Whether you're a client trying to understand the difference or even an undergraduate, this question is hugely enjoyable, with many blurred lines.

To help educate the public, we have written this for context, but as a disclaimer, there is quite some diversity within each profession, such that some Chiros may operate more like Osteopaths and others more like Chiros in how they apply spinal manipulations.

We certainly use chiropractic tables within our osteopathic practice because they are much more versatile. As we work and train with the Chiropractic department at Wimbledon Clinic, we employ many techniques traditionally seen with the Chiro profession, particularly if we find the client is more comfortable using a particular technique, it will often get favoured to use with that individual regardless of whether the method was initially associated with a specific profession. We should also point out that much of the latest evidence of the effectiveness of spinal manipulation therapy focused on the type of manipulation primarily associated with chiropractors, called high-velocity low-amplitude (HVLA) manipulation, which means quick but soft, often phrased by Chiropractors as an adjustment.

Background Of Osteopthy & Chiropractic

Osteopathy and Chiropractic originated from 19th-century American folk traditions of bone setting, with founders Daniel D. Palmer (Chiropractic) and Andrew Taylor Still (osteopathy) having possibly interacted. Both therapies focus on the musculoskeletal system, employing hands-on techniques to diagnose and treat structural and functional abnormalities. The "high-velocity thrust" is a prominent technique involving a quick, sharp motion to restore movement in restricted joints, often producing a characteristic "cracking" sound. While chiropractors typically apply direct thrusts on vertebrae, osteopaths usually use the limbs as levers. Both professions also utilise soft tissue techniques, like muscle energy methods, and functional techniques that rely on subtle neuromuscular responses and advanced palpatory skills. Cranial osteopathy, a subset, involves gently handling the skull and sacral bones to influence cerebrospinal fluid rhythms. The McTimoney School of Chiropractic emphasises techniques with less focus on high-velocity thrusts. Notably, many of these methods overlap with those used by physiotherapists trained in manipulative therapy, making practical distinctions between the professions minimal from a general practitioner's viewpoint.

What Happens During a Treatment?

During a treatment session, manipulative therapists (osteopaths and chiropractors) conduct a patient history, palpate for muscle tension and skin circulation changes, and assess movement restrictions to diagnose musculoskeletal issues and neuromuscular dysfunctions. Chiropractors may employ X-rays for diagnostic assistance, whereas osteopaths typically reserve them for ruling out severe conditions. 

Treatment sessions last between 15-30 minutes, with initial consultations possibly extending longer. Techniques vary, but up to four high-velocity thrusts are usually administered per session. Chiropractic treatment for back pain might involve six sessions with decreasing frequency, while osteopaths often adopt a more "as needed" approach.

Osteo Vs Chiro Therapeutic Scope

Originally, both osteopathy and Chiropractic were considered comprehensive medical systems. Andrew Taylor Still addressed conditions like infectious diseases and blindness, with back problems rarely mentioned. Early chiropractors believed spinal misalignments were the root of most diseases, treatable through chiropractic methods. Modern practitioners have shifted focus primarily to musculoskeletal disorders, with low back pain being the most common complaint. Other conditions treated include neck and shoulder pain, sports injuries, repetitive strain injuries, and headaches. While they can't alter disease progression in ailments like arthritis, practitioners aim to alleviate secondary symptoms such as pain from muscle spasms. Cranial osteopathy is reputed for addressing pediatric issues like colic and behavioural problems.

Osteo Vs Chiroprcatic Research Evidence

Extensive randomised controlled trials support the effectiveness of spinal manipulation for back and neck pain, though critiques highlight potential non-specific treatment effects. A notable UK trial with 741 participants showed Chiropractic offering long-term benefits over hospital outpatient care, but methodological weaknesses like unblinded outcome measures were noted. Another trial with blinded outcome assessments indicated that both physiotherapy and manipulation outperformed placebo and general practitioner care, with manipulation showing superior results after one year. There's also limited evidence supporting manipulative treatments for headaches, including migraines. However, there's scant reliable evidence for benefits in other commonly treated musculoskeletal conditions. For non-musculoskeletal issues, aside from some positive findings in dysmenorrhea, evidence suggests manipulative therapy doesn't benefit conditions like asthma and hypertension. Research on cranial osteopathy and McTimoney Chiropractic remains limited.

Safety of Osteopathy and Chiropractic

Severe adverse effects, such as stroke or spinal cord injury post-cervical manipulation, are rare, with estimates ranging from 1 in 20,000 to 1 in a million procedures. Enhanced awareness and improved practices in recent years may have reduced these risks. More common side effects, affecting 25-50% of patients, include mild pain, headaches, and fatigue, typically resolving within 24 hours.

Professional bodies have established contraindications, especially for high-velocity thrusts, and practitioners are trained to screen patients for individual risk factors. Even when specific techniques are contraindicated, alternative manipulative treatments might be safely employed.

Practitioners Osteo vs Chiro

Osteopaths and chiropractors predominantly operate in community and private settings, often working solo from home-based clinics or group practices, including multidisciplinary and general practices. Some have contracts with health authorities, fundholding practices, or primary care groups. All private health insurance plans now cover manipulative treatments.

Osteopathic and Chiropractic Regulation

Osteopathy and Chiropractic are uniquely regulated by statute among what used to be called complementary therapies, which has effectively removed them from this category.

Legislation in the mid-1990s established the General Osteopathic Council and the General Chiropractic Council, which functioned similarly to the General Medical Council and had the authority to discipline and deregister practitioners. This means both osteopaths and chiropractors are now considered primary care practitioners.

In terms of the public's mind, clients often wonder why osteopathy and chiropractic care aren't available on the NHS; we can report that Osteopathy and Chiropractic care are available on the NHS, albeit only in some regions of the country.

The National Institute of Clinical Excellence (NICE), the advisor group to NHS, also backs manipulation between 2008. Their 2016 advice says:

Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy. [2016].

Whether it's the most prominent independent advisor group on health matters outside of America or through statutory UK regulation, it appears you are in safe hands with either type of practitioner.

Osteopathic Training vs Chiropractic Training

Osteopaths typically undergo a four-year full-time course culminating in a BSc degree (BOst). Chiropractors engage in a four to five-year full-time program, earning a BSc in human sciences and Chiropractic, followed by a postgraduate year in an approved practice to obtain a Diploma in Chiropractic (DC). The McTimoney school offers a four-year course but doesn't include radiography, so this group of chiropractors are more like osteopaths in terms of undergraduate training and ability to diagnose. All these programs emphasise substantial training in biological and clinical sciences. The title "doctor of chiropractic" is honorary and has historical usage within the profession.