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Chiropractor Vs Physical Therapist
This is a complicated topic. There is definitely some crossover between the chiropractor and physical therapist professions. Anytime you are looking for a healthcare provider it is important to know what you want and what each profession offers. The challenge when comparing a chiropractor to a physical therapist is that they are all different. I don’t just mean a chiropractor vs a physical therapist but chiropractors compared to chiropractors and physical therapists compared to physical therapists are very different.
Some chiropractors do essentially no physical therapy in their office while others utilize physical therapy which is essential to stabilizing and maintaining a patient’s spinal correction. Typically structural chiropractors will employ physical therapy exercises unique and different from other chiropractors and physical therapists. These types of physical therapy exercises may be utilized second only to a chiropractic adjustment.
The biggest mistake people make when trying to decide to go to a chiropractor or physical therapist is that they are all the same. It’s important to do your research. Your first step is to determine what kind of doctor you want. Don’t be afraid to read their websites thoroughly. Schedule a consultation and meet with any potential chiropractic doctors or physical therapist to get a better idea of what their treatment focus is and how their office runs.
I have to say that when I originally set out right this blog I didn’t think it would be that difficult. I was wrong. Sure there are some differences and similarities between chiropractors and physical therapists but I figured I would be able to easily highlight the primary distinguishing characteristics. I was wrong. It was not easy. There are certainly a few but the more I kept writing and reading and researching the more I came to realize that there are just as many differences within the professions themselves. Overall, I found more similarities than I had anticipated.
Physical therapy has a broader spectrum of treatment that goes more in hand with the medical model. Treatment is based more on the muscles and movement. Physical therapists also seem to have more experience creating exercises and therapy for patients with specific diseases i.e. Chiropractors focus their treatment on the rehabilitation of the spine. Within this chiropractic paradigm there are many variations and to be honest, this is one of the weaknesses of the chiropractic profession.
The main distinguishing factors really boil down to this.
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UNCONVENTIONAL CHIROPRACTOR
Primary Focus
Subluxation identification is often less specific and more subjective. Typically relying on the only palpation of the spine and sometimes being described as emotional and mental.
Treatment Expectations
VERY wide variation. From low force adjustment to VERY low force “emotional” adjustments.
X-Ray
Typically no x-rays or only complaint specific x-rays are taken.
Physical Therapy Utilization
Primarily physical therapy is not commonly utilized and limited to basic strengthening exercises but more commonly symptom-based treatments like STIM, Ultrasound, Heat, non-specific traction.
Medication
All chiropractors do have education and are tested on pharmacology. New Mexico recently allowed chiropractors to prescribe some meds. Preference for these rights is split.
Education
Same as Traditional Chiropractors.
Specialties
Near anything from cold light lasers, detox foot baths, hair removal with some similarities to Traditional Chiropractors.
Medical Rapport
Patients are often confused because some of these chiropractors claim to treat specific diseases with adjustments.
Insurance Acceptance
A mix of insurance and cash.
Spinal Adjustment
Segmental or low force adjustments performed to improve limited mobility of joints, to improve the nervous system for the treatment of symptoms or disease.
TRADITIONAL CHIROPRACTOR
Primary Focus
Focuses on the identification of and correction of abnormal spinal motion alignment often referred to as a subluxation.
Subluxation is commonly treated segmentally (one vertebra or joint at a time).
Treatment Expectations
Focuses on neuromuscular symptoms like neck pain, mid back pain low back pain, headaches, sciatica, etc. Success is based on symptoms.
X-Ray
All chiropractors are able to take and read x-rays. Utilizing x-rays primarily for imaging of chief complaints only. Some chiropractors don’t take them at all (I do not recommend getting adjusted by ANYONE who does not have x-rays of the area(s) they adjust).
Physical Therapy Utilization
Limited to basic posture exercises but more commonly symptom based treatments like STIM, Ultrasound, Heat, non-specific traction.
Medication
All chiropractors do have education and are tested on pharmacology. New Mexico recently allowed chiropractors to prescribe some meds. Preference for these rights is split.
Education
3-4 years undergrad (essentially all chiropractic schools require bachelor’s degree now, if they don’t know they soon will) and four years graduate. All chiropractors do post-graduate education (hours vary by state).
Specialties
Varies: Pediatric, Pregnancy, Sports, General Non-specific, Neurological, Personal Injury (car accident victim care), Scoliosis, Nutrition, etc.
Medical Rapport
Divided: some want to be more “medical” and has prescription rights. Others want to limit scope of treatment by chiropractors in an attempt to be more accepted by the medical community.
Insurance Acceptance
Commonly In-network because of the symptoms based treatment they provide. Due to low reimbursing and treatment frequency restrictions offices typically see a higher volume of patients with shorter visits.
Spinal Adjustment
Primarily segmental adjustments performed to improve the limited mobility of joints, most commonly spinal joints, to reduce inflammation and nociception (pain).
STRUCTURAL CHIROPRACTOR
Primary Focus
Subluxation is determined radiographically using evidence normal models. Measured displacement of the spine both segmentally and especially globally. Physical therapy via specific spinal exercises and spinal remodeling traction are essential to this type of chiropractic care.
Treatment Expectations
Focuses on making objective changes to the spine and posture that are measured via standardized x-ray imaging. While treatment is concentrated to the spine, research, numerous cases studies, clinical examples and anatomical common sense indicate correcting abnormal spinal postures can and do have a positive effect on abnormal human physiology. Diseases are not treated directly.
X-Ray
Take standardized full spine x-ray imaging before and after treatment.
