It saddens and scares me to understand how the excessive and unnecessary use of digital technology is harming the healthy functioning of our fragile nervous systems. We’re caught in a rapidly progressive whirlwind of commercialised digital chaos, and we’ve sadly (and almost innocently) become addicted to using smart devices.

I’m noticing an alarming amount of young people who are coming to see me for joint and muscle concerns that I wouldn’t necessarily expect to see in people who are under the age of, say, 30.

Also, I’m finding that young people are starting to see me more and more for random neck symptoms and signs that mimic people who’ve suffered a physical injury (such as a whiplash injury or a mild head trauma) which isn’t good.

Our inappropriate (or unnecessary) use of digital technology might be responsible for causing a new, modern-day clinical syndrome called ‘tech neck’.¹

You might know other common names for ‘Tech Neck’, too, such as: ‘Computer neck pain’, ‘Postural strain’, ‘Monitor neck pain’, or ‘Screen neck pain’.

‘Tech neck’ syndrome can give people many different muscle and joint concerns, such as:

• Neck pain.
• Shoulder girdle pain.
• Upper back pain.
• ‘Pins and needles’, tingling or numbness sensations especially in the upper limbs.
• Headaches^1,2,3

People get ‘tech neck’ posture when they repeatedly slouch their heads forward to use their smart devices. Also, people who spend many unnecessary hours a day using a handheld smart device increase their risk of getting a lot of bad changes to their spine structures (which include ligaments, tendons, and bones).¹

People who regularly adopt ‘tech neck’ posture ‘switch off’ their brains’ ability to ‘talk’ to their neck structures, properly. Your brain relies on getting constant positive information from your body movements (which is called somatosensory feedback) to help it stay ‘switched on’.  Unfortunately, if people keep doing a ‘tech neck’ posture and they don’t maintain healthy neck movement habits, their brains start to get lazy and learn bad body movement and posture behaviours.^3,4 Therefore, people can get early neck (or cervical spine) degeneration issues if they keep doing repetitive poor body movement habits (or ‘tech neck’ posture).¹

The process of your nervous system ‘learning’ how to do something new (whether it’s good or bad) is called, neuroplasticity.

So, is someone who keeps doing a ‘tech neck’ posture an example of good neuroplasticity or bad neuroplasticity for their body’s muscle and joint function?

When you use a smart device, you’re most likely to get ‘tech neck’ syndrome when you do a combination of six habits:^2,3,5-7

1. You have your head/chin tilted down by 30 degrees or more.
2. You sit, as opposed to stand.
3. You hold and use a smart device with one hand, only.
4. You write/send a minimum of 6 text messages a day.
5. You don’t support your arm/s on something when you’re using a smart device.
6. You use a smart device for a minimum of 2-hours a day.

Moreover, people put an extra 18 kilograms of mechanical (or gravitational) stress on their neck structures when they tilt their head down by 30 degrees (or more) to look at the screens of their smart devices (image 1).^6,7

However, some scientists^8,9 have found that ‘tech neck’ doesn’t necessarily cause people to get neck pain which is interesting because it completely opposes what many people think about ‘tech neck’ side effects.

So, is ‘tech neck’ really that bad for our bodies if it doesn’t always cause us to get neck pain?

Overall, my answer is, “Yes” and this is my reasoning:

Our brains use special, invisible mapping systems to help us familiarise ourselves with our environments and hence warn us about potential stressful or dangerous stimuli. There are two main invisible maps that our brains use to alert us about getting hurt: our retinotopic (or seeing/visual) map, and our tonotopic (or hearing) map.  However, I’ll keep things simple and from now on, I’ll refer to these maps as our brains’ ‘stress radar’.^10-12

The process of us feeling worried, scared, stressed, or threatened is called our body’s ‘flight and fight’ response – that is, if we see or hear something that feels like it could hurt us, we either quickly decide to run away (or ‘flight’) or stay to protect ourselves (or ‘fight’).

Your ‘stress radar’ warns you about the possibility of you experiencing danger – it tells you about random surrounding movements, sounds and colour changes.¹¹

For example, pretend that it’s garbage night and you need to take your wheely bin out to the front of your house. You don’t bother to turn on your front light because you think to yourself, “I know and trust my neighbourhood. I’ve got this”.

