What's the difference between a physio, an osteopath, a chiropractor, a sports therapist, and so on?

To use a truly unoriginal expression, if I had a penny for every time someone asked me a question along those lines... I'd possibly have made more money than I have doing what I actually do. So it might amuse you to know that I've asked those questions too... and sometimes, I still do!


I always like to offer a very succint answer before I go into my usual diatribes, and the one I have developed over the years is:


"A good therapist should do the same as any other good therapist, whatever their title".



It's a nice idea, but it doesn't help you choose who to see, if you don't have a personal recommendation from someone you trust (which would almost always be what I would recommend seeking first). So I'll try to break this down in a practical way for you.


This is very much a UK-specific understanding of these professions, which actually vary significantly from country to country; as such, it is important to note that only the first three specialities listed are offered on the NHS and in other words, officially recognised by the medical world. (Also please note that the accompanying photos are not intended to be representative of the profession they are included alongside)


Physiotherapists

are typically who your GP will refer you too for any muscle or joint pain. There are lots of different types of physiotherapists, so for the purposes of this blog post I'll be referring to those specialising in musculoskeletal conditions (e.g. a sprained ankle, tennis elbow, or a persistently achey knee).


In general, physiotherapists focus on diagnosing the issue, and prescribing corrective exercises. It is increasingly uncommon for physiotherapists to do any massage or manual therapy; often, if they use anything it will be acupuncture needles (for a technique called "dry needling", targeting trigger points and "knots" in muscles, rather than working with energy meridians like in Chinese medicine), or other tools such as ultrasound machines or shockwave therapy, to get a very specific job done in a short amount of time.



Osteopaths

stereotypically focus on performing gentle manipulations, but often may prefer to use massage techniques, joint mobilisations, or other tools that physios might use.


Like physiotherapists, they are able to diagnose conditions and prescribe further diagnostics like MRI scans. Like any bodyworker or healthcare professional, they will generally prescribe homecare exercises, but will usually spend significantly more time doing manual therapy and giving out fewer exercises than physiotherapists.


Osteopaths tend to approach the body and pain more holistically, and can often perform manipulations of visceral organs as well as working with bones and connective tissues.



Chiropractors

tend to have a pretty bad reputation among other bodyworkers in this country, as cowboys who will aggressively crack your back and neck as soon as they get their hands on you. This is where I refer you back to my summative statement; a good chiropractor will, of course, not do that (but a bad physio or osteo, or other therapist trained in manipulations and mobilisations, might).


In general, chiropractic is very similar to osteopathy, in that it approaches musculoskeletal conditions more holistically than physiotherapy might. There is perhaps more of an emphasis on spinal health and posture, but this may be because it's what has typically been associated with the field, and is therefore what patients have come to expect.



Sports (rehab) therapists

like the above practitioners, claim the title after completing a university degree; but unlike physiotherapists, osteopaths, and chiropractors, are not recognised by the NHS. As such, they can't officially diagnose any conditions or request scans.


Sports therapists (sometimes called sports rehab therapists, or sports rehabilitators) are essentially musculoskeletal physiotherapists (as opposed to neurological or respiratory physiotherapists) with some cross-over into sports-specific strength & conditioning. In other words, they would be the ideal people to work with once your NHS physiotherapist has discharged you following an acute injury (i.e. you can walk and go to work), but before you are ready to perform whatever your sports coach wants you to do (i.e. cutting drills and full-contact training or competition).


They will generally combine manual therapy techniques with exercise prescription, but would also typically spend some time taking you through the exercises as a personal trainer might, rather than give you a list of exercises to do on your own.



Sports massage therapists

specialise in the hands-on component of injury recovery, and do not complete a university degree, so it can be hard to know what "quality" of therapist you get and what their educational background might be; they could have done anything from a weekend-long course to a full year-long qualification in a specific massage school - or they might be a physio or sports therapist who took a sports massage course alongside their degree. As always, the formal education rarely matters as much as the competence and self-development (and experience, and innate talent, and confidence, etc etc) of the specific therapist, but I think it's important for people to know there can be vast differences behind the title.


Any half-decent sports massage course will emphasise the importance of giving homecare advice such as exercises, but many massage therapists are not well-versed in the variety of exercises, loading protocols, or in coaching technique and cueing. In an ideal world, physios/osteos/chiros would work closely with a trusted sports massage therapist who can help release tight muscles from injury or rehab (and feed back on things like other areas of tension or loss of tone or imbalanced muscular development), while the health professional assesses the progress of the injury; all too often, people are unable to do the prescribed exercises by physios because they are just too tight and sore!




Strength & conditioning specialists

specialise in sport-specific (or activity-specific; e.g. wanting to pick up your child following a shoulder injury) training.


While not often considered as a contender among the above list, S&C professionals can be a valuable part of an injury rehabilitation process. While they do not generally have an education in injury-specific rehab protocols (for example, the rate of healing of different tissues), they have a thorough understanding of loading protocols and the specificity of training adaptations. As such, they are often the perfect specialist to help keep you fit and strong (and motivated) during your injury recovery, complementing exercises given by your physio/osteo/chiro with an understanding of correct technique and effective cueing.



Where I fit in


As a sports massage therapist and S&C specialist, I love working alongside physiotherapists, osteopaths and chiropractors, incorporating their exercise prescriptions into more well-rounded sessions for my clients and using hands-on techniques (either in a movement session or in a dedicated massage appointment) to improve range of motion in areas of restriction and activate muscles in under-active areas.


We are such complex beings, even just physiologically - and then you add a dense layer of psychological and lifestyle considerations into the mix - that we really shouldn't be relying on one therapist or one modality ever; the only sensible approach, in my opinion, is one that is multidisciplinary, and it's so important that we actually connect with our therapist or trainer on a personal level. I would go so far as to say that the current unwritten hierarchy of professions is anathema to healthcare.


So as well as a hopefully explanatory blog post, consider this my manifesto and a plea for more collaboration between those of us who should all have the same goal: to help our fellow humans feel better.

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