Physical Therapy Utilization
Physical therapy techniques are focused on posture and spinal correction and stabilization i.e. spinal remodeling traction, mirror image and spinal stabilizing exercises based on standardized x-ray imaging.
Medication
All chiropractors do have education and are tested on pharmacology. New Mexico recently allowed chiropractors to prescribe some meds. Preference for these rights is split.
Education
Same as traditional chiropractic with post graduate focus of structural chiropractic care.
Specialties
Structural care, Scoliosis, Personal Injury (car accident victim care) with structural chiropractic focus.
Medical Rapport
Works with medical providers when clinically indicated, but has no desire to become medically oriented to prescribe drugs. Often more accepted by the medical community because treatment is based on evidence-based research.
Insurance Acceptance
Typically out of network or cash only because care is based on structural need and not solely on symptomatic removal. Fewer restrictions on reimbursement from insurance but the patient usually has to pay upfront. Offices typically have a lower volume of patients, with better quality of care and longer visits.
Spinal Adjustment
Performs segmental adjustments in early and acute care combined with mirror image postural adjustments to correct multiple abnormal spinal segment shifts simultaneously for objective long-term structural spinal changes.
PHYSICAL THERAPIST
Primary Focus
Motion and muscle based treatment. Similar to chiropractic in that they are focused on conservative treatment to avoid the use of drugs and surgery. Physical therapy focuses more on exercises instead of spinal adjustments.
Treatment Expectations
To maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. This is very similar to traditional and structural chiropractic but with less importance being put on the structure of the spine and its effect on the function of the nervous system specifically as it pertains to chiropractic adjustments.
X-Ray
Physical therapists are not able to take or order x-rays.
Physical Therapy Utilization
Physical therapy techniques are typically more diverse.
Medication
No, unless in military. Physical therapy do have education and are tested on pharmacology.
Education
Similar to chiropractic. Requires a bachelor’s degree, however, some physical therapists have only a Master’s degree.
Specialties
Varies greatly.
Medical Rapport
Referred to more commonly by medical doctors. Likely because they focus specifically on post-surgical or disease focused rehabilitation e.g. cardiac or pulmonary rehabilitation.
Insurance Acceptance
Varies similarly to chiropractic. Some offices take insurance some only cash. Physical therapy like chiropractic is considered specialty healthcare.
Spinal Adjustment
***Minimal education of joint manipulation. Typically only one elective course that is not required.
IN North Carolina:
“Physical therapy”………“Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, manipulation of the spine unless prescribed by a physician licensed to practice medicine in North Carolina, or medical diagnosis of disease.”
***NOTE: in the state of North Carolina, according to the North Carolina Board of Physical Therapy Examiners, “”Physical therapy”………“Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, manipulation of the spine unless prescribed by a physician licensed to practice medicine in North Carolina, or medical diagnosis of disease.” This is particularly odd given that the medical community has practically no understanding of a spinal adjustment as their education is rooted in drugs and surgery.
Please understand that I am not trying to degrade or ridicule any one type of chiropractor or physical therapy. The unconventional chiropractors can and do help people. Being a structurally focused chiropractor I clearly have a bias and am of the opinion that Structural Chiropractic IS and should be the gold standard for the entire profession. Those who don’t focus on the treatment and correction of the spine in an objective method should have a separate professional degree to treat under, perhaps physical therapy. The leniency and discord of the chiropractic profession in this matter is likely a source of confusion for patients and other healthcare professional. Sadly those low force techniques do not have a profession they can call their own outside of chiropractic and because chiropractic has such a strong rooted history in holistic drug-free and surgery-free treatment, which correlates with their philosophy, they commonly practice under the chiropractic license.
This is where physical therapy stands strong. They do not seem to have the same internal disputes about the scope of and basis of their profession the way chiropractic does. This is why chiropractic often has a bad reputation. It’s not the only reason. I’m talking to you American Medical Association who was found guilty in a federal antitrust where they engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession.” This campaign of misinformation still permeates our culture and the medical community and is certainly a reason why medical doctors refer to a physical therapist before chiropractors. For more on this issue see our previous BLOG.
Overall, both professions have their pros and cons. There isn’t one that is better than the other as a whole. The main principle is that you want to find a doctor that is going to treat you in a way that is in line with your beliefs and values regarding, as they pertain to your health. Second, you need to find a chiropractor or physical therapist that is going to be able to help you with the problem that you are having. For example, if you’re an athlete and just want your knee to feel better after you injured it, you may want to see either a sports focused chiropractor or physical therapist. Then again you may prefer a more comprehensive approach from a structurally focused chiropractor who will attempt to identify and address any potential spinal or pelvic shifts that may be putting excess stress on your knee in addition to adjusting your knee. You probably want to avoid a physical therapist who only works with cardiac patients or a chiropractic who doesn’t have a lot of experience adjusting extremities like knees and feet.
The best way to determine the right healthcare provider for you is to go in for a consult, which is often free so that you can talk directly the doctor and see the office. It’s a good idea to rule out chiropractors or physical therapists via reading on their websites so you don’t waste your time meeting lots of doctors. And if you find that you’re not happy with the treatment you’re getting find someone else just don’t make the mistake in assuming that because the chiropractor or physical therapist you are seeing isn’t helping you that the whole profession they represent can’t.
As always, I welcome comments. If you are a physical therapist and you notice that there is something pertaining to your profession that I missed or inaccurately stated, please let me know. I know my profession very well, as I suspect you know physical therapy very well if you’re a physical therapist. The more we know about each other the better we can help our patients.
