Feeling better and being ready for the demands of life are related goals, but they are not always achieved at the same time. Pain may improve before strength, endurance, confidence, or activity tolerance returns. Conversely, someone may perform well in a sport while struggling with discomfort or limitations in everyday movement.
Combining appropriate chiropractic care with Functional Movement Systems assessment and individualized exercise offers a practical way to connect these needs. At Arête Health, this means using clinical evaluation to understand the problem, selected assessments to clarify movement priorities, appropriate treatment to address relevant symptoms and impairments, and progressive exercise to develop capability.
The research supports important components of this approach, particularly exercise and the selective use of manual therapy for certain musculoskeletal conditions. However, evidence for those components should be distinguished from evidence that a specific chiropractic-plus-FMS package is superior. Our rationale is to organize supported interventions around the individual, measure the response, and adjust care accordingly.
Chiropractic care can include evaluation, education, exercise prescription, soft-tissue treatment, joint mobilization, and spinal manipulation. Manipulation is one possible intervention within that broader scope. Its appropriateness depends on the condition, examination, patient preferences, risks, and alternatives.
Functional Movement Systems contributes a framework for observing and assessing selected aspects of movement. The Functional Movement Screen, or FMS, examines seven fundamental patterns in appropriate people without pain during testing. The Selective Functional Movement Assessment, or SFMA, helps clinicians organize further examination when pain is present. The Y Balance Test and Fundamental Capacity Screen can add information about dynamic balance and selected physical capacities when suitable.
These tools can help structure decisions, but screening is not treatment. A movement limitation does not automatically establish a cause of pain, and an improved score does not necessarily mean someone has recovered or become a better athlete. The value depends on how findings inform clinical reasoning, exercise choices, and meaningful progress.
For rehabilitation, the strongest rationale is connecting symptom management with active recovery. NICE guidance for low back pain recommends considering manual therapy only within a treatment package that includes exercise, with or without psychological therapy. This supports a model in which hands-on care has a defined role alongside activity and self-management rather than becoming the entire plan (National Institute for Health and Care Excellence [NICE], 2016).
Clinical trials provide additional context. The UK BEAM trial found that manipulation followed by exercise produced modest improvements in back-related disability compared with best general-practice care alone. Treatment was delivered by chiropractors, osteopaths, or physiotherapists, and the exercise program was not an FMS-based intervention. The study supports the potential usefulness of combined care for back pain without validating every manual-therapy-and-exercise combination (UK BEAM Trial Team, 2004).
The benefit of adding manipulation also varies. In a randomized trial involving people with chronic neck pain, supervised strengthening exercise with and without spinal manipulation produced similar outcomes, and both performed better than a lower-dose home-exercise-and-advice program. This is an important clinical lesson: additional treatment is useful when it contributes meaningful benefit, not simply because it can be included (Evans et al., 2012).
Within our rehabilitation approach, movement assessment helps translate the evaluation into practical priorities. Someone with low back pain may need a manageable lifting variation and progressive strengthening. Another person may need targeted mobility work, education about symptom response, or further investigation. When manual therapy improves comfort or motion, we can reassess whether that change helps the person participate in useful exercise. Exercise does not require an adjustment first, and treatment should be reconsidered when its contribution is unclear.
For wellness, the emphasis shifts toward accessible activity, physical capacity, and sustainable habits. Movement screening may help identify exercise variations, establish a baseline, and guide discussion about goals. A person returning to exercise after years of inactivity may benefit from supported strength training, shorter conditioning sessions, and clear progression criteria. Someone already active may need greater variety or a better balance between training and recovery.
Chiropractic evaluation can contribute when pain or a musculoskeletal concern interferes with those goals. The wellness rationale does not require assuming that a symptom-free person needs routine manipulation to prevent disease or maintain “alignment.” Instead, the plan should connect appropriate assessment and care with the abilities the individual wants to preserve or develop.
For osteoarthritis, for example, NICE recommends therapeutic exercise tailored to the person’s needs, including local strengthening and aerobic fitness. Manual therapy for hip or knee osteoarthritis is considered alongside exercise. In this setting, the useful combination is individualized symptom management, appropriate activity, and progressive development of function—not an expectation that manipulation or screening reverses cartilage changes (NICE, 2022).
Special populations require greater individualization. Older adults with fall concerns need assessment of walking, strength, balance, and relevant medical or environmental contributors. Selected movement observations may supplement established measures, but an FMS score alone cannot determine fall risk. Where manual therapy is considered, bone health, medications, symptoms, and other clinical findings influence technique selection or whether treatment is appropriate at all.
People with hypermobility may need strength and control within their available range rather than additional flexibility. After surgery, healing timelines and the surgeon’s restrictions govern testing and loading. In neurological conditions, established neurological and functional measures remain central. The contribution of a movement framework is to help organize relevant observations and exercise decisions within condition-specific care.
