Osteopathy or Chiropractic?

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(Opinion)

All the time we get asked what is the difference between osteopathy and chiropractic, and we all have different answers. People often say things like ‘osteopathy is more holistic, chiropractors are mainly interested in the spine’. But this is pretty inaccurate in my view. Both groups tend to say things like ‘holistic’, ‘working with the body’s own healing processes’, ‘treating the causes and not the symptoms’, and other phrases like that. But there is a whole range of interpretations for these things.

You pays your money and you takes your choice.┬áBut here is my answer…

At a fundamental level, chiropractic is defined by technique, and osteopathy is defined by its theory. And this is more than an academic distinction: it makes a world of difference to the patient experience, and, I believe, to outcomes.

So in a sense, chiropractic is a statement about the method of treatment, without making any claims for the thinking that guides the application. Osteopathy, on the other hand, defines a way of looking at problems and lets the practicalities follow from that. It is like the difference between a car and a road-map. Clearly osteopathy is not worth much without some practical methods: but Chiropractic theory can be summed up essentially as the art of correcting subluxations. Beyond the idea that subluxations impair nerve function, and correcting subluxations should help, there is no distinctive chiropractic vision of health and disease. It is a pretty linear way to look at the treatment of a highly non-linear system; the living human body.

Whether for any of us this makes one way better than the other, depends on our own world view and what we want from life.

Bear in mind this is a conceptual difference, and says nothing about what an individual practitioner thinks or does. And when all is said and done, what really matters is the vision of the practitioner and not what banner he or she goes under. But a chiropractor can quite legitimately function without any broader hypothesis of health and disease: the medical model will do. You just correct the subluxations and Bob’s your Uncle. Whereas for an osteopath to function without invoking the osteopathic philosophy of what it means to be healthy, and how the body deals with disease, is to fall short of his job description.

This is not so much a matter of right or wrong, but of consumer choice. And so the trademark should stand for something, and it should give the client some clues. And unfortunately when practitioners try to be all things to all people, to mould their practice to the expectations of the client instead of to the definitions of their discipline, the result is a public who are confused about who we are and what we do.

And so in short, chiropractic is to osteopathy as a set of spanners is to the study of engineering. “Chiropractic is nothing if not specific” is the famous catchphrase of DD Palmer, the founder of chiropractic. And that alone speaks volumes as to what matters to chiropractors. And to be fair, specific correction of subluxations (misalignments of bones or joints) can give impressive relief to specific areas of pain, at least in the short term, and even to related organs.

Osteopathy has an alternative view of the subluxation, and we call it the lesion. The osteopathic lesion is the stress or strain that has caused the bone to be misaligned or the joint to be rigid in the first place. And it can exist beyond the bone itself, because it involves the entire pattern of influence upon the bone. Importantly, therefore, when you correct the subluxation directly, you do not reduce the lesion, you merely reduce its appearance. In fact removing the subluxation can increase the lesion, because doing so disturbs the most natural equilibrium. In a way, the lesion is there to help us.

An individual bone, joint, segment or other body part is subject to forces from outside. It is suspended within muscles and ligaments, it moves according to the way the body deals with digestion, elimination, movement, immunity, occupation, chairs, beds, habits, stress, hopes, dreams, fears and loves. And all of these influences are external to the bone or joint in question. To correct the localised subluxation and expect the rest of the universe to de-rotate around it is fanciful at best.

And so, specific adjustment is not enough to correct lesions. The effect is the patient can feel better locally but still be stressed generally. And the removal of the compensatory rigidity or misaligment can in fact make matters worse overall. The smart way to loosen a tight joint – and to keep it loose – is to lessen the stress upon it so that movement will be more useful to the body than rigidity. Don’t expect the change to be immediate however, because these are adaptations that take time to happen. Healing is not what the healer does: it is what the body does afterwards.

If all that is confusing, here is an analogy to help. Imagine taking a piece of wire or string and twisting it from both ends. Waves and kinks will start to form along its length. In order to resolve the pattern you have to untwist the whole system. If you go directly to the kinks and tackle them individually, you actually put more stress and strain into those areas, not less.

Treating all the kinks is no good either, it is simply a more comprehensive way to mess up the system. However it can look initially better; just as in the human body, treating the local area of disturbance can bring some relief. But what we need to realise is that in life, our symptoms are actually protective mechanisms and healing processes. The real disease is usually invisible. When we palliate, ie. treat symptoms above all else, we are in effect suppressing the body’s natural responses: we are taking the system out of its lowest energy state and moving it towards an even less sustainable situation. And that is to suppress healing.

The consequences for human health of treating too specifically are not just conceptual: once aware of these patterns, after a few years of observation in practice we can see these progressions in actual patients. Quick and impressive relief is soon replaced by less relief, or chasing symptoms around the body. Eventually it may stop working altogether. An overall degeneration may ensue, which all the while is interpreted as ageing, or unavoidable disease. And the temporary relief obtained after specific treatment is perceived as keeping the patient going, when the broader effect can in fact be to accelerate the decline.

And if we believe that what happens to the organs and what happens to the spine are reflections of each other (they are), then it is only a matter of time before the stress palliated in the posture shows up as stress on the organs. Of course by the time that happens suddenly the ‘holistic’ practitioner is now quite able to say ‘not my department, go and see a doctor for some drugs’, and wash his hands of the whole case.

But these are not exclusively the problems of chiropractic. Treating everything from head to toe does not get around the problem of specificity, and many practitioners of many disciplines treat the body as lots of parts, the idea being that once you get all the parts working the whole thing will work better. That is how I was taught in college, and it sounds reasonable, because that is how you fix a car. But the body does not work like that. In a living system, the parts are all self-maintaining, self healing, self repairing, providing the whole system is supporting them. And so the real aim of holistic treatment is not to do lots of things to lots of different bits of the body, but to get the whole thing in tune and so that the parts can take care of themselves. Only then are we treating the body as a living system rather than as a dead machine.

This is not just a semantic difference, it makes a massive difference in practice. Because chiropractic is nothing if not specific, whereas osteopathy is by definition anything but specific! Treating lots of parts is not the same as treating the whole. The ‘pathy’ part of osteopathy has often been misinterpreted to mean disease (from bone). In fact it is more to do with pathos – sympathy with the bone, understanding its niche in the ecology of our being. As I have explained, the lesion has a context, and it is this ecology which we are seeking to improve. In doing so the lesioned ‘part’ has a more supportive environment, and therefore the lesion is lessened. The body as a whole becomes more comfortable and the lesion is therefore no longer required.

How ‘treating the whole’ becomes real in practice would be an entire course of study. Suffice to say for now, that the osteopath can treat almost anything but the bit that hurts, improving the relationships and coordination of body parts: the chiropractor seeks out the subluxations, corrects them directly, and perhaps deals with the context as a separate matter. And to be fair, many osteopaths see therapy that way as well.

And I am not saying that therefore chiropractic is wrong and osteopathy is right. I am saying I became an osteopath because it makes more sense to me, for reasons I have tried to explain here. I would hope all practitioners have chosen their direction for good reasons of their own. And I hope to encourage patients to think about what sort of practitioner they want, and why.