Feb 2014 01

What's the difference between an osteopath, a physiotherapist and a remedial massage therapist?

By: Dave Wheeler

The similarities between osteopaths, physiotherapists and remedial massage therapists

There are many similarities between the 3 professions, which is why the question gets asked a lot:


Firstly, all 3 professions treat musculoskeletal pain.

Secondly, they are all manual therapies with a high level of ‘hands-on’ treatment including massage, joint movement and manipulation.

Thirdly, they are all trained to a high level of knowledge of human anatomy and physiology.


So there’s a lot of overlap, but they're actually really different.


What does a physiotherapist do?

Firstly, physio is the only one of these treatments broadly available on the NHS. That said, physiotherapists are as stretched as everyone else in the NHS, so appointments are usually very short. Physiotherapy is also available from a private clinic, of course.

Physio’s treat 4 main systems in the body:

  • Musculoskeletal (bones, joints, muscles)
  • Neuromuscular (the brain and nervous system)
  • Cardiovascular (heart and circulation)
  • Respiratory (lungs, etc.)

Physiotherapy is around 60% hands-on, with other techniques such as observation and ultrasound being used. Philosophically, physiotherapy focuses on the problem area presented and there are defined treatment protocols for most conditions.

In the NHS especially, great emphasis is placed on rehabilitation programmes of exercises and correct movement to regain as much function as possible (for example breathing or range of movement).


What does an osteopath do?

Whilst physiotherapy is widely available on the NHS, osteopathy is not. Osteopathy is an alternative therapy which concentrates on the musculoskeletal system (muscles, joints and bones).

Philosophically, osteopaths work from the viewpoint that all body systems are interconnected and that the body is self-healing; the role of the osteopath, therefore is to restore muscular imbalances to allow the body to heal itself.

Osteopaths use touch, massage, passive joint movement, and thrust techniques ("cracking") to rebalance the body. Around 90% of treatment is hands-on.

The NHS Choices website notes that there is good evidence that osteopathy is effective for the relief of lower back pain.


What does sports & remedial massage therapist do?

Sports & remedial massage focuses on the muscles within the musculoskeletal system.

It looks at the way that the musculoskeletal system works as a whole and focuses on the way that a particular person is compensating for injury or dysfunction through their lifestyle. It seeks to address both the symptoms and the causes of those symptoms.

Remedial massage is, like osteopathy, an alternative treatment and is not available on the NHS. It is around 90% hands on.

Remedial massage involves deep tissue massage, neuromuscular techniques, passive and active stretching. It also ‘steals’ relevant movement patterns from physiotherapy and some joint manipulation from osteopathy.


Logo of the ISRM - Institute of Sports and Remedial Massage‚Äč


Just a health warning here though, when I talk about remedial massage therapists, I’m talking about a qualified therapist registered with the Institute of Sports & Remedial Massage (ISRM). See my previous blog post Dummies guide to massage therapists – whilst the terms “physiotherapist” and “osteopath” are protected, anyone can call  themselves a massage therapist, so check to see that you’re getting who you pay for.


So who should I see?


  • Physiotherapists treat a wide range of conditions for a number of body systems.
  • Osteopaths treat joints, bones and muscles from the perspective of the body as a self-healing system.
  • Remedial massage therapists treat muscles from the perspective of understanding the causes of dysfunction.

As always, if you think I can help, give me a call.