Do I Need a Chiropractor or a Physical Therapist?

Chiropractic Care

Chiropractors treat musculoskeletal pain, specifically focusing on the back and neck. They practice spinal manipulation, by which they correct subluxations (partial dislocations of the spine) (1). Chiropractic adjustments are based around maintaining and correcting the body’s “alignment.” According to chiropractors, proper alignment can relieve pain and improve bodily functions (2). Chiropractors typically use their hands to apply pressure to joints, which often causes cracking noises (3). These sounds come from gas bubbles popping between the joints.

Chiropractors typically lie patients down on adjustable tables. They then adjust the table up or down in order to stretch out patients' legs, spines, and torsos. Some chiropractors also use equipment such as activators – hand-held devices that issue mechanical shockwaves into the spine (4).‍

Physical Therapy

Physical therapists treat musculoskeletal pain through whole body manipulation and various exercise regimens. They recommend and guide patients through programs designed to stretch, strengthen, and increase balance in the body (5). By helping patients become stronger, more flexible, and more coordinated, physical therapists seek to address pain through increasing blood flow, removing pressure from nerves, and improving posture and movement mechanics (6).

Physical therapists use a range of instruments to treat including equipment for ultrasound, whirlpools, and electrical stimulation (7). Many physical therapists also use standard gym equipment like exercise balls, athletic tape, bikes, and treadmills.

Both chiropractic treatment and physical therapy draw on other physical treatments to complement manual therapy. For example, they may incorporate orthoses (bracing) for some patients, and may recommend X-rays, acupuncture, phototherapy, or ergonomic interventions (8).

Chiropractors generally begin their education by enrolling in a pre-med undergraduate program, in which they take classes on biology, anatomy, and physics. They then complete a Doctor of Chiropractic degree at a chiropractic school, which takes approximately four years. After formal schooling, the National Board of Chiropractic Examiners (NBCE) administers board exams required prior to state licensure (9).

Physical therapists begin with a similar pre-med undergraduate education followed by a Doctor of Physical Therapy degree. After receiving a Doctor of Physical Therapy Degree, which typically takes three years, a therapist may participate in residency or fellowship. Doctors of Physical Therapy can pursue board certifications in various specialties. These specialities include (10):

• Cardiovascular & Pulmonary: Addresses conditions such as chronic (left side) heart failure, hypertension, and cardiomyopathy (11).
• Clinical Electrophysiology: Includes carpal tunnel syndrome, muscular dystrophy, and myositis (12).
• Oncology: Serves patients currently suffering from or recovering from the effects of various cancers and cancer treatments (13).
• Women's Health: Qualified to treat pelvic floor dysfunction, postpartum conditions, and post-mastectomy lymphedema (14).
• Geriatrics: Focuses on conditions such as Parkinson’s disease, osteoporosis, and stroke (15).
• Neurology: Includes traumatic brain injury, Multiple Sclerosis, and Hydrocephalus (16). 
• Orthopaedics: Addresses cervical pain, tendon repairs, and shoulder impingement (17).
• Pediatrics: Serves juvenile patients in acute care, outpatient hospital capacities, and in schools. Pediatric physical therapy can also include equine-assisted therapy and aquatic therapy (18).
• Sports: Specifies in patient care and treatment plans for athletes (19).
  

Both chiropractors and physical therapists must complete continuing education hours throughout their career. The continuing education courses help chiropractors stay informed about updated treatment techniques. Requirements for the number of continuing education hours a practitioner must complete each year vary by state.

In general, physical therapy is used as a first-line treatment for all kinds of musculoskeletal pain. This includes back pain, knee pain, shoulder pain, and neck pain. Chiropractic care is more commonly considered for back pain and neck pain. Your primary care doctor may be able to help you determine treatment options would work for you. In some cases of back and neck pain, visits to both a chiropractor and physical therapist may be helpful.

In order to determine the best type of treatment, ask your general practitioner questions like:

• How has physical therapy/chiropractic care served other patients with my condition?
• Do you generally recommend physical therapy or chiropractic care more often than the other?
• How long should I try physical therapy or chiropractic care before considering the other?
• Should I try physical therapy and chiropractic care simultaneously? 
• Who are your recommended physical therapists and chiropractors? Why do you recommend them specifically?
  

The answers to these questions can help you determine which type of care is best suited for your condition. Additionally, the websites for many physical therapy and chiropractic offices feature patient testimonials, which may be useful to look through. Stories of patients with conditions similar to yours who found pain management plans that worked for them may help you determine which type of practitioner could be the best fit for your needs.

