What is the difference between an osteopath and a physiotherapist?
Andrea Rippe (BOst, MSc Paed Ost) is a registered osteopath and Pietro Susini (BSc Phys, MSc Ost) is a registered osteopath and a physiotherapist. This is not the most frequently asked question (which is,” what is the difference between an osteopath and a chiropractor” – see below!), but it is the question we are most qualified to answer.
LENGTH OF TRAINING
Osteopaths train longer at 4 years (full time). Physiotherapists train for 3 years (full time). WHY?
ORTHODOX vs ALTERNATIVE
UK physiotherapists train with and work within the NHS. On graduation, we work as part of a team like an apprentice to get you back on your feet after surgery or injury. We are given a diagnosis by the consultant or GP and use an evidence-tested protocol to rehabilitate you. So we don’t do the clinical diagnostic work when we first see you.
Osteopaths are alternative (trained outside the NHS) therapists. We start practising as independent clinicians on day one after graduation. To ensure your safety, we need to be able to make a diagnosis before we decide to treat you. Making a diagnosis means differentiating between the likelihood of your back pain or shoulder pain being caused by a muscle strain, a joint strain, osteoporotic fracture, or cancer, for example. Obviously, we would treat you for the first two conditions, and refer you back to the NHS or a private clinic for exploration of the second two conditions. The extra year of study gives us the clinical tools to decide whether it is appropriate and safe to treat you as soon as we’ve registered.
REHABILITATION vs PAIN MANAGEMENT
Physiotherapists rehabilitate you after surgery or injury – often brilliantly. If you’ve had a stroke and lost the ability to walk, we can follow a protocol to train you muscle by muscle. Physiotherapy worked for Andrea’s grandfather after a stroke so he could continue to live at home. And physiotherapy did this for her father after both hip replacements, allowing him to climb stiles again when out birdwatching. These excellent protocols can be adapted uniquely to your body, ability and stage of recovery.
Osteopaths don’t use treatment protocols. We could work out how to rehabilitate you from first principles, but it would probably be quicker and more effective to see a physio for post-op rehab. We use your case history and clinical examination to diagnose the cause of your pain or stiffness and we use our hands to relieve pain and improve flexibility so that your body heals quicker with fewer compensations and side effects.
HANDS ON vs. HANDS OFF
A physiotherapist could, in theory, rehabilitate you without touching you, completely successfully (although most would probably use their hands at some point.) By visually assessing your muscle weakness or dysfunctional movement pattern we could prescribe and instruct you how to perform the appropriate exercises. With modifications at each session – adapted to your increasing ability – your performance can be restored and amplified.
It would be unthinkable for an osteopath not to touch you. Manual therapy is the osteopath’s primary tool for relieving pain, reducing stiffness and restoring function, be it to a muscle, joint, limb or spine.
HOLISTIC vs. REDUCTIONIST?
Physios are frequently accused of reductionism and osteopaths lauded as holistic. We believe these labels are confusing and wrong. Teaching someone to walk after a stroke or hip replacement is hardly reductionist. Intervening to give someone their quality of life back is a truly holistic goal. Restoring the ability to bend and straighten a replacement knee joint is without doubt reductionist and also vital to the owner of the knee!
Some osteopaths could easily fall into a reductionist approach to back pain and simply manipulate spinal joints to restore flexibility without addressing the cause of the stiffness. A more holistic osteopath would explore and address their patient’s lifestyle, medical history and state of mind for insight into the causes of the stiffness.
SO SHOULD YOU SEE AN OSTEOPATH OR A PHYSIOTHERAPIST?
We’re going to go out on a limb here, but broadly, for rehabilitation post-operatively or following serious sports injuries, you are better off with a physiotherapist.
For acute, subacute and chronic spinal pain, you are better off with an osteopath.
If you’d prefer to be given an exercise programme to do at home, its probably a physio (unless your osteopath has a sports / exercise background.) If you have a horror of touch or hate the idea of having to dress down to your underwear for examination, its physiotherapy. (Although you can wear shorts and t-shirt for osteopathic examination, we really prefer to see the contours of your muscles and spinal curves to help our diagnosis).
When you have tension headache, knots in your muscles, tired, aching neck or shoulder, sciatica, back stiffness, its osteopathy. If you feel like you just need to be pulled and stretched and pummelled, it’s osteopathy!
DOES IT MAKE ANY DIFFERENCE WHETHER YOU SEE A PHYSIOTHERAPIST OR AN OSTEOPATH???
Again, this is a little controversial but, possibly not! The difference in length of training makes less and less difference as therapists gain more experience. Let’s take the example of frozen shoulder. Your physiotherapist will prescribe a protocol of training exercises for you to increase your shoulder movement day by day. We know this work – there is plenty of research to demonstrate that this is a faster route to mobility than ‘wait and see’.
An osteopath might investigate whether you had a) adhesive capsulitis – an immune system reaction to stress or trauma; b) a rotator cuff muscle strain that they could treat manually; c) other shoulder muscle strain that they could treat manually; or d) nerve impingement causing weakness of the arm muscles (and masquerading as frozen shoulder). Senior and independent physiotherapists would also go through this thought process.
