Physical therapy and chiropractic care are both popular forms of alternative healthcare, but somehow they don’t seem to get along very well. While some physical therapists acknowledge that chiros can provide relief for certain ailments, many don’t see them as part of the same profession. So what’s going on here? What is it about chiropractors that puts physical therapists off?
Firstly, it’s important to remember that both professions have different approaches to treating injuries or pain. Physical therapists focus on injury prevention, rehabilitation, and restoring normal body function through exercise and manual techniques. Chiropractors, on the other hand, diagnose and treat musculoskeletal conditions and disorders primarily through spinal adjustments.
This difference in approach has led to some skepticism from physical therapists towards chiropractic care. Some feel that the manipulative techniques used by chiros may be risky for certain patients – particularly those with underlying health issues. Others may question whether spinal adjustments are truly effective in providing long-term results – especially if not combined with exercises to strengthen supporting muscles.
“At the end of the day, a bit more collaboration between these two fields could go a long way in improving patient outcomes and boosting mutual respect.”
Despite these concerns, there are plenty of PTs who work closely and collaboratively with chiropractors – recognizing that each profession has its own unique benefits. But overall, it seems that a bit more understanding and dialogue is needed between these two groups in order to address misunderstandings and find ways to better serve their patients together.
Fundamental Differences in Approach
Differences in Beliefs and Philosophy
One of the primary reasons why physical therapists don’t like chiropractors is because they have fundamentally different beliefs and philosophies about healthcare. Physical therapists follow an evidence-based approach to treatment, relying on scientific studies and data to determine the most effective ways to heal injuries or alleviate pain.
On the other hand, chiropractors rely heavily on their own philosophy and belief systems when treating patients. They often believe that spinal misalignments are the root cause of all health problems and can be corrected through adjustments. This difference in approach and fundamental beliefs can create tension between the two professions.
“Physical therapy typically involves more than just manipulating joints, as a chiropractor might do. Physical therapeutics generally involve treadmills, strengthening exercises, hot/cold compresses, ultrasound and electrical stimulation.” -WebMD
Different Treatment Methods
In addition to differences in beliefs, physical therapists and chiropractors also differ in their approaches to treatment. Physical therapists use a variety of interventions such as exercise, massage, and stretching to help patients manage pain, improve mobility, and prevent future injuries. They prioritize patient education and empowerment, helping individuals take charge of their own health and well-being.
Chiropractors, on the other hand, primarily use manipulations or adjustments to correct spinal misalignments and promote healing throughout the body. While some chiropractors incorporate movement and exercise into their treatments, many do not emphasize these aspects of care as much as physical therapists do. As a result, patients who see chiropractors may be missing out on important opportunities to strengthen their bodies and prevent future injuries.
“Physical therapy and chiropractic care share one common goal: alleviating your pain so you can return to doing the things you love. However, they approach that goal differently.” -Revere Health
Varied Diagnostic Approaches
The ways in which physical therapists and chiropractors diagnose injuries or pain can also differ greatly. Physical therapists use a range of assessment tools to evaluate patients’ functional abilities, mobility, strength, and balance. They may also look at X-rays, CT scans, or MRIs to get a better understanding of what’s going on inside a patient’s body.
Chiropractors, however, often rely more heavily on palpation and other manual techniques to identify areas of tension or misalignment in the spine. While some chiropractors do order imaging tests when necessary, others may make diagnoses based solely on surface-level assessments of a patient’s spine. This difference in diagnostic approaches can lead to discrepancies in treatment plans and potentially less effective care for patients.
“Physical therapy focuses on improving bodily function through prescribed exercises and movement, while chiropractic care emphasizes spinal manipulation to address underlying problems that cause discomfort.” -Houston Chronicle
Lack of Scientific Evidence
One of the reasons why physical therapists may not always support chiropractors is due to the lack of scientific evidence supporting some of their techniques and practices.
Although there are studies that have been conducted on chiropractic care, many of them have limitations and do not provide substantial evidence for certain treatments. For example, a study published in JAMA Network Open found that spinal manipulative therapy showed statistically significant and clinically relevant improvement for chronic low back pain, but noted that more high-quality research was needed to confirm these findings.
