When to consult? A guide to practitioners (osteopaths, chiropractors, naturopaths, dieticians, psychologists, reflexologists)

Nearly four out of ten French people report having already used some form of complementary or alternative medicine. (1) Knowing when to consult an osteopath, a chiropractor, a naturopath, a dietician, a psychologist, or a reflexologist nevertheless requires understanding what each of these complementary medicine practitioners actually does, and what the law and science say about it.

The purpose of this guide is not to recommend these approaches, but to draw up a factual state of affairs. Not all are equal on a legal level: some correspond to regulated healthcare professions, others to so-called "non-conventional" practices devoid of any specific legal framework. For each discipline, you will find a neutral definition, the level of recognition, the concrete course of a session, and what to expect, or not, from it.

A preliminary distinction: regulated healthcare profession or non-conventional practice

French authorities distinguish "conventional" practices, which are based on scientifically validated treatments or a strong professional consensus, from "non-conventional care practices" (PSNC), located outside the reference biomedical field. (2) This boundary is important: it determines the practitioner's title, their training, the authorized content of their acts, and the possibility of reimbursement.

Three major categories coexist.

1. Medical and paramedical professions (physicians, dieticians, physiotherapists, etc.) are regulated by the Public Health Code and are the only ones authorized to diagnose and treat diseases.

2. Regulated titles without a professional order (osteopath, chiropractor) are based on a title protected by law but do not constitute healthcare professions registered as such.

3. Finally, well-being practices (naturopathy, reflexology, etc.) are unregulated: their practice is unrestricted.

In all cases, a non-medical practitioner who makes a medical diagnosis or treats an illness exposes themselves to the offense of illegal practice of medicine.

The osteopath

Osteopathy is based on manual manipulations and mobilizations of musculoskeletal and myofascial structures. The legal framework provides that their sole purpose is to prevent or remedy functional disorders, excluding organic pathologies requiring medical intervention. (3)

The title of osteopath has been protected since the law of March 4, 2002 and is regulated by Decree No. 2007-435 as well as the 2014 decrees, which set training at 4,860 hours over five years for baccalaureate holders. (3) The osteopath registers with the Regional Health Agency. However, they do not have a professional order and are not listed among the healthcare professions in the Public Health Code. Their sessions are not reimbursed by Social Security; some complementary health insurance companies offer a flat-rate package.

During a session, the practitioner conducts an interview then a palpatory examination, and applies external manual techniques: joint mobilizations, rapid manipulations of low amplitude (which may be accompanied by a clicking sound of no diagnostic value), myofascial work. Patients consult mainly for spinal and joint pain. Scientifically, it is observed that spinal manipulations produce effects comparable to other recommended treatments on chronic low back pain, without demonstrated superiority. (4)

A non-physician osteopath is obliged to refer any symptom requiring a diagnosis or further examination to a medical doctor. Recourse to osteopathy never replaces a prior medical opinion in the event of unexplained, persistent pain or pain accompanied by warning signs.

The chiropractor

Chiropractic focuses on neuromusculoskeletal disorders of the locomotor system, particularly in the spine. Decree No. 2011-32 of January 7, 2011 authorizes chiropractors to perform external, manual or instrumental, manipulations and mobilizations. (5)

The title is protected and regulated, training takes place over five years in an approved establishment, and the practitioner is registered with the health authorities. As with osteopathy, there is no professional order and sessions are not covered by Social Security.

However, one feature distinguishes chiropractic: the legal framework provides that the chiropractor can perform manipulations of the cervical spine without a prior medical certificate. (5) In return, the decree imposes on them a precise list of clinical signs and contraindications from which they must abstain, the obligation to inform the patient of risks, and that of remaining reachable within 48 hours following a cervical manipulation.

A session includes an assessment, sometimes tests, then joint "adjustments". The most frequent reasons are neck pain, low back pain, and thoracic back pain. Scientifically, the level of evidence is similar to that of osteopathy for spinal pain.

Cervical manipulation is subject to specific vigilance: in rare cases, it is associated with a dissection of the cervical arteries that can lead to a stroke. The absolute risk is very low and the causal link remains debated, as cervical pain itself can precede and reveal the dissection. (6) This uncertainty justifies strict adherence to contraindications and seeking informed consent. In case of doubt, a prior medical opinion is required. The page dedicated to chiropractors details their scope of practice.

The naturopath

Naturopathy is defined by the World Health Organization as a set of methods aimed at strengthening the body's defenses through means considered natural: lifestyle advice, nutrition, herbal medicine, stress management. In France, it is a non-conventional practice.

The legal framework here is essential to understand: naturopathy is unregulated. There is no state diploma, the title is not protected, and there is no professional order; anyone can, in theory, declare themselves a naturopath. (7)

Private federations (FENA, OMNES, SPN) try to structure the profession via charters and a voluntary standard, which has no regulatory value. Naturopathy is also subject to close monitoring by the Interministerial Mission for Vigilance and Fight against Sectarian Drifts (MIVILUDES), due to reports of promises of healing and refusal of medical care. (7)

A session takes the form of a "vitality" assessment and an interview on lifestyle habits, followed by personalized advice. Practitioners claim to act on fatigue, stress, sleep or digestion. The naturopath legally has no right to make a diagnosis, treat an illness, or suggest stopping a medical treatment: they must refer the patient to a healthcare professional as soon as a symptom justifies it. No reimbursement from Social Security is available. This discipline is by no means a substitute for medical care, and any therapeutic promise must be considered a warning sign.