For you, the outcome may well be the same for both styles of treatment, particularly if the diagnosis was, indeed, adhesive capsulitis. But if the osteopath concluded that rotator cuff muscle spasm was the cause of the restriction and they could get a finger onto your subscapularis (rotator cuff) muscle under your shoulder blade and use pressure and stretch to make it relax, you might gain a few extra degrees of movement much more quickly (making your physio exercises much more effective).
DOCTORS REFER TO PHYSIOS. DO THEY REFER TO OSTEOPATHS?
Yes and no. Some osteopaths work within the NHS alongside musculoskeletal teams, notably at Queens Medical Centre in Nottingham. The osteopaths there work with orthopaedic consultants and senior physiotherapists. In the past, some osteopathic clinics received ‘Any Qualified Provider’ status to treat musculoskeletal complaints in their health authority. Since austerity economics, patients have less choice about whether they see an osteo or physio.
Many osteopaths treat doctors and their children. But GPs can’t refer their patients to osteopaths. This is because by referring NHS patients to NHS physiotherapists GPs can ensure that there is equal access to care for all patients. As explained above, osteopaths usually work outside the NHS as private practitioners.
Therefore, it seems to us that access to physiotherapy rather than osteopathy is an economic and political decision rather than a clinical one.
HEALTH INSURERS COVER PHYSIOTHERAPY. DO HEALTH INSURERS COVER OSTEOPATHY?
Yes, they all do. At Kennington Osteopaths and Physiotherapy, we offer both osteopathy and physiotherapy with health insurers including BUPA, AXA, Aviva, Nuffield Health, WPA and many, many more.
Both osteopaths and independent physiotherapists examine you to help them make the correct diagnosis. This can range from watching you walk, to testing your sciatic nerve function, evaluating your tendon reflexes, measuring blood pressure, exploring your ankle, knee or back, inspect your fingernails for signs of cancer, heart problems or pernicious anaemia, and a host of other interesting things.
At Kennington Osteopaths & Physiotherapy, because osteopaths don’t have direct access to blood testing, an MRI machine or an x-ray, we rely heavily on evidence-based clinical tests. We will refer you to your GP, or a private centre if you prefer, for MRI, x-ray or blood tests if necessary.
WHAT DOES BEING ‘REGISTERED’ MEAN?
We like your questioning!
In the UK, physiotherapists must be registered with the HCPC (Healthcare Professions Council), the regulatory body that oversees many allied health professions such as nurses, midwives and podiatrists. This means they have demonstrated that they are educated to an appropriate clinical level, have indemnity insurance and stay up to date with their training. No one can pretend to be a physiotherapist.
Only osteopaths can call themselves osteopaths. We are proud that our title became protected by the Osteopaths’ Act in 1993. We’re not sure why, but we pay a lot more to our registrar the General Osteopathic Council (around £650 per year) than physiotherapists pay to the HCPC (we think this may be a result economies of scale at HCPC). We also have to prove we are insured, are of good character, have no criminal record and are maintaining our clinical training (we must demonstrate we’ve spent at least 30 hours per year studying — the same as physios). YAY!
STILL WITH US? WANT TO HEAR MORE INTERESTING FACTS?
Generally, physiotherapists within the public healthcare system, cover the role of mechanics of the human body, employing a range of vitally important rehab skills ranging from neurological and musculoskeletal, to cardiovascular and respiratory physiotherapy, returning patients to good health after chronic disease and injury.
In the USA, osteopaths are called family doctors with prescribing rights, the ability to carry our minor surgery and all the things that your GP does. Some UK osteopaths consider themselves to be bloodless surgeons, as they work to alter internal tensions around the spine, pelvis and skull to restore normal function to tissues like discs, joints and organs.
Chiropractors tend to follow an alignment theory in their approach to any musculoskeletal condition. This anatomy-based model drives their manipulative practice, which is often characterised by manipulation (joint cracking).
Chiropractors have specialised tables to make joint manipulation easier and quicker so treatment is on average slightly shorter (often 20 minutes).
Although all osteopaths are trained to manipulate joints, they are much more likely to incorporate other manual techniques in their practice. Some will undergo prolonged training using the cranio-sacral model of manipulation and visceral manipulation in addition to the baseline musculoskeletal techniques.
Osteopaths use standard treatment tables, and we commonly treat muscles as well as manipulating joints (in fact, we might only massage, stretch or activate muscles that are in spasm and their functionally adjacent tissues during a treatment). This means our treatments are slightly longer on average (often 30 minutes).
We hope this clears things up a little. We also really hope that other osteopaths and physiotherapists (or chiropractors!) don’t feel misrepresented by this blog.
Because we all train in different colleges but operate in the same market, it can be easy to be disparaging about our therapeutic cousins! At Kennington Osteopaths & Physiotherapy we believe that offering a mix of skills and specialities offers our clients the absolute best of all worlds.