Sounds like the start to a bad joke doesn’t it?!! Let’s start with the similarities:
Osteopath, a Physiotherapist and a Chiropractor THE only three manual therapy titles which are protected by legislation. Registration is important. This means it is illegal to pretend to be an osteopath, physiotherapist or chiropractor unless you have satisfied stringent professional entry requirements and thus the public are protected from charlatans. NB Other manual therapies, like sports massage, Rekie, Biomechanics coaches etc are not protected in this way and anybody can set up to be one even with no training or qualifications.
Manual Therapy Techniques
Osteopaths, Chiropractors and Physiotherapists will use a range of manual therapy and exercise techniques. No techniques are exclusively available to only one profession.
Before discussing the differences I will make two caveats:
I am an osteopath. I am friends with, have trained with, have been treated by and have worked with several chiropractors and physiotherapists but the clear bulk of my professional peers and influences are osteopaths. I have tried to write this article from the neutral perspective but welcome any comments from professionals or lay people particularly with reference to bias or clarity of point. (For this reason I have made the article available on my face book page)
Except for a couple of differences in the training which I shall deal with first it is only possible to draw distinctions between the professions by discussing them in generalisatic terms. Individual practitioners within a profession may develop their own style and this may have a distinct flavour. That is to say an Osteopath may be observed to have a Chiropractic style or vice versa but neither would or could claim to be the other profession as they are regulated by separate bodies.
· Physiotherapists train for 3 or 4 years (full or part time) with a year on NHS placement
· Chiropractors and Osteopaths train 4 or 5 years (full or part time) and build a minimum 1,000hours clinical experience in outpatient clinics associated with their schools.
· Chiropractic and Osteopathic degrees are considered to be ‘medical’ degrees whereas physiotherapy degrees are ‘supplementary to medicine’. This essentially means that Osteopaths and Chiropractors are expected to understand pathology (the course of disease) where as Physiotherapists need only understand existence.
· As they have studied ‘medical’ degrees Osteopaths and Chiropractors are in theory entitled to use the ‘Dr’ prefix. Physiotherapists are not.
· Chiropractors do routinely choose to use the ‘Dr’ prefix.
· The Osteopathic profession chooses not to use the ‘Dr’ prefix because it is felt this might be confusing and misleading.
Treatment style (Remember this is just a generalisation!)
· Chiropractors use ‘manipulations’ (Joint clicking!) as the main stay of their treatment approach and focus on the effects of ‘manipulation’ on the Central Nervous System (CNS).
· Osteopaths use a combination ‘manipulation and massage’ and focus treating the person as a whole system.
· Physiotherapists are more likely to use ultrasound or Tens machines and are more likely to incorporate exercises in treatment.
· The cost of treatments is fairly standard across the board and varies with location as much as profession. That said a standard chiropractic treatment is likely to last 15-20 minutes where as a standard Physiotherapy or Osteopathy treatment is likely to be 30-40 minutes.
Hopefully this has helped shed some light on a confusing problem for the consumer. It is important to note that much of this information is based on generalisations and is likely to be wrong in the case of many specific examples.
Unfortunately these ‘so called’ differences can lead to tensions between the physical therapy professions. But infact and even within each profession there are variations of style which lead to subsets and consequent tensions within the profession. Osteopaths have Cranial, Chiropractors have Mctimoney and Physiotherapists have Bobath and Mckenzie. These all just boil down to different styles of approach which, in this author’s opinion reflects the rich diversity of what we describe as ‘real people.’
People are all different and respond in differing ways. Some people will respond better to a very gentle treatment, whilst others may need and more physical approach. This point leads to the fallacy behind all of these titles. At the end of the day Osteopaths, Chiropractors and Physiotherapists they are all offering the same thing. That is to try and help you as a person and the only thing that really differentiates us is marketing! In my opinion titles just make the market unnecessarily confusing. For the time being my best advice is to stick to the registered professions but ask around. Ask friends or colleagues what a practitioner is actually like. Ask about their style. Were they physical or gentle? Did they rush you or take time? Did they actually listen and try to help YOU. Please don’t just ask about the sign on the door because honestly, you’ll be none the wiser!!
(Working practices and legislation vary around the world. This article is based on UK legislation and working practices.)
"I was in a play that required me to run 3k a night on a treadmill. I had strong pain in my calf that would have prevented me from performing.
Adam was available at short notice and sensitive to the fact that I had to perform that evening and enabled me to do so, he gave me valuable information about what was wrong and how I could tackle it in the weeks to come.
I would highly recommend Adam at the Lace Market Clinic, as an actor he is very understanding of our needs, located close to the theatres in the city centre and offers a flexible schedule that works around call times and performances.
After going to the Lace Market Clinic I was able to perform that night and after seeing him a second time I am confident that I will be able to do the rest of the run."
(Elliot is the lead actor. Lonliness of a Long Distance Runner)
Myofascia is more of a complete term to use than fascia. Fascia is the collagenous connective tissue that gives support and structure to our muscles and thickens to from tendons where muscles meet bone. Fascia is therefore integral to muscle, it is impossible to treat one without treating the other. This why we prefer the term myofascia because myo = muscle. That said it is possible to direct manual treatment towards one structure or the other as they respond differently to the types of mechanical stress we can apply in physical therapy.
Think of a muscle as a raw chicken breast wrapped in cling film. If you wanted to change the consistency of the chicken meat (muscle) you might try something similar to massage... essentially give it a good brisk pummelling but if you wanted to change the consistency of the cling film (NB without tearing it!) you would probably apply a very slow stretching force directed globally at the whole thing or focused on a specific part by pinching it to apply a local area of resistance thus localising the force. But you can see that both techniques will affect both structures, meat and cling film.
