PT v. Chiropractic


"Can't you just crack it back in?"

What's the difference between PT and chiro?

That's like asking one Pennsylvanian the difference between PA and all of the West Coast. There are plenty of similarities, for sure. I've read much about various chiropractic philosophy. I've even visited a local chiro just to experience what goes on there. But I haven't been trained in the way.

I do know that all physical therapists are not the same, and can only assume it’s no different with chiros. Surely some are better than others. Here's my typical answer that attempts to appeal to common-sense perspective.

What's the story?

Do you know what elite orthopedists and researchers label most cases of spine pain? They call it "nonspecific." No joke! While stubborn back and neck pain remains a mystery to most everyday people, clinicians are armed with X-rays, MRIs, clinical tests, and pertinent medical history information. With all this, the top dogs of medicine readily acknowledge that we often can't be certain of exactly what’s causing the pain.

Pain that improves (or worsens) with different movements, activities, or positions is often mechanical in origin (i.e. from moving parts of the musculoskeletal system as opposed to an infection, kidney stone, etc.). Most cases of mechanical pain are treatable, or at least manageable, without resorting to surgery.

The first question then, is not "what exactly is causing the pain," but "what, if anything benefits the pain?" Medications, lotions, nutritional supplements, and ultrasound do not get to the root of a mechanical joint problem. Diagnostic imaging and a label (sciatica, stenosis, etc.) rarely tells you if the problem will respond to treatment, much less the best treatment.

While other general labels like subluxation and muscle strain may feed your hunger for a label, they often lack reliability and do nothing to help you get dressed and drive to work without feeling miserable.

Subluxed Jelly Donut

Just Fix It?

In the end, only you can really help yourself. If modalities like massage or electric stimulation have failed to provide lasting relief, they are not getting to the root of the problem. Traction/decompression and spine manipulations are often beneficial. But why should you remain better from these if you do nothing to function differently outside the clinical setting? What happens once you get up off the treatment table?

There's at least a few things you should always be doing:

1. Specific stretches or other corrective exercise to reinforce the PT or chiropractic manipulation/mobilization.
2. Identify and practice new movement patterns.
3. Strengthen the legs and core muscles in a safe and functional manner.
4. Train your body in ways that improve on weak areas without irritating the problem.

Who's this about, anyway?

Is the primary goal to help you manage your health or to wow you with mad cracking skills? Manipulations have merit, but they should not be given to everyone with pain in order to deliver it to the few who really need it. What if you can drastically improve your chances of staying better? If it’s possible that you can treat the problem yourself with some coaching and guidance, would you not like to fully explore that option?


It only makes sense that forceful manipulations do carry some risk, especially in the neck area. If a manipulation is needed to restore movement or alignment, it's also likely that manipulating with the wrong technique or direction can cause harm.

YIPES. THIS is not a representation of all cervical manipulations, much less all chiropractors. But still - YIPES.

I don't know the entire story behind this forceful neck cranking. But I imagine that the last thing this sedentary young lady needs is someone whaling to "fix" the already loose segments of her upper cervical vertebrae.

It takes a little more time to build forces in a gradual manner. But along the way, you may learn that you didn’t need forceful cracking. Just because something cracks does not mean it was "out" to begin with. Test that theory on your knuckles.

That's All Good, But My Back...?

All health care clinicians are called to humbly acknowledge the limits of their services, to foster patient independence and ownership of their health, and to explain the rationale behind treatments. Any clinician that attends to these concerns is probably a good one. In my practice, I’ve had the privilege of helping many, but certainly not everyone. Some people respond better to fruit smoothies and a hot shower than they do to chiro or PT.

With an active role in treatment, you're absolutely more likely to stay better without needing to be "fixed" three times per week for the rest of your life. At the very least, you learn something about your body and the limits of conservative care.

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