In this article, we consider different treatment options for musculoskeletal pain. Firstly, we look at the differences between Chiropractic, Physiotherapy and Osteopathy. Then, we look at Remedial Massage and myotherapy.
Each type of therapy has its supporters. The bottom line is that the style of treatment you’ll receive when seeing a Chiropractor, Osteopath, Physiotherapist, Remedial Massage therapist or Myotherapist is highly dependent upon the skill set of the practitioner that you see. There is, however, some certainty in what you can expect when you visit each of these practitioners, which we’ll discuss below.
Let’s start with Chiropractic, Physio and Osteopathy. They’re commonly confused and the similarities and differences between them are little-known. This sets up a difficulty for would-be clients, who, having no idea of who to turn to for help, often turn to their GP. Unfortunately, within the medical model, treatment for musculoskeletal pain is simply ‘take two of these and call me in the morning’ – usually anti-inflammatories, sometimes muscle relaxants. This isn’t always the case, especially if you have a great GP who understands the benefits of holistic care.
Once upon a time, there were marked differences between these three types of therapy. Primarily, Physios were the only practitioners referred to by GPs, and they treated only local areas of pain. Unlike Chiropractors and Osteopaths, Physiotherapists offered exercises and generally did not manipulate the joints. For their part, Chiropractors only ever manipulated the spine. Osteos (being the most under-represented of the three professions)…well, who even knew what they did?
Times have changed, though, and now there is a high degree of overlap between the three. All three manipulate. All three are trained in soft tissue techniques and postural pattern correction. So how do you choose who to see?
The tertiary education that each of these therapists receives when studying in Australia is similar. All three study anatomy, physiology, pathology and biomechanics. All three work with bones, joints, muscles and connective tissue. There are differences, however, in the philosophies of the three therapy types. Add to this the focus individual therapists pursue as they progress through their careers, and you’ll see that choosing a practitioner really comes down to the care and expertise of the individual practitioner for your particular issue.
That said, there are a few things that differentiate Chiro, Physio and osteo from one another. Read on to find out more…
Chiropractic is a holistic therapy, which means that practitioners take into account the whole person rather than just the injured area when treating clients. Specifically, Chiropractors are interested in the close relationships between the movement of the spinal vertebrae and their surrounding muscles, and the nerves exiting the spinal cord at every vertebral level. The spinal bones protect and support the spinal cord and nerves, so if one area of the spine isn’t moving well, the impact on the nervous system can range from clinically absent to profound.
Chiropractors work with the joints of the spine and pelvis, and are also trained to work with the extremities, that is, the hips, knees, ankles, shoulders, elbows and wrists. Considering the impact of poor joint movement on the body as a whole is what sets this type of therapy apart.
When the spinal bones aren’t moving well, Chiropractors investigate how this lack of motion might be influencing the way the spinal cord and its nerves are able to function. Lack of movement in the spine has been shown to cause local inflammation, decreased range of motion and pain. Joint dysfunction and associated tension in the muscles that support the spine can cause referred pain, for example, into the neck, arms, hands, legs or feet. Numbness and pins and needles into the arms and legs can be another sign that spinal vertebrae aren’t functioning well.
To address these problems, Chiropractors use manipulative therapy and soft tissue (massage) techniques. This combination gets the vertebra moving again, and it can also be applied to other areas of the body, for example, shoulder or knee joints. There are many other techniques that Chiropractors may employ to improve motion and decrease pain, and some Chiropractors will also offer sports taping, exercise and nutritional advice to support healing.
Chiropractors will address the relationships between different areas of the body to improve your overall posture and whole body function. They view a healthy spine as a precursor to a healthy life, and will usually recommend maintaining flexibility and movement through regular check-ups.
Physiotherapists generally treat local areas of pain and dysfunction, such as a sprained ankle, knee pain, or lower back injury. For this reason, they’re widely known as the go-to guys for sports injuries. When an injury occurs, a Physio will examine and diagnose the problem, then treat it using a combination of mobilisation and massage. In the past, they rarely used manipulative techniques, however,it is now quite common for a Physio to offer it as part of their treatment. Alongside these methods, Physiotherapists will often use a combination of dry needling, ice and heat packs and TENS or ultrasound. Sports taping may be used to support injured areas and limit or influence movement of muscles and joints as healing takes place.
As an exercise-based therapy, rehabilitation exercises to strengthen or stretch the affected area usually form part of the treatment offered. The level of recovery achieved by a client is dependent upon their willingness to stick to the exercises prescribed.
Osteopathic treatment is focused around the principles that structure and function are interrelated and that the body has the ability to heal. Osteopaths take into account many influencing issues such as vascular and neural health as well as biopsychosocial factors when assessing a client’s complaint. Like Chiropractors, Osteopaths work with the whole person. They have a broad view of the human body, and consider the natural tendency of our systems to make compensations when pain and dysfunction occur. For example, tension in the neck may give way to headaches, and foot pain may manifest as tension in the quads and eventually affect the lower back. Due to this understanding, an Osteopath may end up treating parts you don’t expect, to address the original issue.
Osteopaths treat local injuries as well as postural problems. Massage, manipulation, stretching and gentle balancing techniques all may be used to improve mobility and to decrease inflammation and pain. Some Osteopaths may also advise you on at-home rehabilitation exercises to stabilise and strengthen your body.
The overall goal of Osteopathy, like Chiropractic, is to restore the whole human to a better state of flexibility, function and movement.
Remedial Massage is a deep and therapeutic style of massage. A Remedial Massage therapist works on muscles, tendons, ligaments and connective tissue and tailors the treatment to a specific goal. Goals of Remedial Massage may include reducing tension and pain, increasing muscle flexibility, shifting inflammation or improving range of motion.
Healthy muscle tone is important. Over- or under-exercise, sitting at a desk or sustaining other repetitive postures for long periods can contribute to tension in the muscles. Once muscles develop tension, movement can become painful and range of motion in the joints the muscles support can decrease. Imbalance between the left and right body, and between groups of muscles that work together to support particular areas (think rotator cuff muscles in the shoulder) can cause chronic dysfunction if left untreated.
Remedial Massage can support other types of physical therapy, such as Chiropractic and Osteopathic treatment. While these types of therapists may use some soft tissue techniques in their treatments, their focus is on improved joint mobility. A Remedial Massage therapist, on the other hand, will focus on areas of dysfunction within the muscle tissue that supports the joints. This combined approach is anecdotally considered to be more beneficial than one type of therapy alone.
During a Remedial Massage session, a client can request for the therapist to work on a broad area of muscle tissue or a specific site. Many clients attend for a regular full body massage, finding benefit in having a general ‘work over’ of their whole muscular system. The interconnectedness of muscular structures in the body means that addressing tension in the glutes, for example, can assist with knee and ankle movement.
Remedial Massage therapists are also highly skilled at locating and addressing specific sites of dysfunction with a muscle. Problems that may occur within a muscle may include inflammation, adhesions (scar tissue) and trigger points (complicated, painful ‘knots’).
Myotherapists work similarly to Remedial Massage therapists to improve the state and function of muscle tissue and other connective tissues. Myotherapists work with muscles, ligaments, tendons and fascia.
Just like Remedial Massage therapists, Myotherapists work to reduce pain, improve areas of tension and restore greater motion and flexibility. They use deep tissue massage to effect change, as well as trigger point therapy, stretching and mobilization. Along with these techniques, Myotherapists are trained to use dry needling, Chinese cupping, TENS and ultrasound therapies to address soft tissue dysfunction. They may also offer rehabilitation advice for at-home care. These may include stretching and strengthening exercises, or modifications to posture, diet or lifestyle.