What is the difference between an osteopath, a chiropractor, a physiotherapist, a massage therapist, an acupuncturist, and a kinesiologist?

What is the difference between an osteopath, a chiropractor, a physiotherapist, a massage therapist, an acupuncturist, and a kinesiologist?

Training, legal oversight, and treatment methods distinguish these six professions in Quebec. These professionals may treat people living with pain or an injury, but their roles and areas of expertise differ. To compare them, consider:

• The training received.
• The presence or absence of a professional order.
• The Basic Principles of the Profession.
• Types of treatment available.

What kind of training do these various professionals have?

Educational paths range from university studies to community college and private school programs. The path depends on the profession and where the person studied.

In Quebec, the current academic path for physical therapists leads to a master’s degree. Chiropractors pursue an undergraduate doctorate, and kinesiologists typically earn a bachelor’s degree in kinesiology. Acupuncturists can earn a college diploma in acupuncture at Cégep de Rosemont. Pathways for recognition of prior learning also exist for individuals trained elsewhere. Training for osteopaths is currently offered by private institutions. Massage therapists complete programs at massage therapy schools, the requirements for which vary by school and professional association. Physical therapy training; chiropractic training; acupuncture certification; requirements of the Federation of Kinesiologists; massage therapy training.

Chiropractors, physical therapists, and acupuncturists must be members of their professional order to practice in Quebec. The order regulates the practice to protect the public. As of September 2026, massage therapists, osteopaths, and kinesiologists are not regulated by a professional order. Professional associations may set requirements for their members, but they are not professional orders. On June 16, 2026, the government announced plans to integrate osteopaths into the Order of Chiropractors and kinesiologists into the Order of Occupational Therapists. This announcement does not mean that these integrations are already in effect. Consult the official list of regulated professions and the government announcement dated June 16, 2026.

What is osteopathy?

Osteopathy uses hands-on examination and manual techniques to influence the movement of various parts of the body. Its traditional explanations are based, in particular, on the idea that these techniques promote the body’s ability to heal itself. The scientific question concerns these specific mechanisms, not the existence of natural healing abilities.

The osteopath interviews the patient, observes their movements, and examines various areas with their hands. Some approaches also focus on the skull or internal organs, such as those in the abdomen. Two reviews, published in 2016 and 2018, examined these specific approaches. They found issues with the reliability of manual examinations—that is, results that are not sufficiently consistent from one examination to the next. They also highlight the lack of solid evidence regarding the specific effects of these techniques, despite some favorable results in trials. These conclusions do not apply to all manual techniques or to osteopathy as a whole.^{1, 2} Some manual techniques and their effects may resemble those of physical therapy. However, the proposed explanations and the treatment plan may differ.

What is physical therapy?

The physical therapist assesses movement difficulties and physical abilities to establish a physical therapy diagnosis. This diagnosis outlines the problems the therapist can address. It takes into account how the symptoms began, how they have progressed, and what factors increase or decrease the pain. The therapist supplements this information with a thorough physical evaluation. In particular, they examine joint movement, flexibility, strength, and the ability to control movements. Depending on the symptoms, they also assess nerve responses to movement. They then develop a treatment plan that may include tailored exercises and recommendations for activities, postures, and sports. They may also use manual therapy to help improve mobility, depending on your needs.

What is chiropractic?

Chiropractic evaluates and treats problems affecting, in particular, the muscles, joints, and nerves. Manual therapies, including spinal manipulations known as “adjustments,” play an important role. However, certain traditional explanations linking spinal problems to organ diseases remain contested by scientific evidence.^{3, 4}

The chiropractor will ask you about your symptoms and perform a physical examination. In some cases, the chiropractor may order medical imaging. For common back pain without warning signs, current guidelines do not recommend routine imaging. A 2021 review estimates that 90 to 95 percent of lower back pain cases seen in primary care, such as in family medicine, show no indication of a serious cause. In the absence of concerning signs, imaging rarely guides care and can lead to unnecessary tests or treatments. It remains indicated when a serious problem is suspected or when it is necessary to plan a specific treatment.⁵

According to the traditional theory of chiropractic subluxation, a malfunction or misalignment between the vertebrae disrupts nerve signals and contributes to various health problems. Adjustments are therefore presented as a way to restore these signals. This explanation remains prevalent in some professional discourse, but it is not shared by all chiropractors. It should not be confused with a true subluxation in the medical sense, which refers to a partial displacement of the surfaces of a joint.

