As Physiotherapists we are often asked the difference between Physiotherapy and Chiropractic so we’ve summarised a few key points to help you understand. Some people have the belief that there is an ongoing rivalry between the two professions, but it is just not true.

Physiotherapy is thought to have a broader scope of practice than chiropractic treatment does.  A well trained physiotherapist should have the ability to mobilise and manipulate the spine, perform muscle release techniques, use acupuncture or needling treatments, teach core stability exercises, help work on your posture and balance or build a sport specific training program for you.

Physiotherapy is geared towards;

• Restoring mobility
• Improving independence
• Restoring functionality
• Improving psychological well being
• Returning to sport following injury
• Regaining strength from injury or surgery

Physiotherapists treat back and neck pain, sciatica, arthritis, swelling in joints, repetitive strain injury, sports injuries and cartilage, ligament and tendon injuries. Treatment is aimed at being able to help you help yourself and manage the symptoms that are affecting your body. We treat children all the way through to adults and have expertise in respiratory conditions and neurological conditions that shouldn’t be missed.

Physiotherapy practice is widely recognised by the NHS and insurance companies as a conservative treatment modality used in an attempt to avoid injection therapy or surgical interventions. Following surgery consultants within the orthopedic profession will often refer patients for a course of physiotherapy treatment to ensure they reach their healing potential.

Chiropractors….

Chiropractic treatment uses techniques of manipulation to relieve pain, realign the spine, adjust posture, and restore joint function. The practice of chiropractic is focused on the spine and treatment involves the use of the practitioners hands to adjust the joints of the spine and limbs where signs of restricted movement are found. Gentle, specific manipulation techniques (often refered to as ‘clicking’) help to restore normal body movement. Treatment aims to make you move better and more freely.

Chiropractors treat acute and chronic low back and neck pain, sciatica, neck related and tension headaches, neck related dizziness or vertigo and extremity joint conditions.

While both practices utilise manipulations, chiropractors use a style that frequently makes use of shorter and more forceful movements. In contrast a physio will use these less often, and supplement their manipulations with therapeutic exercise and/or massage.

Similarities between chiropractic and physiotherapy

While the two fields are quite different, they do still share some common ground in terms of treatment and outcome. Both use manipulations and both look to restore joint function, improve posture, and relieve pain as clinical end points. This is where the similarities more or less end however, as the two disciplines are quite different in how they are applied and why.

What Is Manipulation & Mobilisation?

Manipulation & mobilisation are manual techniques used by physios in order to improve the mobility and function of your soft tissues, joints, muscles, tendons and ligaments.

Manipulation is usually performed as a very fast, accurate movement on the neck or back area and provides pain relief and increases flexibility. This is a safe and effective technique used as part of a treatment plan or session. Often it’s accompanied by a small “pop” or click as a result of the release of pressure.

Mobilisation is a slower technique performed on joints, ligaments or muscle, and is also used for pain reduction and flexibility improvement. It is slower than manipulation, with smooth movements applied in a repetitive process which can be either firm or gentle, depending on what is more appropriate for your condition being treated.

What are the benefits of joint manipulation?

Joint manipulation is one of the most popular methods of providing greater range of motion (ROM) and pain relief to patients. Also sometimes referred to as ‘manual therapy,’ joint manipulation uses a variety of techniques to provide benefits to patients.

What are the benefits of joint manipulation?
Joint manipulation is a technique utilized by healthcare and physiotherapy professionals to reduce pain and increase range of motion while working in conjunction with other treatment techniques to improve a patient’s overall quality of life.

Causes of joint dysfunction
Joint dysfunction can be caused by a number of issues including:

• Underuse – people who have been confined to a wheel chair or bed may experience serious pain and damage in their joints as a result of underuse.
• Overuse – either over a short period of time of high exertion, or through a lifetime of continual use.
• Natural joint dysfunction – joints naturally deteriorate over time, but this fact does not make the process any less painful, inconvenient or damaging. Natural join dysfunction can be mitigated through joint manipulation.
• Trauma – through injury, accident, or over a long period of time.
• Post-opt – issues arising after an operation for both related and unrelated issues.

Effects of joint manipulation
Joint manipulation has many clinically proven effects which include:

• Relief of musculoskeletal pain
• Faster recovery time from acute back sprains
• Increase in range of motion
• Positive physiological effects on the central nervous system
• ‘Unlocking joints’

Side effects of joint manipulation
Joint manipulation is considered a safe procedure with very minor side effects which include headache, mild radiating pain, and local discomfort. There are some risks associated with joint manipulation performed on the spine. These include stroke, spinal injury, herniated disks, and fractures in the ribs or vertebra, and other related issues. That is why it is important to always use certified professionals who have experience with joint manipulation.

