"Should I see a chiropractor or a physical therapist?" I hear some version of this almost every week, usually from someone who has already tried one of them. The chiropractor vs physical therapist question often gets framed as a rivalry. For most active adults with back, knee or shoulder pain, it isn't one. At Impact Health Institute in Johnston, a big part of my job sits right where the two professions overlap.
Here's my honest answer. The letters after a clinician's name matter less than how that clinician works. The research comparing the two shows this pretty clearly. What does matter is whether you get a real exam, a clear working diagnosis, hands-on care when it helps, and a plan that gets you back to the things you love doing.
What a Chiropractor Does
Chiropractors are doctors of chiropractic (DC) who diagnose and treat problems of the spine, joints and muscles. Most people know us for spinal manipulation, the "adjustment." Many chiropractors also use soft tissue work, dry needling, exercise and education. You can see a chiropractor directly, without a referral.
Practice styles vary a lot. Some chiropractors focus mostly on adjustments, with frequent short visits. Others, like me, spend most of each visit on rehab: assessing how you move, then building strength and capacity alongside the hands-on care.
What a Physical Therapist Does
Physical therapists earn a Doctor of Physical Therapy (DPT) degree and are experts in exercise, movement and recovery after injury or surgery. Many also use hands-on techniques like joint mobilization and soft tissue work. They're usually the first call after a surgery like an ACL reconstruction or a joint replacement.
In Iowa, you can see a physical therapist without a physician referral; Iowa is one of the states the American Physical Therapy Association lists with unrestricted direct access. PT clinics vary too. Some give you an hour one-on-one with the therapist. Others split the therapist's time across several patients, with aides running much of the exercise.
Chiropractor vs Physical Therapist: What the Research Shows
The most direct comparison is a 1998 trial in the New England Journal of Medicine. Researchers randomly assigned 321 adults with low back pain to chiropractic manipulation, McKenzie-method physical therapy, or an educational booklet. Across two years of follow-up, there were no significant differences between the chiropractic and physical therapy groups on any outcome. About 75% of patients in both treatment groups rated their care as very good or excellent.
One detail I like: the McKenzie method used by the PT group is the same Mechanical Diagnosis and Therapy (MDT) system I'm trained in. Good methods don't belong to one profession.
The same pattern shows up in neck pain. A 2012 trial in the Annals of Internal Medicine followed 272 adults with recent neck pain. Spinal manipulation beat medication for pain over the long term. But a few sessions of home exercise with advice produced similar results to manipulation at most time points. Hands-on care helps. So does movement you do yourself.
Who you see first can also shape what happens next. A 2019 study in BMJ Open looked at insurance records for more than 216,000 people with new low back pain. Those who started with a chiropractor or a physical therapist had much lower odds of early and long-term opioid use than those who started with a primary care physician. It's an observational study, so it can't prove cause and effect. But it suggests either one is a reasonable first stop.
What Actually Matters When You Choose
Instead of picking a profession, pick a clinician. Here are the questions I'd ask on a first call:
Will I get a thorough exam and a clear explanation of what's going on?
Will I work one-on-one with the clinician for the whole visit?
Does the plan include progressive strength work that fits my training, not just passive treatment?
Is there a clear end point, with a way to measure when I'm ready?
Will you refer me out if something doesn't fit, like imaging or a surgical consult?
I'll take a modest stance here. Adjustment-only care that never builds capacity falls short. So does a printed sheet of band exercises with no progression. Most active people need both: something to calm pain down, and a plan to load the area back up.
A Pattern I See Often
Here's a common story, with details blended from several patients. A golfer and lifter in his 50s from Urbandale has had on-and-off shoulder pain for a year. He's tried a round of physical therapy with band exercises, and later a stretch of weekly adjustments. Each helped for a while. The pain came back every time he returned to bench pressing or a full golf swing.
Neither approach was wrong. What was missing was a plan that connected the hands-on care to the loads his shoulder actually faces. We calmed things down with manual therapy and dry needling. Then we rebuilt pressing strength and rotational control in steps, and tested both before he went back to full golf and heavy bench.
How We Blend Both at Our Johnston Clinic
As a rehab-focused chiropractor, I combine hands-on care with functional rehab and strength programming in one place, one-on-one. Every program has a start line and a finish line, in three phases: Reduce Pain, Rebuild, Return. Most musculoskeletal problems improve in two to three months, and your home program blends with the training you already do. I wrote more about what a rehab chiropractor actually does in our first post.
When someone needs post-surgical rehab or care outside my scope, I refer out. Sometimes the best answer for a patient is a great physical therapist, and I'm glad to say so.
So, Chiropractor or Physical Therapist?
If you're recovering from surgery, start with a physical therapist who follows your surgeon's protocol. If you're an active adult in Des Moines with back, neck, knee or shoulder pain from training or daily life, either can be a strong choice. Ask the questions above, and choose the clinician who examines carefully, explains clearly and gives you a plan with an end date.
Week 4 FAQ, references and bio
Paste the FAQ at the end of the post under a "Frequently Asked Questions" heading, then the references and the author bio.
Frequently Asked Questions
Is a chiropractor or a physical therapist better for back pain? Neither profession wins outright. In a randomized trial of 321 adults with low back pain, chiropractic manipulation and McKenzie-method physical therapy produced similar results over two years. The clinician's approach, including a thorough exam and progressive strength work, matters more than the title.
Do I need a referral to see a chiropractor or physical therapist in Iowa? Not under state law. You can see a chiropractor directly, and Iowa allows unrestricted direct access to physical therapists. Some insurance plans, Medicare and workers' compensation cases may still require a physician referral, so check your plan.
Can I see a chiropractor and a physical therapist at the same time? Yes, as long as both know about each other and the plans don't overlap or conflict. A rehab-focused chiropractor who combines hands-on care with strength programming can often cover both roles in one place.
Should I see a chiropractor or a physical therapist after surgery? Start with a physical therapist who follows your surgeon's protocol. Once you're cleared and moving well, a rehab chiropractor can help with the later return-to-sport phase, like getting back to lifting, running or golf.
References
Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339(15):1021-1029. doi:10.1056/NEJM199810083391502
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1 Pt 1):1-10. doi:10.7326/0003-4819-156-1-201201030-00002
Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019;9(9):e028633. doi:10.1136/bmjopen-2018-028633
Study details verified on PubMed on Oct 30, 2026. Iowa direct access status from the APTA direct access by state summary.
Author bio
Dr. Dylan Baker, DC, is the founder of Impact Health Institute in Johnston, Iowa. He holds a B.A. in Exercise Science from Benedictine College and graduated with honors from Logan University. He has advanced training in Dynamic Neuromuscular Stabilization (DNS), Mechanical Diagnosis and Therapy (MDT), SFMA, the Grip Approach and Motion Palpation Institute methods.
