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Exercise is best...the Physiotherapy way!

I frequently get asked by patients (human and equine) what the differences between phyiotherapists, oesteopaths and chiropractors are and which is best. It is not a clear cut difference, in fact there are several things which overlap. I will do my best to try and explain the founding principles of each profession and the types of treatment they use. My personal opinion is that physiotherapy is best but I am a but biased! In all seriousness I have worked with some great practitioners and ultimately it is a personal choice and whatever works best for you in both the short and long term is the best. There are many similarities between the three professions and include:

  • all treating musculoskeletal pain conditions

  • all have protected titles, meaning that a therapist cannot call themselves a chiropractor, osteopath or physiotherapist unless they have completed the relevant accredited course.*

  • all have to complete a full time (or equivalent) undergraduate or postgraduate degree.

* Equine, canine, animal, veterinary physiotherapist (and variations with an animal prefix) are not protected title. Read here about new register trying to regulate animal musculoskeletal practitioners

The main difference are the philosophies of each profession and treatments used.

The main treatment of choice is manipulation of the spine (will also do in other joints) to create adjustments in chiropractor. The adjustments are based on the theory and belief that pain is caused by subluxations of a joint(s). However this is not the same subluxation used in medical terms to describe an incomplete or partial joint dislocation. This theory is not evidence based and can't be shown on XRAY or by any other imaging. This is similar to patients being told by chiropractors that there spine or pelvis is out of alignment. They believe that the body has to be in correct alignment for it to be healthy and previously used to treat medical conditions such as asthma. There is some evidence to suggest that chiropractor is useful in treating back pain.

Osteopathy also focuses on alignment as an important component of improving pain and function and commonly use gentler manual techniques than the mobilisations used by chiropractors (but will still manipulate joints). Their philosophy is based upon the belied that in order to the body to be healthy all body tissues are required to move according to their function. However for both oseteopathy and chiropractor an important consideration in the treatment of pain related problems is that research has showed that structural symmetry rates poorly in relation to a patients prognosis. Outcome is more dependent upon a persons belief about their spine (Important factors to consider when treating back pain.)

Physiotherapy is a healthcare profession that works with people to identify and maximise their ability to move and function. Physiotherapy plays a key role in enabling people to improve their health, wellbeing and quality of life. (Chartered Society of Physiotherapy). Physiotherapists use manual therapy techniques such as massage, myofascial release, mobilisations or manipulations in addition to rehabilitative exercises for any injured body part. The focus of management of pain conditions is based upon a biopsychosocial model where the patients attitues, beliefs and behaviours are identified to help create a treatment plan.

So hopefully that helps explain things a bit more! Regardless of which profession you seek for treatment of yourself or your horse ask yourself a few questions once you have started treatment...

  1. Have they described to you what is causing you pain? And more importantly do you understand?!

  2. Have you been given advice and education and home exercises which are helping?

  3. Are you starting to feel better? Or are you seeing improvements?

  4. Have goals been set so you can follow your improvement?

These are the questions I find people who have received multiple sessions of treatment from practitioners (on either themselves or their horses) don't have the answers to and have spent a lot of money to not be better. From a personal point of view if my patients are getting better within a few sessions with a significant improvement after 4-6 sessions then I am happy. If they are not showing any or enough improvement in relation to the goals we have set then we need to have a discussion about the next step in their management whether than be medication, imaging, cognitive behavioural therapy, specialist review.

The other main point I want you to think about is that the practitioner shouldn't be doing the same thing each time with only short term gains. You are just plastering over the cracks.

If you have any questions please ask. Thanks for reading!

Jennifer Taylor

Chartered Physiotherapist and Veterinary Physiotherapist

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