Physical Therapy vs. Chiropractic Care: A Comparative Analysis for Back Pain Relief

Hot Take:

So, there I was, swiping through my Instagram feed (@TheraXPro), when suddenly, I started getting inundated with videos of chiropractors adjusting/manipulating their patients' backs. The cavitations were loud, the views were in the millions, and the comment section was saltier than the rim of a margarita glass on February 22nd. Google it if you don't know! 

Why are people so salty, you may ask? It has to do with the ongoing turf war between physical therapists and chiropractors regarding expert opinion and rights to specific interventions. I decided to do a deep dive into this unceasing dispute and summarize my findings below. To help narrow the parameters, I specifically looked into back pain... which did not narrow it at all. Grab some popcorn and cue the music, and let's see if we can turn those salty margaritas sweet.  

Introduction:

Back pain is a common ailment that affects millions of people worldwide. When seeking relief from back pain, individuals often consider two primary options: physical therapy and chiropractic care. Both approaches have their merits, but they differ significantly in their methods, philosophies, and treatment outcomes. In this blog, we will compare and contrast physical therapy and chiropractic care as methods for back pain relief to help you make an informed decision about which approach may be more suitable for your specific needs.

Physical Therapy:

Physical therapy is a healthcare discipline that focuses on improving a patient's physical function, mobility, and overall quality of life. When it comes to back pain relief, physical therapists use evidence-based techniques to address pain, improve strength, flexibility, and promote long-term recovery.

1. Evaluation and Assessment:

   - Physical therapists conduct a thorough assessment to identify the root cause of back pain, considering factors like posture, muscle imbalances, and overall biomechanics.

2. Treatment Techniques:

   - Physical therapy typically employs exercises, stretching routines, manual therapy, and modalities like heat or ice to alleviate pain and improve function.

   - Exercises are tailored to the individual's needs, targeting specific muscle groups and addressing weaknesses, the nervous system, or imbalances.

3. Education and Lifestyle Modifications:

   - Patients are educated about ergonomics, posture, and proper body mechanics to prevent future back pain episodes.

4. Evidence-Based Approach:

   - Physical therapy relies on scientific research to guide treatment plans, ensuring the effectiveness and safety of interventions.

PT Summary:

Physical therapists approach back pain by identifying the problem and developing a plan of care for a long-term solution. Chronic back pain can be a debilitating obstacle in which patients may not feel comfortable approaching exercise and movement. It requires a tremendous internal locus of control to be adherent to physical therapy, especially when pain is the culprit. A good clinician should be prepared to explain that relief may not be instantaneous and utilize communication strategies to help motivate the patient to continue to move!  

Chiropractic Care:

Since I am not a chiropractor, I utilized two primary sources when defining the role of chiropractic care - Evaluation of United States chiropractic professional subgroups and Associations between demographics and clinical ideology, beliefs, and practice patterns.  

Chiropractic care is a complementary and alternative healthcare discipline that focuses on diagnosing and treating musculoskeletal issues, and can be divided into one of three subgroups: 1) A group focused on correcting spinal subluxations to free the body’s self-healing capacity. 2) A group focused on spine and musculoskeletal conditions. 3) A group focused on primary care or specialties dealing with a range of conditions beyond the spine.

1. Evaluation and Assessment:

   - Chiropractors perform spinal assessments to identify misalignments or subluxations, which they believe can be a source of back pain.

2. Treatment Techniques:

   - The primary technique in chiropractic care is spinal manipulation or adjustment, where the chiropractor uses controlled force to realign the vertebrae.

3. Holistic Approach:

   - Chiropractors often emphasize the importance of spinal health and its role in overall well-being.

4. Symptom-Centric Approach:

   - Chiropractic care typically focuses on treating the symptoms of back pain, and the treatment plans are often shorter-term in nature.

Chiropractic Summary:

I am not a chiropractor, but after my deep dive, I've realized that it's crucial for chiropractors to maintain a holistic perspective, considering the interconnectedness of the musculoskeletal system and the impact of lifestyle factors on back health. A patient with significant pain may opt for a more passive intervention to give them relief. A patient might fear exercise and movement and prefer a skilled chiropractor to provide hands-on techniques to relieve pain. This requires a greater external locus of control from the patient than previously described in the PT summary. Collaborating with other healthcare professionals when necessary ensures a well-rounded approach to managing back pain. 

Comparing and Contrasting:

1. Philosophical Differences:

   - Physical therapy takes a long-term approach, focusing on improving overall physical function and addressing the root causes of back pain.

   - Chiropractic care places a significant emphasis on pain modulation through spinal adjustments to allow for immediate relief.

2. Treatment Duration:

   - Physical therapy often involves a longer treatment plan that may span several weeks to months.

   - Chiropractic care often results in shorter-term treatment, with patients typically receiving more frequent adjustments.

3. Evidence-Based Practice:

   - Physical therapy relies on a strong foundation of scientific research and evidence.

   - Chiropractic care is more variable in its scientific support, with some techniques having limited scientific backing.

4. Patient Involvement:

   - Physical therapy often involves active patient participation in exercises and rehabilitation.

   - Chiropractic care is more passive, with patients receiving treatments primarily from the chiropractor.

My Conclusion:

The choice between physical therapy and chiropractic care for back pain relief ultimately depends on your personal preferences, the underlying cause of your pain, and the treatment philosophy that aligns with your values. Physical therapy offers a comprehensive, evidence-based approach that focuses on long-term results and patient education. The potential drawback is that the patient must be motivated to do the work (I.e., Exercise and move!). Chiropractic care, on the other hand, may provide quicker relief for some individuals, particularly if they believe their pain is related to spinal misalignments.

If only PTs and chiropractors were Planeteers that could aim their rings at the sky and there comes Captain Pain-relief! It seems silly, but my deep dive has helped me conclude that chiropractors are great for short-term pain modulation strategies. BUT, if the patient does not capitalize on that relief by treating the underlying cause, it could become a zero-sum game. That is where the PT could come into play. This could be the potential power of an interdisciplinary approach.  

It's important to consult with healthcare professionals and discuss your specific needs, preferences, and medical history to make an informed decision regarding the most appropriate approach to alleviate your back pain. Ultimately, both physical therapy and chiropractic care have their merits, and the right choice depends on individual circumstances.