What’s the difference? Part one

A question I get asked almost every day is “Heather, what’s the difference? What’s the difference between a Physiotherapist, Sports Therapist, Chiropractor, Osteopath, Massage Therapist and Personal Trainer? Don’t you all do the same thing?”

There are some cross overs in our practice so no wonder it’s a confusing area for people! It’s a muddy area and I’ll do my best to shine a light on it today. It’s going to be lengthy so I’ll split it in to two parts. This part will look at Physiotherapy, Chiropractic and Osteopathic intervention.


The Chartered Society of Physiotherapy defines the profession as a science based approach to treating the whole person where the person is empowered to be involved within their own care (1). Your Physiotherapist has been to university, attaining a degree in the subject, and has spent many years dedicating their lives to helping others through learning the profession, developing the profession and continually improving themselves through continuing professional development. Physiotherapists aren’t afraid to change with the times and ensure they work to the research at all times. In fact, it’s a requirement dictated to them by the Health and Care Professions Council whom all practicing Physios in the UK must be registered with (2,3). They work in a variety of health and social care settings including musculoskeletal medicine, cardiorespiratory care and neurological rehabilitation. Some are also involved in research, teaching and improving services. They treat people of all ages through a combination of advice, education, manual therapy, where indicated, and exercise prescription (4). Importantly, within the UK, Physiotherapists are recognised by the NHS as an Allied Health Profession which is involved in multidisciplinary team approaches to the assessment and treatment of patients within and outwith a hospital setting – the only profession out of the above to be recognised as such. Physiotherapy is widely available on the NHS as well as within the private sector through insurance companies.

Now, when people hear exercise, they instantly think of the gym. And I’ve heard it time and time again ‘I go to the gym/run regularly/am really active I need more than just exercises’. Well, you don’t. The exercises that a Physiotherapist prescribes are specific to your complaint. The programme you’ve been given has been designed following a thorough assessment of YOU, the person, and has been thought out critically – there’s a reason that you’ve been given the exercises the Therapist has put together.  It’s not a haphazard approach to throw your way, pie in the sky idea. These exercises are specific to YOU and to YOUR issue. As we’ve spoken about above, your Physio has spent years honing their craft. Don’t dismiss their critical thinking so quickly.

That’s not to say that manual therapy doesn’t have it’s place within a Physio appointment. In fact, a lot of research supports the use of manual therapy IN CONJUNCTION with exercise prescription. But it also tells us that manual therapy is a quick fix that will give immediate symptom relief lasting for 2-5 days. The exercises and the participation within the rehab programme is the key to recovery and overall prevention and is what is supported by RESEARCH AND SCIENCE. The same way that your Oncologist provides you treatment in line with the RESEARCH AND SCIENCE in to Cancer Care, your Physiotherapist will provide you with treatment in line with RESEARCH AND SCIENCE in whichever field of medicine they happen to be working within.

Physiotherapy is generally safe as it focusses on movement and exercise but there may be some discomfort or some aches as you go through your treatment and exercises. If this is the case, tell your Therapist immediately.


The British Chiropractic Association defines a Chiropractor as a regulated health professional who can diagnose and treat issues with the musculoskeletal system (5). They have a particular interest in the back and neck but may provide treatment to other areas of the body that are causing issues and are the source of the pain. According to this governing body, Chiropractors should be providing exercise prescription alongside their treatment sessions.

The National Health Service in the UK supports this definition and goes on to explain that the profession is classed as complimentary and alternative medicine meaning that it is not a conventional medical treatment and it is not widely available on the NHS in the UK although some areas, and private insurance companies, may offer it (6). This is because the scientific evidence surrounding the majority of the assessment and treatment methods that are often used is lacking and is of low quality.

But what does a session involve? We’ve spoken above how a Physio session tends to include thorough assessment and then specific treatment to you the person. Chiropractic sessions are not too dissimilar in that there is an assessment however their treatment tends to focus more heavily on manual therapy including spinal manipulation where they use their hands to apply force to the spine. Because of this, you may experience pain and discomfort – tell your Chiropractor immediately if this happens. There have been instances where people have suffered serious illness (including stroke) during or following chiropractic intervention but this is very rare.


The General Osteopathic Council describes Osteopathy as a registered health provider who looks at diagnosing, managing and treating the musculoskeletal system as well as related body systems (7). They go on to explain that Osteopathy tends to focus on manual therapy (similarly to Chiropractic intervention) and self help may also be provided.

The NHS expands on this definition further and explains that Osteopathy is based on the notion that the wellbeing of a person is dependant upon their bones and connective tissues running smoothly together. This makes sense – when we move well we feel good, however, there is currently no good evidence to support Osteopathy for musculoskeletal disorders (8).

A session generally involves a thorough assessment (similar to physiotherapy and chiropractic care) and treatment often includes physical manipulation, stretching and massage to improve your musculoskeletal issue. Again, there is limited evidence to support the use of these techniques.

Generally, sessions are safe with limited risks although you may experience discomfort or pain with the passive nature of the treatment. If this is the case, let your Osteopath know straight away.

Osteopathy isn’t generally available on the NHS although insurance companies may provide cover.


To summarise, Physiotherapy, Chiropractic and Osteopathic care has a lot of crossover. All professions are registered with governing bodies in the UK and all will complete a thorough assessment of you the individual and then use these findings to provide a diagnosis and treatment plan. Not all of the treatment methods within all 3 settings has scientific backing which means that it might not help in getting you better. What is found time and time again in the research is that exercises – specific and whole body – will improve your symptoms and will get you better and this is the bread and butter of a Physiotherapist although a Chiropractor and Osteopath should and may respectively provide these within their sessions for self care after treatment.

I hope part one of “what’s the difference” has been useful and, as always, I’m keen to hear your opinion. It can always be a bit divisive when discussing similarities and differences within professions but hopefully this has been informative.

Chat soon =]



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