Physical therapists can be incredibly helpful for working out injuries, kinks, and tension. As someone who carries a lot of pain, all three have had a part to play in my rehab at different points. Here's what each one does and how they differ, from someone who's been a patient of all of them.

What the research says

All three approaches, physiotherapy, chiropractic, and osteopathy, share a common aim: reduce pain, improve movement, and support the body's capacity to heal itself. None of them cure concussion directly. What they address are the physical consequences that often accompany it: neck and shoulder tension, postural dysfunction, restricted movement, and musculoskeletal pain that contributes to headaches and fatigue.

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Neck injury frequently accompanies concussion, even when it isn't the primary diagnosis. Cervicogenic headache, headache originating from the cervical spine, is one of the most common and undertreated contributors to post-concussion symptoms. Physical therapy targeting the neck and upper back can make a significant difference.

Physiotherapy

Physio focuses on assessing how your body moves, then treating with a combination of massage, guided stretches, movement exercises, and sometimes equipment like resistance bands or exercise bikes. The emphasis is on functional rehabilitation: getting your body moving well again.

For concussion specifically, physiotherapists with experience in vestibular rehabilitation can be particularly helpful. Vestibular physio addresses the balance, dizziness, and visual disturbance symptoms that often follow head injury.

Chiropractic

Chiropractors work primarily with the skeletal system, focusing on misalignments in joints and vertebrae. Treatment typically involves precise, targeted adjustments to realign and release tension.

It can be very effective, particularly for neck and upper back issues that accompany concussion. The limitation is that results often need regular maintenance sessions to sustain, which adds up in cost and time. Some chiropractors also integrate nutritional support and functional testing, which can add real value.

Osteopathy

Osteopathy feels, to me, like a blend of physio and chiro: working with both muscles and bones for a more whole-body approach. Treatments may include adjustments, massage, and stretches, and osteopaths typically give exercises to continue at home between sessions.

There is also cranial osteopathy, which is related to but distinct from craniosacral therapy. It uses similar principles but is practised by registered osteopaths and takes a whole-body rather than purely craniosacral focus.

How to choose

The honest answer is that the quality of the individual practitioner matters more than which modality you choose. A great physio will outperform a mediocre osteopath, and vice versa. Get recommendations from people you trust, check reviews, and don't be afraid to try someone else if the first person doesn't feel right.

Ally's experience

What I've learned from years of being someone else's patient

I've tried all three, multiple practitioners of each, across Wellington and Hawke's Bay. My overall finding: osteopathy has given me the best value for money and the most consistent results. I usually leave sessions feeling genuinely rebalanced in a way that lasts.

Physio was essential during my most serious recovery period. Working through a concussion clinic with a physio who understood TBI was genuinely transformative, the combination of rebuilding physical capacity with someone who understood why I was starting from such a low base made a real difference.

With chiro, I've had both excellent and not-so-great experiences. My first chiropractor in Wellington also incorporated nutritional support and kinesiology, which was an unexpected bonus. Since then the results have been more variable, which tells me the practitioner matters enormously.

The main thing I'd say: don't suffer through months with someone who isn't helping. Move on and try someone else. You're not being disloyal. You're advocating for yourself.