As someone working in the physical therapy world, I often get asked what’s the difference between all the physical therapists out there? I generally get asked this question because patients are trying to decided which one they are going to see, which one would ‘work best,’ or there really is just some general confusion between what they all do and what they all treat.
The answer in short, is each field has it’s own history and approach to assessing, diagnosing and treating your body. Just like most of us have a general practitioner we have come to trust, a physical therapist that you use to whatever extent throughout your life is something unique to each person.
So if you’re wondering where to start, here are some common physical therapy fields I am asked to differentiate from each other, a bit about their history and what to expect in a session with each.
Remedial Massage Therapists (RMT’s)
RMT’s are trained to assess and treat conditions of the musculoskeletal system and may provide varying levels of advice for at home exercise and care.
A session with an RMT could include deep tissue and soft tissue manipulation, various forms of other tissue manipulation techniques (cross-fibre, myofascial release) and in some cases dry needling.
Currently in Australia there are three certification levels for RMT ranging from Cert IV’s, to Diplomas, to Advanced Diplomas. With five main leading bodies that govern RMT’s in Australia, there is a lot of variance in the field and what you may get out of each therapist. Some may be more sports massage oriented, while others work more in the rehabilitation field, all the way down to just general population work in private practices.
It’s important to note, remedial massage was the original stepping stone of Physiotherapy, as physiotherapy was originally governed by and performed under the ‘Australasian Massage Association’ in 1906. It wasn’t until Physiotherapy started to distinguish itself from remedial massage in 1939 and changed to The Australian Physiotherapy Association. This then progressed on to being a degree certification, with the first Physiotherapy degree in Australia being on offer in 1950. (“Choose physio | Australian Physiotherapy Association”, 2020).
If we go even further back in the history books, Per Henrik Ling (1813) a man of Swedish decent, first documented and made massage and specific corrective exercises poignant in a persons healing. This is why ‘Swedish massage’ techniques are foundational and still taught in massage today.
Physiotherapists
The Australian Physiotherapy Association defines physiotherapists as people who are trained to ‘assess your condition, diagnose the problem and help you understand what is wrong.’ (“Choose physio | Australian Physiotherapy Association”, 2020)
They also state the many different aspects and specialties that lie within physiotherapy practice, some specializing in pelvic floor, sports injury management and performance, disability, pain, neurological and orthopaedic as some of the many listed. (“Choose physio | Australian Physiotherapy Association”, 2020)
A session with a physiotherapist could include; soft tissue manipulation, exercise prescription, dry needling, hot/cold therapies, joint manipulation, hydrotherapy and assessment and assistance with aids/splints. (“Choose physio | Australian Physiotherapy Association”, 2020)
As stated before, physiotherapy first landed in Australia in the 1950’s and distinguished itself from the origins of massage via climbing educational ranks to degree certifications only. For you as the patient, this means physiotherapists are trained specifically to rehabilitate the body as a whole and can specialize into even more specific areas as mentioned above.
Osteopaths
‘Osteo’ means ‘something relating to bone’ and therefore directly translated, means a therapist that works on/with bone.
Osteopathy Australia defines osteopathy as therapists that are trained in musculoskeletal and nervous system assessments, manual therapy; clinical exercise programs; and movement, postural, positioning advice and ergonomic assessments. They may also offer therapeutic needling techniques like dry needling, trigger point therapy or acupuncture. Your osteopath may also offer ongoing support and educational advice about your lifestyle, stress management, diet or other factors that may influence your pain, injury or movement. (“Osteopathy Australia’s collection of resources on osteopathy in Australia.”, 2020).
Osteopathic medicine has it’s origins dating back to 1874, when an American physician known as Andrew Taylor Still believed that remedies for diseases are available in the correctly adjusted body, obtained through manipulative techniques and concomitant medical and surgical therapy. This notion is still in the foundations of osteopathic medicine and very in-line with what modern Western medicine seems to be adapting toward, the biopsychosocial health model. This model ascertains that all the social, psychological/emotional and biological/chemical facets of health interact with each other and need to be addressed inclusively of each other in order to effectively rehabilitate a condition.
Chiropractors
‘Chiro’ means ‘of the hands’ and references the manual therapy approach to treating your body as a whole. Most modern physical therapists (and some biomedical practitioners including surgeons, general practitioners, etc) have since accepted and adopted the aforementioned biopsychosocial model of health, but Chiropractors were one of the earlier professions that were thought to be more inclined towards the biopsychosocial model of assessing and treating ailments. Because chiropractors did this with their hands much like a general practitioner would, the name ‘chiro’ meaning hands combined with ‘practitioner’ came to form the term ‘Chiropractor.’
