Which Bodyworker? Remedial Massage Therapy vs. Physiotherapy vs. Osteopathy vs. Chiropractic: Explained
/A common question people ask is: “When should I see a remedial massage therapist, as opposed to a physiotherapist, osteopath or chiropractor?”. These bodywork professionals treat many of the same musculoskeletal system conditions, using different approaches, however sometimes one modality is going to be more appropriate for a particular issue. For some more serious issues you will need to see a doctor for a diagnosis first. For example, if you have sudden excruciating pain in your spine following a movement in your spine where you have twisted, then you could go to a general practitioner doctor or to a physiotherapist as this could be a disc bulge or herniation and a massage isn’t going to help. If on the other hand you’ve been working hard in your garden, run a marathon or been fairly physically active, or your work causes muscular tension (whether it’s office work or you are a tradesperson) then massage therapy will be ideal. In these cases massage therapy is also a more cost effective/value for money option, is enjoyable and you have the added benefit of the relaxation response which will melt your stress away. Here I will give an overview of some some bodywork modalities, and outline some differences.
Remedial Massage Therapy
Naturally I’m going to discuss remedial massage therapy in more depth, as this is one of my modalities (I also do oncology, Swedish and aromatherapy massage) and I’m passionate about it. Remedial massage involves assessment and treatment of muscles, tendons, ligaments and connective tissues of the body with the aim to assist in pain reduction, injury management and rehabilitation. If a person has muscular pain/tension or a moderate injury resulting in pain or loss of function, then remedial massage can help to reduce or eliminate pain and restore function. For general tension in the body Swedish massage, aromatherapy massage and other forms of relaxation massage can help so you don’t necessarily need a remedial massage for tight muscles. Blood and lymph flow are increased by massage which may help the body’s cells to heal more rapidly. Importantly, a remedial therapist has a working knowledge of anatomy, physiology and pathophysiology and therefore knows how to assist with many different issues. They also know when they need to refer you for other treatment or to a medical practitioner (as is the case when massage makes no difference to pain).
The body has an intelligence of its own and can heal given the right conditions. I am a remedial massage therapist and my job is to help create those favourable conditions for the body to return to full health after injury or built up tension. In cases of chronic conditions this can take some time and depends on many factors. Importantly if a client wants the most optimal outcomes they need to take charge of their health and engage in functional movement or corrective exercises and ensure that they are looking after their body well nutritionally too.
Each remedial massage therapist has their unique way of treating clients, with some common things we all do. This includes taking a full health history as well as assessing posture and structural alignment. For me, assessment begins as I greet you at the door - I can tell a lot by the way a person moves and this is most helpful as opposed to when a person knows they are being observed. Remedial massage therapists may also test range of motion and function in the affected areas, which helps determine where the target areas for treatment are. We do these tests at the beginning and end of treatment which enables us to assess whether the treatment is working and helps the client recognise the changes that have already taken place. A good therapist will also ask for feedback, as we want to know how the treatment was for you and what, if anything, could be improved.
As for the treatment itself, many different techniques may be used such as deep tissue massage, myofascial release techniques, acupoint or trigger point therapy, Swedish massage techniques, muscle energy techniques and much more. It is very much a hands on treatment. It can also include stretches and exercise prescription. We look at a client’s structural alignment and movement and aim to balance muscle length and may also discuss ways for the client to strengthen weakened muscles which is important for full recovery.
The aim is to restore the body back to a state of balance and it is best if these issues are caught early. There isn’t much I can do about a hunchback aside from pain relief that is experienced due to the “relaxation response” as a result of massage. I certainly can’t make a hunchback straighten! I’m a holistic bodyworker so I look at the body as a whole. Things like nutrition, mindfulness in how we work and perform activities, stretching and daily exercise are important. Lifestyle is important if you want to live a long life mostly pain free. I believe yoga is an important holistic therapy as it stretches, strengthens and there is a meditative component to it - the mind and body are most definitely linked so it’s important to work on your mind too.
Myotherapy
A myotherapist has done further training beyond what a remedial massage therapist initially learns in their training including some things that physiotherapists learn. However remedial massage therapists tend to learn a lot of what myotherapists learn, throughout our career as we are required to continue our professional education every year (at least 20 hours). A myotherapist learns things like cupping, myofascial release, taping, dry needling and rehabilitation exercises during their qualification whereas a remedial massage therapist may choose to study these after their qualification, as part of their continuing professional education. For example, I have done a lot of training in myofascial release and a bit of training in exercises and stretching (plus many years of yoga practice). If you have a particular injury you are trying to recover from then a myotherapist may be able to help you.
