Chiropractic care and physical therapy both work to naturally heal the body. The main difference is that physical therapy focuses more on rehabilitating specific areas of the body whereas chiropractic care focuses on overall body function and nervous system health by aligning and correcting the spine.
Could you start by explaining the major philosophical difference between chiropractic care and physical therapy?
Dr. Gregg Rubinstein: That’s an excellent question and one that definitely needs explaining. Chiropractic is a science, an art and a philosophy. The philosophy of anything is pretty much the why you do what you do. The art in chiropractic is how you deliver the adjustment or the service, and the science is all the research that’s behind it.
Chiropractic has a very specific philosophy and a why. As far as I can tell, I don’t really know that there’s a specific philosophy in physical therapy, but typically when you look at physical therapy, it’s usually rehab-based after an injury or an accident or something like that. It’s typically where they shine. So, if I tore my rotator cuff, I don’t necessarily want to go to a chiropractor first. I want to check out a physical therapist who’s an expert in rehab.
Of course, my body will respond better to the care if my spine is aligned and my nervous system is optimized and we have better mechanics, but the chiropractor really isn’t the rehab doctor. Although some doctors do like to do that type of rehab, I like to stay in my lane and let the physical therapists be physical therapists and let the chiropractors be chiropractors.
That major premise in chiropractic is really that the body is intelligent and it runs and regulates itself, and as long as there’s good communication from the brain to the rest of the body, that should all work fine. But what chiropractors look at are these vertebral subluxations or the misalignments of the spine, and when those bones get out of alignment, they pinch or irritate the nerves, and that can cause interference or static in the lines of communication from the brain to the rest of the body.
So, in reality, chiropractors aren’t really spine doctors, but we’re really working more with the nerve system. And since that nerve system is the master system that controls every other system in your body, in order for you to be healthy, the pathway needs to be clear from the brain to the body. And when it’s compromised, we have diminished nerve system function, which always leads to slower healing and poorer health.
Typically, when someone goes to a PT, they’re almost always told that their back is weak and that they need to strengthen it, but the issue that I see a lot of times is that if you start strengthening a spine before it’s properly aligned, you can actually build that problem into the spine or build that aberrant pattern into the spine and it can continue to have problems later.
So, I always look to correct the alignment first, then work on the flexibility so it doesn’t get injured in the first place. Lengthening the muscles will also help keep the bones lined up, as the more relaxed the muscles they are not so tight and they don’t keep pulling the bones out of alignment.
In summary, a chiropractor can certainly help with back pain and neck pain and headaches, but keeping your spine healthy and keeping the nerve system optimized is truly the chiropractor’s sweet spot. I refer almost all of my rehab to physical therapists because that’s truly what they are trained to do.
What is different in the treatments or the techniques that each use in their practice?
Dr. Gregg Rubinstein: So, as I alluded to before, a physical therapist will diagnose and treat a specific problem. Typically, you’re going to use a lot of different modalities like heat, ice, stim, and lasers. They sometimes do massage and stretching and strengthening exercises.
Chiropractic is much more holistic in nature, and it’s not really treating a specific problem, but we’re detecting and removing those misalignments in the spine. When you remove the subluxations or those misalignments, you’re optimizing the nerve system so the body can heal, run and regulate itself better.
The primary modality in chiropractic is the specific chiropractic adjustment with one simple goal in mind, to remove interference, restore normal communication so the body can heal, run and regulate itself as it always has done. That intelligence that we’re born with runs in every stage of growth and development and then it runs and regulates our body throughout our lifetime. So, it’s so important to have a healthy spine since it really protects your central nervous system.
If someone is in pain and looking for relief, how would they determine who to call first, a chiropractor or a physical therapist, or would they be treated by both, one after the other?
Dr. Gregg Rubinstein: It’s really to the individual to choose how they treat their health and manage their health problems. I believe people always have the right to choose what they do to themselves and what they put into their bodies. And when it comes to prevention and keeping your spine and nerve system healthy, I would always choose chiropractic hands down over anything else.
