Bridge to Health Blog
Bridge to Health Blog

What's the difference between an Osteopath, a Chiropractor or a Physiotherapist?

Written by Mathieu Rossano   Posted in:Osteopathy   December 8, 2016

What's the difference between an Osteopath, a Chiropractor or a Physiotherapist?
"So… what’s the difference between an osteopath, a chiropractor and a physiotherapist?" is no doubt the most frequent question posed to us by our patients… and for good reason – it is confusing!

Most of you will have heard of or experienced physiotherapy due to the abundant number of “physios” within the NHS, but are you familiar with the key differences between an osteopath and a chiropractor? Why go to see one over the other? With this in mind, the Bridge to Health osteopaths have knocked their heads together to try and provide a balanced perspective on the main differences between the three professions.


  • This profession was created at the end of the 19th Century (1890s) by the medical profession as orthopaedic rehabilitation therapists
  • Physiotherapists work mostly within the NHS and also in private practice. They tend to work in close relationship and under supervision of the medical profession especially within the NHS.
  • As a rule physiotherapists tend not to diagnose conditions – they look for instruction from the medical profession as to the presentation and course of treatment expected.
  • No spinal or joint manipulations – articular realignment techniques that often produce a ‘click’ and are very effective at improving joint mobility.
  • Use more gentle joint mobilisations – easing a joint into its functional range of motion - and soft tissue (massage) techniques. They will also make use of treatment technology such as TENS machines.
  • Good at post operation and sports injury rehabilitation, but typically treat the tissues considered injured rather than the broader picture of an injured body / patient, and as a result may not necessarily discern the root cause or causal chain of a specific problem
  • With the pressures currently weighing on public healthcare, NHS physios often have little more time than to hand out generic exercise sheets
  • NHS physiotherapist sessions tend to be shorter and comprise of less ‘hands-on’ treatment.

Common link between Chiropractors and Osteopaths

  • Both disciplines originated in the osteopathic model
  • Both disciplines focus primarily on the alleviation of body aches and pains
  • Both disciplines view the body in a holistic manner, as a self-contained, fully interconnected, self-healing unit.
  • The level of training is the same - 4 years, compared to 3 years for physiotherapy.
  • Both chiropractors and osteopaths are able to diagnose musculoskeletal conditions and screen for a range of other non-musculoskeletal disorders through clinical tests. 


  • Formed in the 1890s in the US; the first chiropractor Daniel David Palmer is the pupil of the first Osteopath but “parts ways” to found the chiropractic profession.
  • Some chiropractors use the official title of “Doctor”
  • Tend to include and rely on (often in-house) diagnostic procedures such as X-rays, MRIs, blood and urine tests.
  • More holistic approach than physiotherapy (seeking root causes vs only presenting symptoms) yet focuses more exclusively on the spine for diagnosis and treatment
  • More emphasis on (mainly spinal) joint adjustments and less soft tissue work. There is often frequent repetition of the same manipulations as without working on the related muscular tension, the same joints can revert back to restriction
  • Treatments tend to be shorter and over a longer time scale.
  • Often a focus to sign patients upfront to long term, intensive, course of treatments – course of treatment can easily run upwards of £1,000.


  • Founded in 1874 by Andrew Taylor (AT) Still
  • AT Still’s founding principles of osteopathy are:
    • The body is one functional unit – there is no point focusing on a particular symptomatic structure without considering how it impacts the broader body, or how a broader succession or “chain” of body/joint adaptations may have resulted in malfunction of a body part
    • “The rule of the artery is supreme”: a healthy blood supply results in a healthy body environment (“homeostasis”); conversely, the root cause of all systemic diseases (cancer, auto-immune diseases) involves toxaemia (toxins within the blood) – Osteopaths will focus on improving blood supply to dysfunctional areas, helping to improve oxygen and nutrient supply and encourage drainage of toxic  metabolic by-products.
    • “Structure and Function mutually govern each other” – e.g. a joint misalignment and resulting adjacent muscle tension may adversely affect the good function of other neighbouring systems (neural, lymphatic, visceral, vascular…)
    • “The apothecary lies within” – this view suggests the body is a self-repairing unit of health and given the right nutrition, exercise, lifestyle and (occasional) realigning treatment can often restore itself to good health.
  • Osteopathy has a more holistic approach than physiotherapy (seeking root causes vs only presenting symptoms) considering the spine, but also all other bones and joints, muscles, ligaments, as well as fascial, neural, lymphatic and visceral structures and systems.
  • Recognises that the area of pain may be the last link in what can be quite a long chain, and will treat the underlying cause which will help with the symptoms and help prevent recurrence. 
  • Treatments draw on a combination of spinal manipulations, soft tissue and joint mobilisation, but also muscle energy techniques, counter-strain, lymphatic drainage, and other techniques hinging on practitioner interest and further training – e.g. kinesio-taping, dry needling etc.
  • Osteopathic treatment sessions tend to be longer than physiotherapy and chiropractic, with fewer treatments overall, aiming to not ‘over-treat’. When good health is restored, a preventative maintenance approach is taken – of a treatment every 3-4 months to prevent bad musculo-skeletal habits from building up. This is often less expensive than seeking a course of treatment once a problem has arisen. a nutshell....

Physiotherapists are more prominent within the NHS and tend to rely on the medical profession for diagnosis of conditions. Treatment tends to focus on soft tissue work, stretching and joint mobilisations, but generally no manipulations. Due to high demands on the NHS, sessions with physiotherapists often consist of very little ‘hands-on’ treatment, with more focus on exercise prescription. 
Chiropractors have 4 years of training, enabling them to diagnose conditions. They work in private practice. There is usually more of a focus on joint manipulations and slightly less on soft tissue work. It is not uncommon to see a chiropractor several times a week over a longer time period, which can become expensive.
Osteopaths train for the same length of time as chiropractors and are also able to diagnose musculo-skeletal conditions through clinical tests. They mostly work in private practice, but some osteopaths may work within the NHS focusing on rehabilitation.  Treatment sessions are usually longer than chiropractors and therefore often less treatments are needed. Osteopaths are generally more ‘holistic’ and include a variety of soft and deep tissue techniques, joint mobilisations and manipulations, as well as exercise prescription, lifestyle and postural advice.
For any further questions on osteopathy and the ways it may be able to help you, contact the Bridge to Health team on 01895 200050 or email us at .

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