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These two therapies have much in common, although the philosophy and training is different. Generally Osteopaths are historically British bone manipulators whereas the philosophy of Chiropractor treatment was originated in the USA and disseminated widely to the UK over the last 10-20 years. Chiropractic and osteopathy are both manipulation-based therapies used for treating problems associated with bones, joints and especially the back. The two therapies have much in common, but chiropractors tend to focus on the joints of the spine, and the nervous system, while osteopaths put equal emphasis on the joints and surrounding muscles, tendons and ligaments. More recently practitioners have extended the scope of their therapies to include other joints, other injuries and some practitioners have included sports medicine therapy; which usually falls within the scope of physiotherapists.
Chiropractors and osteopaths share conventional medicine’s view that the human body is like a machine and that problems of the musculoskeletal system are due to a breakdown of part of the machine. This is known scientifically as bio-mechanics. Biomechanical modelling of the structure of the spine is possible but is very complicated once the action of the muscles, ligaments and forces generated by walking are included.
However simplistically biomechanical problems of the spine often do relate to poor posture. This scientifically relates to altered bio-mechanics and abnormal, eccentric or unbalanced forces being generated in the spine and musculature as a result of long term abnormal or and unusual posture and therefore force transmission through the spine. As a consequence all musculo-skeletal therapists to a larger or lesser degree believe that correction of the posture or spinal alignment balances the forces and relieves pain. They suggest that if the structure of the body is improved and the spine put back into alignment, the function of the body improves, problems will be alleviated and good health will be restored. Whilst osteopaths relate this to spinal pain chiropractors tend to hold the philosophy that this can also relate to other parts of the body such as headaches, chewing and generally to wellbeing and general good health.
Misalignment of the spine occurs following a mismatch in leg lengths, significant injuries producing abnormal posture such as a tibial fracture, local stiffness following a whiplash type neck injury or alternately spasm of the back muscles due to local pain from an inter-vertebral disc, spinal facet joint problems, poor posture at work typing or operating a computer. Alternately it can follow an injury, fall or other accident (even one that happened years before), or to long-term poor posture. The posture problems may not necessarily relate to the static standing position but may relate to the seated position, sleeping position or even the dynamic gait whilst walking. Thus any position adopted for a significant length of time may account for the resulting postural problems, pain and postural malalignment.
Areas of Practice
Osteopaths and chiropractors mainly treat back and neck pain. But some also treat other health problems, such as headaches, migraines, vertigo and tinnitus (ringing in the ears). Problems which may be covered include.
Shoulder referred pain
Hip referred pain
Leg pain referred from the spine
Heart and circulatory problems
While osteopathy and chiropractic are well accepted by many conventional medical practitioners, the scientific evidence for the measured incidence of therapeutic success is relatively sparse. Few studies have compared either chiropractor or osteopathy treatment to physiotherapy, pain therapy or orthopaedic surgery. Very few medical studies have compared the two therapies with each other. However, the evidence is stronger for chiropractic than osteopathy, with some studies showing that chiropractic may be effective for short-term pain relief in acute low back pain.
There have also been several studies of spinal manipulation and mobilisation techniques (by osteopaths, chiropractors, physiotherapists and doctors) for lower back pain. They suggest that the techniques, whoever does them, do provide short-term relief from pain, and improvement in mobility. However care and caution are needed.
There have been fewer studies of manipulation and mobilisation techniques for neck pain.
At a consultation
The first consultation with a chiropractor or osteopath generally takes about an hour. The chiropractor or osteopath will ask detailed questions about general health, lifestyle, emotional state, and medical and family history. He or she will also perform a physical examination, with the patient sitting, standing, walking and possibly carrying out other movements. Reflexes may be tested with a reflex hammer, and blood pressure may be measured. Some chiropractors (but not usually osteopaths) also use X-rays and other conventional medical tests to help them make a diagnosis.
Later sessions usually last about 30 minutes. The number of treatments each person needs and how often they are needed depends on the problem. At the first treatment session, the practitioner should give an idea of the length of treatment required.
Treatment is usually carried out with the patient lying down in various positions. Chiropractors mainly use a manipulative technique on the spinal column and pelvic area consisting of short, rapid forceful movements called high-velocity thrusts. These are designed to realign and mobilise the spine, and may result in an audible sound – a clicking similar to knuckles being stretched.
High-velocity thrusts may be used to mobilise the spine by all therapists, but these play a much smaller part in osteopathic treatment than in chiropractic. However a wide range of other techniques may be used, from stretching of soft tissues and massage to rhythmic joint movements and manipulation, on other parts of the body as well as the back. And, they may use only gentle “release” techniques with some people, particularly children and older people. These are called “muscle energy” techniques and are used to release tension in specific muscles. Some therapist also do cranial or mandible manipulation.
However it is accepted by all therapists and doctors that spinal problems commonly result in local pain, muscle spasm which subsequently results in local stiffness and positional or postural problems. Certainly it is irrefutable that once therapy has resulted in a degree of pain relief and resolved the local stiffness a degree of mobility, function and pain relief may follow. However the duration and significance of the improvement is often variable and the longer term effect questioned. However if the short term improvement is associated with structural alterations of seated or driving posture or orthotics (postural insoles) then a longer term improvement may be produced.
Physiotherapists and doctors sometimes use spinal manipulation and mobilisation techniques similar to those used by chiropractors and osteopaths.
Some osteopaths do cranial manipulation, also called cranial osteopathy. This consists of gentle manipulative techniques on the cranium (skull). A belief underpinning cranial osteopathy is that childbirth, an accident or long-term muscle tension can cause compression of the cranium. This, in turn, can affect how fluid called cerebrospinal fluid flows in the spine and around the brain, and so can result in health problems. Practitioners claim that gently manipulating the bones of the cranium can correct the flow of cerebrospinal fluid, by restoring the skull to its natural shape. Some doctors question this as the bones of the scull are rigidly fixed together in the adult skull and do not significantly move.
Craniosacral therapy is similar to cranial osteopathy. Its practitioners believe that the flow of cerebrospinal fluid affects every cell in the body. However, there is little scientific evidence to suggest that cranial osteopathy or craniosacral therapy are effective.
Side–effects and risks
The most serious potential risks of chiropractic and osteopathy are chronic pain, spinal cord injury or stroke after manipulation of the neck. These are rare, though there have been calls for research to establish how significant the risk is. It has been suggested by some that osteopathy is less risky in terms of spinal injury because osteopaths usually use less forceful manipulation techniques on the spine. Less serious, but more common, side–effects include discomfort or mild pain at the point of manipulation, mild headaches or tiredness, which should disappear within 24 hours of treatment.
For certain people, forceful manipulation can be dangerous and should never be done. This includes pregnant women and people with osteoarthritis of the neck or osteoporosis of the spine. Chiropractors and osteopaths are trained to check patients for these and other risk factors.
Finding a practitioner
All chiropractors must be registered with the General Chiropractic Council and osteopaths with the General Osteopathic Council to legally call themselves chiropractors or osteopaths. People can only become registered if they have completed an accredited course.
General Chiropractic Council
020 7713 5155
General Osteopathic Council
020 7357 6655
Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.