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What’s the Difference Between Physio and Osteo: A Comprehensive Guide

Physiotherapists and osteopaths focus on similar injuries and treatment methods, but have a few core differences. This article provides a short distinction between the two forms and then dives much deeper.


If you're just looking for the short breakdown of how physiotherapists and osteopaths differ, then I'll save you from having to read the whole article:

Physiotherapy focuses on musculoskeletal health and body movement disorders. Physios use techniques like massage, ultrasound, and exercise programs with the goal of addressing current issues and fixing the long term cause.

Osteopathy focuses on leveraging the body's natural healing processes in a controlled way to alleviate issues, specifically with a focus on the spine and joint mobilisation. Osteopath treatment is similar to chiropractors, except they focus on restoring alignment and relieving pain. They can also serve as a primary caregiver and prescribe medicine.

Keep reading if you're interested in a deeper breakdown in where these two practices came from, the kind of techniques they use, the qualifications involved, and some deeper differences.

Understanding Manual Therapy

Health professional working on a back
Manual therapy can help with neck pain, sports injuries, and chronic pain.

Definition and scope of manual therapy

Both physiotherapy and osteopathy are manual therapy techniques.

Manual therapy (commonly associated with hands-on healing) is a form of physical therapy that utilises manual treatment, joint manipulation, and massage to alleviate chronic discomfort and control musculoskeletal disorders.

The goal of this kind of treatment is to improve and maintain your musculoskeletal system's physical function. This type of treatment is typically employed in conjunction with other forms of physiotherapy, such as exercise therapy. The manual therapy focuses on treating pain and increasing your range of motion.

Physiotherapy and osteopathy are two distinct forms of manual therapy with different philosophies and techniques

Physiotherapy and osteopathy are two different forms of manual treatment. That's because each of them has their own belief system, and the tools are different.

Physiotherapy is a scientific healthcare tradition that is centred around restoring mobility to patients with physical impairments, typically because of trauma, or age. It is a major focus of the therapy to boost physical mobility and function.

Osteopathy is a healthcare philosophy that is largely dedicated to treating musculoskeletal disorders. The use of the musculoskeletal system to affect the entire physiological system is a major aspect of osteopathic treatment. The physical therapist, chiropractor, and osteopath are the only ones who can help you figure out which therapy is right for you.

Origins and Philosophy

Historical background of physiotherapy and osteopathy

Physiotherapy as a profession kicked off in the late 19th century, pivoting from the practice of massage therapy.

21st century physiotherapy has gone on to develop its own body of research, in particular biomechanics and exercise physiology. However, a big chunk of what a physiotherapist does is using what we now know about the body to help solve musculoskeletal issues.

Osteopathy, on the other hand, was founded in the late 19th century by an American Dr. Andrew Taylor Still. Dr. Still was an MD, but he was frustrated with the limitations of the medicine of the day and went looking for a different way to treat illness.

Dr. Still didn’t believe that the large doses of medicines and surgeries that medicine of the time used were particularly safe or even helpful. So, he developed a different system - a system that acknowledges what we now take for granted: That the body is a self-healing, self-regulating organism.

Both disciplines have evolved over time. Physiotherapy has grown to become a much larger profession with a more established evidence base, including biomechanics and exercise physiology.

Osteopathy is still a manual therapy profession, but it has its roots in medicine, not movement. It has also grown into a larger profession but it still tends to be about manual therapy and exercises.

Core principles and philosophies of each discipline

Physio providing treatment
Physios focus on connective tissue, spinal and joint manipulation and musculoskeletal pain.

Physiotherapists focus on the musculoskeletal system. That basically means muscles, bones, and the head, neck and back. They're also trained to be experts in the way we move, which is really the big difference between physio and other health professions.

Improving movement and function is the primary goal of every intervention a physiotherapist does. If you’re seeing a physiotherapist and they’re not trying to get you moving better, they’re probably not doing their job. It might mean getting your muscles moving better or getting your joints moving properly, or getting you moving better.

Osteo providing treatment
Spinal manipulation techniques are a big part of osteopathy.

Osteopathy is built on the idea that the body is self-healing and self-regulating. It’s about giving your body the right conditions to do what it’s built to do. Every intervention an osteopath does should be about helping your body do its thing.

Osteopathy typically uses manual therapy, which is a hands-on technique for helping your body heal itself. A common one is spinal manipulation, which is like a chiropractic adjustment. Osteopathy, however, uses it as part of a bigger package.

Treatment tables

Alevo pro-lift range
Alevo manufactures tables specifically for osteopathy and physiotherapy.

Physios and osteos both have equipment dedicated to their speciality.

Alevo treatment tables make an electric Pro-Lift range for physiotherapists that assists in supporting patients during examinations and can be adjusted to help with activities and exercises while the patient is sitting or lying down.

The osteopathy range favours a flatter design that allows the practitioner to perform more complex positional contortions. However, this range is also electric, and the tables have a range of settings that reduce the strain on the practitioner.


Physio using treatment techniques.
Physio using treatment techniques.

Definition and scope of physiotherapy

The academic definition of physiotherapy (also known as physical therapy) is a healthcare profession dedicated to enhancing, maintaining, or restoring physical strength, function, and mobility.

Its scope is twofold: treating current problems and reducing the risk of future ones.

Together with the treatment, physiotherapists work with patients to prevent a problem in the future. If you’ve got a history of falling over, a physio can help you to become more stable on your feet. If you’ve got painful ankles, a physio can work with you to help keep them from hurting again.

