Chiro Vs Physio

[beckyw]

So then guys I'm new to this forum and was wondering about your thoughts on Chiropractors?
I am a Chiropractor and would rather work with physios than against them but there seems to be a certain amount of naivity (educational or personal) as to what we can and can't do. I see a lot of people who have seen a physio first NHS or private and I am confused as to why physios (not all) have a problem with us. Being brutally honest (not rude) I would like to know your real thoughts on us.
Thanks

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[ophqui]

its all about the evidence base. The BCA was really against giving a list of evidence at all to prove the effect of chiro, and when it did the evidence was really shoddy. Since our entire profession is founded on disregarding treatments that dont work or have no evidence, how could we, in good conscience, recommend a patient to go to a chiropractor?

I certainly dont hold the profession in low esteem personally. I've seen a fair few patients (for other, unrelated problems) who swear by a chiropractor for back pain etc, i'd never say 'oh you shouldnt do that, chiropractors are rubbish,' but if physio was to see the profession as an equal, there would have to be a pretty strong body of evidence to support it, and more of an open attitude to evidence in general. Maybe it exists and im just ignorant of where to find it, or biased against it though, being a physio.

[beckyw]

thanks for that.
the Bromfort report is now our standard for research. We treat low back pain, acute and chronic, neck pain, knee, extremity pain, lateral epicondylitis, frozen shoulder, plantar fasciitis, migraines, headaches. We also treat a lot more and well. It's not that there isn't any research becuase we treat it all day everyday and the BCA definatley has never been sketchy about finding us research, its always been there. I also think there is a big misconception that we manipulate everyone, well we don't, it's not suitable for everyone, rehab, dry needling, STW, US all sorts. We are trained in all of it. I just wish we could get this through to everyone

[mulberry]

there is some great research on why patients visit chiropractors or physiotherapists.
the crux of it was that physio were more likely to have patients visit them when the condition was more serious in nature and medically orientated while patients who preferred more holistic contemporary approaches preferred chiropractors.

the numbers games shows that physio and chiro numbers are very competitive

i think both codes sell themselves short too much

its not about what code you belong it is the patients needs that are most important

[beckyw]

I absolutley agree that pts are the most important factor in all of this and its not about numbers. My clinic is in an area that, for some reason is suurounded by physios that do not like us and openly tell their patients to not come to us. One even told a pt it was ILLEGAL to see us both at the same time even though he was seeing me first he had to go to them.

I think chiros and physios have very different roles. We both see acute and chronic cases and from medical to non-medical conditions.

I just wish we could work together, accept that we treat different conditions in different ways and get along

[physiobob]

Let's not open that pandora's box. Both are valuable practitioners. While where there why not also compare Osteopaths and Chiro's. After all Chiro's came from an off-shoot of the original osteopath profession. I would say in the majority of cases it is about the client and the therapist. There are good & bad clients. There are good and bad therapists. In my book I have always respected the Chiro's and the Osteo's. In fact I refer to both. I do however often hear clients tell me that their chiro said they shouldn't be seeing a physio for their issue. And the case continues.........

Let's talk about positive approaches, and some varying views to treatment. Much more useful.

[beckyw]

I think we'd be very naive if we didn't "open pandora's box". It's a perfectly normal grown up conversation. If we don't discuss it the divide will grow

[alophysio]

Hi beckyw,

Interesting post

I will lay may cards down first...
1. There are good and bad in every profession
2. My difference with chiros are with philosophy
3. I refer to chiros if my patients want me to.

In essence, traditionally and from what i gather from Chiropractor association websites are that chiropractors are interested in structure and optimal nerve health. Adjustments tot eh spine help with interferences with optimal neural health...forgive me if i am wrong.

I also am led to believe (and have observed) that chiropractic *tends* to be passive - as in the patient gets adjustments whereas physios tend to be active - the patient has to do exercises etc.

I think the truth is someone in between.

