When you have back pain, muscle aches or a sports injury it can be difficult to decide whether to see a physiotherapist, biokineticist, chiropractor or doctor. Gone are the days when heat or ice and bed rest are best. Early movement or exercise is often helpful even with tissue injuries. But knowing that rest isn’t enough still leaves the next question: what should you do, what should you avoid, and who should guide you? Articles like this can easily upset practitioners because we don’t always agree. Still, here is my best-intentioned attempt at how to choose.
Physiotherapy has existed in South Africa for more than 100 years. It has helped millions of people and failed others. Matching the condition to the person’s expertise is however more important than matching it to a profession. Considering the clinician’s strengths relating to your needs rather than picking the ‘best’ profession.
Biokineticists, for example, may be consulted for pain relief. Physiotherapists don’t always love hearing that, perhaps because biokinetics is much younger and it can feel like the profession was duplicated. Even professionals battle to pinpoint the differences: You’ll find both in gyms, both might talk about posture or blame certain muscles not “firing,” and both commonly prescribe rehabilitative exercises to do at home.
A common misconception (which I once believed) is that treating pain falls outside the scope of biokinetics. Conversely, some biokineticists believe physios may not provide final phase rehabilitation. At a recent meeting with the governing board of the Professional Board for Physiotherapy, Podiatry and Biokinetics (PPB) of the HPCSA, it was made clear that the scopes of physiotherapy and biokinetics differ far less than many assume.
What is the difference between a physiotherapist and a biokineticist? There are a few things one profession may do which the other may not.
Biokineticists
- Finger-prick blood tests
Physiotherapists
- The acute management of traumatic injuries
- Manual joint mobilisation
- Manual joint manipulation
- Dry needling
- Electrotherapy beyond exercise-related modalities
To my knowledge, chiropractors and medical doctors have none of these restrictions, but I’m open to correction.
Even so, having access to more treatment options doesn’t necessarily lead to better results. Individual skill varies widely. You may find a physiotherapist better at exercise prescription than the average biokineticist, or a biokineticist better at massage than many physios. The same variation exists with spinal manipulation from chiropractors. So how should you approach this logically?
If you have strong trust in a particular health professional, there’s no harm in seeing them first—even if the condition might technically fall outside their scope. An ethical clinician will recognise those limits and refer you if someone else is better suited to help. The initial appointment may feel wasted, but the directional guidance should be of great value. Otherwise, some general considerations may be helpful:
- If you’ve always had good, lasting results with chiropractic care, there may be no reason to change.
- If you want short-term relief, a GP prescription, a massage may or a quick chiropractic session may temporarily help.
- If your goal is to avoid surgery, starting with a surgeon may not be the best decision.
- Significant bleeding or obvious bony disfigurement, straight to the emergency room.
- Fever with pain, see a medical doctor.
- For general strength and lifestyle changes, biokineticists have ample expertise here.
- If you prefer passive treatment, relief may be short-lived, but chiropractors and some physiotherapists often offer these options.
- If you want the best chance of understanding and managing the condition long term, choose someone who prioritises an accurate assessment and diagnosis (without creating undue fear) over the delivery of some fancy treatment, irrespective of their profession.
Those who know me understand that careful assessment is where my interests lie. I refuse to assume and therefore focus on understanding how symptoms behave so we can identify the cause and the best way to manage it. This mindset began during my physiotherapy training and deepened significantly while I credentialed in the McKenzie Method.
Treating without appropriate assessment can lead to ineffective care or serious problems, which is why my priority is always to understand first. From there, the best or referral options will be clear and the risks appreciated. Consider these concerning scenarios:
- Dry needling where we didn’t know there is a tumour
- Strengthening exercises for unknown vascular compromise or an infection.
- An MRI revealing an incidental finding you can never “unsee”.
- Massage or other passive therapies falling short of addressing the cause, resulting in persistent recurrences.
So, who should you see? Someone who assesses you comprehensively. Not just the painful area, but the person in front of them and the wider factors influencing health because that deeper knowledge is where true value is ultimately uncovered.
Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.