle, stress management, diet or other factors that may influence pain, injury, or movement.

So, what do statistics say about who people might choose to see?

According to one study,1 it seems that people are more likely to pay their own money to see a physiotherapist, compared to, say, an osteopath (figure 1).

But why? There appears to be four main reasons why people choose to see a chiropractor, a physio, or an osteo:1

People may be more persuaded to see a particular profession if their private health insurer pays them a good claim benefit for its service fees. People are more likely to visit a profession if it has good public acceptance or awareness (and hence reputability). People tend to go with the whole ‘safety-in-numbers-kind-of-thing’ which (I feel) includes ‘word-of-mouth’ referrals. Also, media and medical professionals’ opinions can greatly shape people’s decisions about what type of profession/s they see. It’s important that a profession has good commercial relationships with other reputable healthcare/medical professionals. A person is more likely to see a particular profession if, say, their General Practitioner (or Medical Doctor) says to them, “Go and see this person because I’ve heard that they’re good”. Some practitioners don’t do insurance claim cases (such as Workers Compensation claims) which can drastically narrow people’s choices about what type of profession/s they can see. Therefore, practitioners who accept insurance-based cases have a better chance of seeing more people.

But what happens when something big and unexpected challenges the Australian private healthcare norm, such as a global pandemic?

Has the COVID-19 pandemic changed how we utilise chiropractic, physiotherapy, and osteopathy? Interestingly, yes, it seems that it has.

During 2020, out of the three manual therapy services, physiotherapy suffered the biggest relative drop in revenue (17.0%) and chiropractic was the least impacted (4.7%).5

I was seriously shocked when I first read this report. I thought that physiotherapy would’ve been the strongest and securest profession especially because Medical Doctors are more likely to refer their patients to see a physio (compared to a chiropractor or an osteo).4

So, out of the three manual therapy services, what could potentially explain why more people decided to see a chiropractor during the COVID-19 pandemic?

Well, one theory is that physiotherapy provides more specialised services (such as: neurological rehabilitation, geriatric services, and sports injury prevention and rehabilitation), compared to osteopathy and chiropractic. Therefore, it’s possible that the enforced COVID-19 pandemic Government restrictions (such as, public stay-at-home directives, limited public access to aged care facilities, and closures of community sporting activities) may have greatly limited people using specialist physiotherapy services.5

Another theory is that because the COVID-19 pandemic devasted the Australian economy, perhaps people forfeited or stopped paying their ‘extras treatment’ private health insurance cover to try and save more money.5

Although both theories (or situations) can explain why physiotherapy suffered a big revenue drop, it doesn’t necessarily explain why people appeared to bias their decisions to see either a chiropractor or an osteopath (especially if they decided to drop their ‘extras treatment’ private health insurance cover).5

I guess the question is: has the COVID-19 pandemic changed the way Australian people use manual therapy services and if so, what could this mean for the future of chiropractic, physio, and osteo?

A final note.

When someone asks me, “Should I see a chiropractor, a physio or an osteo?”, I tend to resort to offering them the same advice that was given to me by one of my chiropractic mentors. When it comes to you choosing to see a practitioner (irrespective of whether they’re a chiropractor, a physio or an osteo), find someone who:6

Doesn’t over service you (or gets you to see them for more visits than you feel is appropriate or necessary). Gets you to keep paying for unnecessary testing procedures (such as digital imaging) or asks for you to pay for your future visits up front (or in bulk). Shows you empathy. Gets you your desired clinical result/s. Enjoys their work. Will refer you to see someone else who can help you if they can’t.

References

Lystad, R., Brown, B., Swain, M., and Engel, R. Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Chiropr Man Therap.2020; 28: 49. Website: https://www.chiro.org.au/patients/about-chiropractic/faq/#chiropractors-do (accessed on 23.12.2022). Website: https://choose.physio/what-is-physio (accessed on 19.12.2022). Website: https://whatisosteo.com/about-this-website/what-is-biopsychosocial-care/ (accessed on 19.12.2022). Lystad RP, Brown BT, Swain MS, Engel RM. Impact of the COVID-19 Pandemic on Manual Therapy Service Utilization within the Australian Private Healthcare Setting. Healthcare (Basel). 2020 Dec 13;8(4):558. Website: https://www.choosingwisely.org.au/consumers-and-carers (accessed on 19.12.2022).

Figure 1. The annual cost of services received by chiropractic, osteopathy, and physiotherapy in Australia between 2008 and 2017, inclusive.4