Physiotherapy
A physiotherapist provides treatment for people suffering from physical problems arising from injury, disease, illness and ageing. A physiotherapist often treats similar conditions to a remedial massage therapist such as neck pain, back pain, sciatica, carpal tunnel syndrome and so on, however they are also fully qualified and equipped to diagnose conditions and to treat more serious issues. This could include working with people following surgery to help them learn to walk again and gain strength, working with children with cerebral palsy, helping a person adjust to using a walking frame or wheelchair, to management of disc herniation or bulge, bursitis, or tendonitis. Following an operation/surgery, a person may be referred to a physiotherapist to help restore function and strength to muscles. A physiotherapist also has access to electrotherapeutic agents that they may use to treat dysfunction. If a condition is not improving with remedial massage, or if a diagnosis is required, sometimes we will refer the client to a physiotherapist (or a doctor).
Physiotherapists are valuable, it just depends on what your issue is as to whether you need to see one or whether a remedial massage will help. Sometimes clients will see both while they are recovering from an injury (for example frozen shoulder and many other conditions can benefit from massage therapy and physiotherapy).
Chiropractic
Chiropractic treatment uses manual adjustment of the spine to treat musculoskeletal problems throughout the body. It can help treat or manage issues like back and neck pain, as well as headaches and many other issues. Chiropractic treatment focuses on the relationship between structure (spine), and function (nervous system) with the aim to restore and maintain health through the optimisation of this relationship.
Some clients find that seeing a chiropractor and a massage therapist helps their issues greatly as massage therapists treat the muscles and chiropractors adjust the spine. Chiropractors are also trained to recommend exercises to treat and rehabilitate health conditions related to the bones, muscles and joints. They may also provide nutritional and lifestyle advice. Chiropractors are also able to diagnose conditions and order x-rays and other tests to be done.
For a client with restricted movement in the back, where massage therapy alone doesn’t appear to be enough, I may refer them to a chiropractor as spinal adjustments may help. I’ll mention yoga here again as yoga works on the spine a lot - if you aren’t practicing yoga or something similar regularly then your range of motion in the spine will slowly decrease. The yogis say you are as young or as old as your spine, so you want to look after it! A young spine is flexible and injury free. You can increase flexibility by doing yoga regularly - ensuring that you aren’t pushing your body too hard to begin with as you don’t want to cause yourself injury. It is a practice that builds up over time.
Osteopathy
Osteopaths tend to focus on the health of the entire body, rather than just the impaired part. They assess how your bones, joints, muscles, connective tissue, nerves, circulatory system, and internal organs function as a whole body unit. The study of biomechanics means that an osteopath will look at how each part of the musculoskeletal system interacts with and influences every other part. Any joint or muscle injury would be treated as part of the whole body, since they will affect other parts of the musculoskeletal system. Osteopaths treat many issues including back pain, persistent headaches, sporting injuries, vertigo, tendonitis and so on.
Osteopaths tend to use gentler massage techniques in comparison with physiotherapists and they also prescribe stretching and exercises. They may also do spinal manipulation and visceral (abdominal/pelvic) manipulation. The aim of treatment is to support the body’s self-healing capacity which is the same philosophy of massage. In my humble opinion, osteopathy appears to be a step beyond physiotherapy, (it is a five year degree opposed to four years for physiotherapy) and is also more holistic which is aligned with the way I view the body. Of course it depends on the therapist, as with anything health related the therapist needs to suit the client. I would recommend it for persistent issues that are not responding to remedial massage therapy and appear to require further treatment. As with all of these other therapies, you can see an osteopath and a massage therapist as they are complimentary therapies - you don’t have to exclude one for the other.
Common issues and which therapy to use first - a general guide
This is by no means a complete list, and opinions can differ. It really is a personal choice who you see for what issue. Sometimes you may need to visit your general practitioner doctor first to see what they think the issue could be as sometimes massage or other bodywork isn’t going to be appropriate. For example cramping or pain and swelling in the leg could indicate deep vein thrombosis which can be serious and massage can make it more likely for the blood clot to move so you would want to get that checked out before seeing a massage therapist. This is one of the few contraindications for massage.
Extreme pain in spine - possible disc bulge or herniation: go to a G.P. or physiotherapist for diagnosis first, follow their advice. For ongoing management of pain, massage can help in conjunction with strengthening exercises prescribed by a physiotherapist.
Sciatica (shooting pain down legs) - see a remedial massage therapist or myotherapist first to see if that helps.
Muscular pain/aches/tightness - remedial massage therapist.
Chronic back pain that has already been treated by a remedial massage therapist/myotherapist or physiotherapist several times: try an osteopath and see a G.P to rule out other possible causes.
