Intended for healthcare professionals

Clinical Review ABC of complementary medicine

The manipulative therapies: osteopathy and chiropractic

BMJ 1999; 319 doi: (Published 30 October 1999) Cite this as: BMJ 1999;319:1176
  1. Andrew Vickers,
  2. Catherine Zollman

    Osteopathy and chiropractic share a common origin. Their roots can be found in folk traditions of “bone setting,” and both were systematised in the late 19th century in the United States: Daniel D Palmer, the founder of chiropractic, is said to have met with Andrew Taylor Still, the founder of osteopathy, before setting up his own school The therapies remain relatively similar, and many textbooks and journals are relevant to both. The term “manipulative therapy” refers to both osteopathy and chiropractic.

    High velocity thrust delivered by a levered thrust, the technique usually used by osteopaths


    Osteopathy and chiropractic are therapies of the musculoskeletal system: practitioners work with bones, muscles, and connective tissue, using their hands to diagnose and treat abnormalities of structure and function.

    High velocity thrust given as a direct thrust on the spine, as favoured by chiropractors

    The best known technique is the “high velocity thrust,” a short, sharp motion usually applied to the spine. This manoeuvre is designed to release structures with a restricted range of movement. High velocity thrusts often produce the sound of joint “cracking,” which is associated with manipulative therapy. There are various methods of delivering a high velocity thrust. Chiropractors are more likely to push on vertebrae with their hands, whereas osteopaths tend use the limbs to make levered thrusts. That said, osteopathic and chiropractic techniques are converging, and much of their therapeutic repertoire is shared.

    Practitioners also use a range of soft tissue techniques that do not involve high velocity thrusts. For example, the “muscle energy techniques”(known as “proprioceptive neuromuscular facilitation” by physiotherapists) make use of post-isometric relaxation to increase restricted ranges of movement.

    Chiropractors and osteopaths may use soft tissue techniques to increase a joint's range of movement or relieve muscular spasm

    Osteopaths and chiropractors may also use what are termed …

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