What is the difference between physical therapists and chiropractors?

Greetings, I enjoyed reading your post. It is an intriguing topic, not one I’m that acquainted with but certainly want to know more about. Janet

Dear Carla,

It’s great to read your article about the diference between chiropractic and physical therapy.

Here in Brazil we have a diferent situation where the chiropractic is a specialty of PT. I’ll explain better: If a PT want to pratice chiropractic, he/she will participate of a continued education program in chiropractic, and can be specialized in chiropractic.

So, here in Brazil there’s no difference, it’s all PHYSICALTHERAPY, where the PT is the profession and the Chiropractic, the specialty.

Isn’t it great?!

I’m curious Ines, what is so “great” about it?
You plagiarize a profession that yours has knocked and condemned for years.

I believe you offer a weekend course and call it a “certification” in something you named “Chiropt”. The course outline, it’s claims and even the name itself seemingly assumes, arrogantly, that this qualifies one to do what we do. Personally I would not let someone who took a weekend course near my neck to adjust it nor any of my patients. We study years to perfect our techniques for a reason.

Additionally, Carla I think you conveniently left out a few things in your comparison. Chiropractors are considered Doctors. Physical therapist are not but rather are classified as “therapists”. Chiropractors, unlike PT’s, can therefore see patients with out referral and are trained and qualified to make a diagnosis, take radiographs, order diagnostic tests and then treat or refer as appropriate. This is due to a greater amount of education required to become a Doctor.

Further, the label placed on us as “Alternative” is just that, an alternative to the mainstream medical approach or concept of treatment for a given ailment. We offer an alternate way to treat something which fortunately your profession is now catching onto. This is evidenced by Ines Nakashima’s attempted marketing of her weekend class of “CHIROpt”. Although we recognize the sincerest form of flattery is imitation we would caution that true competency in chiropractic requires much more then a two day seminar.

She also conveniently forgot that chiropractors also rely on evidence based medicine and research. Many also do not use the subluxation concept but practice more in a manual medicine mode. The evidenced based medicine comment was sort of a backhand slap at the profession (they don’t use research and evidence). Chiropractic specialties involve radiology, orthopedics, neurology, rehabilitation, occupational health, and sports medicine to name a few. Chiropractors perform more manipulative therapy than any other profession and don’t learn to do so in weekend seminars.

I think it is silly that one jumps to conclusion that Carla is ripping apart chiros. Firstly, she starts with saying, “First and foremost, each individual practitioner in each profession treats in his own unique way. This article will endeavour to enlighten you on the basic principles of difference between the two professions and shall provide a generalised overview.”
Carla merely stated the differences between physical therapists and chiros. In no shape or form did she say that chriopractic skills are not evidence based.
I also believe that standing radiographs are not considered the “gold standard” for diagnostic radiography.

Dr. Daniel Culliton,
This reply is mainly for you.
The physical therapy profession is performed by a majority of practicing clinicians whom are Doctors of Physical Therapy. Although many of us have a phD or DPT, we do not put the words Dr. in front of our name, because like other medical professionals, the credentials after our name are good enough. We can autonomously practice without referral and make a clinical diagnosis based on an individuals biomechanical presentation/symptoms. Physical Therapists are also considered within the “medical model” and all insurances cover our services (sorry bud) because of the evidence behind our approach. Vertebrae rarely sublux and in the radiographs that do show that one has shifted on another, this is a sign of instability not immobility which would require a manipulation. All accredited PT schools include education on high velocity, low amplitude thrusts and students are tested to make sure they are safe and competent to perform these techniques. We have always performed these techniques as well as mobilizations of bones so if you think we are “just catching on” then you are incorrect. In actuality, alot of the research to support manipulations came from great PTs such as Geoffrey Maitland and Dick Erhardt.

Physical therapy schools are associated with large universities, medical schools, health care systems whereas yours are separate entities. You don’t have to call me doctor (despite my credentials) for me to know that I have the ability to get patients better. In actuality, the majority of patients I see are botched chiropractic cases. And Ryan has a good point in terms of diagnostic radiography, a standing radiograph is not the gold standard for diagnosing vertebral subluxations/spondylolisthesis. Sorry about you guys losing business to us. Evidence simply supports what we do.

Joe,

Sorry for the length but your comments require it.

I was unaware that the “majority of practicing clinicians … are Doctors of Physical Therapy”. I find that interesting, could you please site any references to support that statement?

I will say that despite the recent inception of the DPT program (eight starting in 1999) that currently the majority of PT students are going this route. However the majority of practicing PTs do not hold that title to my knowledge. I double checked with a few institutions that provide the degree to be sure. The officials at these programs also related to me that despite the doctorate degree status in this field, PTs or DPT’s are not what is considered “Portal of Entry Providers” in most states like MD’s, DO’s or say DC’s are. In order for one to become qualified as a “portal of entry” there are certain core educational requirements required. Therefore PTs in general still remain beholden to referrals from these providers to see their patients.

