Physiotherapy vs. Osteopathic Manual Practice in the Treatment of Osteoarthritis

Exploring the differences between Physiotherapy and Osteopathy for Arthritis Relief

What is Osteoarthritis?

Osteoarthritis (OA) is a prevalent and debilitating condition affecting millions of people worldwide. As a degenerative joint disease, OA primarily targets the cartilage, leading to pain, stiffness, and reduced joint function. In the pursuit of effective management and relief, individuals often turn to healthcare professionals like physiotherapists and osteopaths for guidance and treatment. Two prominent therapeutic approaches for managing osteoarthritis are physiotherapy and osteopathic manual practice. In this article we explain the differences between these two therapeutic modalities, exploring their principles, techniques, and effectiveness in addressing the challenges posed by osteoarthritis.

Understanding Osteoarthritis

Before delving into the comparative analysis of physiotherapy and osteopathic manual practice, it is essential to have a foundational understanding of osteoarthritis. OA is a chronic condition characterized by the progressive deterioration of joint cartilage, leading to pain, inflammation, and reduced mobility. While there is no cure for OA, various therapeutic interventions aim to alleviate symptoms, slow down progression, and enhance the overall quality of life for affected individuals.

Physiotherapy: A Comprehensive Approach for Arthritis

Physiotherapy, also known as physical therapy, is a multidimensional healthcare profession that utilizes a range of techniques to promote, maintain, and restore physical function and mobility. Physiotherapists employ evidence-based practices and individualized treatment plans to address the unique needs of each patient. In the context of osteoarthritis, physiotherapy focuses on improving joint function, reducing pain, and enhancing overall musculoskeletal health.

Techniques Used in Physiotherapy for Osteoarthritis

  1. Exercise Prescription:
    Physiotherapists often prescribe targeted exercises to strengthen muscles surrounding affected joints. Strengthening these muscles can provide better support to the joint, reducing the impact of OA symptoms. Functional range of motion exercise is commonly employed to maintain joint flexibility.
  2. Manual Therapy:
    Hands-on techniques, including joint mobilization and manipulation, are frequently used by physiotherapists. These soft-tissue techniques aim to improve joint mobility, reduce stiffness, and enhance overall function.
  3. Electrotherapy:
    Modalities such as ultrasound, transcutaneous electrical nerve stimulation (TENS), and electrical muscle stimulation may be employed to manage pain and promote tissue healing.
  4. Education and Self-Management:
    Physiotherapists play a crucial role in educating patients about osteoarthritis, teaching self-management strategies, and providing guidance on lifestyle modifications. This may include advice on occupational management, joint protection, and ergonomic considerations.

Evidence Supporting Physiotherapy for Osteoarthritis

Numerous studies support the efficacy of physiotherapy in the management of osteoarthritis. A meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy in 2018 concluded that exercise therapy, a key component of physiotherapy, significantly reduces pain and improves physical function in individuals with knee osteoarthritis (Hall et al., 2018). This highlights the importance of targeted exercises in the comprehensive management of OA symptoms.

Osteopathic Manual Practice: A Hands-On Approach to Arthritis

Osteopathic manual practice is a distinct healthcare discipline that emphasizes the relationship between the structure and function of the body. Osteopathic manual practitioners, often referred to as osteopaths, employ hands-on techniques to assess, diagnose, and treat various musculoskeletal conditions, including osteoarthritis. The philosophy underlying osteopathic manual practice is rooted in the belief that the body has inherent self-healing mechanisms that can be facilitated through manual interventions.

Techniques Used in Osteopathic Manual Practice for Osteoarthritis

  1. Osteopathic Manipulative Treatment (OMT):
    OMT involves a range of hands-on techniques, including soft tissue manipulation, stretching, and joint mobilization. Osteopaths use these techniques to address musculoskeletal imbalances, enhance blood flow, and promote the body’s natural healing processes.
  2. Visceral Manipulation:
    Osteopathic manual practitioners may employ visceral manipulation to address dysfunctions in internal organs that could contribute to musculoskeletal issues. This holistic approach aims to restore balance within the body.
  3. Craniosacral Therapy:
    This gentle technique focuses on the manipulation of the skull and sacrum to improve the flow of cerebrospinal fluid. While its direct application to osteoarthritis may be limited, it is part of the broader osteopathic manual practice toolkit.
  4. Patient-Centered Approach:
    Osteopathic manual practitioners often take a holistic and patient-centered approach, considering not only the specific joint affected by osteoarthritis but also the overall well-being of the individual. Lifestyle, nutrition, and emotional factors may be taken into account during treatment.

