Osteopathy, physiotherapy or chiropractic: who should you see?

By Elliott Reid (M.Ost), VP institute of Osteopathy (President from Nov 2026) Osteopath and Founder, Revitalize Clinic, Gravesend

Choosing between an osteopath, a physiotherapist and a chiropractor can feel like the most important decision you’ll make about your pain.

In my experience, it isn’t. There’s often more difference between two osteopaths, or two physios, than there is between the professions themselves. One physio might be mostly hands-on. One osteopath might be mostly exercise-based. The title on the door tells you less than you’d think.

So it’s worth choosing on different grounds. But first, it helps to know where each one came from.

Where each profession came from

Osteopathy was founded by Andrew Taylor Still, an American doctor, in 1874 (Britannica). Still had become disillusioned with the medicine of his day, after losing three of his children to an epidemic. He set out to treat the whole person rather than the disease alone, and to help people move towards health.

From this came one of osteopathy’s best-known ideas: that the body has its own medicine chest. In Still’s words, “all the remedies necessary to health exist in the human body” (Still’s autobiography, 1908). The idea is simple: if you support the whole person, mind and body, they have the best chance of getting better.

Physiotherapy in the UK grew out of massage and Swedish remedial gymnastics, a system of therapeutic exercise. The profession began in 1894, when four nurses founded the Society of Trained Masseuses, which later became the Chartered Society of Physiotherapy (CSP). It developed inside hospitals and alongside doctors, so it inherited conventional medicine’s focus on specific injuries and diseases. That made it more prescriptive, with specific exercises and advice for specific problems.

Chiropractic came a year later. Daniel David (D.D.) Palmer gave the first chiropractic adjustment in Iowa in 1895 (Palmer College of Chiropractic). Palmer’s original idea was narrower: if the spine and nerves are working properly, the rest of the body will follow.

Today, all three are regulated health professions in the UK, and each title is protected by law. Osteopaths are regulated by the General Osteopathic Council, chiropractors by the General Chiropractic Council, and physiotherapists by the Health and Care Professions Council (GOV.UK). Whoever you see, check they’re registered.

Why this question matters to us

People often come to us unsure who they should book in with. The honest answer is that at Revitalize we take the best of all three, and leave behind the ideas that haven’t stood up to research.

Exercise only works if you can do it

Exercise is the foundation of physiotherapy, and it’s well supported. For low back pain, NICE guidance recommends exercise. It says hands-on treatment should only be used as part of a package that includes exercise, not on its own (NICE).

But an exercise that works brilliantly in a research study isn’t much use if you don’t have the time or energy to do it. So yes, we give exercises. We just shape them around where you are right now: your work, your family, your energy, your stress. That part is more osteopathic, because it looks at the whole person.

Hands-on treatment, without the myths

We also use hands-on treatment, which is common in both osteopathy and chiropractic. But we don’t claim it puts bones back in place or realigns joints.

The research is fairly clear on this. In one well-known study, researchers placed tiny markers in the pelvic bones of people with sacroiliac joint pain and measured the joint very precisely before and after manipulation. The bones hadn’t moved, yet the clinical tests that were positive beforehand were now normal (Physical Therapy journal review). The effect seems to come from the nervous system, by reducing pain and changing how the area feels, rather than from moving anything back into place (Journal of Orthopaedic and Sports Physical Therapy, 2018).

So we use hands-on treatment for what it’s good at: comfort and pain relief.

Sometimes you’re in so much pain that you can’t help yourself. Or you don’t have the physical or mental energy for a demanding rehab programme. That’s when we take the wheel for a while. We use more hands-on treatment to steer the early part of your recovery, then hand control back to you as you get stronger.

This is why patients sometimes get confused about what I am. Give someone exercises and they assume I’m a physio. Spend a session mostly on hands-on treatment and they assume I’m an osteopath who doesn’t do exercise. Neither is quite right. It depends on what you need that day.

How we decide what you need

The consultation tells me how you’ll best move forward.

If you tell me you’re extremely stressed and short of time, I’ll lean on hands-on treatment to ease things and give you some comfort. That gives you the breathing space to start making progress.

If you seem lost and unsure what to do, the session becomes more about decisions we make together: what’s going on, what your options are, and which one suits you.

What happens in your first appointment

Your first appointment lasts about 45 minutes, and most of it is spent on you rather than on paperwork. Here’s roughly how it breaks down:

• Consultation (about 10 minutes): I’ll get to know you, your pain and what you want to get back to.

• Examination (about 5 minutes): I’ll test where the pain is coming from, whether that’s muscle, nerve, ligament, joint or bone. Very occasionally it’s something more serious that needs a referral. If so, I’ll tell you and write to your GP.

• Advice (about 10 minutes): I’ll explain what I’ve found, what it means and what we’ll do about it, including your longer-term goals.

• Treatment (20 to 30 minutes): if it’s safe to treat, you’ll have hands-on treatment for pain relief, plus any exercises to start with.

So, who should you see?

Rather than choosing by title, choose someone who:

• takes time to understand you, not just the sore spot

• examines you properly and explains what they find

• tells you honestly what treatment can and can’t do

• combines hands-on care and exercise to suit you

• has a clear plan for when you’ll no longer need them

That’s what we aim for at our osteopathy clinic in Gravesend, whoever you see.

Not sure where to start?

Book a free consultation and we’ll point you in the right direction, even if that turns out to be somewhere else. Find out more about osteopathy and physiotherapy at Revitalize, or book a free consultation.

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References

1. Britannica. Andrew Taylor Still: biography. https://www.britannica.com/biography/Andrew-Taylor-Still

2. Still, A.T. Autobiography of Andrew T. Still (revised edition, 1908). A.T. Still University Museum of Osteopathic Medicine. https://www.atsu.edu/museum-of-osteopathic-medicine/wp-content/uploads/2019/04/Still,%20A.T/AndrewTaylorStillBIO1908.pdf

3. Chartered Society of Physiotherapy. CSP history. https://www.csp.org.uk/about-csp/who-we-are/csp-history

4. Palmer College of Chiropractic. Palmer College history. https://www.palmer.edu/about-palmer/palmer-college-history/

5. GOV.UK. UK regulated professions and their regulators. https://www.gov.uk/government/publications/professions-regulated-by-law-in-the-uk-and-their-regulators/uk-regulated-professions-and-their-regulators

6. NICE. Low back pain and sciatica in over 16s: assessment and management (NG59), recommendations. https://www.nice.org.uk/guidance/ng59/chapter/recommendations

7. Tullberg T, Blomberg S, Branth B, Johnsson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 1998;23(10):1124–1128. Summarised in Physical Therapy: https://academic.oup.com/ptj/article/81/5/1135/2857622

8. Bialosky JE et al. Unraveling the mechanisms of manual therapy: modeling an approach. Journal of Orthopaedic and Sports Physical Therapy, 2018;48(1):8–18. https://pubmed.ncbi.nlm.nih.gov/29034802/