Chiropractic care also tends to focus heavily on spinal manipulation as a form of treatment, which has limitations when it comes to treating a variety of conditions outside of musculoskeletal issues. There simply may not be enough research to show its effectiveness for other health problems such as digestive or respiratory issues, leaving room for skepticism among some healthcare professionals.
Conflicting Results of Studies
In addition to inadequate research, some studies on chiropractic care have produced conflicting results. One review published in PLOS ONE examined 33 studies on manual therapies including chiropractic care found inconclusive results regarding the benefits of chiropractic care, citing disparities in quality between individual studies as one possible explanation.
The controversial nature of chiropractic care has led to debates over whether the benefits and risks outweigh each other, leading some healthcare practitioners to choose alternative treatments they believe to be less controversial or risky.
Challenges in Conducting Research
Even with adequate research, conducting clinical trials testing chiropractic care can prove challenging. Chiropractic treatments and patient outcomes can vary from one practitioner to another depending on factors such as severity of patient injury, age, lifestyle, previous medical history, etc., making accurate and controlled testing difficult to achieve.
Further difficulties arise when attempting to conduct research on comparative effectiveness between chiropractic care and alternative therapies, since standardization of protocols for both approaches is extremely difficult. This complexity makes conducting scientifically rigorous studies challenging and may discourage some healthcare providers from endorsing chiropractic care as a treatment option.
“Research on the effectiveness of chiropractic care has been mixed with results that are sometimes uncertain, highlighting the importance of additional trials evaluating its potential benefits.” -National Center for Complementary and Integrative Health
Physical therapists may be hesitant to endorse chiropractors due to the lack of clear-cut scientific evidence supporting their treatments, limited research conducted on its efficacy, conflicting study results, and challenges in conducting good clinical trials. However, attitudes and perspectives towards chiropractic care vary greatly depending on individual patients’ experiences and preferences, making it important for healthcare practitioners to keep an open mind and communicate effectively with patients to determine what treatment plans will work best for them.
Disagreement on the Role of Spinal Manipulation
Physical therapists and chiropractors both use spinal manipulation techniques, but there is often tension between the two professions. One reason for this is a disagreement over the role of spinal manipulation in treatment.
Spinal Manipulation as a Primary Treatment
Chiropractors believe that spinal manipulation, or adjustments, should be the primary form of treatment for many conditions. They argue that misalignments in the spine can cause pain and dysfunction throughout the body, and that correcting these misalignments through manipulation can alleviate symptoms and promote healing.
“The very foundation of chiropractic is to remove any physiological blockages caused by vertebral subluxations. These include areas of joint fixation with associated muscle hypertonicity and restricted range of motion. The result of removing these blockages (subluxations) is improved function.” -American Chiropractic Association
Physical therapists, on the other hand, typically view spinal manipulation as just one tool in their arsenal. While they recognize its potential benefits, they do not believe it should be used as a primary treatment for most conditions. Instead, physical therapists employ a variety of interventions, including exercise, manual therapy, and education, to address a patient’s specific needs.
“Physical therapists have an important role in screening for serious pathology. A thorough differential diagnosis must be performed prior to choosing a treatment approach. If manipulation was consistently effective, physical therapists would use it more regularly than they presently do.” -Eric Robertson, PT, PhD, FAAPMR
Spinal Manipulation as an Adjunct Treatment
Despite their differences in opinion, both chiropractors and physical therapists agree that spinal manipulation can be a useful adjunct treatment for certain conditions.
Chiropractors often use manipulation as part of a holistic approach to patient care, which may also include nutritional counseling and lifestyle modifications. They argue that this type of comprehensive treatment can lead to better outcomes than using spinal manipulation alone.
“As chiropractors, we believe it’s important to not only relieve symptoms, but also address the underlying cause of pain or dysfunction.” -American Chiropractic Association
Physical therapists, meanwhile, may incorporate spinal manipulation into a broader plan of care for patients with musculoskeletal conditions. This could involve using manipulation in conjunction with other manual therapy techniques, such as mobilization or massage, to achieve optimal results.
