What does "functional" mean? And the corollary to that is what does "dysfunctional" mean? In the body, form follows function — the forms that our body takes follow the way that we use it. This applies to muscles, but also to bones, which might be surprising to you. Actually, it applies to all tissues, right down to the cellular level. A great example of bone formation following function is the shape of the skull — if you keep your tongue in the roof of your mouth and breathe through your nose, your skull will have a different shape than if you breathe through your mouth.
Here's a well-known example of sisters, Kelly (left, age 7) and Samantha (right, age 8).
Kelly's breathing was primarily through the nose, Samantha through the mouth. Over the following years, they continued in this way — Kelly worked to better her nose breathing, and Samantha was less successful in learning to breathe through her nose.
Here they are again — Kelly age 10, Samantha age 11. You can see (hopefully — these photos are pretty rough) that Samantha's mouth-breathing has made her face longer, and she's having to use the muscles under her bottom lip to push her lip up (see the dimple in the chin).
In the oro-myofunctional world, these photos are used to show how nose breathing leads to a face that is wider, and which supports better nose breathing. Mouth breathing leads to a face that is longer and better suited to mouth-breathing. Form follows function — nose breathing leads to more nose breathing, mouth breathing to more mouth breathing.
Nose-breathing is considered preferable (the nose handles breathing better than the mouth for a myriad of reason, including better cleaning of the air, humidification, temperature control, and intake of nasal nitric oxide), therefore we could conclude that nose breathing is functional, and mouth breathing is dysfunctional.
But is mouth breathing dysfunctional? She's breathing. The form of her face has followed the function that she has used it for. Is it ideal? What is ideal?
I've used an example from the breathing world because that's where I do most of my study.
But let's talk about movement. I often see on social media the terms FUNCTIONAL ANATOMY, and from that springs FUNCTIONAL MOVEMENT.
What is functional movement? Is there dysfunctional movement? Form follows function — so some movement creates some forms, other movement creates different forms. Are some forms better than others? How do we determine which forms are preferable? Is there an ideal?
Is the preference range of motion? If you sit all day, your hamstrings will likely be shorter, which means that it's harder to touch your toes. If you stretch your hamstrings all day, you may be able to reach well past your toes.
Which of these two people look as though they have functional range of motion? Range of motion for which function?
Is larger range of motion better? If yes is your answer, I refer you to the story of Diane Bruni's hamstring injury — over-stretching the hamstring for many years led to a catastrophic injury. I would also direct you to check out Moses Bernard on Instagram doing Jefferson Curls, a rounded back forward fold with a heavy barbell — don't try this yourself without progressive loading. Two very different examples of long hamstrings.
People who sit in chairs a lot of their day are more likely to have shorter hamstrings, and will be less likely to be able to touch their toes. Does that mean that we shouldn't sit in chairs all day? Does that mean we should never sit in a chair?
Is there an ideal we are looking for in form? Based on what? Images of thin, white, hyper-mobile folks doing poses with their feet behind their heads? In breathing, is ideal only nose breathing all the time? To what end?
Maybe injury is the measure by which we determine functional vs dysfunctional? How about pain? If you want to fall down a rabbit hole I direct you to the pain conversation — what is pain, what causes pain, what relieves pain, should we have an expectation of being pain-free? Too big for this blog post, but interesting, nonetheless.
In breathing, Dr. Rosalba Courtney (one of my teachers — a passionate researcher and advocate for better breathing) defined dysfunctional breathing in her thesis (it occurs in three areas: biomechanics, biochemistry and psychophysiology) There's that word again — dysfunctional. I should also point out that a group she was involved with, of breathing researchers and professionals, had its first gathering and tried to come up with a list to describe functional breathing and couldn't agree on any one item. I often think about that.
So is Functional Anatomy learning about the body as a moving thing, its functions — in other words, this muscle not only attaches and inserts at these locations, but also moves in this way. Or is it a judgment of movement patterns?
This blog post is full of questions. People want definitive answers. But science is about asking questions, and the answers that come from research are an invitation to more questions.
Marketing is about providing solutions — often solutions to problems people don't yet realise they have. Taking the time to figure out what is going on one's own body is complicated, time consuming, confusing. If someone can just tell me what to do, that would be great, thanks. Functional Anatomy is marketing. Most of us are trying to sell something, so I get it.
I've stopped using the words functional and dysfunctional in my teaching, preferring to say, "generalised patterns." What does that mean? We choose to do things in certain ways for specific reasons, in response to our environment. Our bodies will adapt to those choices, creating patterns. If those patterns, at some point, no longer serve you (if you have pain you don't want, or you can't move in ways you would like to, or have symptoms associated with the way you breathe), you might want to interrupt and inhibit those patterns, and then create new generalised patterns with intentional adaptation. (If you want to learn more about the murmuration model of adaptive behaviours you can join me and Laura Wenger in September for Traumatic Stress & the Breath.) I won't tell you what to do, but offer a framework so that you can start to investigate with more understanding.
Generalised Patterns? Yeah, I'm marketing, too, but this feels better to me. When I'm looking at the research, I still look for the terms function and dysfunctional breathing, though.
Dr. Courtney says that breathing should have EAARS — it should be Efficient, Adaptive, Appropriate, Responsive, and Supportive (of the primary and secondary functions of breathing). What do you think about using a similar principle for movement, and dropping the term functional?