The same principle applies to fatigue and autonomic conditions. Orthostatic intolerance may require supported or recumbent positions and changes to rest intervals. For people with ME/CFS and post-exertional malaise, energy management takes priority over fixed increases in exercise. NICE specifically advises against programs using predetermined incremental activity increases for ME/CFS. A combined approach must respect these limits rather than apply a standard progression to everyone (NICE, 2021).
In these situations, the benefit of integration is coordination: selecting appropriate assessments, recognizing when testing should be deferred, adapting exercise, and communicating with other treating professionals. Evidence for rehabilitation within a particular condition should not be presented as proof that chiropractic manipulation treats the underlying disease.
For performance, the central task is preparing the athlete for the demands of training and competition. Movement screening can provide information about selected patterns, while direct strength, power, endurance, and sport-specific testing address other requirements. A comfortable squat, an improved reach distance, or a higher screening score is only useful to the extent that it informs training or accompanies meaningful functional progress.
Chiropractic care may have a role when a musculoskeletal complaint limits training participation. However, research does not support promising that manipulation itself makes healthy athletes faster, stronger, or more powerful. A systematic review of performance-related outcomes in asymptomatic adults found that the overall evidence did not support performance enhancement from spinal manipulation. Some immediate changes were reported, but their practical importance was uncertain (Corso et al., 2019).
Our performance rationale is therefore to evaluate relevant complaints, address appropriate limitations, and connect the athlete with progressive training. Any claimed improvement in speed, jumping, strength, or endurance should be measured directly. Return-to-sport decisions also require consideration of healing, symptoms, psychological readiness, training tolerance, and activity-specific demands.
Across rehabilitation, wellness, special populations, and performance, the common thread is a clear relationship between assessment and action. Each intervention should have an identifiable purpose. We should be able to explain why an exercise was chosen, what a hands-on treatment is intended to accomplish, and which outcomes will determine whether the plan continues or changes.
At Arête Health, this sits within an eco-bio-psychosocial understanding of the person. Injury history, health conditions, and recovery affect physical tolerance. Confidence, expectations, and previous experiences influence participation. Work, caregiving, finances, equipment, and available space shape what can be implemented. A plan becomes more useful when it addresses the barriers that matter in the patient’s actual life.
This also connects with adaptive capacity: developing the ability to meet changing demands while maintaining function and recovering effectively. Within our framework, that means considering the whole progression from a manageable starting point to sustainable participation. The aim is greater independence, supported by knowledge and skills the patient can use beyond the appointment.
Reassessment keeps that aim accountable. We track relevant movement findings alongside pain, strength, endurance, activity tolerance, and patient-defined goals. Can the person walk farther, work more comfortably, resume recreation, or tolerate training more consistently? If a treatment produces only brief relief without useful progress, or a screening score changes without improving function, the plan deserves review.
The benefit of combining chiropractic care and Functional Movement Systems is the opportunity to make care more connected and purposeful. Clinical evaluation establishes priorities, selected screening contributes information, appropriate manual treatment may support symptom management, and individualized exercise develops capacity. Their roles should be chosen according to evidence and the individual’s response.
For the patient, the result should be understandable: a clear starting point, an explanation for each recommendation, and a measurable path toward the activities that matter. That is the standard by which an integrated approach should be judged.
Corso, M., Mior, S. A., Batley, S., Tuff, T., da Silva-Oolup, S., Howitt, S., & deGraauw, C. (2019). The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: A systematic review of best evidence. Chiropractic & Manual Therapies, 27, Article 25. https://pubmed.ncbi.nlm.nih.gov/31183076/
Evans, R., Bronfort, G., Schulz, C., Maiers, M., Bracha, Y., Svendsen, K., Grimm, R., Garvey, T., & Transfeldt, E. (2012). Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: A randomized controlled trial. Spine, 37(11), 903–914. https://doi.org/10.1097/BRS.0b013e31823b3bdf
Functional Movement Systems. (n.d.). What’s the difference between the FMS and the SFMA? https://help.functionalmovement.com/en/knowledge/difference-between-fms-and-sfma
National Institute for Health and Care Excellence. (2016). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline NG59). https://www.nice.org.uk/guidance/ng59
National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline NG206). https://www.nice.org.uk/guidance/ng206
National Institute for Health and Care Excellence. (2022). Osteoarthritis in over 16s: Diagnosis and management (NICE Guideline NG226). https://www.nice.org.uk/guidance/ng226
UK BEAM Trial Team. (2004). United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: Effectiveness of physical treatments for back pain in primary care. BMJ, 329, 1377. https://doi.org/10.1136/bmj.38282.669225.AE