You casually wheel your bin out to the road and as you park it on the curb, you hear a twig snap behind you. You startle. Your ‘stress radar’ triggers your body’s ‘flight and fight’ response.

Your ‘stress radar’ detects that there’s something moving to the left of your body. Your brain quickly tells your head and eyes to turn left and look at the unknown object that’s moving closer you.

As you’re getting ready to ‘flight’ (or run away), your brain quickly recognises that it’s nothing other than your neighbour’s friendly pet goat, Allen.

Your ‘rational’ brain kicks in and it quickly ‘switches off’ your ‘flight and fight’ response – your ‘rational’ brain says to you, “It’s all good – it’s just a goat. There’s nothing to worry about.” You breathe a deep sigh of relief, and before you go back inside, you wish Allen a lovely evening.

Our eyes are connected to our spine muscles.^{13, 14}

It’s very important that our eyes and head work together (as a team) because it helps our vision (or visual acuity) to stay sharp and focused.¹¹ Also, scientists have discovered that our neck muscles tense when we think (or anticipate) that something’s going to move.¹⁵

So, wait a minute, are you saying that my neck muscles automatically tighten when I even think about scrolling my social media pages up or down on my smart device? Yes, that’s exactly what I’m saying – your neck muscles tense up whenever you think about scrolling (or physically scroll through) content on your smart device’s screen and there’s nothing that you can do about it. It’s a primitive, natural, hard wired reflex that’s part of our neurophysiology. People who spend excessive amounts of time using their smartphones abuse this natural neurologic reflex and consequently, they become victims of ‘tech neck’.

Therefore, your body’s ‘stress radar’ is triggered when we:

• See something move quickly.
• Hear something that could mean danger.
• See something change colour.
• Predict that something’s going to move.^11,12,15,16

Also, did you know that your brain releases dopamine whenever your ‘stress radar’ is activated?

Dopamine is our natural pleasure and reward hormone that helps us to feel good when something (supposedly) positive happens to our bodies. It’s a hormone that helps us to feel addicted to doing healthy things, such as: exercising, socialising with our friends, eating nutritious food, and helping other people. However, sometimes, if our ‘stress radar’ keeps getting unnecessarily ‘switched on’, our bodies can make too much dopamine and we risk becoming addicted to learning bad health habits, such as: alcoholism, taking harmful drugs, or gambling too much.¹¹

So, can you think of a commonly used, handheld digital device that’s been designed to make us: see things that move quickly, anticipate that something’s going to move, see rapidly changing colours, and feel good when we hear an alert tone? A smartphone.

Moreover, people who repeatedly do a ‘tech neck’ posture can indirectly ‘switch off’ parts of their brain that are responsible for controlling their:

• Balance and coordination.
• Voluntary muscle movements.
• Appropriate contextualised emotions.
• Sleep function.^5,17,18

Unfortunately, people who regularly trigger their ‘stress radar’ by doing excessive and unnecessary stressful eye movements (such as looking at their smartphones too close to their faces) and do a regular ‘tech neck’ posture risk themselves getting bad nervous system conditions, such as: dystonia (or severe and sustained muscle contractions), and Parkinson’s disease.^12,18,19

A summary: how do you know if your nervous system could be a victim of ‘tech neck’ syndrome?

Overall, yes, your digital device could be causing you to get neck pain but sometimes, you don’t have to have neck pain to be a victim of, ‘tech neck’ syndrome.

You could have ‘tech neck’ complications if you get a combination of any of the following symptoms and/or signs:

1. You get pain and/or headaches.
2. You get ‘pins and needles’, tingling or numbness sensations especially in the upper limbs, hands and/or fingers.
3. You get distracted easily.
4. You tend to be sensitive to sensory stimuli, such as: sound, light, and touch.
5. You get motion sickness (which includes you not being able to read whilst you’re travelling on transport without you feeling sick).
6. You tend to overreact to common or trivial situations.
7. You tend to have impulsive or aggressive behaviour.
8. You get angry easily or have random emotional outbursts.
9. You have digestive problems and food sensitivities.
10. You startle or get scared easily.
11. You have balance and coordination problems.
12. You get random muscle jerks (or spasms) and can have difficulty controlling your muscle movements.
13. You have obsessive compulsive behavioural tendencies.
14. You have a regular and intense urge to clear your throat or move a group of muscles to make you feel comfortable, better, or relaxed.
15. You get nervous easily and have a restless mind.
16. You regularly get neck muscle and/or back muscle tightness.
17. Your back muscles tire easily when you stand or walk.
18. Your voice appears to be getting softer.
19. You have unexplained constipation.^1,2,3,17,20