The ability to focus techniques on different components within the same structure has lead to schools of thought (specialisms) within manual therapy aimed at developing one set of skills over another. If the main goal of all manual therapies is taken as ‘To Restore Health’ then we are left a situation where two camps with different techniques have the idea that their technique is the best way to restore health. Indeed it is also true to say that some people will benefit more from one approach than the other because their problems are focused primarily in the muscular or the fascial system. Specialism in treating a specific body system does lead to superior knowledge and results with problems relating to that area but remember this:
“If your only tool is a hammer every problem becomes a nail.”
The benefit of understanding this is demonstrated elegantly by orthodox medicine. If you have a problem you go to the doctor. The doctor is the gate keeper. Their role is to direct you towards the right specialism whilst also making sure that those specialisms do not get bogged down with people they can’t help. If you have a headache due to high blood pressure you don’t need referral to a neurologist but there is no doubt a neurologist will be the best person to see if your headache has a neurological cause. But do you want to waste time going through ineffective blood pressure treatment whilst the other condition goes unchecked. This sort of stuff requires quick but important decisions and is the sort of thing that doctors do very very well.
Osteopaths specialise in the human body. We use many and various treatment techniques in a global approach through understanding the interrelationship between the various body systems including fascia and muscle. In fact a good osteopath will take a global picture of your health, considering the role neurological, endocrine (hormonal), articulatory (joints) and visceral (body organs) systems before commencing treatment, and then selecting the most suitable for each patient.
Osteopaths are state registered as primary healthcare providers. It takes a year longer to train to be an osteopath than it does to become a physiotherapist. You can train to do most specialisms in just a few weeks and those that claim to be protected, such as Rolfing, are protected by trade mark law not state regulation thus their advantage boils down to marketing not medical knowledge. In fact the origins of almost all of the alternative physical health specialisms find their roots in osteopathy.
Exercise for low back pain has been used for many years with the assumption that improved control and support of the spine and pelvis will result in reduced pain. This is based on a model that argues that low back pain results from stimulation of nociceptors (pain nerves) due to poor control of the spinal structures. Exercise interventions based on this model focused on changing the strength and endurance of the trunk muscles to improve ‘control’. This is an old and outdated approach.
More recently exercise focus has shifted to control and coordination of the trunk muscles. These philosophies incorporate factors such as re-education of hip and lumbar movement patterns, correction of muscle length and re-education of control of different muscle groups. These approaches that address control of the muscles are gaining support from randomised control trials.
Recent scientific developments are improving and changing our understanding of pain. Specifically in this context no discussion of low back pain is complete without discussing the complex interaction between biomechanics, psychology and the social elements of pain. As this series of articles progresses I will discuss the requirements for control of the bony spine, the motor strategies used by muscles and nerves to meet these requirements, how this system changes when people have low back pain and finally I will discuss my clinical strategy for exercise management of low back pain.
Summary: What the patient with poor core stability needs to know.
Core stability means the functional ability of the muscles to control movement.
The term ‘Core strength’ is outdated. Thus exercises like sit ups or heavy lifting which challenge strength not stability are rarely indicated clinically.
If a ‘core’ muscle is weak there will be a reason why. Strength training to improve this without resolving the reason why is very unlikely to improve stability.
The reason why a muscle is weak does not have to be purely biomechanical. This means a good practitioner will take time and ask lots of questions before committing to treatment.
Adam’s pearl of wisdom: How to choose a practitioner.
Ask how long the appointment slots are. Does a practitioner run a conveyor belt practice with patients in and out in 20 or 30 minutes or do they take the time to thoroughly investigate these very complex issues?
At LMC we use 80minutes for initial consultations and 40minutes for follow ups!!
The Importance of Thoracic (Upper Back) Mobility.
The Benefits of good thoracic ROM.
Better posture – Many people have an exaggerated kyphosis (forward curve of the upper back). Improving thoracic mobility is the first step to dealing with this.
A more stable lower back – Your lumbar spine will be free to provide stability, rather than make up for your lack of mobility.
Healthier shoulders – A rounded upper back brings the shoulders forward and restricts scapular movement especially during overhead movements. Thus increases the likelihood of a shoulder injury such as rotator cuff impingement.
More lung volume – Improving thoracic mobility improves the rib mechanics which improves lung function.
Better functional fitness – By engaging your thoracic spine in times of spinal rotation, flexion, and extension (like throwing a ball or a punch), instead of your lumbar spine, you will get stronger, faster, and more explosive in those movements.
Why does the thoracic spine get stiff?
The thoracic spine (T-spine) is crisscrossed by lots of muscles and connective tissues as well as being where the rib cage attaches. Movement is therefore naturally restricted when compared to the cervical or lumbar spine. This means that when the area becomes dysfunctional is can get VERY tight. As well as having direct consequences on local muscles (such as causing them to ache) it can create problems in other areas of the spine such as the neck and lower back as the whole thing is one functional unit.
I often see patients who have poor core stability AND restricted T-spine ROM. In this circumstance the two dysfunctional states are quite likely to be maintaining each other. I.E. If the thoracic spine is not moving as it should the low back might be forced to function in a way it’s not designed to. Thus, upper back restriction = extra demand on muscles supporting the low back = extra load on lumbar spine = ouch!! Similar is often also true for neck pain which might also be predisposed by poor thoracic mobility.
It is important to remember that improving thoracic mobility may be an essential element in resolving lumbar or cervical issues.
Exercises to improve thoracic mobility
I have produced a video of my favourite thoracic mobility exercises. To view it visit the ‘Video Library’ and scan down until you find it.
NB This video contains some powerful exercises. It has been produced specifically as an aid to treatment not as a replacement for it. If you have poor thoracic mobility, or an undiagnosed condition, doing all of these exercises without advice might make things worse.