The UK has three major manual therapy professions – osteopathy, chiropractic and physiotherapy. However, there is widespread confusion about the differences and similarities between the three professions. Which one should I choose if I have this or that problem? Are they the same?

Manual Therapy

Manual therapy has been used since ancient times to treat musculoskeletal problems like low back pain and other ailments. Most cultures have a history of some form of manual therapy in their health care development.

The Edwin Smith papyrus, from around 1700BC, describes the signs and symptoms of spinal injuries, how these might occur and suggested treatments. Rather unfortunately, when it gets to back pain it says: “Treatment. Thou shouldst place him prostrate on his back…” and stops there as the scribe then died. So we don’t know what treatment the ancient Egyptians had in mind!

In more modern times, “bone setting” practitioners developed in many cultures across Asia and Europe, and treated fractures and dislocations. They still exist in countries where they offer cheaper, more local and faster services than modern health systems.

The major differences between the professions are in the way they think about health, disease, injury and pain. In many cases there may be more variation between members of the same profession than between professions.


The founder of osteopathy, Andrew Taylor Still (1828-1917), was a bonesetter but also a physician, surgeon, inventor and legislator in his native USA. He held that osteopathy was not just a set of techniques, but a specific way of thinking about health.

A.T. Still “Osteopathy is not a system of movements…its application to the patient must be given by reason and not by rule. Osteopathic physicians must be able to give reason for the treatment they give, not so much to the patient, but to themselves.”

An underlying idea is that our human bodies are very good at healing themselves far more effectively than any medicine we have devised, so it’s important to understand the underlying cause of a problem.

A second idea from this is that everything is connected so that a jammed neck might be connected to a tight diaphragm, affecting the fluid flows and tensions in the digestive system which changes a person’s breathing and which in turn affects the neck. This kind of holistic thinking about the interaction between the body’s systems is typical of osteopathy.

Modern osteopaths may think about problems as being related to causes, the connections between the body’s systems and the constrictions imposed on normal body functioning by what has happened to the individual. Then they look at the complexity of the case as each person’s history is individual and complex.

Osteopathic techniques are from very gentle and subtle up to more forceful manipulations of joints and the spine. Treatments include cranial osteopathy, muscle-energy techniques and lymphatic drainage.

You can find an osteopath in your area by searching Local Osteo here.


D.D. Palmer founded chiropractic in the 1890s in the United States of America. It is a complementary or alternative medicine practice that concentrates on the manipulation of the musculoskeletal system.

Most chiropractors hold a mixture of viewpoints from D.D. Palmer’s principles to modern medical and osteopathic views of health and wellness.

One of the unique ideas in chiropractic is that of “vertebral subluxation”, the idea that the alignment of a joint or spinal segment has been altered and that this has consequences via the nervous system which can lead to disease and pain. This is a controversial idea that is not supported fully even within chiropractic circles. Subluxation may be inferred from symptoms or diagnosed by an x-ray examination, which some chiropractors perform routinely.

Chiropractors specialise in the conservative (non-drug, non-surgery) management of problems in the neuromusculoskeletal system, with particular focus on what’s going on in the spinal column and neurological system. Most chiropractors consider themselves back pain/neck pain/musculoskeletal specialists although some claim to be able to influence other conditions such as digestive problems or asthma.

Chiropractic Treatments

Chiropractors refer to spinal manipulation as ‘spinal adjustment’ or ‘chiropractic adjustment’ and this is the most common treatment type. This type of manipulation is high-velocity and occurs over a small distance in the joint treated, often producing an audible “pop” as force is applied.

Chiropractors can also give exercise advice, postural correction, dietary recommendations, advice on activities of daily living and stress reduction training. Maintenance treatment is often recommended to keep the spinal and other joints aligned appropriately.

Risks of Chiropractic

The World Health Organization has stated that chiropractic is safe when employed appropriately and skilfully. Chiropractors are trained to recognise instances where manipulation should not be employed and a very large number of adjustments are performed daily without incident.

However, as with osteopathy and physiotherapy, manipulation particularly of the upper neck, has potential dangers beyond the normal short-term soreness or discomfort. As chiropractors tend to use forceful manipulations more commonly than the two other professions, your chiropractor will likely discuss the wisdom of upper neck manipulation with you.

Other treatments used by chiropractors include electrical modalities, exercise programmes, lifestyle advice, manual techniques to joints and soft tissues, complementary procedures and health promotion. In this way, they practise similar techniques to osteopaths.