Osteopathy vs Physiotherapy

How do you know if you need to see an Osteopath or a Physiotherapist?

The short answer here is that if it is a musculoskeletal issue that you need help with either should be able to accurately diagnose the problem and help you with recovery.

People tend to view Osteopathy as just ‘cracking necks’ and physiotherapy as just ‘giving exercises’ but these days the two professions probably have more in common than not thanks to modern evidence based practice. Also, in private practice where all patients will expect some level of hands on work which is traditionally the Osteopaths domain, physios and Osteos treatment strategies tend to overlap. However, here are some key differences between Osteopaths and Physiotherapists in Bristol and the UK.

The Top 3 differences between Osteopathy and Physiotherapy:

1 Education and training, who is more qualified?:

Physiotherapists in the UK qualify with an undergraduate bachelors degree, a lot of their 3yr course is rooted in the NHS and viewed through the biomedical paradigm so even Physios who work solely in private practice will have some NHS experience, they can also qualify via a 2yr masters course if they have a previous degree in a related field. Osteopaths can graduate with a degree or a masters in Osteopathy, without any time in the NHS but including up to 1500 hours of clinical practice before qualification, despite this Osteopaths are recognised as Allied Health practitioners within the NHS.

Within their training Physios will spend a lot of time focusing on triage and pathways where as an overwhelming percentage of training for Osteopaths focuses on hands on and observation skills.

2 Treatment approach:

Osteopaths focus is hands on, using touch and observation to diagnose, they will view the body as an interconnected set of systems and use that understanding to deliver treatments aimed at improving the whole health of the person. Physiotherapists are much more observation driven, using pattern recognition and focusing more on joint mechanics and muscular strength. In the modern age both professions will likely work to prevent future injury or illness in their patients and although historically Osteopathy would lay claim to having a ‘holistic view of the body’ both Osteopaths and Physiotherapists should take into account other factors such as the individuals health status, lifestyle, fitness or activity levels, diet and even profession when treating.

3 Techniques used:

Osteopaths generally have a much broader ‘toolkit’ of manual therapy techniques and their treatments are likely to be biased towards hands on with soft tissue techniques and manipulations of joints (producing the popping sound you get when you crack your knuckles). Modern physiotherapists tend to be very hands off now but traditionally Physiotherapists would employ massage techniques or the use of adjunct therapies such as shockwave or infrared lasers which are less supported by evidence but still in use today. Both Physiotherapists and Osteopaths are likely to prescribe exercises for MSK complaints as well as possibly lifestyle advice.

The evidence:

Physiotherapy practices have a much larger body of evidence behind them and this leads to lots of claims about what is and isn’t evidence based. There are two reasons for this, one; Physiotherapy is a much larger profession with 75,000 (and counting) qualified physios in the UK compared to around 5000 Osteopaths practicing here, Two: as mentioned before Physiotherapy is rooted in the biomedical model and so research is carried out under supervision of researchers to an accepted standard. Historically Osteopathic research has not been as rigorously carried out so the quality of evidence is not as high, this is changing with time however. The reality is that evidence in favour of one modality or another tends to shift with time as further research is done even within medicine.

So is Osteopathy better than Physiotherapy?

As you can see from the above, neither is inherently “better”. The main takeaway is that there is massive overlap between these two professions, both sets of practitioners are experts in the field of MSK, both are likely to apply some level of hands on work, both are likely to give some level of guidance around exercise and educate you on the condition that has been assessed and both should be following the latest evidence for Musculoskeletal care.

Your goal as patient should be to find someone like Jasper who will work with you, listen to your concerns and address them through their treatment without pathologising and using fear inducing language.