I get asked at least twice a week what I think about chiropractors. Some people have this belief that there is an ongoing rivalry between the two professions, but it is just not true. There is room in the allied health field for practitioners with different approaches; in fact we are all better off for it. As a physiotherapist, I am obviously biased, but I think for some people, chiropractic treatment may be the best thing for them and for others it may be the worst thing they could do for their pain and that is where the big difference between the two professions is the most evident to me.
Physiotherapy has a much broader scope of practice than chiropractic treatment does. A well trained physiotherapist should have the ability to manipulate the spine, perform muscle release techniques, use acupuncture or IMS needling treatments, teach core stability exercises, help work on your posture and balance or build a sport specific training program for you. Most chiropractors focus purely on joint manipulation with a smaller percentage also using muscle release techniques like Active Release (A.R.T.) or Trigenics. Chiropractors may be the best at using manipulation as a treatment technique by virtue of pure experience and practice, but I would prefer a clinician that has the ability to manipulate me (if need be), needle me (if need be), use myofascial release (if need be) and spend the time with me to help me prevent the problem from arising again. A good physiotherapist should be able to do everything a good chiropractor can do and more.
The problem is that not every physiotherapist is well trained and just like any profession there are 'good' ones and 'bad' ones. The same holds true for chiropractors. Some physiotherapists will bring their clients in hook them up to three different machines over the course of an hour and barely pay any attention to them. Some chiropractors will treat six people per hour for a pop, pop, pop and have their clients come 2-4 times per week for the better part of a year. Sometimes the business can get in the way of the healthcare and interfere with optimal care. The model of practice the physiotherapist, the chiropractor or the family physician choose to work in can unfortunately dictate the modality of treatment more than the actual needs of the patient.
The one glaring difference I should mention is the number of clients I have treated that have been injured by their chiropractors. I do support the use of manual therapy, manipulation and 'adjustments' but have found that some chiropractors tend to be either too aggressive, or manipulate a joint when they shouldn't due to a lack of other treatment options or lack of time spent. Well trained physiotherapists will perform a lot of spinal adjustments, but you will typically find their technique to be more on the conservative side than your average chiropractor. There are risks and rewards to spinal manipulation. Just make sure you are comfortable with the potential risks and the competence of the person treating you.
I have treated just as many people that have been dissatisfied with their previous physiotherapy experience as I have people that have been put off by their chiropractor. With previous physios, clients usually developed resentment from being ignored and felt like they weren't accomplishing anything; with chiropractors clients usually developed a sense of dependence when they were looking for empowerment. In both cases, the clients just want someone to take the time to explain what the problem is, what the clinician can do to help that problem and what they can do to help themselves. Ten minute appointments, or juggling four clients at a time don't provide that opportunity. The best allied health professional you can find to help you is the one that is well trained with a variety of skills and works in a model that he has the ability to spend enough one-on-one time with you to address your problems.
If you live in the Metro Vancouver area, here are links to a few good physios and chiros that I know:
- Envision Physiotherapy (my clinic)
- Integrative Healing Arts (Chiro & Naturopath)
- Diane Lee & Associates (Physios in White Rock)
- Synergy Physio (North Vancouver)
There are more, but use these clinics as a measuring stick to assess if you are getting the best quality of care by your allied healthcare practitioners.