Chiropractor or Physiotherapist: Who should I choose, and what should I expect from treatments?

Should I be going to a chiropractor or a physiotherapist?

I probably get this question more than any other by office staff, friends, current patients, potential patients, and even teammates. The answer is pretty simple actually. The answer depends on three simple questions: 1) What is your current injury? 2) What is the chiropractor or physiotherapist's area of specialty and passion? 3) What is your goal from the treatment? Let's explore why these three questions are so important and why you can't accurately choose until you know the answers to these questions. 

1) What is your injury? 

You don't need the diagnostic skills of Dr. Gregory House to understand what happened and where it hurts. Is it a chronic injury that has been around for months or even years? Is it a sports injury? Is it an arthritic condition? Could your pain or injury be coming from your spine? Once you decide where your injury is, and roughly how it happened, you can start to understand the special-needs of your condition. Just as there are various places to bring your car for repairs, depending on the cars problem, there are physiotherapist and chiropractors who specialize in specific areas. Is it a transmission problem (Mister Transmission), is it a muffler problem (Speedy Muffler), do you need a body shop? There are chiropractors and physical therapist to specializes in sports injuries, chronic pain, motor vehicle accidents, workplace injuries, arthritic conditions, ect. Now this can be confusing as many clinics claim to specialize in all of these areas, and some actually do, but it's rare and usually only in major city centres. The way to tell is to call and talk to the practitioner and find out what areas they have completed specialized training after graduating. 

2) What is the chiropractor's or physiotherapist's area of specialty and passion? 

The answer to these questions can be identified by a simple website and social media search on the practitioners that are available to you. I suggest using the under-utilized "phone app" on your smart phone to call and have a conversation with the potential practitioners you have access to. Once again the questions to ask are simple. Ask the practitioner the areas he or she has specialized in after graduating, what courses have they taken after graduating, the types of patients they are most passionate about, and the ones they see most often. Knowing the area the practitioner is passionate about, and if that area lines up to your injury, you should have a very positive experience during your rehabilitation. Simply walking into a clinic, or going to your closest practitioner, or starting with the most advertised practitioner drastically increases the possibility of your disappointment in injury outcome. If his or her area of specialty does not line up with your injury or your goals for rehabilitation, there will almost certainly be a disconnect between what you want and what you get with treatment. 

3) What is your goal, or expectation, for treatment? 

The requirements, expectations, and goals for treatment are significantly different from patient to patient and nearly always entirely individualistic. The goals of your grandmother who has a sore knee, who is no longer able to get in and out of a car are significantly different from the goals of a young athlete with provincial or national level aspirations, who may be experiencing back pain while participating in their sport. Simple goals of returning to your normal activities of daily living in a sedentary lifestyle are substantially different than returning to a physical job or expecting to return to sport, even if it's just on the weekends. Many clinics and practitioners claim they treat sports injuries but few have truly done the specialized work to understand the true needs of an athlete. For athletes recovering from injury, the absence of pain is not the marker for injury resolution. Often athletes themselves have a poor understanding of this concept. Specific objective sport related performance markers, range of motion, strength, power, mobility and stability must be demonstrated in order to be considered "healed" and ready for competition. If these haven't been tested with sport specificity, recurrence of injury in or around this area is highly probable. The number one predictor of future injury is past injury. 

So determine as best you can what kind of injury you feel you have and seek out the clinician most suited for your needs. There is a tremendous amount of overlap to the scopes of practice between the chiropractors and physiotherapists. It is essential that you discover what practitioner options you have and what areas of further knowledge these practitioners have pursued. Then, and only then, you can answer the popular chiro versus physio question for yourself. Much like anything in life, do your homework and you will be much more satisfied with your experience. 

WHAT SHOULD YOU EXPECT FROM A QUALITY TREATMENT?

Now that we know there are significant differences and specializations not only between chiropractors and physiotherapists but within the chiropractic field as well as within the physiotherapy field.  Educate yourself about your potential practitioner to choose wisely.   You also need to know what a quality treatment should include. The following three components are absolutely essential to be considered a complete treatment, and when used effectively will ensure your most rapid recovery from injury. 

1. HANDS ON soft tissue work. 
2. ACTIVE movement corrections and movement restorations (exercises). 
3. PASSIVE pain reduction and expedited healing techniques. 

1) HANDS-ON soft tissue work includes palpating, feeling and measuring full range of motion and strength, and specialized techniques such as stretching PNF stretching, ART, Graston technique, mobilizations manipulations, glides, massage etc. Options here are nearly endless and entirely practitioner specific.  This is generally the one-on-one time with you and the practitioner. This is where the patient benefits from the practitioner using his/her specialized hands-on knowledge of the anatomy and biomechanics in the area to help the affected tissues return to pre-pathological condition.   

2) ACTIVE component attempts to improve the way you move. The musculoskeletal system’s predominant function is locomotion or movement. No amount of passive treatments can retrain this system to return to pre-injury level. Any treatment that lacks an active component is an incomplete treatment. Chiropractors who only adjust and do not show movement modification are to be avoided, just as physiotherapists who only apply heat and ultrasound to your injury are to be avoided. Rehabilitative movement or rehabilitative exercises are absolutely essential to a complete treatment. 

3) PASSIVE pain reduction and healing assistance techniques are used to make this process of movement change as comfortable, and as efficient as possible. These are what us jargon aficionados call therapeutic modalities. These include, but are not limited to, ultrasound, laser Doctor Ho (TENS) units, interferential current (IFC) units, muscle stimulators, spinal traction spinal decompression... And the list goes on and on. 

As some cat torturer once said "There's more than one way to skin a cat". This dark analogy holds true with how treatments are administered or how the healing process is improved. Every single appointment may not be exactly one third hands-on care, one third active care, and one third passive care, but over the course of multiple treatments this ratio should be fairly well-maintained. Nearing the end of treatments, active components should be drastically increased. In summary, treatments should be complex in nature, testing multiple systems helping you along with pain management and movement restoration. Chiropractors who only adjust, or simply want to sell you a pair of orthotics are likely far more concerned with patient flow than patient healing. Just as physiotherapists who only put you on a TENS unit or have ultrasound administered by a kinesiologists are likely more concerned with patient numbers than patient satisfaction and injury healing. Just like any profession, there are amazing individuals in both fields and epically inept individuals in both fields.  If you have actually made it to the end of this blog post you probably now have a much better idea how to tell the difference. 

The final note I would like to make revolves around treatment numbers for injuries. There are a certain percentage of patients who believe chiropractors and physiotherapists are magicians. I assure you there is no magic or gifted healing touch involved in either of these fields. Expecting to come into a clinic with an injury that is traumatic, or been around for weeks, months, or years, and have everything restored in one treatment is expecting too much. There are very few studies using less than 6 to 12 week intervention periods in the physical medicine literature. In fact, most of the research is conducted over 12 to 36 treatments. Unfortunately, treatment protocols are currently often designed around extended health care coverage rather than the proven research. This leads to disappointment on both ends. Nothing worth accomplishing ever happened with little to no effort, and if your chief concern is to stay within your coverage rather than getting better, you may be disappointed. Prevention, and living a optimized healthy lifestyle is by far the best defence against incurring the financial cost of healthcare, but that is an entirely different blog post.  

Choosing a Chiropractor or a Physiotherapist is much more dependant on the individual practitioner than their designation.  Do your homework and find out what will best suit your particular injury/issue, and your specific goals.