Patients often think of physiotherapy as a treatment to help you recover from injury, which it is. But the ultimate goal of physiotherapy is to help you move better. This means not just recovering from an injury, but keeping the problem away in the future. This is why physios load patients up with exercises to do at home

Common Physiotherapist approaches and treatments

Physios work on whole body systems.
Physios work on whole body systems.

Physiotherapists use a bunch of techniques to help their patients move better.

  • Manual handling is anything that a physio does with their hands. It might be a massage, joint mobilisations, or spinal manipulation.
  • Electrotherapy is treatment with electrical currents.
  • Ultrasound, TENS machines and shockwave devices all get used to help the body.
  • Exercise programs are probably the most important. When you’re seeing a physiotherapist, doing an exercise program is one of the best things you can do to get better.


Osteopaths use techniques to reduce pain.
Osteopaths use techniques to reduce pain.

Definition and scope of osteopathy

The academic definition of osteopathy is a branch of healthcare that emphasises the treatment and prevention of musculoskeletal disorders through the manipulation and massage of the skeleton and muscle tissues.

Osteopathy is a manual therapy profession in which a body’s health is based on how it moves. It is also about helping the body heal and regulate itself.

These are the main aspects of osteopathy:

  • Pain Management
  • Injury Rehabilitation
  • Chronic Conditions
  • Posture and Alignment
  • Systemic Benefits
  • Prenatal and Postnatal Care

Unique techniques and approaches

Osteopaths have a deep bag of tricks and techniques for helping patients.

  • Manual Therapy, i.e. stretching, massaging, and mobilising joints and muscles.
  • Spinal manipulation, this technique is where the osteo applies a precise "thrust" to the joints of the spine or other areas.
  • Muscle Energy Techniques (MET) is an approach in which the patient gets into a specific position and direction against a counterforce applied by the osteopath.
  • Counterstrain: identifying a tender point and helping the patient into a position to relieve pain.
  • Myofascial Release: applying gentle, sustained pressure into myofascial connective tissue.
  • Cranial Osteopathy: the gentle manipulation of the skull bones.
  • Visceral Manipulation: Gentle manipulations to address the internal organs (viscera)

Education and Training

Both practices take a holistic approach to training and education.
Both practices take a holistic approach to training and education.

Overview of education and training for physiotherapists and osteopaths

Physiotherapy is typically a 4-year degree, with the option of further study. Osteopathy is a 5-year degree program in Australia, and once fully qualified, an osteopath is accredited by a registered osteopathic board.

Key differences in training between the two disciplines

During training, physiotherapists are exposed to various medical conditions and are expected to treat a wide range of patients. Because physios can often work as part of a team alongside different specialists, they need to have a grip on all aspects of healthcare.

Physios will often jump between hospital placements, community health clinics, and private practices during their placement.

Osteos go through a similar regime, with some more specialised training in spinal manipulation and joint mobilisation.

Assessment and Treatment

Example of soft tissue treatment.
Example of soft tissue treatment.

Similarities and differences in assessment processes

Both physiotherapists and osteopaths use similar assessment techniques, including physical examination and medical history.

Because physiotherapy is considered a paramedical practice, physios may often assess a patient’s condition to diagnose the problem before treating it with exercise and manual therapy; while osteopathy is considered an alternative form of medicine, osteopaths do not put as much emphasis on advanced assessments and are more interested in what they can feel and manipulate.

Treatment approaches and techniques used by physiotherapists and osteopaths

Physiotherapists use a combination of manual and treatment therapy to treat muscle and joint problems. They also recommend long-term solutions like exercise programs that are specifically tailored to your injury, condition, and overall health.

Osteopaths, on the other hand, may use spinal manipulation and other therapies to manipulate your body but might not provide exercise programs. Interestingly, they both use similar assessment techniques to diagnose the problem.

Specialised Areas of Practice

Physiotherapy specialisations (e.g., sports, paediatrics)

The most common specialisations for physios are:

  • Sports physiotherapy
  • Pediatric physiotherapy
  • Post-operative rehabilitation
  • Elderly treatment

Osteopathy specializations (e.g., cranial osteopathy, visceral manipulation)

Osteopaths can specialise in areas like:

  • Cranial osteopathy
  • Visceral manipulation
  • Pediatric osteopathy

Choosing the Right Practitioner

Factors to consider when deciding between a physiotherapist and an osteopath

First, think about what type of treatment you prefer. Are you happy to try exercise programs? If so, a physiotherapist may be the best option. However, if you've got pain that needs a quick solution, especially with a "realignment," an osteopath is probably the way forward.

The next thing to think about is the severity of your condition. An osteopath is less likely to be able to help with long-term solutions if you are in the very early stages of your condition.

The final thing to think about is cost. If you’ve seen a physiotherapist or osteopath before, you’ll know that they can be expensive.

Questions to ask when selecting a practitioner

This might be going too deep, but if you're seeing a physio or osteo for the first time and unsure what questions to ask, here are a few good places to start:

  • What experience do they have in treating conditions like mine?
  • What techniques do they use, and are they evidence-based?
  • Do they have any additional qualifications or specializations?


Wrapping up, physiotherapists and osteopaths are very similar. There's some overlap in their treatments, but physios focus mostly on movement, and osteos are more about muscular skeletal systems and spinal manipulation.