15 Dec Two Tents
A Guide to How Osteopathy and Physiotherapy Differ
People often ask what the difference is between osteopathy and physiotherapy. One of my biggest frustrations as an osteopath is that we lack a clear definition of what we do. Ask a group of osteopaths to answer the question, and you will invariably get nothing but an argument.
I’ve worked alongside physiotherapists all my career and experienced more physiotherapy as a patient than I have osteopathy. Osteopathy seems mysterious to many, so, please allow me to present an analogy that might help you see some differences.
What follows is all opinion, based on experience and the way I work. There is no offence intended, and anything perceived as a generalisation, is probably, in fact, a generalisation.
The Osteopath’s tent
A physiotherapist and an osteopath set out on an adventure. They want to explore nature and decide to camp each night. One evening, having pitched their tents, they set off in search of food.
When they come back to their tents, they see that the osteopath’s tent has been caught in a strong gust of wind, and while it’s still standing, it’s visibly distorted. Some of the panels of the tent are stretched taut, and some are hanging loosely. The tension of some of the ropes is very high, while others are hanging slack.
The physio walks around the osteopath’s tent and sees where the fabric is loose and where it is tight. He suggests pulling some of the panels tight and loosening off some of the other fabric. He spots that some ropes need tightening, and others need slackening.
The osteopath agrees with this, but instead of working on the fabric panels from the outside, he climbs inside the tent and starts correcting the shape of the frame. As he gets the shape of the tent correct again, the panels return to their normal shape, and the ropes even out.
This is how I feel when I work as an osteopath. I sense that I am aware of muscle tightness or weakness, but I prioritise working on the shape of the structure in front of me. Once that is correct, I will then reassess and can add stretching, mobilisation or strengthening as required to help the frame stay true.
The physiotherapists I have worked with typically get their results by working on the fabric of the tent, strengthening here, stretching there. When this work is done, the frame might get pulled back to its true shape. But the point I’d like to make is that the evaluation of the problem starts in a different place.
The Physiotherapist’s Tent
Now let’s look at the physio’s tent. While the osteo and physio were away searching for food, a bear came and mauled the tent, tearing the fabric, leaving scratch marks and flaps of material hanging loose.
The osteo looks at the tent, but seems satisfied that the frame is true, square, and solid. This is where the physio shines. Having received such a trauma, the physio sets about repairing the fabric of the tent. They have techniques for drawing the torn pieces of the panel back together, and techniques for ensuring a good repair. They can tighten floppy ropes and stretch tight ones.
After a flurry of activity, the tent is back to its proper state of health, a few scars, but all together, and perfectly good enough to sleep in for the night. The physio has worked methodically around all the parts of the tent, and when their work is done, the tent is good.
What does this all mean?
In this analogy, there are several themes worth outlining.
- Generalisation vs specialism.
Osteopaths are, by nature, generalists. We spend our time evaluating physical injuries the same as physios, but we don’t tend to specialise in body parts, whereas physios often do.
There are physios who are experts at looking after shoulders, and those that look after knees. They couldn’t swap jobs. This puts them in alignment with orthopaedic surgeons, who also specialise in specific body parts.
Osteopaths keep a broader view of the body, so might lack such a depth of knowledge in each area. But in contrast, they can stand back and look at the bigger picture, knowing that they can comfortably interact with all the moving parts before them. This aligns osteopaths perhaps more closely with the work of a family doctor.
This difference is reflected in the training – osteopaths are trained to be first port of call, and thus have responsibilities to diagnose and make appropriate referrals should a patient present with a non-mechanical problem. Physios, in contrast, are typically trained to work in an environment where they are referred patients with a diagnosis someone else has come up with.
- Big picture vs little picture
Perhaps you can see how an osteopath might start big picture and zoom in on areas, whereas a physio is perhaps biased to start zoomed in and move out as required.
This is reflected in the typical patients who perhaps thrive under either approach. A sporting injury that snaps ligaments in a knee is perhaps better suited to the orthopaedic approach – seeing a surgeon who only deals with knees, followed by physiotherapy from a physiotherapist who also only ever helps with knees.
In contrast, a slowly building case of knee pain with no obvious cause is perhaps better suited to the wider view of an osteopath, who will look at that knee within the context of the person’s whole body, as well as their lifestyle and environment. Perhaps their knee is the victim of a problem elsewhere in their body and would not benefit from a knee-only approach.
Unsurprisingly, there are pros and cons to these approaches. I know as an osteopath that if I ever need complex knee surgery, I will go looking for a specialist knee physio after surgery. But when I meet someone who has experienced an insidious onset of low back, neck, and shoulder pain over the course of several months, I am more likely to suggest that they see an osteo, as the generalist view might be more useful.
- Methods and methodology
Physiotherapists have sometimes asked to watch me work, so they can observe the methods we use. They’re often underwhelmed (like my patients). But the issue is not the methods I use.
It turns out that the various techniques of “doing” manual therapy are common across physio, osteo, chiro, massage. Even when different techniques have different names, the mechanical principles are the same. No one discipline can really claim ownership of any method.
Instead, we must appreciate that there are different methodologies and these can influence the appreciation a clinician has of their problem (sorry, patient). Subsequently, the application of the methodology influences each clinician’s decision-making process as they decide how to help their patient.
As an aside, osteopaths will claim a philosophy behind their way of work, but it’s not that grand. There are a set of rules or tenets that osteopaths typically get taught, but while inoffensive and harmless, they represent no more than some words of advice from a character held up as some kind of guru. No offence, but it’s time to move on.
I hope this helps you in some way gain a sense of not necessarily what osteopathy and physiotherapy are, but perhaps of how they function. With that idea, you might understand which you might want to seek for any given condition.
Toby is an osteopath at OpenHealth, and regularly contributes to our blogs.