“Manipulation is useful for when you want to make large corrective changes, but there are many other manual therapy options available. We have a saying in physical therapy: if all you have is a hammer, everything looks like a nail.” -Eric Robertson, PT, PhD, FAAPMR
In the end, while there may be disagreement over the best role for spinal manipulation in treatment, both professions share a common goal: helping patients find relief from pain and improve their overall function and quality of life.
Concerns about Safety and Risk of Injury
The safety concerns surrounding chiropractic care and physical therapy have become a topic of concern for many people. Many individuals may wonder why the two professions seem to be at odds with each other, despite sharing some similarities in their approach towards treating various injuries.
Potential for Stroke or Neurological Damage
Chiropractic adjustments are known to be associated with risks such as stroke and neurological damage. According to a study published in 2010, there is a small but significant association between neck manipulation by a chiropractor and the occurrence of vertebrobasilar artery (VBA) stroke. While this association does not necessarily imply causation, it nonetheless raises concern regarding the safety of spinal manipulations performed by chiropractors.
“Vertebral Artery Dissection Following Chiropractic Manipulation” – NCBI
This same study suggests that patients who are older than 45 years old, female, and have a history of migraine headaches are particularly at risk for VBA strokes following cervical spinal manipulation. Despite these findings, chiropractors vehemently deny any correlation between spinal manipulation and vertebral artery dissection, citing low occurrences and lack of clear causality.
Risks Associated with Spinal Manipulation in Children and Elderly Patients
In addition, experts warn against utlizing spinal manipulations on children and elderly patients due to increased risk of injury. In 2007, an article was published comparing the force used during traditional high-velocity-low-amplitude chiropractic manipulations versus low-force methods often taught and utilized in pediatric chiropractic. The result showed “the forces required…were comparable,” indicating the same level of risk despite possible limitations on technique or knowledge where seen in inexperienced clinicians working with an at-risk population.
“Pediatric Chiropractic: Are We Expanding Our Avenues Of Care?” – DynamicChiro
Safety Concerns with Chiropractic Techniques
The safety of chiropractic techniques is also a concern for physical therapists. One particular technique used by chiropractors, called ‘spinal decompression therapy’, has been flagged as potentially risky. The American Physical Therapy Association (APTA) warns against lumbar spinal decompression, stating that there is little evidence to support its effectiveness and much potential for harm.
“Lumbar Spinal Decompression” – APTA
Risks Associated with Physical Therapy Techniques
Physical therapists have their own set of concerns regarding patient safety, particularly when it comes to executing manual therapy or mobilization. In particular, high-velocity manipulations pose a risk for older patients who may already be at risk for fractures. This notion was highlighted in 2010, where researchers found “increased incidence of fracture after rehabilitation treatment,” which includes these types of manipulations.
“Incidence of Fracture After Rehabilitation Following an Acute Hospitalization and Mobility Limitation With Older Adults” – PubMed Central
In response to such findings, many physical therapists encourage patients to take an active role in their care, asking questions and discussing the pros and cons of various approaches before making decisions regarding their plan of care moving forward.
The conclusion? There are certainly risks associated with both chiropractic care and physical therapy treatments and techniques. These risks should not be taken lightly, and patients should always be fully informed of them before consenting to any type of procedure or manipulation. Ultimately, it is up to each individual to weigh the potential benefits versus risks and decide which approach makes the most sense for their unique situation.
Competing for the Same Patients
Physical therapists and chiropractors both provide alternative forms of healthcare that aim to alleviate pain, improve mobility, and enhance overall wellness. While their areas of specialization may differ slightly – physical therapy focuses on restoring function while chiropractic care emphasizes spinal alignment – they still share a common goal: to help patients feel better.
Despite being similar in some ways, there is often tension between physical therapists and chiropractors when it comes to patient care. One reason why physical therapists may not be fond of chiropractors is because they view them as competition for the same pool of patients. This notion stems from the fact that both professions employ manipulative therapies: chiropractic adjustments vs. physical therapy manipulation techniques.
As a result, chiropractors and physical therapists tend to focus on different strategies when it comes to marketing, patient care, and building relationships with other healthcare providers.
