Having a Bad Back - Physiotherapist, Osteopath or Chiropractor?

Ever had back issues and you do an online search but are unsure of the rehabilitation medicine that you should be going for? You are not alone, with medical systems becoming more specialised these days, it can be hard for a patient without any prior knowledge or experience in the medical field to know the difference between the different disciplines. UFIT Osteopath, Paul Stoenescu gives us a break down on the difference between a Physiotherapist, Osteopath and a Chiropractor to help you make an informed decision.

These disciplines are promoted separately nowadays, mostly due to marketing interests, but you can still see the similarities that bring them together for the greater good of the patient.

Let’s start with the similarities:

      •     We all treat musculoskeletal pain conditions

      •     We all have protected titles, meaning that a therapist cannot call him/herself a Chiropractor, Osteopath or a Physiotherapist, unless they have completed the relevant accredited course

      •     We all have university-based education (typically a 4-year course)

      •     In most countries, we are primary healthcare providers – that means we are responsible for diagnosing, treating or referring patients without the intervention of a general practitioner

 There are more similarities than differences between these professions. Simply put, the difference between a physiotherapist, a chiropractor and an osteopath are in the philosophy of each profession and the modalities and/or techniques used to achieve the therapeutic goal.

Differences between the 3 disciplines:

•       Osteopaths work from the viewpoint that the “body is a whole” and all the systems are interconnected and able to self-heal so long as proper function is restored

For example, when treating your back, an osteopath might want to work around the hip area, or the legs to analyse your posture in order to determine where the compensation patterns are coming from. All these help with finding the root cause of your problem.

•       Conversely, physiotherapy is more closely aligned with traditional Western medicine. The focus is more on the problem area presented and treatment is specific to the affected area, rather than the whole body 

If you were having physiotherapy treatment for your back, a physiotherapist would mostly work around that specific area, as well as giving you some specific exercises to do at home to aid muscle recovery and strengthening of core elements.  

      •     Chiropractors are more focused on the biomechanics, function and structure of the spine, and tend to be quite limited in the exploration of other underlying causes which might have triggered the spinal imbalance in the first place

In consequence, the treatment will probably be focused on the spinal area through manipulation. 

In modern practice, Physiotherapists, Osteopaths and Chiropractors would each take into account all relevant indications of the presenting complaint and try to find the best strategy for dealing with the specific pathology.


Treatment modalities: Crack or no Crack?

      •     Chiropractors will mostly utilise spinal manipulation to treat what they refer to as misalignments in the spine. Chiropractic technique relies heavily on imagistic diagnosis (X-Ray) which could be costly and may present health issues

     •      Osteopaths typically use gentle manual techniques for improvement of mobility and range of movement but are also trained to do spinal and joint manipulation as well. This enables them to execute the same techniques as chiropractors. Osteopaths undertake 4 years and 2,000 hours of ‘touch therapy’; making them experts in palpation without the need to rely on X-rays.

    •       While osteopathic and chiropractic treatment methods are 90% hands-on, majority of Physiotherapists use a 60% hands-on approach. This is because, apart from manual therapy, Physiotherapists also utilise other specialised techniques. Physiotherapists also have a specific focus on remedial exercises and increasingly offer facilities for supervised exercise as part of an effective rehabilitation program.

Whether you plan to see a Physiotherapist, Chiropractor or an Osteopath, the most important thing is to find a practitioner who "operates under an evidence-based paradigm”. The techniques and exercises he/she will use have already been tested through scientific trials and come up as beneficial.

From my experience as a Physiotherapist and an Osteopath, I think both professions complement each other. Osteopaths provide specific treatment for pain relief while Physiotherapists provide excellent rehabilitation after injury or surgery.


Paul Stonescu is an Osteopath who believes that every person is different and the cause of ailments is not always evident. He works with different specialised techniques to offer an all-rounded experience to determine the root cause of his patients’ problems instead of offering a quick fix. Paul also enjoys participating in marathons and played tennis for almost 15 years prior to his osteopathy career.