Both chiropractic and osteopathy aim at treating and preventing pain with conservative manual treatments that do not prescribe medication. These professions are recognized and regulated in France and patients can visit these practitioners without a prescription. Nevertheless, responsibilities, rights and trainings are different. • The area of expertise: The purpose of chiropractic is to remedy disorders of the musculoskeletal system, that is to say pathologies related to the spine and pain in the joints of the limbs. The chiropractor can intervene on the bones, joints, ligaments, tendons, muscles and nervous system. As for osteopathy, it aims to resolve functional disorders at the osteo-articular, visceral and cranial levels. • Rights: Unlike osteopaths, chiropractors are authorized to perform all types of manipulation and manual, instrumental or mechanically assisted, direct or indirect manipulations and mobilizations with or without a vector of force. Chiropractors are the only non-medical practitioners with the right to perform cervical manipulations without prior medical diagnosis. Chiropractors are allowed to use equipment other than their hands. They can supplement the care with advice or analgesic techniques. Osteopaths can only practice non-forced and non-instrumental manipulations. • Training: Chiropractors are trained in a single school in France and training is standardized internationally. Thus, the profession offers a homogeneous and recognized level in Europe and worldwide. Conversely, osteopaths are trained in around thirty schools in France, with heterogeneous training content. Moreover, their diploma is not recognized abroad and it is often difficult to obtain equivalences.

The areas of expertise, rights and training of chiropractors and physiotherapists differ. • Unlike the physiotherapist, the chiropractor is a first contact therapist. Patients can consult a chiropractor directly, without a medical prescription. He must therefore first of all make an assessment of the clinical situation, then propose a treatment plan to treat the disorders of the musculoskeletal system. • While the physiotherapist is a movement specialist who mainly uses rehabilitation exercises, electro-physiotherapy and manual massage or assisted by adapted devices, the chiropractor uses spinal manipulations in which he has acquired an expertise. • Chiropractors are trained in a single school in France, IFEC, so the profession offers a homogeneous and recognized level in Europe and around the world (thanks to the ECCE accreditation). Physiotherapists obtain their State Diploma (DE) after a first year of selection followed by 4 years of training, i.e. 5 years. The training is not standardized internationally, which can sometimes complicate installation projects abroad.

Chiropractic is recognised and legalized in France since 2002 and chiropractors are registered with the ARS (Regional Health Agency). The chiropractic degree is recognised by the French Ministry of Health. In 2011, the HAS (French National Authority of Health), the National Council of the Order of Physicians (CNOM) and the High Council for Public Health (HCSP) have approved memo sheets for the profession that were created by chiropractors.

Chiropractic appeared in the United States in the 19th century, but French pioneers didn’t import it until the 1950s. Today, there are only 1,400 chiropractors in France (compared to 27,000 osteopaths, 86,000 physiotherapists and 58,000 general practitioners), which explains why it is still not well known. Additionally, there is only one chiropractic school in France, compared to approximately thirty osteopathy schools.

In a chiropractic session, bones may or may not crack during joint manipulations. Even though the sound can be quite loud, this cracking is neither painful nor dangerous. It comes from a sudden change of pressure inside the joint, which produces the phenomenon called “cavitation”.

More than 400 supplementary health insurance plans cover chiropractic consultations, depending on the organisation and the contract. Chiropractic treatments are not covered by the national health insurance plan.

Chiropractic studies are exclusively specific long cycle studies: full time, 5 years long (BAC +5), based on an international standard and taught in France in a school approved by the Ministry of Health. Chiropractic is the only health profession benefiting from an officially standardized teaching method in the world. In France, 4960 hours of lessons are provided, i.e. 300 ECTS university credits. Students receive a general education similar to that of medical students, partly provided by medical doctors, chiropractors, academics and doctors of science (PhD) and science researchers. The training also includes supervised clinical practical training of 1350 hours including 300 complete and validated consultations in the care center, internal to the school. The training is accompanied by on-the-job learning through compulsory internships from the 4th year in a public or private hospital.

The 1400 chiropractors in France observe ethical and deontological rules which guarantee patients the reliability and safety of care. The effectiveness of chiropractic and its contribution to the management of musculoskeletal pathologies have been demonstrated by numerous studies and publications (JAMA, BMJ, The Lancet, etc.). Studies show that the profession is not very accident-prone. The manipulations are safer than taking nonsteroidal anti-inflammatory drugs or other morphine derivatives, as a Lancet publication argues * ​ * Prevention and treatment of low back pain: evidence, challenges, and promising directions. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Lancet. 2018 Jun 9;391(10137):2368-2383. doi: 10.1016/S0140 6736(18)30489-6. Epub 2018 Mar 21. Review. PMID: 29573872 ​