Ultimately, i believe that a good physio will have it over a good chiro because physiotherapists manipulate (adjust) joints and have lots of passive treatments but are ultimately the experts at "beautiful movement" - that is combining the treatment of the following systems...
1. Myofascial system
2. Articular System
3. Neural system including motor control in which physiotherapists are the world leaders in research and practice
4. Visceral system - this is more like classic osteopaths but more and more physios are learning about the visceral system and how their function affects fascial pulls etc
5. cognitive/psych system

That is not to say that a chiropractor can't be great at all of the above as well. I feel that the training i have observed that chiros have had do not lend themselves to biomechanical analysis whereas physios have this training as part of undergraduate studies...

Ultimately, i think good chiros and good physios have a lot to offer. I have a couple of chiros i trust and i love to talk to them and we share knowledge - isn't that how it should be?

[alophysio]

BTW, "Bad Chiros" are people who tell my patients that i can't help them and they need to see that chiro for 3 times a week for 6 weeks to get better...that is plain bad practice in books!

Same goes for "bad physios" - they put machines on everyone that comes along and never look to see why someone has a problem in the first place! They too see clients x3/wk for 6 weeks.

Patients aren't dumb - they get this feeling that there should be something different...

I never ask a patient to stop seeing a chiro - i simply ask them how the chiro has been going for them. If they i feel that the results will be muddied, i ask them to choose and i assure them i won't be upset if they want to go to the chiro - i am always here for them if it doesn't work out.

I have lots of chiro patients who go to the chiro for their regular adjustments but come to me when their pain is bad.

Go figure!

[Poonam Chhikara]

hi, m a physio working since 2 years.
i never ask my patients not to go to chiro (or any other thing like ceragym, acupressure etc.)

If i say so, pt. may think of it as a professional jealousy.
Show to the pt. that u r free to go to anyone u like.......
and explain him about how ur therapy works. explain the mechanism of action in pt. language.

pt. will automatically rely on you.

Even if few pts go, they will come back to u if they have faith in u......
i have experienced it many times...

[beckyw]

absolutely!!!!!! I totally agree that there are good and bad in every profession. Chiros do however take part in a LOT of passive care too. Part of our training is rehabilitation and although I think that is where physios can be very good it is something we do also. I think we have a name (for what ever reason) for manipulating and thats it. Chiropractors are first class manipulators, hence the 5 year training course, not just a post-grad course in SMT afterwards. I run back care exercise classes and I would never say to a pt that I need to see them 3 times a week for 6 weeks, that's unethical and uneccessary.
As for not having biomechanical analysis skills, again, 5 years training and hours and hours of it suggests we are as good as the next profession.

It seems to me that people are very quick to "assume" they know everything about how and what we train in. Manipulations are a very very skilled manouevre and it takes years to perfect. Exercises / rehab and preventative care are all incredibly important for chiropractors and without all of them combined it is impossible to treat someone. I feel some people shouldn't be so judgmental and unless you have done and passed a chiropractic degree will you ever know what we do and don't do.
Additional Comment I forgot:

BTW, "Bad Chiros" are people who tell my patients that i can't help them and they need to see that chiro for 3 times a week for 6 weeks to get better...that is plain bad practice in books!

Same goes for "bad physios" - they put machines on everyone that comes along and never look to see why someone has a problem in the first place! They too see clients x3/wk for 6 weeks.

Patients aren't dumb - they get this feeling that there should be something different...

I never ask a patient to stop seeing a chiro - i simply ask them how the chiro has been going for them. If they i feel that the results will be muddied, i ask them to choose and i assure them i won't be upset if they want to go to the chiro - i am always here for them if it doesn't work out.

I have lots of chiro patients who go to the chiro for their regular adjustments but come to me when their pain is bad.

Go figure!

I agree there are good and bad in every profession, I also say the same as you if my pt is already seeing or due to see a physio. That it is up to them to make the decision on who they see. I think the difference is is that because NHS physios are free for them they have their dedicated 8 sessions then come back. Others stay. I can understand from the pt point of view that they are usually desperate to see anyone who will help and want to try it all.
I still wish we could all work together. No professional "slagging" matches anymore would be lovely. I wouldn't dream of telling someone not to go somewhere or stop going.

