What is the difference between an Osteopath and a Chiropractor?

AT Still

This is a question osteopaths hear from time to time.  While from the practitioner’s point of view there are some profound differences, the difference between an Osteopath and a Chiropractor isn’t simple to explain.  Fundamentally osteopathy and chiropractic are both forms of physical medicine that use manipulation and other techniques.  Both are registered professions under the 1993 Act in the United Kingdom.  Neither osteopathy nor chiropractic invented manipulation as there have been bone-setters as lay-healers for centuries.

  • Osteopathy and Chiropractic both developed in the USA in the second half of the nineteenth century
  • Chiropractic has since its outset, been more focused on spinal manipulation and a neurological interpretation of physical therapy
  • Osteopathy is more broadly interested in all systems of the body and how they interact
  • Osteopathy uses a broader range of physical therapies as well as spinal manipulation
  • Osteopathic therapy is concerned to be as gentle as possible and still be effective

For the patient, the most obvious difference is the length of time they will spend in treatment.  Osteopaths are trained to consider the entire body when treating a problem, so while they are likely to manipulate the spine if it is required, they are also concerned with musculature, connective tissues, peripheral nerves, lymphatic flow and a host of other body systems.  Osteopathic treatment attempts to be as gentle as possible, so can often be much less direct than chiropractic.

A good practitioner from either tradition will come to a similar diagnosis and may treat in a similar way. As an osteopath, I would say I have more tools in the box and therefore more alternatives. In addition, I believe that the broader scope of interest in bodily processes beyond spinal neuromuscular reflexes make my diagnoses more detailed, nuanced and accurate.

More about osteopathy

Osteopathy was founded by AT Still, a medical doctor in the Midwest of the USA in the nineteenth century.  He learned medicine while apprenticed to his father, a preacher and frontier doctor.  Still lost his wife and several children to a spinal meningitis epidemic which contributed to his loss of confidence in the materia medica available to doctors of the time and lead to him exploring alternatives. He first started using osteopathic methods of treatment in 1874, and founded his first medical school in 1892 which taught Osteopathic Manual Therapy (OMT), medicine and surgery.

Throughout the twentieth century in the USA, medicine and osteopathic medicine were in conflict.  However from the late 1960′s Doctors of Osteopathy (DOs) were officially acknowledged as the equivalent of MDs on a state by state basis.  On the downside, it is estimated in the US that fewer than 2% of DOs used OMT as a principal part of their practice.

Osteopathy was brought to the United Kingdom by JM Littlejohn in 1898.  In the UK osteopathy developed as an alternative modality rather than as a medical practice.  For that reason it has remained a purely manual therapy.  It is also the reason UK and Commonwealth osteopaths don’t take the title Doctor.


More about chiropractic

Chiropractic was invented and developed by DD Palmer in the USA, who treated his first patient with manual therapy in 1895.  From the lessons he learned and ongoing clinical experiences, DD Palmer developed a nerve focused philosophy of manual therapy that sought to resolve disease through reducing vertebral misalignment or subluxation. “A subluxated vertebra… is the cause of 95 percent of all diseases… The other five percent is caused by displaced joints other than those of the vertebral column.”(Palmer D.D., The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

DD Palmer

Chiropractic was developed further and systematised by BJ Palmer, DD Palmer’s son.  BJ Palmer was reputedly a phenomenal spinal manipulator, and there are YouTube clips demonstrating his technique.  BJ Palmer was more commercially aware than his father and through his efforts and the efforts of others, schools of chiropractic developed in the USA in the twentieth century. He maintained a “single cause [subluxation], single cure [chiropractic]” philosophy to health care, while many other chiropractors evolved into considering more than spinal alignment. He dismissed them as following osteopathy into the flame of medicine.

Chiropractors considered themselves the equal of medics in learning and took the title Doctor.  During the twentieth century, as the science of physiology developed, as litigated antagonisms with the medical profession were played out and the profession of chiropractic matured, chiropractic has become less adversarial with mainstream medicine.  However, many chiropractors challenge the use of immunisation and hold alternative views to standard medicine.

As a patient, chiropractic treatment focuses on spinal manipulation.  The treatment tends to take around fifteen minutes.  From an Osteopath’s point of view, the manipulative technique tends to be very direct and very effective at producing the audible pop that tends to signal that the vertebral segment has successfully mobilised.  Academically, some of the best research into the neurology of spinal manipulation has been undertaken by chiropractors.