Post surgery muscle weakness/atrophy: physiotherapist or osteopath.
Issues with spinal alignment/stiffness/stuck vertebrae: chiropractor.
Back pain with limited range of movement: chiropractor and remedial massage therapist/myotherapist.
Vertigo: see an osteopath.
Serious Injury rehabilitation (something beyond a muscle strain): physiotherapist or osteopath.
Headaches: remedial massage therapist/myotherapist or aromatherapy massage therapist (essential oils are great for headaches).
Insomnia: remedial massage therapist/myotherapist or aromatherapy massage therapist (essential oils are great for sleep issues).
Arthritis: remedial massage therapist, aromatherapy massage therapist (some essential oils are good for arthritis) and see a naturopath for nutritional advice.
Whiplash: for initial treatment I would recommend seeing a physiotherapist for a period of time. For regular treatment (whiplash can take a long time to fully repair) you can start seeing a remedial massage therapist who has training in whiplash recovery, a myotherapist or an osteopath.
Muscle or ligament injury: importantly if this is a fresh injury, such as muscle strain or a ligament sprain (e.g. sprained ankle), wait at least 72 hours prior to seeing a remedial massage therapist, physiotherapist or osteopath unless you suspect you have a broken bone too. This is because we cannot work on a fresh injury. Instead you will need to apply R.I.C.E: rest, ice (20 minutes on, 1 hour off only while awake and don’t put the ice directly on skin use an ice pack wrapped in a tea towel to avoid ice burns), compression (wrap it but not too tightly), and elevate above the level of the heart. If you are unsure whether to come in for treatment feel free to call first. It’s better to do that than waste time coming for treatment too soon when you need to apply R.I.C.E. Don’t rub your injury or use heat on it for at least 72 hours and avoid alcohol. However, if you suspect you have broken a bone, or it is a serious sprain (ligaments) or muscle tear you should see a physiotherapist early on to start treatment or assess the situation. It just depends on the severity of the issue. A massage therapist isn’t going to touch a fresh injury, especially if you are unsure of what you have done so sometimes you need to go get a diagnosis first.
Unexplained Pain
What if you have been to all of the types of therapists and have pain that will not go away? Please go and see a medical practitioner. Sometimes organ pain can refer and feel like muscular pain so it’s worth checking it out to make sure there isn’t something more serious going on.
Sometimes pain can originate in issues with the mind and emotions, so sometimes holistic counselling can help too. However it is best to see a medical practitioner first to rule out physical issues or get a diagnosis so if you have something serious you may receive early treatment. Then you can see a holistic counsellor along with having medical treatment. Emotional/mental support is just as important as physical treatment. If the doctor finds nothing then receiving counselling can/may clear the issue.
Other Important Matters
Each therapist is unique with different strengths and weaknesses so experiences of these modalities can vary greatly. It is usually the passionate therapists who like to learn who get really good at their profession, whatever their chosen modality is. So if you have had a bad experience with a physiotherapist it doesn’t mean all physiotherapists are bad. Worth saying as us humans have a habit of making sweeping judgements! When some people have talked about a massage they didn’t enjoy and I have enquired further into this, it turned out that the “massage therapist” was not qualified and did not represent the profession at all. In Australia massage therapy is not licensed (so is unregulated) and the closest we have to licensing are Professional Associations. An Association membership means that the massage therapist follows a code of ethics, that they have completed recognised qualifications and are continuing their education each year.
An important thing to consider when seeing any health practitioner is how they make you feel. Research has shown that patients who trust a health practitioner have better outcomes. So whoever you go to, ensure that you feel comfortable and safe with them, and it is reasonable to assert here that this is especially the case if the person is going to be touching you.
Since starting my massage therapy studies over eleven years ago I have realised that there is endless learning ahead of me, which is exciting. It means I get to keep expanding my skills while I keep up to date with the most effective treatment techniques explored through research, my clinical practical experience and the expertise of massage therapists and other bodyworkers who share their knowledge and skills. There is so much to know about the human body, and so many effective techniques. On top of this strong skills are required to work with many different people with different issues, taking into account physical weaknesses people may have and how people’s nervous systems are wired, including trauma. Every year I undertake further studies to expand my skills in these areas. If you are interested in booking a massage therapy session with me feel free to call me or book online.
Thanks for reading,
Belinda
References/Research Articles
Birkhäuer J, et al. Trust in the health care professional and health outcome: A meta-analysis. PLOS one Journal. 2017 February. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295692/ “Overall, we found a small to moderate correlation between trust and health outcomes”
Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 2017 April. https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice?_ga=2.241439106.1819608636.1552814228-1559584666.1552814228 “…clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation…”. “For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation…”
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