[physiobob]

Many chirpractors are becoming much more like physio's. Unlike the traditional physiotherapy movement, chiro's are quick to move with the marketing initiatives that get more clients. They have also worked to address anything that could be negatively said about them. As the years are going bye the chiro is becoming every closer to the outpatient aspect of physio. In time they will catch up but one should remember that musculoskeletal outpatient physiotherapy is but a small component of what is means to be a physiotherapist. And also a small component of the wider knowledge of a physiotherapist across the health spectrum. And perhaps we should all consider the good education on diet and 'naturopathy' concepts that the osteopaths get taught. I refer to them a lot more than the chiro's but then that is in the UK. In Aus I would refer more to the chiro's. In fact one long time chiro who is both a family friend and a therapist of my mother (for over 30yrs) decided to go back to school and become a physio as well. So he's an awesome choice for me to refer to.

[alophysio]

hi beckyw,

I am assuming you were responding to my 2 posts.

To be fair, i used words like "from what i gather from Chiropractor association websites", "i fell", "i think", "i have observed" - i don't assume i know everything, just what i have gathered and researched.

I am trying to understand what you are trying to do here...have a discussion about something, be an apologist for chiropractic or try to convince us about something else?

Can i ask you a question...do you believe that the majority of chiros would ask a patient to see them ragularly - initially a few times a week and tapering off until they only need "maintenance" every 4-6 weeks - or see a patient only a few sessions (say 3-5), deal with their problems, set them up with self management and discharge them?

My personal experience has been the former rather than the latter.

I do not dispute your training or how long it took or anything else about your education. I do however believe that the majority of "opposition" you might face would be because of the passive reliance on the therapist (chiro) that physios have come across - this is very contrary to our training.

Perhaps you are a different type of chiro...

...do you encourage regular visits/checkups/etc to maintain "optimal" health?

If so, in my honest opinion, you would be promoting a passive reliance on you, the therapist.

I do not mean to be offensive, just honest.

What do you believe about physios?

[physiobob]

Thanks alophysio,

The classic example is my mother. She has been seeing her chiro regularly for about 35 years. She still has the same issues and my sister is in the same boat. I always say well he didn't fix your problem did he. After 35 yrs!!!

Now the flip side is the personality of my mother. When she gets a migraine she goies to the chiro, he manips her and her headache goes away. A great result actually. And she is happy to do that and be the passive patient and just keep paying for it.

I think in many ways the clients that see chiro's get what they want from treatment. Perhaps those that see physio's want a different treatment plan, one where they are more active participants.

Of course I am generalising but I would never send my mother to a physio as she just wouldn't be interested. I am a little old school in my training on all of this and I don't manipulate the cervical spine at all so perhaps those physio's who regularly do this would feel also they have the 'quick fix' skill and also the longterm fix skills.

Pandora's box?

[alophysio]

hi physiobob...

Agreed - but those of us who are happy, trained and skilled at manipulating (Gr5) C/S can provide that - i always tell my patients the options and why what i am doing is a short term fix and that they will need to change their habits and motor patterns, recruitment of muscles, etc etc...

beckyw asked us to be brutally honest with what we thought in the OP...the above is why i think well trained physios have it over chiros...at the moment - it is not a glory statement nor a "lording it over someone" statement but a statement of the current status right now...

...if we physios become complacent, chiros will get skilled up and fill the breach.

Is it "us" and "them" - not really at the moment but if it ever comes down to federal funding etc, watch the feathers fly!

[physio2]