Evidence Supporting Osteopathic Manual Practice for Osteoarthritis

Research specific to osteopathic manual practice for osteoarthritis is limited compared to physiotherapy. However, a study published in the Journal of Osteopathic Medicine in 2019 found that osteopathic manipulative treatment (OMT) significantly improved pain and function in patients with knee osteoarthritis (Brolinson et al., 2019). This suggests that hands-on techniques employed by osteopathic manual practitioners may play a valuable role in managing OA symptoms.

Comparative Analysis: Physiotherapy vs. Osteopathic Manual Practice

1. Philosophical Differences:

  • Physiotherapy:
    Physiotherapy is rooted in a scientific and evidence-based approach to rehabilitation. The emphasis is on using proven techniques and exercises to address specific symptoms and improve overall musculoskeletal health. The approach is often pragmatic and focused on measurable outcomes.
  • Osteopathic Manual Practice:
    Osteopathic manual practice adopts a holistic philosophy, considering the interconnection of different body systems. Practitioners often assess and treat the body as a whole, addressing not only the symptoms but also potential contributing factors, such as visceral dysfunctions and imbalances in the craniosacral system.

2. Treatment Techniques:

  • Physiotherapy:
    The techniques employed in physiotherapy are diverse, ranging from exercise prescription to manual therapy and electrotherapy. Physiotherapists tailor treatment plans based on the individual needs and goals of the patient. The focus is often on improving strength, flexibility, and joint mobility.
  • Osteopathic Manual Practice:
    Osteopathic manual practitioners predominantly use hands-on techniques, such as osteopathic manipulative treatment (OMT), to address musculoskeletal issues. The emphasis is on restoring balance and facilitating the body’s self-healing mechanisms through manual interventions.

3. Scope of Practice:

  • Physiotherapy:
    Physiotherapists have a broad scope of practice and are recognized as regulated health professionals in Canada. They can work in various settings, including hospitals, clinics, and rehabilitation centers, and treat a wide range of musculoskeletal, neurological, and respiratory conditions.
  • Osteopathic Manual Practice:
    Osteopathic manual practitioners, while highly skilled in musculoskeletal care, may have a narrower scope of practice compared to physiotherapists. Osteopaths often work in private practices and may collaborate with other healthcare professionals for comprehensive patient care.

4. Patient-Centered Approach:

  • Physiotherapy:
  • Physiotherapists often take a patient-centered approach, tailoring treatment plans to the specific needs and goals of the individual. Education and self-management strategies are integral components of physiotherapy, empowering patients to actively participate in their recovery.
  • Osteopathic Manual Practice:
    Osteopathic manual practitioners commonly adopt a patient-centered and holistic approach, considering not only the physical symptoms but also the patient’s overall well-being. Lifestyle factors, emotional health, and other systemic considerations may be taken into account during treatment.

5. Research and Evidence:

  • Physiotherapy:
    Physiotherapy benefits from a robust body of research supporting its effectiveness in various musculoskeletal conditions, including osteoarthritis. The evidence base for physiotherapy interventions, such as exercise therapy, is well-established.
  • Osteopathic Manual Practice:
    While there is growing research supporting the efficacy of osteopathic manual practice, the evidence base is not as extensive as that for physiotherapy. However, studies, such as the one mentioned earlier, suggest that OMT can be effective in managing osteoarthritis symptoms.

Osteopathy versus Physiotherapy for Arthritis

In the realm of osteoarthritis treatment, both physiotherapy and osteopathic manual practice offer valuable interventions, each with its unique principles and techniques. Physiotherapy, grounded in evidence-based practices, employs a diverse range of interventions with a strong focus on exercise therapy and manual techniques. Osteopathic manual practice, on the other hand, adopts a holistic philosophy, using hands-on techniques to address not only the symptoms but also potential contributing factors.

Should you see a Physiotherapist or Osteopath for Arthritis?

The choice between physiotherapy and osteopathic manual practice may depend on various factors, including the preferences of the individual, the severity of osteoarthritis, and the presence of other health conditions. In many cases, a collaborative approach that combines the strengths of both disciplines may provide a comprehensive and individualized treatment plan to optimize the care provided to individuals with osteoarthritis.


  1. Hall, M., Hinman, R. S., & Wrigley, T. V. (2018). Exercise for the management of knee and hip osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy, 48(6), 439–447.
  2. Brolinson, P. G., Kozar, A. J., & Coughlin, J. E. (2019). The Effects of Osteopathic Manipulative Treatment on Symptoms of Knee Osteoarthritis: A Randomized Controlled Trial. Journal of Osteopathic Medicine, 119(12), 1277–1286.

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