References

1. David D, Giannini C, Chiarelli F, Mohn A. Text Neck Syndrome in Children and Adolescents. Int J Environ Res Public Health. 2021 Feb 7;18(4):1565.
2. Eitivipart AC, Viriyarojanakul S, Redhead L. Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence. Hong Kong Physiother J. 2018 Dec;38(2):77-90.
3. Gustafsson E, Thomée S, Grimby-Ekman A, Hagberg M. Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study. Appl Ergon. 2017 Jan;58:208-214.
4. Kingett M, Holt K, Niazi IK, Nedergaard RW, Lee M, Haavik H. Increased Voluntary Activation of the Elbow Flexors Following a Single Session of Spinal Manipulation in a Subclinical Neck Pain Population. Brain Sci. 2019 Jun 12;9(6):136.
5. Wah SW, Chatchawan U, Chatprem T, Puntumetakul R. Prevalence of Static Balance Impairment and Associated Factors of University Student Smartphone Users with Subclinical Neck Pain: Cross-Sectional Study. Int J Environ Res Public Health. 2022 Aug 28;19(17):10723.
6. Han H, Lee S, Shin G. Naturalistic data collection of head posture during smartphone use. Ergonomics. 2019 Mar;62(3):444-448.
7. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9.
8. Correia IMT, Ferreira AS, Fernandez J, Reis FJJ, Nogueira LAC, Meziat-Filho N. Association Between Text Neck and Neck Pain in Adults. Spine (Phila Pa 1976). 2021 May 1;46(9):571-578.
9. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018 Jun;27(6):1249-1254.
10. Kandler K, Clause A, Noh J. Tonotopic reorganization of developing auditory brainstem circuits. Nat Neurosci. 2009 Jun;12(6):711-7.
11. Hikosaka, O., Kawagoe, R. & Takikawa, Y. Role of the basal ganglia in the control of purposive saccadic eye movements. Physiol. Rev. July 2000;80(3):953-978.
12. Nambu, A. Somatotopic organization of the primate Basal Ganglia. Front Neuroanat. 2011 Apr 20;5:26.
13. Bexander, C., Mellor, R., and Hodges, P. Effect of gaze direction on neck muscle activity during cervical rotation. Exp Brain Res. 2005 Dec;167(3):422-32.
14. Petit L, Beauchamp MS. Neural basis of visually guided head movements studied with fMRI. J Neurophysiol. 2003 May;89(5):2516-27.
15. Goonetilleke SC, Katz L, Wood DK, Gu C, Huk AC, Corneil BD. Cross-species comparison of anticipatory and stimulus-driven neck muscle activity well before saccadic gaze shifts in humans and nonhuman primates. J Neurophysiol. 2015 Aug;114(2):902-13.
16. Schneider KA, Kastner S. Visual responses of the human superior colliculus: a high-resolution functional magnetic resonance imaging study. J Neurophysiol. 2005 Oct;94(4):2491-503.
17. Joel Brandon Brock, Samuel Yanuck, Michael Pierce, Michael Powell, Steven Geanopulos, Steven Noseworthy, Datis Kharrazian, Chris Turnpaugh, Albert Comey, and Glen Zielinski. The potential impact of various physiological mechanisms on outcomes in TBI, MTBI, concussion and PPCS. Funct Neurol Rehabil Ergon 2013;3(2-3).
18. Pong, M., Horn, K., and Gibson, A. Pathways for control of face and neck musculature by the basal ganglia and cerebellum. Brain Res Rev. 2008 Aug;58(2):249-64.
19. Mc Govern EM, Killian O, Narasimham S, Quinlivan B, Butler JB, Beck R, Beiser I, Williams LW, Killeen RP, Farrell M, O’Riordan S, Reilly RB, Hutchinson M. Disrupted superior collicular activity may reveal cervical dystonia disease pathomechanisms. Sci Rep. 2017 Dec 1;7(1):16753.
20. Chen Z, Li G, Liu J. Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment. Neurobiol Dis. 2020 Feb;134:10470