IMO however this should not necessarily be the case. I personally feel that given a limited scope and further training in radiology and diagnosis, PT’s should be able to see patients with out referral. Often times a PT knows more about how to treat or handle a case then the referring primary care provider who historically rate poorly on say musculoskeletal dysfunction. AS it stands however the DPT program is on average a 34 month or 2.83 years, whereas a chiropractic program runs 48 months or 4 years or greater. Simply put chiropractors do have a greater amount of education on average then PT’s or even DPT’s…bud

Btw here is a good comparison between MD vs DC education since it is difficult to compare ours to PTs.

http://www.drgrisanti.com/mddc.htm
or a pubmed review
http://www.ncbi.nlm.nih.gov/pubmed/9737032?dopt=AbstractPlus

Next…
As far as being within the medical model you are correct as I touched upon in my last post, you absolutely are part of the medical model. This is actually where the crux of the matter lies. There has been an underlying animosity between chiropractic and the “medical model” ran by big pharma for generations. Please see:
http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

In this federal anti-trust lawsuit it was found that and I quote, “AMA had violated Section 1, but not 2, of the Sherman Act, and that it had engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession.” And “AMA had entered into a long history of illegal behavior”.

So Joe, simply put it has always been and remains about turf. Who gets access to the money pot, plain and simple, not what’s best for the patient or what “model” is valid. This is where the bias comes in and not due to competency as there are good and bad in every profession….including yours and mine..”bud”. It is also the politics behind the backing of the DPT program. Oh and insurance covers chiro as well so not sure where you are going there.

So zipping up the pants Joe in an attempt to umm well end this p.. contest the PTs have the right idea in terms of moving their profession forward and we chiro’s envy that. Physical Therapists have a strong, unified association backed by the medical model giving it much political clout that frankly chiropractic lacks.

Also, let me briefly touch upon your clinical references. Chiropractic students take a minimum of 271 hours of radiology compared to the 17-148 hours by a medical student and I could not find any hours in radiology required for a PT student. Perhaps you can enlighten me here as to how many hours of radiology is required for a DPT degree.

So I am not sure who said standing radiographs were the gold standard for anything but um yeah I agree, although for musculoskeletal dysfunction weight bearing films often times bear more benefit. So yes thank you for your limited assessment there but I order, take and read plain film radiographs on a daily basis as well as more advanced imaging techniques. Do you?

And……let me address your statement “Vertebrae rarely sublux and in the radiographs that do show that one has shifted on another, this is a sign of instability not immobility which would require a manipulation.” Ummm yes I agree. Again, unless you have further training then the normal requirements for a DPT degree, I believe I have far more expertise in radiographic evaluation. So if you would like, you may ask me questions but please don’t assume to preach to me. Perhaps the confusion between professions on this topic is that chiropractic has an alternative definition of the term subluxated. Therefore you take it out of context when used like this. I however am not what is termed a subluxation based chiropractor and do not subscribe to the subluxation theory. So again preaching to the choir here ..bud…lol.. I like that..”bud” its kinda like we are friends..

Ok so Joe hopefully this clears a few things up but let me finish by saying that I have much respect for many PT’s out there. Many of my colleagues even have a few working for them. Some are highly skilled…some not so much. This is the same with every profession including ours, as the initials after the name do not necessarily infer competence. Also, please don’t be naive enough to think that we all don’t get patients who come to us complaining about other professions.

At any rate I will try continue in any professional discussion or even debate as time allows but prefer not to waste any more time in name calling or my bike is better then your bike diatribes.

I think there is some confusion with the definitions here. Chiropractic is a philosophy of healthcare, manipulation is a modality of treatment. Manipulation is performed by Chiropractors, Osteopaths, Physical Therapists, bone setters, etc. Chiropractic is not synonymous with manipulation. In fact many Chiropractors do not use manipulation in their practice. Manipulation is the same whether performed by any health care practitioner. The idea that is can be different depending who is delivering the the treatment is ridiculous . David P. Schmidt PT,DC

Dr. Culliton,

The DPT program may be less than 4 years. Hoever, prior to that are at least 3 or 4 years of undergraduate study. Four total years of education beyond high school does not constitute a doctorate anyplace else except at chiropracter schools. Just because you call yourself a doctor does not make it so.

Dr. Schmidt makes a good point. There are no magic hands that are anointed by some deceased chiro sycophant. However, as with any procedure requiring a honed physical dexterity there will be some that are more adept then others at it. In addition, those with a more thorough comprehension of a particular procedure (say a short lever osseous manipulation) both in its performance and the structural relations involved; will convey a greater degree of competence. This will also be true of one who has greater degree of practice at it. Now how one achieves this, whether through self instruction, trail and error or via an accredited institution of whatever “Philosophy” is irrelevant. In as much as the implementation of the procedure but philosophy comes into play as to when and why to implement it. With this in mind I would respectfully disagree slightly with Dr. Schmidt that all manipulation is not the same, not only it’s philosophy but in its implementation. Also, when manipulation is thrown into one all encompassing box it leaves the lay person or patient confused since they may not realize the different forms etc that it can involve.

