It seems impossible to navigate the alternative health care space without encountering the term “functional.” From functional medicine, functional nutrition, functional neurology, the term is ubiquitous in various domains. Even for my strictly MSK chiropractors, the realm of “functional” extends to functional rehabilitation and functional movement screens. Why do we love this “functional” word so much, and what does it even mean? While this word may be redundant, I still believe it is the perfect description to delineate the role of complementary medicine in managing chronic conditions. To understand this concept, we first need to understand the crucial difference in chronic and acute conditions.

Acute conditions, or those needing immediate attention, can be addressed with a binary approach. You either have a heart-attack or you don’t; You either have a hip fracture or you don’t. In these types of conditions, medication and/or surgery is standard of care and usually urgent.

However, this same binary approach cannot be applied to longer-term, chronic issues. You do not just wake up one day with a chronic disease, but rather there is often a long road that leads you there. For instance, you don’t just wake up some day with Type II Diabetes. There is first some form of insulin resistance, even before somebody may be diagnosed with pre-diabetes. Before somebody appears to have high blood sugar on their lab work, they may first feel very slight functional deficits, like feeling very tired after every meal with carbohydrates.

Therefore, chronic conditions like Type II Diabetes should not be viewed with this binary, healthy-or-not approach. Rather they should be viewed on a spectrum, in which somebody is moving along a line away from “healthy” and toward “disease/pathology.” We are doing our patients a great disservice if we wait until a patient has a full-blown, chronic pathology before we address their health issues, but unfortunately this is the case for many neglected patients in our health care system. Therefore, it is the role of “functional” providers to look at patients with a tighter lens. This may involve utilizing narrower lab range (“functional lab ranges”) and/or looking at very early signs of deficits during the physical exam. Treatment involves working with a patient to improve their lifestyle habits like nutrition and exercise. In functional medicine/nutrition, this looks like changing a patient’s dietary habits and providing nutritional supplements based on the patient’s lab results. In functional neurology, this looks like giving the patient neurological exercises to improve neuroplasticity and slow cognitive decline. In functional rehab, one would look at improving movement strategies and patient’s adaptation to everyday tasks to prevent future injury.

By looking at patient care with a functional approach, the goal is to detect a chronic issue as early as possible, prevent this patient’s progression along the health to disease spectrum, and improve a patient’s quality of life.

Find out more about NUHS’ Doctor of Chiropractic program here.