Physical Therapy vs. Chiropractic: What's the difference?

Chiropractic or physical therapy… that is the question. And frankly, a good one when you get right down to it. The faces of both professions have continued to grow and develop over the years, largely, both for the good. However, the distinct lines demarcating the lanes of each profession have begun to blur over as of late. Is this a good thing or a bad thing? Well, that depends on who you ask.

What is Chiropractic?

Chiropractic care is likely the most dynamically different between the two as they have, generally speaking, diversified the most within the profession. Similar to how medical doctors perform a variety of different roles from general medicine to plastic surgery to research, the styles of chiropractic also drastically vary. Both the best and worst thing about the chiropractic profession is the freedom that you are granted to practice how you would like. This is great for a provider with a unique niche in mind though it winds up being terribly confusing for the general public.

 When seeing the chiropractor, you don’t know if you will be manually adjusted, adjusted with a clicking tool (an activator or integrator), or with an elaborate machine. Will the whole body be worked on or just the upper neck? Would you see the doctor for 2 minutes or 2 hours? Would you be treated on the 1st or 4th visit? Will you be asked to hold crystals and sign up for an expensive and elaborate care plan? the list goes on. However, the same principle stands for all of chiropractic care, some type of adjustment or manipulation to the spine is performed in hopes of restoring function to the body and thus making the person better in some way. Unfortunately, that is about as clear and concise as it gets when defining chiropractic. No wonder people can’t make up their minds how they feel about the profession.

What is Physical Therapy?

Physical therapy certainly has its differences within the profession as well but, generally, people usually have a pretty good idea of what they’re getting themselves into when starting physical therapy. There will likely be some forms of exercise and/or stretching specific to the injury that they are attempting to overcome. It will likely be slightly more regionally focused (specific body region) than globally focused as in traditional chiropractic. 

What Treatment Option is Best For Me?  

So, the most important thing to consider when attempting to find out what is best for helping your condition is to find out what type of doctor you are seeing. Some people claim that upper cervical chiropractic care can help with a lumbar disc bulge, but it is fairly few and far between that they are successful. A manual chiropractor or PT is probably best for that sort of thing. However, for headaches, it may be a great idea. Or, if you are immediately post-op from surgery, PT is definitely going to be the place to start looking over almost all types of chiropractic care.  

It gets a little more complicated when attempting to figure out who to see between a sports chiropractor and a manually focused physical therapist for general aches and pains. “Manual focused” means that the therapist will be doing hands-on soft tissue and low-grade joint mobilizations in addition to prescribing and overseeing stretches and exercises. There is a ton of overlap between the therapies that both professions provide. 

A sports chiropractor will typically favor manual modalities before overseeing exercises and stabilization drills. They tend to spend a little more time assessing the joints and emphasizing the manipulation of fixed or restricted regions before moving on to the stability and strength phase of care. It’s important to note that this doesn’t just mean mobilizing joints. Soft tissue treatment via a number of therapies, ART, Graston, cupping, etc. is employed within the sports chiropractic realm.

Drawbacks to Be Aware of

A fairly considerable drawback is that many insurance companies don’t reimburse chiropractors for performing the necessary amount of exercise, strength, and stabilization work that is needed to adequately rehabilitate an injury. However, they will reimburse physical therapists fully for that same strength and stability phase of care. Thus, due to the restrictions placed on chiropractors with regard to reimbursements, the ratio tends to be 60-65% manual therapy and 35-40% therapeutic exercises. This tends to be the inverse of physical therapy. 

So, What Does This Mean for Me?

 The general flow of care for both sports chiropractic as well as PT is as follows:

• Maximize mobility of the restricted or damaged tissue, joint or otherwise, and emphasize means to maximize tissue health.
•  Stabilize and strengthen the now mobile joint through therapeutic exercise specific to that region.
•  Increase motor control of the region through various proprioceptive challenges such as balance work and larger-scale functional movements.

Therefore, a loose strategy to follow, which of course varies depending on the condition, would lean towards seeing a chiropractor on the front end of the injury since they tend to focus slightly more on the number 1 listed above. For numbers 2 and 3, perhaps consider transitioning into physical therapy once improvements to the joints and tissues have been made since they will be able to spend the time needed to maximize the stabilization and strength of specific regions. 

Unfortunately, it’s not a hard and fast science when deciding between sports chiros and physical therapists. But one thing stands, therapists (PTs or chiros) who have respect for the other profession and are willing to refer back and forth will always achieve the best outcomes and get you better quicker.