In the cases of both physical therapy and chiropractic care, regular visits are essential for achieving successful outcomes. At the beginning of your treatment clan, your physical therapist or chiropractor may want to see you multiple times a week. Research your options for care with location, cost, and hours of availability in mind. You can find qualified chiropractors through the American Chiropractic Association website, and qualified physical therapists through the American Physical Therapy Association website. In some cases, insurance companies will cover the cost of physical therapy or chiropractic care. Contact your insurance provider to ask for a list of physical therapists and chiropractors who are covered in your area.

Not only will accessible care be necessary for you to follow your treatment plan, it will also help you be as relaxed and calm as possible while working with your practitioner. Anxiety can affect flexibility, strength, and healing, so try to choose a practitioner who makes you comfortable, appointment times that work with your schedule, and a location that’s close to your home or workplace.

For patients who suffer from back pain and knee pain, studies show that physical therapy is more effective than chiropractic care (20). Chiropractic care anecdotally relieves knee pain resulting from osteoarthritis, but the strength of research support for physical therapy in cases of knee pain is significantly stronger (21, 22). Physical therapy is also the standard, first-line treatment for back pain.

Chiropractic care isn’t clearly effective for addressing back pain, and in particular doesn’t outperform placebo treatments for back pain (23, 24, 25). For neck pain, however, physical therapy and chiropractic care appear to have similar therapeutic effects (26).

If you find that neither chiropractic care or physical therapy are providing you with the quality of pain relief you need, there are several other options that you can consider and discuss with a healthcare provider.

Cold therapy – sometimes called cryptotherapy – can be conducted at home by applying ice packs or frozen gel packs to the affected area for 10 to 20 minutes. You may find that placing the item directly on your skin harms your skin, so wrap the pack in a towel first. Elevation and rest tend to aid the effects of cold therapy (27).

Conversely, heat therapy can improve pain tolerance and aid in muscle relaxation, both of which can contribute to pain relief. A warm bath or shower for 15 to 20 minutes may provide positive therapeutic effects. Heating pads, which can be purchased at a pharmacy or online – can also provide comfort, as can homemade heat packs made from microwaving a damp towel. Be careful when applying a heating pad or hot pack as they carry a risk of burning your skin (28).

In the case of neck or back pain, you may find that a belt, brace, or collar provides pain relief. Speak to a healthcare provider about whether you should try a support device and, if so, how frequently you should wear it. While supports can provide relief and be effective, they can cause muscles to weaken as well. Your doctor should be able to advise you on how often you can safely wear a support, and whether an over-the-counter or prescription support would be best for you.

Non-steroidal anti-inflammatory drugs (NSAIDs) come in both over-the-counter and prescription-strength forms, such as COX-2 inhibitors. NSAIDs have proven helpful for all types of musculoskeletal pain, with comparable positive effects to opioids and far fewer side effects (29). Topical NSAIDs like diclofenac gel are particularly effective for joint pain, including knee pain (30).

Muscle relaxants have positive therapeutic effects for musculoskeletal pain, especially when spasms are present or when relaxants are combined with NSAIDs (31). Tricyclic antidepressants can also relieve nerve-related neck and upper back pain, and SSRIs are useful for treating chronic pain (32, 33).

Steroid and anesthetic injections can be effective for relieving neck pain (34, 35). Heat-based injections, also known as radiofrequency denervation (RFD) can also provide short-term pain relief for chronic neck pain. Acupuncture may also be worth a try, as research shows that it relieves neck pain similarly to other courses of treatment (36).

In terms of side effects, NSAIDs can cause stomach pain and heartburn (37). Diclofenac gel shows limited side effects relative to other NSAIDs and may be a good option to consider (38). Muscle relaxants carry risks of fatigue, drowsiness, headache, and nervousness (39). Tricyclic antidepressants may cause irregular heart rhythms and dizziness, while SSRIs can trigger insomnia, headaches, and nausea (40). Speak to a healthcare provider about your family history, as well as your personal clinical history, in order to determine which treatment plan will be safest for you.

Physical therapy and chiropractic care share similarities. However, a key difference when assessing which provider can best help you is the chiropractic focus on manipulation of the spine as opposed to the physical therapy focus on manipulation and exercise of the whole body. In general, the traditional medical community supports physical therapy over chiropractic care. This is also supported by the scientific literature, especially in the cases of back and knee pain.

However, chiropractic care does appear to show comparable efficacy to physical therapy in cases of neck pain. Chiropractic care also does not feature many downsides, so despite the relative lack of research support for chiropractic care as compared to physical therapy, patients can still consider chiropractic care if they so desire.