The underlying philosophies of physiotherapy and chiropractic medicine have emerged as the two dominant forces in manual therapy in the West. Without getting into an extensive and ethereal debate about the beliefs of B.J. Palmer (one of the fathers of chiropractic medicine) vs. Per Henrik Ling (a father of early physiotherapy), let’s look at some actual data.
Skargen and Oberg 1997, 1998 and 2004 published three studies. They were comparisons of chiropractic and physiotherapy treatments on neck and low back pain. They were a 6 month follow-up, a 12 month follow-up and a 5 year follow-up.
Of the 323 patients in the initial study; chiropractic medicine was more favorable for patients whose episode of back pain had started less than 1 week previously while physiotherapy was more effective at chronic pain (defined as pain lasting > 30 days). No difference at the 6 month follow up in cost or effectiveness for neck or low back pain was found.
Interestingly, by the time the 12 month follow-up came, some differences have emerged among the groups. 60% had a recurrence of back pain. 59% of the patients of sought chiropractors and 41% of those who sought physiotherapists went on to other health care professionals. By this point, it was demonstrated that physiotherapy was cheaper than chiropractic medicine.
In general, the overall effectiveness of the two treatments was similar but the cost of the physiotherapy group was slightly lower. Chiropractic medicine is more effective at early intervention and physiotherapy at later intervention.
At the 5 year follow-up, 314 individuals were contacted (97% of the original population). 52% reported some level of back pain and disability, This is similar to the 60% at the 1 year follow-up indicating that some back pain is indeed chronic, poorly diagnosed, mismanaged or some combination thereof. In fact 84% of those who still pain after 12 months still had pain after 5 years. 63% reported at least 1 more incident since the 1 year follow-up and 32% reported they had seen a health care professional in the last 4 years.
At the end of the 5 year period there was no difference in effectiveness for either manual therapy practice but physiotherapy was slightly cheaper (and very slightly).
Now, Peterson et al 2010 compared the McKenzie mechanical approach to low back pain vs. chiropractic manipulation. They completed 2 month and 1 year follow-ups on the patient population. 350 patients were randomly assigned to chiropractic care or McKenzie approach physiotherapy. The outcome measure of the Roland Morris Disability Questionnaire was used. Both groups showed remarkable improvement by the end of treatment but the McKenzie group showed far greater improvement (71% vs. 59% for a 12% difference). At 2 months and 12 months, the McKenzie group continued to outperform the manipulation group by 12% each time. This is only a single study and focuses on one specific treatment method for one specific condition and cannot be generalized to all physiotherapy or physiotherapists or all of chiropractic medicine.
So we can see that some tools in each toolbox are effective at dealing with various problems but at this time no one is coming out ahead. What should (and to some degree is) occur is an exchange of ideas and philosophies about the body and how it heals and aligns to maximize the number of techniques one has access to in order to help more patients.