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Chiropractic vs. Physical therapy

Most people in the Portland area offen wonder , "What's the difference between a chiropractor, a physical therapist and physician; and who do I see for my particular problem?." Unfortunately, the question is not as straight forward as it seems. Simply put chiropractors usually work on individual joints and physical therapist work on more global movement.

I almost went into physical therapy school because Montana is very narrow on health care, but I did not want to just follow treatment recommendations of medical doctor.

The American Chiropractic Association 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.”

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 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 its 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.

Chiropractor: A chiropractor is a health care profession that diagnoses, treats and assists in the prevention of mechanical disorders of the musculoskeletal system, particularly the spine, as theoretically these disorders affect a patient's general health via the nervous system. Chiropractors are usually known for back pain because manipulation is much easier in the back with wonderful results.

A chiropractor's purpose is to restore function and stability to the joint (spine). This is done by "realigning" the vertebrae in a patient's spine by manipulation. Releasing tension in the spine allows for muscles to be relaxed and thus relieving pain associated with the misalignment. Misalignment is from a joint fixation, which injury or stress is the main cause.

A chiropractor also affects the patient's nervous system. The nervous system consists of the brain and spinal cord; with the brain is at the top and the spinal cord running through the spine while branching off in pairs at each vertebral level. The nervous system controls every muscle, organ and cell of your body. With correct alignment of the spine, it allows the brain to talk to every part of your body which promotes better movement and balance.

Physical therapist: A physical therapist, is a health professional who evaluates, diagnoses and provides treatment to individuals in order to develop, maintain and restore maximum movement and function throughout life.

This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Components of movement and function evaluated by a physical therapist include: strength, range of motion, flexibility, balance, posture, body mechanics, coordination, endurance and general mobility; such as walking, stair climbing and getting in and out of a chair or bed.

Physical therapists help people with orthopedic conditions such as knee pain or osteoporosis; joint and soft tissue injuries such as fractures and dislocations; neurological conditions such as stroke and Parkinson's disease; workplace injuries including repetitive stress disorders and sports injuries. Physical therapists evaluate the components of movement and develops an individualized program to decrease deficits and restore function.

Physical therapy treatment programs include education about the cause of the problem, hands on manual techniques and instructions in exercise to improve function.

Physician: A physician practices maintaining or restoring human health through the study, diagnosis and treatment of disease or injury.

Peiople see a physician when they feel sick, get injured, experience any unknown symptoms, or for annual checkups. The physician will use prior medical knowledge to accurately diagnose a patient's ailment and may prescribe medications or provide healthier lifestyle recommendations.

There are many different types of physicians, each of whom have a specific scope of practice.

It is common for a physician to refer one patient to another physician who specializes in another area. Examples of different physicians include pediatricians, internists and surgeons, just to name a few. Just as physicians refer patients among themselves, physicians also refer to other medical experts such as chiropractors and physical therapists, dependant on the diagnosis and needed care.

All three types of health care professionals provide valuable services that are necessary for one's overall health, wellness and quality of life. Knowing the differences in their areas of expertise will hopefully be beneficial when deciding where to turn for help when health issues arise.


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