London Acupuncturist Roisin Golding, for the Los Angeles Times Syndicate © 1999

What’s the difference between a Chiropractor and an Osteopath?

This should be a really good joke, along the lines of, “Well, a chiropractor makes your joints go ‘pop’ while an osteopath …..” The trouble is, an osteopath does exactly the same thing. But demanding that your practitioner ‘pops’ your joints is like insisting that a doctor write a prescription every time you see her. There are many other, often more appropriate, interventions at her disposal.

Joe Public’s misunderstandings of these traditions are a direct result of both profession’s lack of communication. So let’s redress these misconceptions. Both train for a minimum of four to five years. Chiropractors use short-lever techniques (focusing manipulation on one vertebrae at a time) with some long-lever techniques, whilst osteopaths more commonly use long-lever techniques (affecting the spine through rotation at the shoulders and hips) with some short-lever techniques. Osteopaths maybe associated with the gentle cranial-sacral technique, but chiropractors too use sacral-occipital technique (the difference is in name only.)

Even their history runs parrallel, unsurprising when you consider that the two eager and impressionable young men who founded osteopathy, Andrew Taylor Still, and Daniel David Palmer, founder of chiropractics, spent their early manhood in the mid-America of the mid-1800’s and were exposed a plethora of folk medicines. Among them Irish immigrant bone-setters; Chinese Tui Na practitioners (similar to physiotherapists); and native Americans bone men.

One could say that manipulation, in all probability, was the first medical intervention to be invented. It may not have been subtle, but even cave-men must have had a few dislocated shoulders or stiff backs put to rest, one way or another.

Neil Austin, a chiropractor working in London, explained that whatever subtle differences that existed between the two professions have virtually been eliminated through an expanded education and training programme. “The range of techniques being taught to both groups have converged in recent years, so that now it’s the quality of the practitioner that counts.” The theoretical differences are historical, and play little role in present day management of back problems.

Considering that our own Western traditional medical curriculum was only developed in the mid-1800s, it is surprising that allopathic doctors got the upper hand at all, especially in the treatment of painful and restrictive back conditions. Yet just this year Western medics admitted that their traditional recommendation of bed rest for back pain only prolongs the discomfort. Restricting corsets and braces for conditions such as ankyolosing spondylitis (an inflamatory condition which often leads to fusing of the vertebrae, leading to complete immobility at that joint) have not yet been thrown out as a treatment by many older doctors, even though this treatment does more harm than good.

As osteopaths and chiropractors have maintained all along, mobility at the joints is essential. These professionals are trained well enough (infinitely better than your doctor when it comes to musculo-skeletal disease) to recognise when to manipulate and when not to. They do not rotate a herniated disc, nor do they treat an osteoporotic woman in the same manner as they would a burly footballer who has put his back out while training. They also read x-rays and use them when there is a suspicion of structural change or tumor.

Chiropractors use x-rays a little more often than osteopaths, (chiropractors are trained to take x-rays as well as to read them) but both are aware of the associated health hazards and are reluctant to use them without some justification. This is in direct contrast to Western practitioners. Radiation from x-rays has an accumulative effect especially in bone. Doctors should know, as they are twice as likely and radiologists ten times as likely to die from leukemia as the general public, and some scientists have linked the substantial increase in the general incidence of leukemia to the routine use of x-rays, especially when coupled with exposure from other sources!

In any case, as Sean Durkan, an osteopath working in London, explained, X-rays tell little about what is happening in comon conditions such as herniated (slipped) disc. To see this in detail one would need to look at an MRI scan, although as Durkan further explained, the palpatory skills and clinical judgment of the practitioner will count for more than any high tech equipment in the majority of cases.

The moral of the story is, a well trained osteopath or chiropractor is able to judge when a back needs some conventional medical intervention, better than a conventional doctor can judge when to recommend manipulative therapies. As Austin explained, “we spend five years studying the musculo-skeletal system and everything that can impact on it in detail. This is as much time as doctors spend going over the whole body. They are trained generalists, we are the specialists in this area.”

And the future for the two professions? Austin conceded, “I think basically the historical differences will be forgotten and I think that very soon the two professions, in the United Kingdom at least, will unite.”

Note: osteopaths in the United States are general medical practitioners with a short training in manipulative therapies and are to be distinguished from osteopaths in the rest of the world.

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