By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
It is not uncommon in the course of a day in clinical practice to here the question, “what is the difference between physical therapy and chiropractic?” In large part the difference is three fold: philosophy of practice, work environment and third party reimbursement commonly known as health insurance. While the history spawning each profession is quite diverse the two professions have been on converging paths ever since their individual genesis. I will attempt to bring clarity to the before stated question and with it there is sure to be controversy from each side.
The American Chiropractic Association (ACA) defines chiropractic in this manner; “Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches. Doctors of Chiropractic may also be referred to as chiropractors or chiropractic physicians. They practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.”
In 1895, Daniel David Palmer founded the Chiropractic profession in Davenport, Iowa. The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.” The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile, or restricted in their movement as a result of a tissue injury. Manipulation, or an adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, and allowing tissues to heal.
The American Physical Therapy Association (APTA) defines physical therapy as: “Physical therapists are health care professionals who maintain, restore, and improve movement, activity, and health enabling individuals of all ages to have optimal functioning and quality of life, while ensuring patient safety and applying evidence to provide efficient and effective care. In addition, physical therapists are involved in promoting health, wellness, and fitness through risk factor identification and the implementation of services to reduce risk, slow the progression of or prevent functional decline and disability, and enhance participation in chosen life situations.”
The APTA also provides this historical synopsis regarding the genesis of physical therapy as a profession. “When the polio epidemic became widespread in the United States in 1916, the need for muscle testing and muscle re-education to restore function grew dramatically. The United States entered World War I by declaring war on Germany in 1917, and the Army recognized the need to rehabilitate soldiers injured in the war. As a result, a special unit of the Army Medical Department, the Division of Special Hospitals and Physical Reconstruction, developed 15 “reconstruction aide” training programs in 1917 to respond to the need for medical workers with expertise in rehabilitation. The profession of physical therapy, as it was later termed, had begun.” While chiropractic clearly has it’s historic focus on spinal manipulation the profession has matured and expanded creating high level educational programs including specialty residencies and fellowships. Chiropractors practice in hospitals, military institutions, universities, professional sports teams, etc. Chiropractors in the 21st century treat more than the spine to the point that the director of the sports medicine clinics for the United States Olympic Committee is now a chiropractor. Physical therapists like their chiropractic colleagues have expanded their education to include similar educational programs that recently included the addition of an academic doctoral degree. Physical therapists have traditionally worked in hospitals and by history the military. Private physical therapy practice including home physical therapy practice has expanded greatly in the last 30 years. Physical therapists also work in the professional sports and university settings.
So the long and the short of it is that Chiropractors have a more expansive diagnostic education while physical therapists have an intervention or therapeutic based education. While chiropractors can provide services such as rehabilitative exercise and modality treatments their main form of treatment remains the manipulation. Physical therapists may provide manual therapy like techniques to their patients but therapeutic exercise; modalities and activity modification remain the foundation of physical therapy practice.
Spinal manipulation aside the two professions have converged to the point that some prominent individuals in each profession have begun to discuss the unthinkable; merger. It would not be out of the question to see the first combined chiropractic – physical therapy program within the next 15-20 years.