What is a difference between osteopathic and chiropractic manipulations? What is a physical therapy?

In the US, very few osteopaths practice regular manipulation anymore…it still happens, but is far more common in Europe. In the US, osteopathy has moved more towards mainstream medicine.

A physical therapist is a medical professional who emphasizes and evidence based approach to restoring function. The range of treatment options in physical therapy range from strengthening, stretching modalities and manual therapy, with or without manipulation.

As far as manipulation, itself, the difference isn’t necessarily between the different practitioners, but rather between theory and application. All three receive training in HLVA (high velocity low amplitude manipulation) techniques and many use similar types of techniques, the "dog" technique for example. Although it is now a requirement for all PT students to receive training in manipulation, there are some states that restrict PTs from administering it…even for those who have completed residencies in manual therapy.

There are other types of manipulation that any one of these can perform but may be more or less likely to be practiced by one type of professional or another. "mobilization" usually refers to a low velocity, but high or low amplitude maneuver and is used very frequently by PTs. Craniosacral therapy is a type of "manipulation" (I use that term loosely) where the "rhythms" of a body are manipulated…can be done by any one of the professionals who have trained in this. "Viseral" manipulation refers to a movement of the internal organs.

One of the major differences is in how manual therapy is applied. The way most chiropractors practice is on the "sublxation theory." This theory states that either all diseases in the body ("straight chiropractic") or at least musculoskeletal issues (mixed chiropractic) are caused by "subluxations" of the vertebrae (or other joint). Chiropractors take many x-rays to "look" for a subluxation; and then apply manipulation to "correct" them (however, they do not take post treatment x-rays to see if that is, indeed, what they have done). The validity of a "subluxation" continues to be questioned and may often be treated unecessarily or may be trying to correct a "normal" variant in joint position. A few chiropractors follow other methods of deciding how/why to apply a manipulation, but this is the most common among practitioners.

Manual therapists outside of chiropractic also have other ways of deciding how to apply manipulations. Physical therapists such as Stanley Paris have historically taught that "positional" faults can be felt with the hands and, when combined with observation for loss of motion this plays into the decision on whether to apply a manipulation. However, this, too, has been found to have poor reliability.

Other manual therapists in PT such as Maitland, McKenzie and others promote the use of manual therapy based on a logistical pattern of symptom behavior…both historically and what happens symptomatically with movement. The ability to "classify" patients into categories for those who would benefit from manipulation is a growing trend in manual therapy and is supported by a generous amount of studies. Looking for a collection of signs and symptoms and historical vignettes is a much more reliable way in which to administer manual therapy…however, the technique the manipulation can include almost any type of technique. To further complicate matters, research has shown that manipulation at a "specific" level is no more effective than a "general" manipulation…somewhere within the affected area, but not specific to a certain segment. This is in contrast to what most chiropractors who practice the subluxation theory.

It’s this latter approach to manual therapy that is most common in physical therapists, however, many chiropractors and osteopaths are following suit.

..in the end, as far as techniques themselves, we all borrow from each other