Sunday, 30 April 2017

Clinical Differences between Chiropractic & Osteopathy

Chiropractic has originated from osteopathy and all chiropractic techniques are essentially osteopathic techniques as well (Dr Palmer, founder of chiropractic was one of the first students of Dr Still, founder of osteopathy). However chiropractors mainly focus on using manipulation (also known as grade five mobilization or high velocity low amplitude (HVLA) techniques) in treating patients. Manipulative techniques are aggressive in nature and have caused a small number of deaths, strokes and other neurological conditions in patients receiving cervical manipulation. 

Manual osteopaths (also known as osteopathic manual practitioners in the states) on the other hand use gentle, non-aggressive repetitive osteopathic manual techniques. These techniques have not caused any death, strokes or serious neurological conditions in patients and as such are quite safe. That is one reason why the malpractice insurance premiums of manual osteopaths are so low.  There has not been any report of death or stroke caused by manual osteopaths. The most common side effect experienced by a small number of patients following osteopathic care is stiffness and soreness in the area, similar to the feeling of muscle soreness after exercising for the first time. 

The techniques used by manual osteopaths include osteoarticular mobilization, muscle energy techniques, strain/counterstrain, visceral manipulation, cranial osteopathy, Still’s, manual mechanotherapy (this techniques, considered the lost technique of osteopathy is taught only at our three schools, the National University of Medical Sciences (Spain), National University of Medical Sciences (USA) and National Academy of Osteopathy - Canada), positional facilitated release, balanced ligamentous tension, lymphatic drainage, oscillatory, myofascial release, soft tissue therapy and other techniques. These techniques use minimum force, are repetitive and gentle in nature. In manual osteopathy being gentle is essential. 

Because of the nature of techniques used, chiropractic treatments last a few minutes and as such chiropractors do not follow a time based treatment protocol. Their sessions are treatment based, without checking the time. Because osteopathic techniques are repetitive they require time and most osteopathic sessions last between 30 to 45 minutes. As such most manual osteopaths work based on time, each session being 30 minutes, or 60 minutes and so on.

In regards to the effectiveness of care osteopathic care is by far more effective than chiropractic care. Research has shown mobilization techniques being more effective than manipulative techniques. This has been observed clinically as well. Osteopathy is well known as being the best treatment available for chronic musculoskeletal pain. A recent research done on 500 patients by University of Texas (published in the Journal of American Osteopathic Association) showed that just 6 osteopathic care (once per week) totally eliminated disability and chronic low back pain in 50% of patients.

A 2012 survey in Canada showed manual osteopathy is the #1 choice of patients with chronic low back pain. Manual osteopaths in Canada have a patient loyalty rate of 97% (the most of all health professionals surveyed). A survey done by a University of Toronto PhD student showed patients in Canada consider manual osteopaths the most trust worthy health professionals, when compared with 25 other health professionals.

I have studied both chiropractic (Canadian Memorial Chiropractic College (CMCC) graduate, 1995) and manual osteopathy. Chiropractic is a great profession and has its role in treating some conditions, mainly acute musculoskeletal pain. However manual osteopathy is a complete, more effective health care system specially when dealing with chronic pain. As it is gentle and highly pleasurable, patients seem to prefer manual osteopathy to chiropractic. 

Chiropractic is scary for most patients.  The crack they hear after spinal manipulation scares them. I had many clinics in the past 22 years. Our manual osteopaths were always fully booked. Once patients receive an osteopathic treatment they most likely remain loyal to osteopathy for life. That is why manual osteopaths have waiting lists of weeks to months but most chiropractors do not. If you open the Yellow Pages you will see many ads for chiropractors but not one ad for a manual osteopath. This is because manual osteopaths generally do not need to advertise. Through word of mouth referrals from happy patients their practices get filled up quickly.

All these result in manual osteopaths having the highest job satisfaction rate of all health professionals in Canada (98% satisfaction rate as surveyed in 2012).

There are many dual degree chiropractors/manual osteopaths as osteopathy is a popular postgraduate program for chiropractors. About 3% of our schools alumni are chiropractors.  

To read about the research mentioned above and many other research proving how effective manual osteopathy is in treating a wide range of disorders please visit my Facebook page called "Osteopathy Related Research and Science".

Thank you for reading this article. 

Shahin Pourgol, MBA, DC, DO, PhD 
Founder & President
Canadian Union of Osteopathic Manual Practitioners 

PS. We are the largest provider of European style manual osteopathic education in the world, teaching in 68 countries. We also teach a number of health related degree programs in physiotherapy, athletic therapy, physical medicine, rehabilitation, massage therapy, naprapathy, pedorthics, sports medicine, business management & botanical medicine. To receive our information package please send an email to


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  3. How much is malpractice insurance for an osteopath for 1,000,000/3,000,000 coverage?

    1. It differs with insurers. It ranges from $250 to $350 per year.

    2. In US it is about $150 per year.

  4. I used it and it really did wonder to my patients! thank you

  5. Unfortunately it is difficult in my experience to find a DO that practices manual osteopathy in the States. I have been looking for 25+ years. Any suggestions?

    1. Yes, true. Out of 80,000 American DOs, only about 700 perform manual osteopathy. However there are about 2000 osteopathic manual practitioners across USA. best is to place a post in the "We Love Osteopathy" Facebook group and maybe an osteopathic manual practitioner near you would contact you. However they are hard to find as they get fully booked quickly.

  6. Can you provide references on the statement of "Manipulative techniques are aggressive in nature and have caused a small number of deaths, strokes and other neurological conditions in patients receiving cervical manipulation." Thanks.

  7. Also interested in the reference regarding the “small number of deaths, strokes... in patients receiving cervicap manipulation”

  8. This post is awesome..i've been reading tons of crap posts from other blogs, but shows you have a more educated reader base.

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