Image 1. A picture showing how a person’s worsening ‘tech neck’ posture can force extra and unnecessary mechanical (or gravitational) stress on their vulnerable spine structures.⁷ Therefore, you could put a staggering 27 kilograms of extra mechanical stress on your neck structures if you tilt your head down by 60 degrees to look at your smart device’s screen.

Honestly, this is not an easy topic to write about because there’re so many different things that can cause someone to get a headache. It’s rare for there to be just one simple reason to explain why a person gets headaches. Also, sometimes, finding the cause/s of someone’s headaches can be a planned process of elimination.

Interestingly, did you know that there are no pain receptors in our brains? Therefore, if our brains can’t ‘feel’ pain, what causes us to sense a head-ache?

What causes a headache?

Our nervous systems need 3 important bits of ‘fuel’ to stay healthy:¹

1. A good amount of oxygen in our blood.
2. A sustaining amount of glucose in our cells.
3. Regular activation of our brains, muscles and joints.

Therefore, your nervous system can stay (fairly) healthy if it gets good and regular amounts of oxygen, glucoseand activation.

But what happens if our bodies start to lack one or more of the main bits of ‘fuel’ which our nervous systems need to stay healthy and adaptive to our environments?

When your nervous system isn’t getting enough amounts of healthy ‘fuel’ (such as oxygen), it sends stress signals to your brain saying, “Danger! Something doesn’t feel right.”

Your brain then reads these messages, and it reacts accordingly by triggering an ‘alarm’. Unfortunately, this ‘alarm’ can cause you to get a headache.

There are many things that can drain your body’s ‘fuel’ supplies and cause your brain to trigger an ‘alarm’ which can give you a headache:

• Your joints, tendons and ligaments might not be moving well.
• You might have a lot of (unknown) inflammation within your body.
• You might have ‘angry’ structures in your head that are sending stress signals to your brain, such as: the blood vessels, the meninges, the scalp, and the skull bones.

Interestingly, a head injury, such as a concussion (or a big, “Knock to the head”), is one of the most complicated and easy ways to drain your body’s ‘fuel’ supplies, naturally.²

Types of headaches.

There are many different types of headaches but to try and keep things simple, I’m only going to write about some of the more common headache diagnoses:

A cluster headache.

Typically, a cluster headache is known to cause someone to get a severe, steady and boring-like pain behind one of their eyes and it can last from 30-minutes to 90-minutes. Also, it’s common for people to get ‘flight and fight’ symptoms, too:

• They may get tearing in an eye and/or eye redness.
• They may get Horner’s syndrome.
• One side of their face may become flushed.
• They might get nasal congestion (or blocked sinuses).
• They may start sweating for no real (known) apparent reason.

Additionally, there seems to be a bit of a formula to work out if someone might be suffering a cluster headache: people who get cluster headaches tend to get them once to several times per day every day over a few weeks and then they disappear for several months.³

A headache in the back of the head.

A cervicogenic headache can give someone a headache in the back of their head.

A cervicogenic headache tends to be caused by a lack of communication between your upper neck nerves (or C1, C2 and C3) and the soft tissue structures that make up your neck (such as your muscles, tendons and ligaments). So, it’s almost as if your neck ‘forgets’ how to move properly because it’s not getting good ‘fuel’.³

For example: cars need fuel to work properly but when a car’s tank runs out of petrol it can’t function well until its petrol tank is filled up with fuel, again. Well, in many ways, a car’s engine works very similarly to our bodies; that is, if we don’t have a healthy supply of fuel, we don’t work properly which can cause us to get a headache.

Therefore, the pain of a cervicogenic headache starts in your neck and it travels up to the back of your head and/or face.

Also, other conditions that can cause someone to get a headache in the back of their head are: suboccipital neuralgia, and trigeminal neuralgia.³

A TMJ headache.