A 2021 review included six trials of acceptable or high quality, involving 534 people. For the conditions studied—including childhood asthma and hypertension (high blood pressure)—manual therapy was no more effective than a sham treatment. These findings call into question the idea of treating organ-based diseases with spinal manipulation. The review does not report on the outcomes of treatment for muscle and joint pain.⁴

Saying that an adjustment “put a vertebra back in place” can therefore give a misleading impression of the treatment. A 2009 analysis examined the criteria used to determine whether chiropractic subluxation caused diseases. The authors found that, for the most part, there was insufficient evidence to support these criteria.³ Practices vary. Some chiropractors use an approach focused on pain, movement, and activities, which may share certain elements with physical therapy. Ask the practitioner what they assess, what they recommend, and how they will measure your progress.

What is massage therapy?

Massage therapists use a variety of massage techniques to work on the muscles in order to reduce pain or stiffness. For lower back pain that lasts several weeks or months, a 2015 Cochrane review reported short-term benefits in terms of pain and functional activity compared to no treatment, a wait-and-see approach, or a sham treatment. This benefit was not observed in the long term in these comparisons. Compared with the other treatments included in the review, massage showed a benefit for pain in both the short and long term, but not for functional activity. The quality of the evidence was low to very low, so these results remain uncertain.⁶

What is acupuncture?

Acupuncture is based on traditional Chinese medicine. This tradition describes an energy called “Qi” that is said to flow through pathways known as meridians. According to this model, a disruption in this flow is thought to cause certain types of pain or illnesses. Acupuncturists insert very fine needles into selected points. This is a description of a traditional model, not an established biological mechanism. A trial involving 638 adults with persistent lower back pain compared four groups: acupuncture with points selected individually for each person, acupuncture using the same points for everyone, a sham procedure that mimics the treatment, and standard care. The study sought, in particular, to determine the role of point selection and needle penetration. The authors question the mechanisms traditionally proposed.⁷ The explanations provided may vary depending on the practitioner’s training and approach.

Kinesiology 

Kinesiologists use physical activity and exercise to improve health and physical abilities. They assess physical fitness and design a program that can build muscle strength, cardiovascular endurance, or both. Goals may include improving health, resuming activities, and enhancing athletic performance. The program also helps reduce the risks associated with a lack of physical activity. Kinesiologists work with both sedentary individuals and athletes. The Fédération des kinésiologues du Québec describes their role and client base.

To learn more...

Our physical therapist, Alexis Gougeon, explains in detail the differences between physical therapy, chiropractic care, and osteopathy on the podcast *Tête-à-tête avec la science*. Episode 08, titled “Alexis Gougeon, Chronic Pain, and Physical Therapy,” was released on July 20, 2021. You can listen to the segment starting at 23:30 on the following platforms:

Sources:

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2. Guillaud A, Darbois N, Monvoisin R, Pinsault N. Reliability of Diagnosis and Clinical Efficacy of Cranial Osteopathy: A Systematic Review. PLoS One. 2016;11(12):e0167823. (Back to section: 1)
3. Mirtz TA, Morgan L, Wyatt LH, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropr Osteopat. 2009;17:13. (Back to sections: 1, 2)
4. Côté P, Hartvigsen J, Axén I, Leboeuf-Yde C, Corso M, Shearer H, et al. The Global Summit on the Efficacy and Effectiveness of Spinal Manipulative Therapy for the Prevention and Treatment of Non-Musculoskeletal Disorders: A Systematic Review of the Literature. Chiropr Man Therap. 2021;29(1):8. (Back to sections: 1, 2)
5. Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291. (Back to section: 1)
6. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015;2015(9):CD001929. (Back to section: 1)
7. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-66. (Back to section: 1)
8. Quebec Order of Chiropractors. What is chiropractic? - Quebec Order of Chiropractors.
9. Chiropractic Association of Quebec. What Is Chiropractic? | Chiropractic Association of Quebec.
10. Marcon AR, Murdoch B, Caulfield T. The "subluxation" issue: an analysis of chiropractic clinic websites. Arch Physiother. 2019;9:11.
11. Homola S. Real orthopedic subluxations versus imaginary chiropractic subluxations. Focus on Alternative and Complementary Therapies. Dec. 2010;15(4):284-7.
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13. Osteopathy Quebec. FAQ: Regulation of the Profession.