Sunday, June 24, 2007

Physiotherapy, Chiropractic, Osteopathy: What to choose ?

The patient is often confused between these three therapies and doesn't know what to expect from these different approaches.

Physiotherapy : the physiotherapist is a specialist in rehabilitation. After an injury (fracture, surgery, CVA...) the physio will rehabilitate the patient with massages, mobilisations, ultra-sound, exercises or even teach a patient to use crunches. His approach is generally symptomatic and his recommendations are often statisticly based (eg : in chronic low back pain a series of 3 push ups, 5 sit ups and 7 pulls of the right ear lobe improve the symptom by 47% over a period of 7 weeks. Please don't try this at home, this is just an illustrative example !!!).

Why is this ? I believe that physiotherapists are the right hand of the medical field and have been formed to fit the medical way of thinking. Therefore anything they do must be proven effective and safe, even merely effective is fine as long as it is safe.

The problem is that proving something is hardwork, time consuming, money consuming, and often another study will few months later proves the opposite to be true. A study is often too specific or too global to be constructive.

This approach avoid to talk about the "Unicity" of the patient. It does mean that if two patients complain from the "same" areas or symptoms they will be given the same treatment regardless the root of the problem which is not necessarly the same. The outcome of the treatment is therefore not as effective as it could be : it does not address the root of the problem but the treatment is as safe as it can be.

Chiropractic : Here is a joke for you ... what is the difference between a chiropractor and an osteopath ? 60 000 $ a year.

Chiropractic has been developed in the US at the end of the 19th century by Dr Palmer. Chiropractors claims that the source of our problems comes from the nervous system. Therefore corrections of "subluxed" vertebrae tend to lead us towards balance and recovery. Chiropractors will use spinal manipulations, ultra-sounds, massages, TENS, or other "high-tech" equipments. Often the massage, US, TENS(...) is given by a PA (physician assistant), then here comes the Chiropractor who will manipulate the spine. The chiropractor may need to see you up to 3 times the first week then will decrease the frequency of the treatments.

Personnally I am far from convinced that a back pain necessarly comes from a "subluxed" vertebrae but if you believe that the key of your problem comes from your spine, well then go for it. If you are not getting any better then make your next stop the Osteopath ;)

Osteopathy : Any traumas, injuries, sugeries, infections you had in the past are affecting your body in some way today by creating some restrictions and series of compensations. After a while your body cannot compensate any more, you bend forward to pick up a pen and "click", a vertebrae moved a bit too much and you just suffer from an acute facet lock. Now, is it just a vertebrae or a whole pattern of compensations, interactions, fascial connections, visceral dysfunctions, nutritions(...) that is responsible for your agony ? I would like to believe that we just need to correct a vertebrae, as it would make the work a bit easier, but the human is a little bit more complicated.

Generally an Osteopath will spend between 30 and 40 min with you and only you. During that time at least 40% of the treatment is spent in diagnosis in order to understand where the problem is coming from, this allows a more accurate treatment.

Osteopaths only use their hands, as machines tend to be imprecise and often scare the patient.

Personally I will never see a patient more than once a week and rarely more than 3 times the first month. Some Osteopaths are even reluctant to do more than one treatment every other week. (for some more details about the treatment content please check the other posts !)

What ever therapist you see do no hesitate to try different ones and stick with the one you feel the most appropriate. If you do not feel any improvement after 2-3 sessions, look for another approach or opinion.


Anonymous said...

Not the most professional of comments from a professional! Personal opinion should never get in the way of the best care for the patient. Are you even regulated?!

Pierre de Lasteyrie du Saillant said...

Hi anonymous,
Thank you for sharing your opinion with us. Long time since I last connected on my blog and sorry for the delay.
Yes I am regulated now in France, and was at the time in the UK and Malaysia.
I don't see what is unprofessional about my comment. I don't condemn the competence of the physios, I just say that some of them are too guided by some procedures. Physiotherapy is definitely the recommended therapy for hypermobilities and rehabilitation.
Now concerning chiropractors:
I met and discussed with a few of them: I heard one telling me he was seeing 80 patients a Day! that is 4 patients at the same time every 20 min. Another one told me he was making watch a movie about chiropractic to his patients before the treatment to "educate" them and then was selling them a special package of 20 or 30 treatments (valid 1 year please). Another one was explaining me that he needed a Xray before the first treatment to know which vertebrae to manipulate... If his treatment is effective does he need a Xray each time ? 30 times a year ??? I could go on with this type of example for a few more lines. The only chiropractor that uplifted my point of view about chiros is Dr Twink Lim in Malaysia whom impressed me through her professionalism. I respect chiropractors at least for one thing, it is that they try to establish procedures in their treatment approach which facilitate research.
At last I am an osteopath, I don't have a split personality disorder, and my personal opinion is my professional opinion. I don't see why it gets on the way of the best care of the patient. I would happily refer a patient to a competent doctor, physio, osteopath and chiropractor. Referral is certainly the way for professionalism, and someone who is asking a patient to come 30 times a year for a complaint doesn't know much about best care for the patient. Far from me the idea that every osteopath is perfect. Actually I plan to write an article to criticise osteopathy (and other therapies of course;)and certain osteopathic practice.
Thank you again for your time,

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Ben Cousins Injury said...

Hi Pierre,

I think all these different fields have been created to answer different needs. In my experience, there are flexible, open-minded practitioners in each who like to be aware of, and keep up to date on the progress in, related medical fields.

In my experience, no one can claim to have the superior field of treatment. There are good and bad practitioners in every field and you have highlighted some of the limitations that some practitioners will face unless they work actively to overcome them.

My best results as a patient have been achieved with practices like
Newtown Physiotherapy in Sydney who are constantly updating their knowledge in a variety of aligned fields and take a holistic approach. Another major benefit is an ability to diagnose accurately, and practitioners who resolutely limit their learning to their own field often limit their diagnosis ability for their patients.

I have seen good and bad physiotherapists, osteopaths and chiropractors, as there are good and bad in any profession. There are also leaders and followers in any profession.

I wish you continued success in your profession!

Anonymous said...

I agree there are good and bad in all professions, but as a client, I believe it is good to see and hear the different opinions and methods available. I have been to both bad and good in many different countries, and Pierre has said throughout, that ultimately, you must choose what is right for you.
Find someone accredited with the necessary organisation within their country and question them if you are unsure, if they are passionate about their role and about helping the patient then that is a good thing!
I have personally not felt happy with the treatments I have had in the past from Chiropractors (very short and not enough time on diagnostic for me to feel confident they found the problem - which they didn't!) and my choice is definitely the Osteopath. I find that I don't even need to say what the issue is - if your osteo is good they can tell you from their diagnostic tests where they feel any restrictions or problems. I had chronic pain after a head injury and I suffered for many years. After the first 2-3 treatments I was much improved and they were trying to put more time between treatments rather than the (from my experience) frequent and expense list of re-visits I had been offered by the Chiro. I often ask the question - how can a chiropractor sell a group of 10 or 20 sessions to you at the beginning, surely it is better to see how your body reacts and progress etc along the way....I much prefer the method and way of thinking of my osteo - but I am also glad that I made this decision by knowing the facts personally.