People who have temporomandibular joint (TMJ) issues (or jaw joint issues) are prone to developing headaches.

Also, if someone has a TMJ problem, they may get other symptoms, too:⁴

• They might feel pain in their jaw joint/s.
• Their jaw joint/s might grind or click whilst they try to chew food or talk.
• They may get ear pain and/or ringing in the ears (or tinnitus).
• They may get neck pain.
• They may get dizziness episodes.

A migraine headache.

There appears to be a bit of a genetic (or a family history) component to possibly explain why some people are susceptible to getting migraines.

People who get migraines tend to experience altered brain states because their nervous systems aren’t getting enough amounts of healthy ‘fuel’. Also, a person’s migraine symptoms will really depend on which part of their brain/nervous system is running low on ‘fuel’.

For example, a person could get visual disturbances (which is known as an aura) if their brain’s occipital lobe isn’t getting enough ‘fuel’, or they might get, say, face pain or nausea if their brainstem isn’t getting proper ‘fuel’.⁵

There are 4 things that can cause someone’s ‘fuel’ reserves to drop and trigger them to get a migraine:⁵

1. They may have muscle and joint (or musculoskeletal) stress.
2. They may have hormonal stress.
3. They may have nutritional (or certain food intolerance) stress.
4. They may have nervous system (or neurological) stress.

Also, it’s very possible for someone to have all of these 4 things happening to them at the same time. So, it’s easy to see how one thing can lead to the development of another thing and then, before you know it, you have many factors that need to be treated (or unravelled, like string) before someone’s headaches start to feel better.

When to worry about a headache.

There are a number of things that you should be aware of to tell you that your headache symptoms might not be safe and that you should get medical advice, immediately:³

• You get a sudden (or an ‘explosive’) onset of a severe headache that you’ve never had before.
• Your headache gets worse when you’re lying down during the night.
• Your headache is accompanied by a fever, a really stiff neck and you become sensitive to light.
• Your headaches are accompanied by: pain and tenderness over both of your temple regions, jaw pain (especially whilst you’re eating or talking), and visual disturbances (for example, you might start to get ‘double vision’ or lose the sight in either 1 or both of your eyes).

Chiropractic care and headache treatment.

When it comes to people getting treated for complications of muscle and/or joint dysfunction, such as cervicogenic headaches and migraines, research^6-8 shows that chiropractic care is just as an effective treatment option (or, sometimes, even more of an effective treatment option) compared to drugs and other therapy alternatives.

However, of course, there’s always room for improvement and there still needs to be more research done to work out exactly how effective chiropractic care is for other types of headaches, too. Nonetheless, overall, chiropractic care is a safe^9-22 treatment option that’s certainly worth people considering trying especially if they suffer from headaches.