The Australian Chiropractic Association defined chiropractic work as ‘a drug and surgery free modality of treatment concerned with the diagnosis, management and prevention of mechanical disorders of the musculoskeletal system (spine); this includes the effects of these disorders on the function of the nervous system and general health.’ (“Chiropractic and You – ACA”, 2020) Additionally, the association states chiropractors ‘focus on the detection and correction of abnormal spinal function and its subsequent effect on how the nervous system controls and coordinates the body.’ (“Chiropractic and You – ACA”, 2020).
A Canadian born man known as Daniel David Palmer is believed to be the founder of Chiropractic care and opened a school teaching chiropractic care in 1897. Chiropractors are one of the more controversial physical therapists to date, even in it’s origin stories Daniel David Palmer was placed in jail (1906) for practicing as a medical practitioner without a license in Iowa. Much like in osteopathy, the body system is treated as a whole and it is underpinned with that fact that if the body is assessed and treated accordingly it has it’s own ability to heal, however, some modern-day controversy still exists within the field as some believe this is the optimal way to treat and other biomedical interventions are lesser or even harmful and to be avoided.
It is my personal opinion from being mentored from some incredible Chiropractors in my junior years and working as part of a patients healthcare team alongside Chiropractors, that the opinions of some across any field should not out weigh or detract from others.
Myotherapists
‘Myo’ means ‘of muscle’ or ‘something related to muscle’ therefore, directly translated myotherapist means muscle therapist.
The Myotherapy Association Australia describes myotherapy as ‘the evidence-based assessment, treatment and rehabilitation of musculoskeletal pain associated with conditions.’ (“What is Myotherapy? |,” n.d.) Myotherapists can be diploma based or degree based certifications and you may notice some myotherapists adopt ‘Clinical’ in front of their title to distinguish the difference, as they hold degree certification. A session with a Myotherapist may include: deep tissue and soft tissue massage, dry needling, electo-dryneedling, TENS application, joint mobilisation, hot/cold therapies, pain education and exercise prescription.
Janet Travell is generally credited for pioneering myotherapy by bringing to the attention the existence of myofascial trigger points to healthcare workers when she worked in a cardiac ward in the 1940’s. It is debatable even then as to if this is the origin of Myotherapy, as right up through to 1999 where Janet Travell published two volumes ‘The Trigger Point Manuels’ with Dr. David Simons, she never recorded manually handling or treating trigger points and formed her works on observing clinicians. Bonnie Prudden in the 1970’s first coined the phrase ‘myotherapy’ and later published a series of her manual therapy work involving trigger points.
Myotherapy really only started to come into practice only 15 or so years ago in Australia. (Myotherapy Association Australia, 2019). The first university in Victoria to get accreditation for a degree in Clinical Myotherapy was Southern School of Natural Therapies in 1981 and the course was initiated in 2003.
So there you have it, the history of common physical therapists and how each came to be.
(Fun fact, they are written and order from earliest discovery to most recent!)
The take away from this I hope is that each has their own back story and yes, in some cases do overlap each other as they came as branches off of each others own scientific significance. For example, RMT and physiotherapy developed from massage and from massage, RMT, physiotherapy and trigger point work, myotherapy was born. It’s also interesting to see the early foundations of biopsychosocial healthcare models deriving from both osteopathic and chiropractic medicine.
As a patient I encourage you to have a look at what physical therapists are around you and now that you understand a bit about what each field does (Am I right? Here’s hoping!), give them a try and ask all the questions! Curiosity will fast track your journey to finding the right fit.
Wishing you all health, wellness & success,
Jess Jelleff
BhSc Clinical Myotherapy
CEO of Affinity
Reference:
What is Myotherapy? |. (n.d.). Retrieved April 16, 2020, from https://www.myotherapy.org.au/find
a-myotherapist/what-is-myotherapy/
Osteopathy Australia’s collection of resources on osteopathy in Australia. (2020). Retrieved 14 August 2020, from https://www.osteopathy.org.au/about-osteopathy
Chiropractic and You – ACA. (2020). Retrieved 14 August 2020, from https://www.chiro.org.au/patients/about-chiropractic/chiropractic-and-you/
Choose physio | Australian Physiotherapy Association. (2020). Retrieved 17 August 2020, from https://choose.physio/what-is-physio
Image Sources Ordered in Appearance:
https://upload.wikimedia.org/wikipedia/commons/8/8f/Pehr_Henrik_Ling.jpg
https://upload.wikimedia.org/wikipedia/commons/a/a1/Photographic_portrait_of_Dr._Andrew_Taylor_Still%2C_Winter_1903_Wellcome_L0040491.jpg
https://upload.wikimedia.org/wikipedia/commons/a/af/Daniel_David_Palmer.jpg
https://commons.wikimedia.org/wiki/File:JFKWHP-AR6661-E(1).jpg
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