For example, was the manipulation preformed to cause joint cavitation, improve segmental mobility, stretch the soft tissues, to induce some type of neurological response or perhaps as a placebo for a self perceived benefit by the patient? Also, what type or style of manipulation preformed is important for say the degree of reactive soreness felt or the ultimate effectiveness of the desired outcome. So I don’t think that “the idea that it can be different depending who is delivering the treatment is ridiculous”, I think its paramount.

With that said I don’t think the initials after ones name means that they can or can not perform the same manipulation whether it is the implementation or the philosophy behind it. However ones degree does however tend to lend a clue to both. Hopefully I juggled that well enough not to offend anyone.

~~AS to David Smith, tsk, tsk, tsk…again with the insults and “my bike is better then your bike” mentality. In addition your argument is faulty making you seem foolish which I am sure you are not…just passionate.

In general two years of undergraduate study is “required” to get into any medical, osteopathic, chiropractic or physical therapy school etc. This is due to advanced placement and or accelerated programs. This does not mean that many or most do not have more. However the national or individual state requirements for licensure may vary.

With regards to chiropractic there are many states that require a bachelor’s degree in addition to a graduate degree in chiropractic in order to practice, for instance NC where I am.

Therefore David the MINIMUM required for a degree in chiropractic is just over 6 years ( not 4 as you erroneously stated) post high school although as stated above many have 8 or more. This is the same for a MD or Osteopath etc. With regards to chiropractic the growing trend is more and more states are requiring a four year bachelors degree regardless of school admission policy. BTW I don’t know of any of the other branch of healthcare doing that on a state level. Is that the same for PT? It is my understanding that once a PT or DPT degree is obtained all states allow licensure to practice regardless of level of undergraduate study.

So no David just because I say I am a doctor is not what “makes it so” as you say, it is the level of my education in my given field that makes it so. Hopefully this helps clarify your lack of understanding.

Here is another article that was well written just merely stating what physicians, physical therapists, and chiropracters:
http://savannahnow.com/bryan-county-now/2010-08-11/differences-between-chiropractors-physical-therapists-and-physicians

OK. wow. that’s really all I have to say.

From what I have seen in my practice of the patient’s that came from “doctors of chiropractic” that they basically were charged for an x-ray, “popped”, and put some tingly e-stim and heat on them. First of all, I have never heard of a chiro checking VBI – and don’t give me that crap about it isn’t proven!.

I have also had an acute ankle sprain where a chiro manipulated their cervical spine and lumbar spine and heated the ankle. really? is that evidence based practice or what?

Also, just because something is “shifted” in an x-ray does not mean it needs to be manipulated. A majority of spinal issues can be resolved with simple mobilization and stabilization exercise/flexibility. Not popping something and putting tingly stuff on someone to trick them into coming back for 60 visits.

But, if someone wants to go to the chiropractor i’ll definitely be happy enough to fix them when they are ready.

Thanks.

p.s.- 4 years of undergraduate, 3 years of graduate school, 1 year fellowship program and accreditated certification programs.

hunterstark,

You fall prey to what much of the other posters have, your bias clouds your judgment or you are being intellectually dishonest with yourself. I say this because you relate in your comments an elitist attitude or a lesser God Complex then Jack did in a Few Good Men.

I have never bashed the PT profession as a whole or discounted what they do and would never think to. However I could tell you horror story after horror story of just outright incompetence I’ve seen by PT’s.
Example: Actual patient quote yesterday when I asked how the PT was going I referred them too “she told me to ten reps and then she went and text on her phone ..I told her I was done and she said ohh um do ten of these now”
Does that mean the whole profession is worthless as you elude chiro’s are. NO, I am not so naive or blinded by bias to think so. I just won’t refer to that PT again. BUT I still will refer to good PT’s when I think it is necessary.

As far as your experience with these chiro patients, when you have been in practice long enough you will hear patients complain about all kinds of practitioners, just don’t be so naive that a few are not going somewhere else and complaining about you. Also, did you contact that doctor and inquire about is clinical rationale for treating the ankle like that? Perhaps there was a valid reason that you were not made aware of..or did you base your condemnation on arrogant assumption?

As far as your other typical knee jerk chiro bashing talking points of VBI, extensive visits, bones shifting on xray etc I didn’t see that as the topic being discussed here but since you seem to want to introduce them what’s your point exactly and perhaps I can offer you my perspective… Or are we just a bunch of school yard kids shouting at each other from across the playground?

I enjoyed reading the debate above. Its sad however that some of us professionals don’t act like one.

I am a PT by profession and have come across some exemplary PTs who I look upto. I have also met some very competent Chiropractors.

Why do we have to be in an either/or situation?We could/should be working together for the maximum benefit of patients.

I do however believe that high velocity-low amplitude thrust techniques are just that- “technique” . It is not patented to either one of these professions. I was trained and tested in my PT school to make sure that I can safely and effectively apply thrust techniques. Both professions are required to update their clinical skills by CME programs.

PTs should stop criticizing chiros with how and why they treat their patients because we only have partial understanding of their profession/rationale.
At the same time chiros should also respect the fact that manipulations is one of the techniques where both professions overlap.

Lets respect and grow together.

P.S. – 4 yrs UG, 2 yrs PG,1 yr specialization in ManualTherapy

Nidhi:

My sentiments excatly.

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