How does joint manipulation work?
Joint manipulation is generally used as part of a broader physiotherapy plan which includes a range of other techniques in addition to joint manipulation. Your physiotherapist will consult with you to determine whether joint manipulation is the right treatment for you.

Undergoing joint manipulation is initially much like undergoing massage. In many cases your physiotherapist will ask you to lie on a massage table where they will precisely apply pressure through their hands to manipulate your joints.

Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. These modalities are warranted in many instances and most therapists would agree that exercise is needed to help restore muscle imbalances. However, many therapists now approach the restoration of function from a different perspective. These therapists are interested in why a muscle isn't functioning properly and view back exercise not as the driving mode of recovery but as a complement to manual therapy. They may, for instance, look to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome rather then directly manipulate the piriformis muscle through exercise.

Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension, and joint dysfunction.

Manual Physical Therapy is Less Established for Back Pain Management

While all physical therapists have the option to use manual therapy in their practices, many don't spend the time or the resources to become efficient in this area of practice. Patients should be aware that it is a lesser known physical therapy technique among physicians and may not be as commonly prescribed. Also, many of the conditions that practitioners treat with manual therapy are not demonstrated with imaging or lab tests but rather during motion testing and treatment, and therefore insurance company reimbursement may be limited.

While patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.

Manual Physical Therapy can Offer Pain Relief for Acute and Chronic Back Pain

Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction, and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.

• Soft tissue work, including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.
• Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called 'amplitude') to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.

Before beginning manual therapy or any type of physical therapy, the practitioner usually performs a full assessment of the blood and nerve supply in the area, as well as a bone and muscle assessment, in order to decide whether or not there is an increased risk of complications from the use of these back pain management techniques. Depending on the results of that assessment and each individual back pain patient's particular situation, the healthcare provider may perform some or a combination of the following types of manual physical therapy:

Soft Tissue Mobilization

It is important to recognize the role of muscles and their attachments around the joints. Muscle tension can often decrease once joint motion is restored, but many times the spasm will continue to be present. In such cases, muscle tension should be addressed or the joint dysfunction may return. The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue (called 'myofascial adhesions') such as scar tissue from a back injury, move tissue fluids, and relax muscle tension. This procedure is commonly applied to the musculature surrounding the spine, and consists of rhythmic stretching and deep pressure. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.

Strain-Counterstrain

This technique focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful 'tenderpoints'. The therapist finds the patient's position of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing. This technique is gentle enough to be useful for back problems that are too acute or too delicate to treat with other procedures. Strain-counterstrain is tolerated quite well, especially in the acute stage, because it positions the patient opposite of the restricted barrier and towards the position of greatest comfort.

Joint Mobilization

Patients often get diagnosed with a pulled muscle in their back and are instructed to treat it with rest, ice and massage. While these techniques feel good, the pain often returns because the muscle spasm is in response to a restricted joint. Joint mobilization involves loosening up the restricted joint and increasing its range of motion by providing slow velocity (i.e. speed) and increasing amplitude (i.e. distance of movement) movement directly into the barrier of a joint, moving the actual bone surfaces on each other in ways patients cannot move the joint themselves. These mobilizations should be painless (unless the operator approaches the barrier too aggressively).

Muscle Energy Techniques

Muscle energy techniques (METs) are designed to mobilize restricted joints and lengthen shortened muscles. This procedure is defined as utilizing a voluntary contraction of the patient's muscles against a distinctly controlled counterforce applied from the practitioner from a precise position and in a specific direction. Following a 3-5 second contraction, the operator takes the joint to its new barrier where the patient again performs a muscle contraction. This may be repeated two or more times. This technique is considered an active procedure as opposed to a passive procedure where the operator does all the work (such as joint mobilizations). Muscle energy techniques are generally tolerated well by the patient and do not stress the joint.

High Velocity, Low Amplitude Thrusting

The goal of this procedure is to restore the gliding motion of joints, enabling them to open and close effectively. It is a more aggressive technique than joint mobilizations and muscle energy techniques that involves taking a joint to its restrictive barrier and thrusting it (low amplitude of less the 1/8 inch) to, but not past, its restrictive barrier. If utilized properly, increased mobility and a decrease in muscle tone about the joint should be noticed. This technique is utilized for restoration of joint motion and does not move a joint beyond its anatomical limit. Therefore, no structural damage takes place and the patient should not have an increase in pain following the treatment.

Maintaining Back Pain Relief Long-Term

To continue the healing process and prevent recurring pain, back pain patients are encouraged to engage in other appropriate treatments (including an exercise program) during and after manual therapy treatment. Exercise programs for back pain usually include stretching and strengthening exercises and low-impact aerobic conditioning, and should include a reasonable maintenance exercise program for patients to do on their own. The goal is to maintain the right type and level of activity to prevent the pain from re-occurring and avoid the need for frequent return visits to the therapist.