Hi everyone, Here are my thoughts on chiropractic in the US. Chiropractic is based on the subluxation idea, which has no scientific basis. The chiropractic definition of subluxation is ambiguous and there is no evidence that it can be detected or corrected. Chiropractic was founded by one person (Daniel Palmer) in 1895 who was a grocer and a magnetic healer. Magnetic healers believe they can heal people with their magnetism. Palmer believed a subluxated vertebra is the cause of 95 percent of all diseases. This subluxation idea still exists in chiropractic today. There are some chiropractors who don’t adhere to the subluxation theory, however chiropractors who denounce this foundational theory are basically telling us that chiropractic has been wasting patients’ time and money since 1895.
Chiropractic schools are not affiliated with hospitals or universities. Chiropractors are not permitted to work in hospitals and do not complete hospital internships or residencies. Chiropractic schools do not require students to complete a research project, thesis or dissertation. Chiropractic schools have a very lax screening process and many do not require an undergraduate degree, clinical experience, letters of recommendation, entrance exam or interview prior to admission. Chiropractic schools accept 100% of their applicants.Chiropractic students are taught by other chiropractors.Chiropractic students do not receive clinical training in any type of medical setting. Chiropractic students never get to see real patients with real medical conditions. They do their examinations on fellow students, friends and family members who don’t have medical conditions. These fake patients are recruited by chiropractic students in order to meet graduation requirements.
Chiropractors have no clinical experience in any acute care settings, sub acute care, rehabilitation, skilled nursing facilities, transitional care units, intensive care units or home health. They have no clinical experience with traumatic injuries such as fractures, dislocations, burns or wounds. Chiropractors have no experience with any serious medical conditions, in fact, a chiropractor can complete his/her entire career without seeing one drop of blood. Yet they wear a white coat and call themselves doctors who can diagnose disease. How can they possibly diagnose disease?
<O</O<O</O

[alophysio]

Hi Physio2

Thanks for your thoughts. I personally wouldn't go so far but perhaps the training in the USA is different that in the UK and Australia?

I think the Seinfeld episode involving Chiropractors (and George) was funny...

But having said that, there are many chiros i trust and would sent my patients to if asked - i do manipulations like a chiro or osteo might but not many physios do...it is just another tool in the kit for me...

Thanks again

[beckyw]

I am not an apologist, and never would be. I am mearly trying to understand the differences. I do not have a plan for all pts. Each plan is individual. Some want "fixing" and will return when they need "fixing again", others want to have regular treatment and I am not the only chiropractor to do this. I give them self regulating rehab and exercise, nutritional advice and other help.

I have found some of the comments on here quite inflammatory, not your posts but generally on this forum and I find it deeply unproffesional.

I also don't see the problem with having passive reliance on a practitioner, whoever it may be. If you know there is someone who can treat you, however that may be becuase you can't treat yourself then i see no issue. I wouldn't buy a car and never take it for a service or have anything fixed!!

I do encourage regular treatment, manipulation / massage / dry needling / exercise because I know it works! but regular might mean every 4 months, as you would go to the dentist.

As for what I believe about physios - I think they have their role as do every practitioner but the local hospital here, promotes quite an agressive stance on our profession. I think there is a misconception as to what we do. We don't manipulate everyone, if they need different treatmnet and I can offer it then that's what I will do. I have also heard from my patients that care they have had is quite hands off, to leave someone in traction with a heat pack on to me is perhaps not what they need. I'm not saying that this is waht all physios do but that is what they are like round by me and I just wanted to know if there was a general consensus amongst the physio community about what we do. A lot of people have misconceptions about our training and unless people have done the course I think commenting in that is wrong. I know its taken me 5 years to learn how to manipulate and I don't think it should be carried out as a post-grad course. This isn't all about you btw, its just a general rant to whoever wants to join in.
Additional Comment I forgot:
UK chiros have to go through 12 months of treating the public. we then have a year of working for someone under yet more guidance. Not friends and family, genuine paying patients (that we don't get paid for) practising on our friends would do us no good at all!! Yes, we are taught by chiropractors but we are also taught by pharmacologists, neuroscientists, radiographers. Perhaps you should look into it a bit more
Additional Comment I forgot:
also, a 5 year degree of pathology, dermatology, radiology and neuroscience makes us better diagnosticians than most. In fact a recent piece of research has shown that chiropractic STUDENTS know more than fully qualified medics!

[alophysio]

Thanks Beckyw,

You sound like the kind of chiro i might work with (possibly - i don't work too well with many physios!)...you are also probably representative of the kinds of chiros i am talking about - the lines between chiro and physio will become blurred soon.

I hope i haven't offended you - i always try to be careful with my words...

CHeers

[beckyw]

no you haven't offended me at all. We get a lot of stick in the media and sometimes it feels like we have to fight for what we do,
thank you for being honest

[alophysio]

Thanks Beckyw...i was thinking...the quicker you get rid of dodgy chiros (and we get rid of dodgy physios), the better off you will be in the media!

Cheers