References

1. Kharrazian, Datis. 2013. Why isn’t my brain working? A revolutionary understanding of brain decline and effective strategies to recover your brain’s health. Elephant Press, U.S.A.
2. Joel Brandon Brock, Samuel Yanuck, Michael Pierce, Michael Powell, Steven Geanopulos, Steven Noseworthy, Datis Kharrazian, Chris Turnpaugh, Albert Comey, and Glen Zielinski. The potential impact of various physiological mechanisms on outcomes in TBI, MTBI, concussion and PPCS. Funct Neurol Rehabil Ergon 2013;3(2-3):xx-xx.
3. Blumenfeld, Hal. 2010. Neuroanatomy through Clinical Cases, Second Edition. Sinauer Associates, Inc., U.S.A.
4. Yuanyuan Yin, Shushu He, Jingchen Xu, Wanfang You, Qian Li, Jingyi Long, Lekai Luo, Graham J Kemp, John A Sweeney, Fei Li, Song Chen, Qiyong Gong. The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies. J Headache Pain. 2020 Jun 19;21(1):78.
5. Harcourt, Adam. 2020. Mastering migraine: finally understand migraine, how to correct its 4 main factors and take your life back! Baker & Taylor, U.S.A.
6. Goertz, CM., Long, CR., Vining, RD., Pohlman, KA., Walter, J., and Coulter, I. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Netw Open. 2018 May 18;1(1):e180105.
7. Bronfort, G., Evans, R., Anderson, A., Svendsen, K., Bracha, Y., and Grimm, R. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012;156(1):1-10.
8. Hurwitz, E., Carragee, E., van der Velde, G., Carroll, L., Nordin, M., Guzman, J., Peloso, PM., Holm, L., Côté, P., Hogg-Johnson, S., Cassidy, JD., and Haldeman, S. Treatment of Neck Pain: Noninvasive Interventions. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. February 15, 2008 – Volume 33 – Issue 4S – p S123-S152.
9. Todd, AJ., Carroll, MT., Robinson, A.,and Mitchell, E. Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature. J Manipulative Physiol Ther. Nov-Dec 2015;38(9):699-712.
10. Alcantara, J., Ohm, J., and Kunz, D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore. 2009;5:290-295.
11. Doyle, MF. Is chiropractic paediatric care safe? A best evidence topic. Clinical Chiropractic. Volume 14, Issue 3, September 2011, Pages 97-105.
12. Rafter, N., Hickey, A., Condell, S., Conroy, R., O’Connor, P., Vaughan, D., Williams, D. Adverse events in healthcare: learning from mistakes. QJM. 2015 Apr;108(4):273-7.
13. Rubinstein, Sidney M. Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks? J Manipulative Physiol Ther 2008;31:461-464.
14. Carnes,, Mars, Thomas S., Mullinger, B., Froud, R., Underwood, M. Adverse events and manual therapy: a systematic review. Man Ther. 2010 Aug;15(4):355-63.
15. Jevne, J., Hartvigsen, J., Christensen, HW. Compensation claims for chiropractic in Denmark and Norway 2004-2012. Chiropr Man Therap. 2014 Nov 7;22(1):37.
16. Gouveia LO., Castanho P., Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976).  2009; 34(11):E405-13.
17. Hebert, JJ., Stomski, NJ., French, SD., Rubinstein, SM. Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases. J Manipulative Physiol Ther. Nov-Dec 2015;38(9):677-691.
18. Walker, BF., Hebert, JJ., Stomski, NJ., Clarke, BR., Bowden, RS., Losco, B., French, SD. Outcomes of usual chiropractic. The OUCH randomized controlled trial of adverse events. Spine (Phila Pa 1976). 2013 Sep 15;38(20):1723-9.
19. Makary, MA., Daniel, M. Medical error-the third leading cause of death in the US. BMJ. 2016 May 3;353:i2139.
20. Classen, DC., Resar, R., Griffin, F., Federico, F., Frankel, T., Kimmel, N., Whittington, JC., Frankel, A., Seger, A. and James, BC. ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. Health Affairs (Project Hope). 2011;30(4):581-589.
21. Cassidy, JD., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, FL., Bondy, SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S201-8.
22. Kosloff, TM., Elton, D., Tao, J., Bannister, WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19.

One question that I get asked a lot is, “How do I know if I should see a chiropractor, a physio or an osteo?”

Do you know what? If I’m being perfectly honest with you, I’m a bit confused about how to answer this question. Yes, I can easily research and give you a ‘textbook’ definition of what chiropractors, physio’s and osteo’s (supposedly) do but times are changing. Many practitioners are being encouraged (both professionally and socially) to evolve and change their clinical service model/s to merely, “Keep up with the Joneses.”

I even went as far as calling an osteo clinic and writing to a physio to see if they could help me draw a definitive line in the sand between what chiropractors, physio’s and osteo’s do but I discovered that, overall, I can’t.

There’s a lot of common ground between what chiropractors, physio’s and osteo’s do because they can use similar (or the same) types of treatments to improve people’s muscle and joint (or musculoskeletal) function.

Consequently, it doesn’t surprise me that a lot of people are confused about what chiropractors, physiotherapists and osteopaths do. I’ve lost count of how many times I’ve heard people say statements like:

• “I see my chiropractor because they give me a massage before they adjust me. I like that they give me home stretches to do, too,” or,
• “I go to see an osteo because I like that they do a bit of massage, dry needling, and joint manipulation,” or,
• “I see a physio because they give me a massage, they stretch my muscles and sometimes, they ‘crack’ my back. And then they give me all these exercises to do at home.”