Chiropractic stands alone in what we do. And yes, chiropractic is very effective in helping people with musculoskeletal injuries like back pain and neck pain and headaches. And it just makes sense that if the spine is better aligned, the better it functions and the less irritation you’re going to have to the nerve system, but that’s not where the chiropractor job ends.
The body heals by replacing damaged cells with healthy new ones, and all of those functions are neuro regulated. So, if the messages are disturbed by those misalignments irritating the nerve and don’t get through, the body’s abilities to heal itself are compromised. And that’s why people with damage to their nerve system like quadriplegic, paraplegic have trouble healing and the nerve system connections are basically shut down or limited.
Any area of the body that doesn’t have proper nerve supply will not and does not heal. And when you think about it, if someone’s paralyzed and you look at their legs, their legs are super skinny because without that nerve energy, the cells start to die off. So, when the spine is misaligned or subluxated, the nerve system isn’t optimized and the body’s inherent recuperative power is diminished.
Seeing a chiropractor is going to be good regardless of what type of injury you have, and it certainly can be done in conjunction with physical therapy. And it doesn’t really matter what condition you have when you see a chiropractor. You can have herpes, headaches, or a hangnail, it doesn’t really matter. You’re always going to be better off with chiropractic in your life as part of your healthcare team.
So, you come to the chiropractor to keep your spine and your body healthy, and you use PT when you need rehab from recovering from a surgical procedure or a torn muscle or a torn ligament. Typically, you’ll see the orthopedist or a medical doctor and they’ll hand you a prescription for either drugs, surgery recommendations, or physical therapy. And I always recommend trying the natural options first because the drugs and surgery options will always be there after you’ve exhausted the natural ways if they’re not working for you. So that’s really what I look at.
And so, you get to choose, but if I’m rehabbing a knee and ankle or I’m post-trauma, usually the physical therapists are very well-trained to do that. You can work in conjunction with a chiropractor to make sure that the spine and nerve system stay healthy, but really, chiropractic stands alone as well.
So, it’s really up to the individual to choose depending on what type of problem they have. I like to use physical therapists for rehab for my shoulder, and when my knee was banged up, but for general spine care, I think that the chiropractors are the best trained, have more experience doing the spinal adjusting, and that’s where I like to recommend.
Generally speaking, do both chiropractors and physical therapists require the same amount of education and licensing in order to practice?
Dr. Gregg Rubinstein: Especially more recently, the chiropractors have always had a doctorate title, but the physical therapist recently came up with this DPT, which is a Doctor of Physical Therapy. And what’s cool about that is they no longer require the referral of a medical doctor or an orthopedist in order to do their work.
But we are basically similarly educated in anatomy and physiology. But what happens is, is that as the practical techniques come in, chiropractors are going to focus on the spinal adjusting, and then the physical therapists are going to focus on the rehab, the exercises and the different modalities and techniques.
The education is similar and both now carry that doctorate degree. So, I would say that the education is pretty solid in both camps. I would never disparage their education. They know an awful lot about rehab and they truly are the rehab experts.
Lastly, could chiropractic care be considered more proactive to help prevent injuries and physical therapy more reactive for after an injury?
Dr. Gregg Rubinstein: Absolutely. I would say that certainly is a fair statement. And some physical therapists are better than others and they work hard to keep the body strong and flexible, which is always a good thing, except in the incidents of strengthening the spine before it’s correctly aligned, which is where I do have a little bit of a different opinion.
But only a chiropractor is able to check and adjust a spine to remove pressure from the nerves as they exit the spine, and really detecting and removing the subluxation is the sweet spot of the chiropractor, because when you interfere with the neurology, the body just is not optimized and doesn’t work the way it should.
Clearing out the spine and having a healthy nerve system is definitely more proactive in prevention, but you can do a strengthening program with a physical therapist after everything’s lined up, and that would be quite proactive too, because again, you’re trying to prevent further injury.
So, they both have their niche. I would say chiropractic is a little more holistic, proactive, and preventative, where physical therapy is reactive in that they’re trying to handle specific problems and rehab the spine, but not many people just go to physical therapists just to keep healthy. It’s usually more rehab after an injury.
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