Falls, Motor Vehicle Accidents (MVA), and work-related injuries often leave those involved with pain and functional limitations that can persist for days and weeks beyond the injury date. For those needing help, often Physical Therapy (PT) or Chiropractic care is prescribed. In fact, the two are often viewed as interchangeable treatments. While there are some similarities between the two professions (manual therapy, treatment for neck/back disorders, and use of modalities like TENs, heat, or ultrasound), there are actually a number of significant differences between the two professions. These differences can dramatically impact how an injury heals, and it’s important to understand these differences when selecting the right provider for treatment after injury. These differences include:
One of the fundamental differences between physical therapy and chiropractic is exercise. Results Physiotherapy focuses on exercise in conjunction with manual therapies, modalities, etc. so that patients can build strength, increase range of motion, and improve neuromuscular control and proprioception. Exercise prescription is one of many exercise-focused classes required to complete graduate school and receive a Doctorate of Physical Therapy.
With chiropractic care, exercise is very often not a component of treatment, as it is not a requirement in all chiropractic schooling; instead, many schools focus on including business courses to teach chiropractors how to open their own practices rather than educate further on patient care 1. 2. 3. This is problematic, as research has demonstrated that patients typically have better outcomes and see fewer episodes of recurrence when therapeutic exercises are implemented with treatment 4. 5.
Physical therapy and chiropractic further diverge in terms of frequency of visits. At Results Physiotherapy, treatment usually begins with 2-3 visits per week for a period of 4-6 weeks. As individuals progress, their frequency will decrease accordingly to 1-2 visits per week with continued completion of home exercise programs (HEPs). Home exercise programs are completed in conjunction with in-clinic treatment to empower patients to continue working toward their own benefit at home. “Patients who adhere to their prescribed exercises are significantly better at achieving their goals and demonstrate a greater increase in physical function.” 6
As discussed in a previous blog, Four Reasons Finishing your PT Homework is Crucial for Recovery completing home exercise programs benefit patients in helping to reduce pain and inflammation, build strength, and improve flexibility. Just as exercise prescription is much less common from chiropractors, the same follows suit for home exercise — treatment is solely linked to your relatively short time in the office. Frequency of chiropractic visits can vary greatly, and in many cases is continued for months to years on what is called a “maintenance” basis — meaning that patients continue to pay for months of unnecessary treatment under the guise of it being as necessary as regularly attending a dentist.7
The Chiropractic profession routinely relies on medical imaging (x-rays) as a means of diagnosing a condition. The idea is that the x-ray will highlight areas of involvement, and then with continued re-imaging, track a patient’s progress. While this may sound like a perfect approach to target painful or dysfunctional structures, there is a problem with use of medical imaging: it’s not very reliable at diagnosing musculoskeletal complaints.
Just to be clear, musculoskeletal complaints include: neck pain, back pain, or any symptoms originating from muscles, joints, ligaments, discs, etc.) As we have discussed in other blog posts (Positive MRI findings — A Problem or Just Part of Aging?) medical imaging has fallen from grace in terms of being valid/reliable for accurately diagnosing these types of conditions. In fact, recent literature highlights use of imaging in chiropractic care, or perhaps it’s misuse: “benefits for the use of routine spinal X-rays being proposed by some elements of the profession [chiropractic]. However, evidence of these postulated benefits is limited or non-existent.
There is strong evidence to demonstrate potential harms associated with spinal X-rays including increased ionising radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased unnecessary costs. Therefore, in the vast majority of cases who present to chiropractors, the potential benefit from spinal X-rays does not outweigh the potential harms.8” At Results Physiotherapy, our physical therapists place emphasis on performing a thorough clinical exam (no x-ray needed), relying on findings to guide treatment. Not only does this limit ionizing radiation exposure and “over-diagnosing,” but it also reduces cost and allows for faster targeting of symptoms (by not being misled by irrelevant imaging findings).
Evidence based medicine requires willingness to learn and change. Best practice today may change in the future as more information becomes known. At Results Physiotherapy, our PT’s focus on providing treatment supported by current literature. Whether this be a move away from the use of ultrasound (due to lack of supporting evidence) or the use of a set of clinical tests, our providers receive a significant amount of education (that is supported by current best evidence). Unfortunately, the same cannot be said for some practicing chiropractors.
While it should be noted that none of the claims listed below were found on the American Chiropractic Association’s (ACA) website, a simple Google search of “conditions treated by chiropractors” revealed a variety of chiropractic practices across the country claiming to treat: 9,10,11
These claims fall outside the consensus from other healthcare providers (and frankly, the research cited as evidence is often poorly performed). This ultimately casts a shadow on these providers and the profession, and outlines a disconnect from evidence based medicine.
Not only does this impact the treatment to the patient, but it may also decrease the reliability of their findings, something particularly problematic if these providers are treating worker’s comp, MVA, or other cases involved in litigation. Selecting a good provider adds credibility to a case. Considering some of the claims out there, legal counsel would be advised to use a Results Physiotherapy PT provider to ensure credibility and implementation of evidence based medicine.
