Who should I see for my back pain?

A comparison between physiotherapy and chiropractic consultations in Australia.

Physiotherapy and chiropractic are two health professions that offer treatments for conditions affecting the musculoskeletal system. This can include pain and injury of body parts including back, neck, arms and legs, while both professions have similarities, there are also key differences between the two.

Similarities:

Both chiropractic and physiotherapy aim to alleviate pain and improve the function of your body and musculoskeletal system. Improving the function of joints and muscles can alleviate pain and disability. If your physiotherapist or chiropractor is only using one type of treatment modality – monotherapy, you are encouraged to ask them to prepare an exercise prescription as this will improve your health outcomes. Clinical practice guidelines, which are based on evidence-based research, have found that multimodal manual therapy, combination of muscle-based mobilisation, massage, joint manipulation, exercise prescription, pain-science education achieve the best results for the management of back and neck pain.

Both professions use manual therapy techniques, including mobilisation and manipulation, to treat conditions such as back pain, neck pain, and joint pain.

Both physiotherapy and chiropractic may use additional treatments such as exercise, rehabilitation, and education to support their manual therapy techniques. Clinical practice guidelines endorse exercise therapy in the management of common health conditions such as back and neck pain.

Both chiropractors and physiotherapists are university trained in Australia. Physiotherapists complete a minimum of four years of undergraduate study. Chiropractors complete a minimum of five-year degree combining undergraduate and postgraduate studies.

Diagnosis: Both chiropractors and physiotherapists are trained to diagnose a wide range of medical conditions related to the musculoskeletal system. Both chiropractors and physiotherapists work with your medical doctors (GP and medical specialists) and other allied health professionals to achieve the best health outcomes and achieve your health goals.

Both chiropractors and physiotherapists will work with you to formulate your health goals beyond the immediate goals of improving your pain and related disability.

You can consult with a chiropractor or physiotherapist without the need for a medical referral as both are primary care professions.

Differences:

On graduating form university, physiotherapists can work in both hospitals and private primary care practices. Physiotherapy care is available through the public health care system (Medicare) within a physiotherapy Out-patient clinic if referred by your GP or with a hospital referral. Chiropractors currently work solely within the private primary care practices system. Chiropractors work in solo or multidisciplinary medical clinics.

Scope of practice: As Physiotherapists have experience in training within hospitals, they a wider scope of practice beyond musculoskeletal problems, such as pulmonary rehabilitation and bone fracture care. Chiropractors, however, focus specifically on the pain and dysfunction of the musculoskeletal system.

Manual therapy techniques: Chiropractors and physiotherapists may use slightly different manual therapy techniques. Chiropractors may use more hands-on manual therapy alongside exercise therapy, while physiotherapists might use more gym-based exercise therapy with less hands-on therapy, including exercise therapy, joint mobilisation and soft tissue massage. Chiropractors, on the other hand, focus primarily on spinal manipulation.

In Australia, both physiotherapy and chiropractic consultations are available through private practices and may be covered by private health insurance. Additionally, your GP may give you a Medicare referral for Allied Health Services which will cover some of your chiropractic or physiotherapy treatment. These Medicare referrals are limited to 5 allied health consultants within a 12-month period. Patient eligibility criteria apply, and your GP is the only health practitioner able to write these referrals.

In conclusion, chiropractic and physiotherapy are both allied health professions that aim to improve the function of your body and musculoskeletal system. There are more similarities than differences between the two professions. However, just like any other professions you will also find differences within these professions too, as some chiropractors and physiotherapists may have completed further studies and training to treat particular health conditions. For example, further studies and training in pain management, neuro-vestibular rehabilitation, sports injury rehabilitation, workers compensation case management, paediatric care, to name a few. This means that the treatments and mode of care can look very different even within the same chiropractic or physiotherapy profession.

Both professions can be effective for treating conditions affecting the musculoskeletal system, and the choice between the two will depend on your specific needs and preferences.