United In The Art Of Gentle Manipulation
Sydney Morning Herald
Thursday June 10, 2004
When it comes to fixing a bad back, the rivalry between physiotherapists, osteopaths and chiropractors is intense. They're like a bunch of socialites vying for attention on the red carpet each convinced of their legitimacy and status on the health care A-list.
The three disciplines share much in common so it's not surprising that some of the public is confused. All specialise in treating conditions caused by mechanical joint dysfunction such as back and neck pain and advise on maximising mobility and quality of life. Practice in each field requires several years' study and training.
Nonetheless, the classifications vary. Physiotherapists are known as allied health professionals located within the traditional Western medical model who work closely with GPs. Osteopaths and chiropractors, meanwhile, have their origins in alternative health practice.
The key claim of physiotherapy is that it is ``evidence-based". In other words, all of the treatments used by physiotherapists to promote mobility and fitness from manipulation of the joints to muscle stretches and massage are clinically proven to work, based on an extensive database of trials.
The Australian Physiotherapy Association requires its members to stay updated on the latest research findings. For Mark Brown, the executive director of the APA's NSW branch, this sets physiotherapists apart from ``ratbags" who make questionable anecdotal claims.
``There are some really good [chiropractors and osteopaths] whose work closely accords to current evidence," he says. ``Then there are others who have ideas which are not supported."
But physiotherapy's emphasis on evidence-based treatment is downplayed elsewhere.
``Look, evidence basis is a goal that everyone aims for," concedes Stephen Robbins, executive director of the Australian Osteopathic Association. ``The difficulty is that the human body is not a standard machine it [varies] based on a person's interventions and environments. Treatments that work for one person mightn't work for another."
Others, such as Rodney Brennan, the former principal of Nature Care College, cite the difficulty of funding alternative therapy research. ``Unlike orthodox medicine, [alternative] medicine doesn't sit in the hands of a few very wealthy companies or organisations," he said in an interview last year. ``To come up with $1 million . . . is an extremely big ask."
The defining characteristic of osteopathy is its philosophical understanding of the human body as a self-healing, holistic unit. Practitioners employ gentle manual therapy without resort to drugs, focusing not just on painful areas but the body's overall equilibrium. This includes advising patients on diet, exercise, stress, posture and breathing.
``People come to osteopaths for soothing, non-invasive treatment," Robbins says. He admits that osteopaths charge more than physiotherapists but touts the discipline's efficiency, claiming that many patients are ``back on deck" after just three consultations.
Chiropractors, in turn, specialise in spinal manipulations to protect the nervous system, which is seen as integral to the body's self-healing. Practitioners also are skilled in radiography and use X-rays to diagnose incorrect alignments and fractures.
With physiotherapists and GPs increasingly using spinal therapy, Joe Ierano, the public education officer for the Chiropractics' Association of Australia , argues that chiropractors have the edge in terms of experience.
``Chiropractors are experts on the minutiae," he says. ``Physiotherapists have only embraced spinal manipulation in the last 10 to 15 years while chiropractors have been doing it for over a century."
However, the relationship between physiotherapists, osteopaths and chiropractors may change.
Under the Federal Government's Medicare Plus package, which in a ground-breaking move groups the three disciplines under the same allied health banner, each is eligible for funding subsidies contingent upon GP referral and the development of multidisciplinary patient care plans.
``A multidiscplinary approach is the way for the future," Ierano says.
© 2004 Sydney Morning Herald
