What's the difference between a chiropractor and an osteopath? Why it’s Like Comparing Superman to the Avengers...

This is the question we get asked so often. People often try to compare chiropractors and osteopaths as if they’re two neatly defined, uniform professions. But in Belgium, that comparison is a bit tricky....

It's a bit like superheroes!

Chiropractors in Belgium: Healthcare’s Superman

Superman is Superman. You know what to expect.

Belgian chiropractors are the like that: :

• All chiropractors have all completed a full‑time university master’s degree, typically 4–5 years.

• They are all members of one of two, quite similar, professional associations.

• You know you will get your insurance reimbursement.

Of course there will be some variation between chiropractors but in general they will all be very specialised in treating conditions of the back, pelvis, neck and other joints.

There will be a close similarity in approach and in treatment methods. When you meet a chiropractor in Belgium, you know what you’re getting — just like when Superman shows up.

Osteopaths in Belgium: The Avengers of Healthcare

Now imagine trying to compare Superman to the entire Avengers team, a variety of superheros who have acquired their powers in different ways. So a direct comparison is not really possible because there is such a variety within that team.

Belgian osteopaths can come from three different backgrounds:

• A full‑time university master’s degree in osteopathy

• Medical doctors who retrain in osteopathic methods

• Qualified physiotherapists who complete part‑time postgraduate osteopathic training

This creates a profession with considerable internal diversity. According to the osteopaths themselves: "Osteopaths do not all work in the same way... it is not surprising to receive a different treatment when changing osteopaths."

Within the team of Avengers we do have Captain Marvel who is different to the other Avengers but who is quite similar to superman. Similarly, there will be plenty of osteopaths who practice very like chiropractors, and may even have less in common than other osteopaths.

So what is the difference between the different osteopaths and the ones like the chiropractors?

As usual you will find a number of explanations on the internet. I don't agree with most of what I read.

Sometimes you read explanations about how one group is more holistic, one group is more specific, one group uses imaging more, one group focussed more on bones, another more on muscles, or nerves or joints.

Personally, I expect that any good chiropractor or osteopath, or kinesiotherapist:

• takes an holistic approach to examination and treatment plan.

• is able to perform a specific, focussed treatment where necessary.

• has a respect for the body's natural healing ability.

  
  

I expect that all chiropractors and some osteopaths (and some kines of course):

• are very, very good at adjusting (i.e. manually manipulating) the joints of the spine and limbs due to years of training and practice

• will always examine the spine to check for links to the patient's main complaint, even if the patient does not complain of spinal pain

• have great experience of spinal and pelvic treatment due to a vast majority of patients who present themelves with spinal and pelvic problems

• while not actually being a radiologist, would have more than basic skills at reading MRI's and X-rays or at least be able to interpret such reports and integrating the details into the diagnosis

• use, not only, the adjustments for treatment but also use other treatment modalities

• treat the joints, the nerves, the muscles, the fascia, the tendons either directly or indirectly

I expect that some other osteopaths (and similarly some kinesiotherapists):

• have less training with adjustments/manual manipulation of the spine, pelvis and other joints

• take a more focussed approach and do not always check the spine in cases of conditions such as ankle or shoulder problems

• have experience of a wider variety of physical conditions and thus less experience with spinal and pelvic treatment

• do not read spinal x-rays and mri's very often

• favour using other treatment modalities rather than joint adjustments

And of course there are some osteopaths and kinesiotherapists who have specialities where they do not treat spinal conditions at all - for example kinesiotherapists who specialise in cardiopulmonary rehabilitation.

It doesn't mean that one group is better or worse. It just means they are different. The difference is not strictly between the group called chiropractors and the group called osteopaths or kinesiotherapists. A big reason for a difference is because of the variety amongst osteopaths and amongst kinesiotherapists.

So I mention Kinesiotherapists all of a sudden:

In Belgium Kinesiotherapy is simply a different word word physiotherapy so Kinesiotherapists and Physiotherapists are exactly the same. Kinesiotherapists are again a different group of superheroes - consider these the X-men, again a group of trained professionals with widely varying specialities.

There is a subgroup of kinesiotherapists who may work similarly to chiropractors or osteopaths, particularly within the group who study manual therapy as a post-graduate specialisation. There are also many kinesiotherapists who have different speciliaties and work in different ways.

The important points:

Whoever the therapist is they should:

• Be appropriately qualified.

• Have insurance.

• Be recognised by the mutuals/insurance companies.

• Invest in continued education.

• Be answerable to some authority.

An easy way to check is that they should be a member of a professional association. Apart from that, hopefully each therapist can share information on their website.

Another point is that noone can be both a chiropractor and a osteopath. Similarly noone can work concurrently as a kinesiotherapist/physiotherapist and chiropractor or osteopath at the same time. The professional organisations forbid this. Someone may have all the skills of different professions but when they actually do their work then they have to decide which group they below to.

My personal opinion

As a chiropractor I am naturally biased towards my profession. We have trained for four or more years, full-time at masters degree level. We spent hours every day of these four years practicing our diagnosis and treatment of neck and back dysfunctions, amongst other things.The physiotherapy training and most osteopathic trainings are not so intensively focussed. This is the main objective reason why I consider the chiropractic training to be superior for pelvic and spinal dysfunctions. Furthermore, while we see a variety of conditions every day in our practices, almost all the patients have some degree of spinal involvement in their conditions. This gives a great range of experience of spinal conditions over the years.

In the end of the day...

You, the patient, needs to be satisfied that your therapist is doing the best job possible for you.

For sure, it is important to check out any therapist's website before booking an appointment, to make sure you're going to the right place.

And then of course you, the patient, needs to be happy with who you find. It's important to have a practitioner who is, not only, appropriately qualified but someone with whom you have good communication. Someone who understands your goals and can help you arrive there.