Osteopath or physio?

If you have just moved to Paris, the French system is confusing on this point, and the two professions do not overlap the way they do in London or Sydney. Here is how it works, and who to see for the problems that bring people to my door.

How it works in France

A physiotherapist, un kinésithérapeute or “kiné”, is a state-registered health professional. Sessions are reimbursed by the French public insurance at 60 % of the agreed rate, the rest by your complementary insurance (mutuelle), and in most practices you need a prescription from a doctor to be reimbursed. Direct access has existed since 2023, but only within certain coordinated structures and for a limited number of sessions.

An osteopath holds a title regulated since 2007 and works in direct access: you book without seeing a doctor first. Nothing is reimbursed by the public insurance. A consultation here costs 100 €, and most French mutuelles and international insurers reimburse part of it on the receipt I give you.

What each one does

The physio rehabilitates. They work over time, with frequent sessions: exercises, strengthening, recovering range after surgery or immobilisation, a gradual return to sport. When a shoulder comes out of six weeks in a sling, that is who you need, and more than once.

The osteopath looks first for why it hurts. The session starts with an examination that traces the mechanical origin of the pain, often some distance from where it is felt, then treats it by hand. Sessions are spaced out and few: one to three for a recent problem. If nothing has moved by the third, it is the diagnosis that needs revisiting, not the number of sessions.

The two are not rivals: I regularly refer patients to a physio for the follow-up, and I see patients who come out of physiotherapy because the picture is mechanical and rehabilitation alone has stalled.

Lower back pain and lumbago

For an acute lumbago, the back that locks in a single movement, the osteopath is the right first call: one to three sessions, and movement returns from the next day. For a back that has hurt for months or comes back every winter, the physio brings what I do not, a supervised exercise programme over time. The two then complement each other, one to release the lock, the other to prevent the next.

Sciatica and herniated disc

A disc herniation on an MRI does not tell you who should treat you. What matters is the examination: does the pain really run down the nerve, is there weakness, a missing reflex? Without neurological signs, this is the osteopath's territory, and it is precisely for these discs that the practice is equipped with a spinal decompression table: slow, targeted traction on the disc in question, most often L4-L5 or L5-S1, that lowers the pressure inside the disc where the nerve is compressed. Bring your MRI: I will show you the level concerned and tell you whether you are a good candidate. With weakness that sets in, or trouble passing urine, it is neither one nor the other: it is a doctor, fast. The physio comes in afterwards, when the pain has dropped and the back needs rebuilding for good.

Tendinitis

Achilles tendon, tennis elbow, a shoulder that catches, a heel that hurts at the first step of the morning: a tendinitis that drags on will not settle with rest alone. The practice has a shock wave therapy unit for exactly this, with documented efficacy in chronic tendinopathy, which I combine with the osteopathic session: three to five sessions as a rule, 60 € each. At the same time, the osteopath looks for why the tendon is overworking, a stiff ankle, a hip that does not rotate, a workstation, because a tendon treated without correcting the cause flares up again. The physio then brings the eccentric loading that gives the tendon its strength back; the two complement each other, and I refer readily.

Stiff neck

An ordinary stiff neck settles in one or two osteopathic sessions, without forcing and without cracking a neck already in spasm. Physiotherapy adds little here, except in infants, where the two approaches share the follow-up. A locked neck with a fever is not a stiff neck: call 15, the French emergency number.

Knee

A knee that hurts without a lesion is almost always a knee paying for the others: an ankle that no longer unfolds, a hip that rotates badly, a tilted pelvis, and the knee, in the middle, takes the load at every step. This is where the osteopath is decisive, because the work covers the whole chain from ankle to hip, not just the joint that complains. After cruciate ligament or meniscus surgery, rehabilitation belongs to the physio and takes months; osteopathy comes alongside, as soon as the surgeon allows, to free what stiffened above and below during immobilisation, so that the knee recovers in a leg that moves well. When a lesion is in doubt, an ultrasound or an MRI settles it.

And the chiropractor?

Chiropractors also hold a regulated title in France, not reimbursed by the public insurance. Their practice centres on the spine and on joint manipulation. The osteopath examines and treats more widely, the skull, the pelvis, the limbs, sometimes the abdomen, with techniques ranging from very gentle to manipulation. For a strictly spinal pain, the two overlap.

When you need a doctor first

Neither osteopath nor physio for progressive weakness, numbness around the perineum, trouble passing or holding urine, pain that wakes you every night and that no position relieves, a fever, unexplained weight loss, or pain following a fall or an accident. These need a medical opinion before any hands are laid on. A general practitioner consults in the same building; if you have no doctor in Paris yet, that is where to start.

Practical points for newcomers

You do not need a prescription, a French social security number or a French address. Bring any imaging or reports you have: I read them before examining you. At the end of the session I tell you plainly whether the follow-up is with me, with a physio or with a doctor, and I give you a receipt for your insurer. Consultations are in English, French or Portuguese.