A few weeks ago I had a chat with a Daily Express journalist. He was exploring the differences between chiropractors, osteopaths and physiotherapists for a piece in the paper. I explained that, in my view, there were a lot of similarities between ostoepaths and chiropractors. Both are regulated by an Act of parliament like doctors and dentists; both study for 4 or 5 years for a BSc or MSc degree; both have been going for over 100 years; both use manipulation to treat muscle and joint problems; both have a special interest in treating spinal problems like back pain and neck pain; both advise exercises and lifestyle changes and both are mostly not available on the NHS - yet.

So what is the difference Adrian, the journalist, asked. The main things are some subtle differences in the spinal techniques used and probably most important of all - chiropractors will recommend preventative check-ups more often. Whether this is appealling to you depends on whether you like idea of preventing future episodes of, for example, back pain. If you go to a dentist for check-ups you probably like the idea of preventative chiropractic too.

There are a couple of other differences between chiropractors, osteopaths and physios. An important one is that chiropractors are qualified to take and read x-rays. We have an x-ray unit on site.

There are about 2500 chiropractors in the UK. Osteopaths number about 4000. In the rest of the world the situation is reversed with about 60,000 chiropractors and about 10,000 osteopaths. The difference in the UK is probably because there has been an osteopathic college here since the 1920's but a chiropractic college only since 1965.

There are about 40,000 physios, mostly working in the NHS, whereas almost all osteopaths and chiropractors work in private practice. In the last few years, however, there are several Primary Care Trusts in the NHS employing them. Indeed the 2006 Department of Health Musculo-Skeletal Framework recommends that this should be more common. The NICE chronic back pain guidelines published in June 2009 back up this view.

The difference between chiropractors and physios boils down to spinal manipulation. Whilst a few physios do go on to gain a qualification in manipulation most don't and it is not taught at an undergraduate level to any great extent. Physios do spinal mobilisation which is less vigorous and less effective for things like back problems in my view.

Physios will tend to do more work on extremity problems like frozen shoulder and tennis elbow and other pulls and sprains. They are very good at this and use exercises and machines like ultrasound and in our clinic laser therapy which is wonderful.