The dietician

Unlike the previous three, a dietician is a regulated healthcare professional. The Public Health Code defines a dietician as a person who dispenses nutritional advice and, under medical prescription, participates in the nutritional education and rehabilitation of patients with metabolic or eating disorders. (8)

Use of the title is reserved for holders of a recognized diploma (BTS in dietetics, BUT in biological engineering option dietetics, and henceforth a state diploma); illegal practice is punishable by one year of imprisonment and a fine of 15,000 euros. (8)

A dietician must be distinguished from a "nutritionist", who is a specialized medical doctor, and from "nutrition coaches" without a protected title. In private practice, consultations are generally not reimbursed by Social Security, except for certain specific pathways (healthcare facilities, dedicated programs); complementary health insurances may contribute.

A consultation begins with a personalized dietary assessment, eating habits, history, objectives, then leads to a nutritional plan and follow-up. The reasons range from weight loss or gain to support for diabetes, digestive pathologies, or eating disorders. Scientifically, evidence-based dietary management has a recognized place in many pathologies. Nevertheless, the dietician remains a link in a coordinated pathway: they act in connection with the physician, without substituting for them for the diagnosis.

The psychologist

A psychologist is a professional in behavior, emotions, and mental health. Their title has been protected by law since 1985 and requires a master's level university degree (5 years of higher education) with an internship, as well as registration in the professional directory (RPPS). (9) They must be distinguished from a psychiatrist, who is a medical doctor and can prescribe medication, and from a psychotherapist, whose title is subject to its own regulations.

A session is based on an interview: assessment of the request, then support according to different approaches (notably cognitive-behavioral therapies, the effectiveness of which is supported for several disorders). Reasons for consultation include anxiety, depression, stress, relationship difficulties, or painful life events. In terms of reimbursement, the public system Mon soutien psy allows, in 2026, to benefit from up to 12 sessions per year with a contracted psychologist, at a rate of €50 per session, covered at 60% by Social Security and accessible with direct access, without prior prescription. (10) This system remains a minority: a large proportion of private psychologists do not participate, and their consultations are then subject to unregulated fees. For severe disorders or vital risk, referral to a medical doctor or psychiatrist remains indispensable.

The reflexologist

Reflexology is based on the idea that pressure applied to "reflex zones" of the feet, hands, or ears corresponds to organs or functions of the body. Practitioners claim to promote relaxation and a self-regulation process. In France, it is a non-conventional well-being practice.

The legal framework is comparable to that of naturopathy: reflexology is not recognized by health authorities, has no state diploma or regulated title, and falls within the scope of well-being rather than healthcare. (11) A few private certifications of "reflexologist" level have existed in the National Directory of Professional Certifications, and a voluntary standard was published in 2025, but none of these steps confers a therapeutic status. Scientifically, the assumption of a correspondence between reflex zones and organs is not demonstrated, and the available clinical studies are few and of low level of evidence; medical authorities classify reflexology among unrecognized practices. (11)

A session consists of a time of discussion followed by a massage with targeted pressure, aiming for relaxation. This is precisely how the practice is most prudently presented: as comfortable support, without curative aim. Reflexology cannot cure an illness; the practitioner is required to refer to a physician when symptoms require it. It must never delay a medical diagnosis.

How to identify a regulated practice from a risky practice?

Several concrete benchmarks help you consult with full knowledge of the facts. Check the practitioner's title, training, and potential registration with health authorities. Beware of any promise of healing, particularly for serious illnesses, as well as any speech encouraging you to interrupt a medical treatment or to avoid conventional medicine: these are warning signs identified by authorities. A professional practitioner knows the limits of their scope of action and refers you to a physician when necessary.

For functional and musculoskeletal disorders managed by healthcare professionals, the challenge is often continuity and coherence of follow-up. Digital solutions like Andrew®, used by physiotherapists and other therapists, make it possible to prescribe exercises and ensure traceable follow-up between sessions, in a logic of coordinated and evidence-based care. This illustrates the difference in approach between documented support and a practice without a framework. To go deeper into the subject of manual and well-being approaches, you can read our guide to complementary and manual therapies.

Conclusion: an active patient, but never instead of the medical doctor

Osteopathy, chiropractic, naturopathy, dietetics, psychology, and reflexology cover very different realities: two regulated healthcare professions (dietician, psychologist), two protected titles without an order (osteopath, chiropractor), and two non-conventional practices with unrestricted access (naturopath, reflexologist). Knowing this framework, the course of a session, and the level of evidence allows for decisions to be made without illusion or principled rejection.

One principle remains constant regardless of the discipline: none of these approaches replaces a medical diagnosis, and any persistent, unexplained, or worrying pain first warrants a medical opinion. Being an active participant in one's health means precisely asking the right questions, checking the framework, and keeping the medical doctor at the center of the healthcare pathway. To understand how exercise-based support fits into structured management, consult our article on therapeutic patient education for chronic pain.

Are you a practitioner wishing to structure your patients' follow-up through exercise and therapeutic education? You can speak with the Andrew® team to see how the tool integrates into your practice.