Once, I had a person call me to ask if they could see a chiropractor and if so, they didn’t want any joint manipulation done on them – they just wanted a massage to help loosen their tight back muscles. I left the conversation feeling confused – I thought to myself, “But I’m a chiropractor – I adjust joints. Why didn’t they call a massage therapist?” To me, that’d be the same as someone going to a French restaurant and asking the chef to make them their best soufflé without using any eggs.

So, where’s all this public confusion about the three manual therapy services coming from? My theory is that because health science is rapidly evolving, many allied health practitioners are learning novel and innovative ways to improve their clinical competencies. This means that patients are being exposed to heaps of new, unexpected, and similar treatment services when they see either a chiropractor, a physio or an osteo. Consequently, you end up getting conversations between people like:

Person 1: “I just went and saw my chiropractor and they did some dry needling to help my back pain.”

Person 2: “Wait – my physio does dry needling. I thought that chiropractors just adjust joints?”

Person 3: “Hey – my osteo does dry needling, too.”

So, personally, I’ve observed that the type of service (and care) a patient gets is dependent on the treating practitioner’s personality traits (which includes their ethics) and influences (both professionally and socially), irrespective of whether they’re a chiropractor, a physio, or an osteo.

What’s the (professional) difference between a chiropractor, a physio and an osteo?

In Australia, chiropractors, physiotherapists, and osteopaths are registered allied health professionals and they’re specially trained to diagnose and treat musculoskeletal conditions, such as: back pain, neck pain, migraine, and headache.¹

Chiropractic Treatment.

According to the ‘Australian Chiropractors Association’,² there is a common misconception that chiropractic care involves a singular therapeutic technique – spinal manipulation (or a spinal adjustment). However, chiropractors use a patient centred, multi-modal model of care.

Most Australian chiropractors provide a therapeutic approach to care that incorporates a range of manual therapies, such as: spinal adjustment, joint mobilisation, soft tissue techniques (which includes electrotherapies), exercise prescription, rehabilitation, nutritional recommendations, and lifestyle advice. These have been shown to be of benefit to people with a range of musculoskeletal conditions.

When treating patients, chiropractors make an assessment and develop a treatment plan (in accordance with the needs of the patient) and provide advice on future management strategies.

Physiotherapy Treatment.

According to the ‘Australian Physiotherapy Association’,³ physiotherapists are trained to assess a patient’s condition, diagnose the problem, and help them understand what’s wrong. A physio’s treatment plan will consider a patient’s lifestyle, activities, and general health.

The following are common treatment methods use by physiotherapists:

• Exercise programs to improve mobility and strengthen muscles.
• Joint manipulation and mobilisation to reduce pain and stiffness.
• Muscle re-education to improve control.
• Airway clearance techniques and breathing exercises.
• Soft tissue mobilisation (massage).
• Acupuncture and dry needling.
• Hydrotherapy.
• Assistance with use of aids, splints, crutches, walking sticks and wheelchairs to help people move around.

Physiotherapists work in all sectors of healthcare, such as: public hospitals, private practice, rehabilitation centres, sporting clubs, and community health centres.

Osteopathy Treatment.

According to ‘Osteopathy Australia’,⁴ osteopaths use a whole-body approach (which is often called the biopsychosocial approach) to consider the cause of a patient’s musculoskeletal injury or pain, and not just their symptoms. This means that osteo’s reflect on and manage the biological (body), psychological (mental) and social (environment) factors that may be affecting a patient’s health and wellbeing. It works on the principle that everything is connected.

Osteopathic treatment involves one or a combination of the following manual therapies:

• Checking your musculoskeletal and nervous systems.
• Providing non-invasive manual therapy, when appropriate.
• Developing clinical exercise programs.
• Providing movement, postural and positioning advice.
• Providing ongoing support and educational advice about lifestyle, stress management, diet or other factors that may influence pain, injury, or movement.

So, what do statistics say about who people might choose to see?

According to one study,¹ it seems that people are more likely to pay their own money to see a physiotherapist, compared to, say, an osteopath (figure 1).

