Chiropractic vs Physical Therapy
This is a question that I get all the time in my office; many of my patients often wonder what a chiropractor does that is different from what a Physical therapist does and wonder how they can both treat similar conditions such as low back pain or knee pain. I often get asked how a chiropractor’s therapy is different from a physical therapist’s therapy.
The History of Chiropractic and Physical Therapy (PT)
The term “chiropractic” means, “to be done by hand.” This is a great definition because it accurately describes what chiropractors do, which is work using their hands. The field of Chiropractic was established in the 1890s though similar therapies were found in ancient cultures. I know that for instance, in the old days when did not go to school to become doctors, the equivalent to our today’s orthopedic surgeons where the butchers and the dentists were the town barbers according to the American Dental Association. Chiropractic’s focus is on the spine and nervous system and the impact of nerve interference on the overall health. By using adjustments also known as spinal manipulation, the nervous system is stimulated. I look at adjustments as a “spark’. You need a spark to get a flame and then turn the flame to fire to keep yourself nice and cozy. Just because you have a spark does not mean you have a fire but you know having a fire requires a spark. That is why chiropractic adjustment is not the be all, end all. In fact, the concept of Subluxation Complex is nothing new to the chiropractic profession and those who receive true chiropractic care. You see, the three pillars of health are structure (your nervous system, internal organs and muscles and bones being examples) emotions and nutrition.
Physical Therapy field grew after the first world war because many nurses would focus on treating soldiers who were severely injured after the war; these nurses became specialists at the ability to give these soldiers the independence to move or walk again. The focus of physical therapy is muscles. It is the muscles that are needed to be in top shape in order for the movement to take place. Unfortunately, in today’s society where insurance coverage is utilized and patients are limited by what their insurance covers, physical therapists end up having to focus their attention on pain relief and perhaps some movement restoration. They have ended up practice only a portion of what they are truly trained to do. I hope to see a change in our health care system where insurance covers for catastrophic instances and therefore with a fraction of the cost. That way, people save their money and invest in preventative care and optimizing their health.
Difference Between Chiropractic and PT Education
Both fields require an extensive amount of knowledge, patience, and desire to care for patients. Chiropractors apply and get into an undergraduate program with most undergraduate programs taking 4 years to receive a bachelor’s degree. Typically the majors are Chemistry, Biology and Kinesiology. They then apply into a chiropractic program which takes another 4-5 years and 4900 instructional hours to receive the Doctor of Chiropractic Degree or DC. In order to practice, however, both National boards (4 parts) and State Board exams need to be passed.
A licensed Physical Therapist applies to an undergraduate program to receive a bachelor’s degree with most recent undergrad major being Kinesiology. They then apply to a Physical therapy program and have 4000 hours of instruction to receive their DPT degree. After graduation, just like chiropractors, they have to take both the National and State boards to practice.
Clinical Expertise
Chiropractors and Physical therapists both focus on musculoskeletal conditions and the big difference between the two is that chiropractors perform adjustment or spinal manipulation while physical therapists are not trained, therefore, unable to adjust patients. According to the American Board of Physical Therapy Specialties, there are nine specialties such as Cardiovascular and Pulmonary, Clinical Electrophysiology, Geriatrics, Neurology, Oncology, Orthopaedics, Pediatrics, Sports, and Women’s Health in physical therapy. American Board of Chiropractic Association lists 14 subspecialties under Chiropractic listed below:
Specialty Certificates |
Sub-Specialty Certificates |
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American Chiropractic Board of Radiology Diplomate (DACBR) |
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American Chiropractic Rehabilitation Board Diplomate (DACRB) |
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American Clinical Board of Nutrition Diplomate (DACBN) |
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Chiropractic Board of Clinical Nutrition Diplomate (DCBCN) |
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American Board of Chiropractic Internists Diplomate (DABCI) |
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American Board of Chiropractic Orthopedists Diplomate (DABCO) |
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Academy of Chiropractic Orthopedists Fellow (FACO) |
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American Chiropractic Neurology Board Diplomate (DACNB) |
American Chiropractic Academy of Neurology Diplomate (DACAN) American Board of Chiropractic Neurology Diplomate (DABCN) American Board of Electrodiagnostic Specialties Fellow (FABES) American College of Functional Neurology Fellow (FAFCN) American Board of Vestibular Rehabilitation Fellow (FABVR) American Board of Childhood Developmental Disorders Fellow (FABCDD) American Board of Brain Injury & Rehabilitation Fellow (FABBIR) American Board of Neurochemistry & Nutrition Fellow (FABNN) |
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American Board of Forensic Professionals Diplomate (DABFP) |
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American Chiropractic Board of Sports Physicians Diplomate (DACBSP) |
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American Chiropractic Board of Occupational Health Diplomate (DACBOH) |
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American Board of Chiropractic Acupuncture Diplomate (DABCA) |
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American Board of Chiropractic Pediatrics |
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Do Chiropractors and Physical therapists Treat Animals?
Yes! Both are performed by veterinarians trained in chiropractic and physical therapy and there are chiropractors who only treat animals that are non-veterinarians. In the state of California, the AVA is trying to make it illegal for Chiropractors with training in Animal Chiropractic to treat animals, however, the animal owners who have Chiropractors for their animals prefer the non-vet chiropractors over vet-chiropractors. Check out this link to see somewhat Animal Chiropractic looks like.
How Should I Pick my Chiropractor or Physical Therapist?
Great dilemma right? At the end of the day, the decision is yours. My advice is to never let an insurance company dictate to you what to do about your health. They are here to hopefully collect monthly premiums from you while you don’t use any services. Most insurance companies will give you limits in coverage and then they have the so-called medical necessary to dodge payments. They are quick in paying for medicine but anything that will actually improve the quality of your life is not paid by your insurance plan. As your health declines, because you are not treating the cause of your problem, of course, it takes longer and more money to fix the problem, assuming that it is not too late.
My suggestion is to ask around and read the provider’s reviews. Call the office and get a feel for it. Not scientific? That is right! Your likes and intuition are unique to you and no double-blind study is going to reproduce that result!
Treating Conditions Like Low Back Pain, Knee Pain, Neck Pain, Headaches, and Shoulder Pain
These are two of the most commonly treated conditions by Chiropractors while headache patients typically do not seek care by physical therapists. When it comes to treatment, most passive modalities, the part of treatment involving machines like Electrical Muscle Stimulation and Ultrasound, are used by both the DCs and the PTs. Typically physical therapy offices have some form of rehab equipment that they use to improve movement in the area for which patients seek care at their offices. Unfortunately, typically when the level of pain decreases and there is some degree of improvement in the range of motion, insurance companies deny further treatment. It is a game- a sickening game- that the PT’s have to participate in. These days most chiropractic offices have some form of rehab equipment and then depending on the DC, the rehab center can be extensive or limited. In my practice, for instance, my specialty is Brain-based Neurology and Posture and I incorporate DNS, Dynamic Neuromuscular Stabilization which is a form of developmental kinesiology in my treatments for patients. My gym is mostly set up for Brain exercises that lead to better posture and movement. There are not too many chiropractors that do what I do. My ‘gym’ area, therefore, is rather unique.
In essence as a Chiropractor, I consider physical therapy the closest thing medicine will be to being natural. It is up to the patient and the type of physical therapist to take advantage of this professions expertise to up the game of movement.
When it comes to movement and posture the two professions can work well together to benefit patient care and long term prognosis. I hope for the day to see that as both professions have their own set of unique ability to utilize.
Dr. Shakib