What’s the difference between osteopathy and physiotherapy?

Osteopaths are primary health care practitioners, complementary to other medical practices. They have the ability to diagnose and treat a number of musculoskeletal dysfunctions. Osteopaths work primarily on the neuro-muscular-skeletal system, they also pay attention to relevant psychological and social factors in order to form a diagnosis.

Osteopathy is a system of healthcare and not just a series of techniques applied to the body. It is based on the philosophy that the body should be able to auto-regulate itself in order to maintain a state of health, balance and harmony. The body should be able to adapt and recover from even traumatic events, however sometimes this ability to adapt and compensate gets overwhelmed, and may need some assistance, this is where osteopaths can help.

Physiotherapists are health care professionals who evaluate and manage health conditions for people of all ages. Physiotherapists are considered a profession supplementary to medicine (P.S.M).
Physiotherapists help in circumstances where movement and function are threatened by the ageing process or subsequent to injury or disease. Physiotherapists view full functional movement as at the heart of what it means to be healthy. Physiotherapy aims to promote, maintain and restore both physical and psychological well-being, after taking into account the individual’s health status.

History of Osteopathy and Physiotherapy

Osteopathic medicine was developed in the United States in 1874 by Andrew Taylor Still. Still started out as a Doctor but the death of his wife and children from infectious diseases left him disillusioned with orthodox medicine. Using an alternative philosophical approach, Dr Still opposed the use of drugs and surgery as remedial agents. He saw the human body as having self - healing mechanisms and the duty of the osteopathic physician is to remove any impediments to healthy functioning. He promoted healthy living, good nutrition and the application of manipulative techniques to improve physiological function.
His philosophy was based on the understanding of the integration between body, mind and spirit and the relationship between structure and function. When there is interruption to structure; such as disruption to blood flow or nervous impulses, there is a subsequent interference with the functioning of the tissues supplied by those structures which ultimately leads to disease. By manipulating bones and restoring
structure, he would cure disease.

Physical therapy has its origins in ancient history, Hippocrates advocated the use of massage and hydrotherapy for health back in 460 BC and before that, the need physical (manual) handling of patients was well understood within Ayurvedic medicine. The modern practice of physical therapy was developed in London in 1896. It was discovered that hospital patients needed to be mobilized on a regular basis in order to maintain adequate muscle mass, function and mobility. The popularity of this discovery grew rapidly and in 1920 the Chartered Society of Physiotherapy (CSP) was formed in the Country of United Kingdom. The CSP is the professional, educational trade union for chartered physiotherapists. Anyone looking for a physiotherapist outside of the NHS should endeavour to find a chartered physiotherapist.

Training of Osteopaths and Physical Therapists

Osteopaths undergo 4 years of full time (5 years part-time) training in the UK. Regardless of which school they study at, all osteopaths have to gain an in depth knowledge of anatomy, physiology and pathology in order to be able to diagnose musculoskeletal dysfunction and be aware of pathological conditions that may be expressing themselves in the musculoskeletal system. In addition to this, students will also study pharmacology, nutrition and exercise mechanics in order to achieve a sound knowledge of how the body works in health and disease. All osteopaths have to undergo a minimum of 1000 hours of clinical training.

Physical therapist programs start with the basic sciences; biology, chemistry, and physics, and then go on to study more specialized courses such as kinesiology, biomechanics, neuroanatomy, human growth and development, pathology, and diagnostics. UK Physiotherapy degrees tend to be three rather than four years in length. In order to qualify, students are required to complete 1000 hours of clinically based learning (in hospitals); typically taking place in the final two years. In the UK there are currently 35 universities and tertiary level institutions where physiotherapists can train. Around 70% of physiotherapists work within the National Health Service; while the balance work in private practice.

In 1993 the title of ‘Osteopath’ became protected such that in order to call yourself an osteopath, you must have completed a degree course at one of the 7 approved training institutions in the UK. As well as this all UK practising osteopaths must be registered with the General Osteopathic Council (GOsC). There are approximately 5000 registered osteopaths in the UK. For comparison there are approximately 36,000 physiotherapists.

Most osteopaths work in private practice since osteopathy is largely excluded from the NHS due to the difficulty in providing unbiased medical evidence surrounding its effectiveness. However, there have been many large scale trials on the clinical effectiveness of manipulation in the management of low back pain, which have shown a marked reduction in recovery time.

What do Osteopaths and Physiotherapists do?

Osteopaths treat the whole person and not just the areas causing symptoms. This is because osteopaths believe the cause often originates in another area/part of the body. Therefore, several people may come in with the ‘same’ symptoms, but the reasons for their symptoms may be very different, it would follow that no two osteopathic treatments are the same.

Physiotherapists apply therapeutic techniques and intervention in order to assist recovery of functional limitation and disability following injury and disease. The intervention (particularly with NHS physiotherapists) is often aimed at preventing impairment.

What do Osteopaths and Physiotherapists treat?

Osteopathy is well known for its ability to help with musculoskeletal aches and pains but it is also able to help with a vast majority of different symptoms and conditions in people of all ages; from babies to the elderly! Osteopaths can provide one-off relief from pain and dysfunction or help you to manage any long-term (chronic) complaints.
Common conditions seen by osteopaths include; joint pain, back pain, neck pain, period pain, muscle aches, strains and stiffness, tennis elbow, asthmas, repetitive strain injuries, headaches, migraine, child development problems, arthritis, sports injuries, pain and altered function pre and post joint operations etc
Physiotherapists also treat all of these problems. Since many patients are referred to a physiotherapist from a doctor, physiotherapists might also see a more varied range of conditions. Some physiotherapists specialise in certain areas of dysfunction, for example; neurological physiotherapy and cardiopulmonary physical therapy.
Both osteopaths and physiotherapists have access to more modern diagnostic equipment such as X-ray and MRI.