But why? There appears to be four main reasons why people choose to see a chiropractor, a physio, or an osteo:¹

1. People may be more persuaded to see a particular profession if their private health insurer pays them a good claim benefit for its service fees.
2. People are more likely to visit a profession if it has good public acceptance or awareness (and hence reputability). People tend to go with the whole ‘safety-in-numbers-kind-of-thing’ which (I feel) includes ‘word-of-mouth’ referrals. Also, media and medical professionals’ opinions can greatly shape people’s decisions about what type of profession/s they see.
3. It’s important that a profession has good commercial relationships with other reputable healthcare/medical professionals. A person is more likely to see a particular profession if, say, their General Practitioner (or Medical Doctor) says to them, “Go and see this person because I’ve heard that they’re good”.
4. Some practitioners don’t do insurance claim cases (such as Workers Compensation claims) which can drastically narrow people’s choices about what type of profession/s they can see. Therefore, practitioners who accept insurance-based cases have a better chance of seeing more people.

But what happens when something big and unexpected challenges the Australian private healthcare norm, such as a global pandemic?

Has the COVID-19 pandemic changed how we utilise chiropractic, physiotherapy, and osteopathy? Interestingly, yes, it seems that it has.

During 2020, out of the three manual therapy services, physiotherapy suffered the biggest relative drop in revenue (17.0%) and chiropractic was the least impacted (4.7%).⁵

I was seriously shocked when I first read this report. I thought that physiotherapy would’ve been the strongest and securest profession especially because Medical Doctors are more likely to refer their patients to see a physio (compared to a chiropractor or an osteo).⁴

So, out of the three manual therapy services, what could potentially explain why more people decided to see a chiropractor during the COVID-19 pandemic?

Well, one theory is that physiotherapy provides more specialised services (such as: neurological rehabilitation, geriatric services, and sports injury prevention and rehabilitation), compared to osteopathy and chiropractic. Therefore, it’s possible that the enforced COVID-19 pandemic Government restrictions (such as, public stay-at-home directives, limited public access to aged care facilities, and closures of community sporting activities) may have greatly limited people using specialist physiotherapy services.⁵

Another theory is that because the COVID-19 pandemic devasted the Australian economy, perhaps people forfeited or stopped paying their ‘extras treatment’ private health insurance cover to try and save more money.⁵

Although both theories (or situations) can explain why physiotherapy suffered a big revenue drop, it doesn’t necessarily explain why people appeared to bias their decisions to see either a chiropractor or an osteopath (especially if they decided to drop their ‘extras treatment’ private health insurance cover).⁵

I guess the question is: has the COVID-19 pandemic changed the way Australian people use manual therapy services and if so, what could this mean for the future of chiropractic, physio, and osteo?

A final note.

When someone asks me, “Should I see a chiropractor, a physio or an osteo?”, I tend to resort to offering them the same advice that was given to me by one of my chiropractic mentors. When it comes to you choosing to see a practitioner (irrespective of whether they’re a chiropractor, a physio or an osteo), find someone who:⁶

• Doesn’t over service you (or gets you to see them for more visits than you feel is appropriate or necessary).
• Gets you to keep paying for unnecessary testing procedures (such as digital imaging) or asks for you to pay for your future visits up front (or in bulk).
• Shows you empathy.
• Gets you your desired clinical result/s.
• Enjoys their work.
• Will refer you to see someone else who can help you if they can’t.

References

1. Lystad, R., Brown, B., Swain, M., and Engel, R. Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Chiropr Man Therap.2020; 28: 49.
2. Website: https://www.chiro.org.au/patients/about-chiropractic/faq/#chiropractors-do (accessed on 23.12.2022).
3. Website: https://choose.physio/what-is-physio (accessed on 19.12.2022).
4. Website: https://whatisosteo.com/about-this-website/what-is-biopsychosocial-care/ (accessed on 19.12.2022).
5. Lystad RP, Brown BT, Swain MS, Engel RM. Impact of the COVID-19 Pandemic on Manual Therapy Service Utilization within the Australian Private Healthcare Setting. Healthcare (Basel). 2020 Dec 13;8(4):558.
6. Website: https://www.choosingwisely.org.au/consumers-and-carers (accessed on 19.12.2022).

Figure 1. The annual cost of services received by chiropractic, osteopathy, and physiotherapy in Australia between 2008 and 2017, inclusive.⁴