Full disclosure: I am an osteopath specialising in lower back pain and I may not be the best choice for your particular problem.  Sometimes you would be better seeing a surgeon, or a great massage therapist, or exercise instructor, but if you’re in need of a clinician knowledgeable about lower back pain or sciatica, I think I’ve some useful insights for you.  In this article I take an honest look at the differences between the three professions, trying to help you to make a better-informed decision.  (If you want to skip to the conclusion, read the last paragraph.  If you want all the detail, read on…).

Firstly, please note that Chiropractors and osteopaths are statutorily regulated i.e. it is a criminal offence to describe yourself as one unless you are registered with the appropriate regulator (below).  “Chartered Physiotherapist” is a protected title, with the Chartered Society of Physiotherapists’ members being regulated by the Health and Care Professions Council (HCPC). It’s still fairly common for some therapists (particularly those attached to some sports clubs) to be described as “physios” although they are not actually fully registered/qualified as required by the HCPC.

The UK’s chiropractic regulator, the General Chiropractic Council describes Chiropractic as “… a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system (bones, joints and muscles), and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.”

The General Osteopathic Council describes Osteopathy as “… a system of diagnosis and treatment for a wide range of medical conditions. It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.”

The Chartered Society of Physiotherapy doesn’t really offer a definition, rather it describes what it does… “Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability.”

So, because the three regulators/associations take a different approach to describing their professions, it’s difficult to separate them from one another.  Before I offer the general perceived differences, it’s worth commenting that an old friend of mine who used to be the Secretary of the British Medical Association in Scotland was commissioned 20 odd years ago by what was then the Scottish Home and Health Dept (part of the Scottish Office) to investigate and report on the differences between the three professions.  His primary conclusion was that there were more differences within each profession than there were between them! i.e. you could have very different experiences from 2 physios, or 2 osteopaths, or 2 chiropractors.

That said, if you’re still keen to hear the differences, I have an ex-sister-in-law who was a chartered physio, and worked in my practice for 2 years.  I also know a few physios, and I’ve consulted two chiropractors over the years (just to see what they were like), and – having been in practice for nearly 30 years – I’ve seen a host of patients who have described their experiences of each of these professions.  In practice, the differences seem to be:

  • Chiropractors do more manipulation (cracking) of spinal joints and less soft tissue work and less exercise prescription.
  • Physios do less hands-on work, used to use a lot more in the way of electro-therapy (less now), but prescribe more exercises.
  • Osteopaths are somewhere in the middle.

BUT, I want to emphasize that as there are so many differences within each profession these generalisations are exactly that – they do not fairly describe individual clinicians and their particular approach. I have met some chiros who are very very exercise-orientated, some osteopaths who almost exclusively manipulate joints (though they’re a dying breed) and some physios who also do a lot of manipulation. The key thing is that you feel comfortable with the treatment and advice being provided, but also that the practitioner is adhering to best-practices.

I hope that’s helped at least a little.


N.B. When it comes to lower back pain and sciatica, the clinical guidelines emphasise the importance of physical activity / exercise prescription.  So if your practitioner is not advising you on this, but is only treating you passively – whether that be massaging soft tissues, articulating/cracking joints, or using machines – please ask them them for advice on activities of daily living and on exercise / physical activity and its role in your rehabilitation.