Marketing Strategies of Chiropractors
The primary marketing tactic used by chiropractors revolves around referrals. Most chiropractors operate in a solo or small group practice environment and rely heavily on word-of-mouth recommendations from satisfied patients to grow their practices. In addition, chiropractors typically target people experiencing back and neck pain, sciatica, disc herniations, and other types of musculoskeletal discomfort through advertising efforts such as social media ads, printed materials like flyers/brochures, and SEO optimization of their website content.
“A successful chiropractor will inspire trust between themselves and their patients. They’re also careful about striking a good balance between using online and offline marketing tools.” -Dr. Ravi Jayaraman, DC
Marketing Strategies of Physical Therapists
On the other hand, physical therapists tend to market themselves differently than chiropractors. They aim to establish relationships with primary care physicians and specialists such as orthopedic surgeons, neurosurgeons, and sports medicine doctors who can refer patients to them for specialized care. Many physical therapy clinics also design marketing strategies that promote their expertise in conditions like Parkinson’s disease, cerebral palsy, stroke rehab as well as rehabilitation following surgery or injury.
“The best way for PTs to increase business is word-of-mouth referrals – from satisfied clients, health practitioners and the broader community.” -Dr. Chris Riches, DPT
Different Approaches to Patient Care
Another reason why tension exists between chiropractors and physical therapists is due to their different approaches to patient care. Chiropractic care emphasizes manual techniques (spinal adjustments), soft tissue manipulation, and exercise therapy. In contrast, physical therapists utilize a wide range of treatment methods and modalities including therapeutic exercises, dry needling, gait analysis, joint mobilizations, electrical stimulation, ultrasound, among others.
Some physical therapists view spinal manipulations as unnecessary and potentially dangerous, whereas some chiropractors believe that physical therapists’ manipulation techniques aren’t effective and may not work for every type of issue.
Though, both professions have valuable contributions to make when it comes to providing pain relief and improved function to those suffering from musculoskeletal injuries or disorders.
“I encourage my patients to find which therapies work best for their specific condition, whether that be chiropractic, physical therapy, or a mix of both.” – Dr. Evan Price, DC
It’s important for patients to understand that while there may be some underlying competition between these two disciplines, both professions strive to achieve a similar goal: helping you regain optimal health and wellness. Always consult your doctor before embarking on any new form of treatment, and don’t be afraid to ask questions about the different types of care available.
Frequently Asked Questions
What are some differences between physical therapy and chiropractic care that may cause tension between the two professions?
Physical therapists focus on restoring function and mobility through exercises, stretches, and other non-invasive techniques. Chiropractors, on the other hand, use spinal adjustments and manipulation to treat musculoskeletal conditions. This fundamental difference in approach can cause tension between the two professions, as well as differences in education, training, and licensing requirements.
Is there a history of rivalry or competition between physical therapists and chiropractors?
While there have been instances of rivalry and competition between physical therapists and chiropractors, the two professions have been working towards mutual respect and collaboration in recent years. Organizations like the American Physical Therapy Association and the American Chiropractic Association have been promoting interprofessional education and communication to improve patient care and outcomes.
Do physical therapists feel that chiropractors overstep their bounds by performing spinal adjustments?
There is some concern among physical therapists that chiropractors may overstep their bounds by performing spinal adjustments, particularly if they are not properly trained or licensed to do so. However, this is not a universal opinion, and many physical therapists recognize the value of chiropractic care for certain conditions.
Are there concerns about the safety or effectiveness of chiropractic care that cause physical therapists to be wary of it?
There have been some concerns about the safety and effectiveness of chiropractic care, particularly in regards to the risk of spinal cord injury or stroke from certain techniques. While these risks are rare, they may cause some physical therapists to be wary of referring patients to chiropractors or collaborating with them.
Are there any instances where physical therapists and chiropractors may collaborate or work together?
Yes, there are many instances where physical therapists and chiropractors may collaborate or work together to provide the best possible care for their patients. This may include co-treating patients with musculoskeletal conditions, sharing information and resources, and participating in interdisciplinary teams to develop comprehensive treatment plans.