The consultation with an Osetopath or Physiotherapist

The initial consultation with both an osteopath and a physiotherapist takes around 1 hour and costs, on average £45. Some treatment is included in the first consultation. Subsequent visits last around 30-40 minutes and cost around £35. Costs vary between geographically. The number of treatment sessions you require will depend on the reasons why you are consulting.

How do Osteopaths and Physiotherapists treat patients?

Osteopaths take a thorough medical history to make sure that you’re safe to treat and that osteopathy would be of benefit to you. They will then perform a physical examination including observation of your body posture in order to come to a diagnosis. Very often an osteopath will ask you to undress down to your underwear in order to observe your whole body posture.
The osteopath will use a variety of carefully applied manual therapeutic techniques however, they are probably best known for using manipulation (an intervention producing that characteristic ‘click’). Osteopaths will also use articulation, and soft tissue massage techniques in order to achieve results. Other osteopathic ‘tools’/ techniques include; functional, visceral (organ) and cranial osteopathy.

Visceral osteopathy is said to relieve imbalances and restrictions within the connective tissues joining the organs to the body and body wall this includes the nerves, blood vessels, and fascia.

Cranial osteopathy is one of the fastest growing areas of osteopathy. It is a very subtle approach which treats the whole body, (not just the head) and as such is becoming very popular especially in the treatment of babies and children.

Osteopathic treatment is not painful and can often be very relaxing. Following an osteopathic treatment, it is not uncommon to have some transient discomfort (lasting 24-48hours), this is just your body adapting to the changes the osteopath has made and re-balancing the system. Patients often report an improvement in all areas of health following osteopathic treatment, not just relief from the original problem that brought them to the osteopath in the first place.

Physiotherapy consultations are very similar, starting with a subjective examination (interview) including medical history, they will then go on to examine the patient to rule out serious pathology and determine functional limitations. This may or may not involve you undressing – dependant of course on the area involved. The results of the examination and interview will guide diagnosis, therapeutic intervention and management of the patient. Physiotherapists use: therapeutic exercise, electrotherapeutic and mechanical intervention, functional training exercises, patient education and counseling as well as working with occupational therapists in the provision of aids and appliances. Emphasis is on health promotion, quality of life, and fitness in all ages. Some physiotherapists will also use manipulation, but this is undertaken as a short post-graduate course. Osteopaths have 2 years of manipulation tuition.

A perspective from an Osteopath and from a Physiotherapist

Dr Steven Sandler, an osteopath who practises at the Great Portland Street Hospital as well as at his own practice in Chingford believes there are 3 major differences between the two professions. To start with, “there are massive differences in the way the two professions are taught, physiotherapists undertake a 3 to 4 year course in order to be able to treat a number of musculoskeletal condition’s, they are a profession supplementary to medicine (P.S.M). What this means is that they are not expected to fully understand the pathology of disease, but are expected to know how to treat it”.

By contrast, “an osteopath undertakes a 4 to 5 year course in order to become primary healthcare practitioner. This means they are not only are they expected to understand the pathology of disease they are also expected to recognise undiagnosed pathology and refer on if necessary”. “Physiotherapists are trained to evaluate, osteopaths to diagnose”.

The second difference is technique and variety of technique. Dr Sandler states that “physiotherapists have an overall training in a vast number of techniques”, which runs the risk of them becoming “jack of all trades (master of none)”.  They become expert in the application of “therapeutic machinery, such as; electrotherapy, aquatherapy, pain management – including acupuncture. They receive very good tuition in exercise therapy but very little tuition in actual ‘hands-on’ therapy.” By contrast, “osteopaths undertake 4 years and 2,000 hours of ‘touch therapy’; they become expert in palpation and manipulation. At the British School of Osteopathy, where Dr Sandler is a tutor, the students treat 1,000 patients per week at the in-house clinic.

“One final and fundamental difference between osteopathy and physiotherapy is the consideration of ‘why this person? why this tissue? why now?’ a physiotherapist may not even consider these questions yet they are fundamental to osteopathic philosophy. A physiotherapist is trained to look at the area involved and fix it, an osteopath may go no way near it”!

Tim Allardyce has trained in both osteopathy and physiotherapy, and is currently based in Croydon. Tim initially trained as an osteopath but decided to complete a degree in physiotherapy as well in order to gain better acceptance within the world of sport. He believes the two professions are “very similar and that the lines between the two are becoming crossed as they become more widely acceptable and available”.

In essence, “osteopathy is a more ‘hands-on’ approach to healthcare”, in contrast “physiotherapy concentrates more on rehabilitation and as such the patient is required to do a lot more of the work” e.g. exercise rehabilitation. “Physiotherapy is especially good following surgery”, whereas osteopathy, in his opinion, is “a lot better at backs, joints and acute injuries…osteopathy is great for getting people out of pain, whereas physiotherapy is great for managing and exercising chronic conditions”.

The content of this page is informed by feedback from clinics in London and also a practitioner in Leeds. Further input was received from osteopathic practitioners in Edinburgh and practices in Glasgow. Finally a contribution was made by osteopaths in the Oxford area