The Top Functional Medicine Lab Tests Every Chiropractor Should Know

Few musculoskeletal issues are solely related to skeletal muscles and the bones to which they attach. Many arise from complex imbalances in the body’s biochemistry, prompting a growing number of chiropractors to look beyond the structural components to address root causes more effectively.

Some chiropractors are at the forefront of a broader shift in healthcare—one where functional lab tests are increasingly used to help identify markers of inflammation, metabolic dysfunction, and hormonal or chemical imbalances that may contribute to pain and impaired function.

This article offers a comprehensive, provider-focused guide to incorporating functional medicine lab tests into chiropractic care, grounded in emerging clinical research and a commitment to better patient outcomes. 

This content is for educational purposes only and does not constitute legal or medical advice. Nurse practitioners should consult their state’s specific laws, regulations, and professional licensing boards to determine their individual scope of practice and legal responsibilities.

Why Functional Medicine Testing is Transforming Chiropractic Practices

To understand the use of functional medicine testing in chiropractic care, it’s necessary to have a solid understanding of functional medicine and functional medicine testing.

Functional medicine is a holistic approach to medicine in which the body’s systems are viewed as interconnected networks. This holistic view allows providers to consider how changes in one system may influence others rather than addressing isolated symptoms.

Functional medicine also places a distinct emphasis on patient involvement and individualized treatment plans. As such, functional medicine focuses on:

• Identifying and addressing the root causes of health issues rather than solely treating symptoms.
• Restoring balance to the body and promoting optimal health.
• Focusing on the interconnectedness of bodily systems, recognizing that changes in one area can impact others.
• Encouraging patients to be active participants in their healthcare decisions.
• Treating each patient as a unique individual with personalized health plans.

Functional medicine providers use functional medicine tests to help establish a detailed picture of a person’s health and pinpoint underlying factors to illness. Functional lab tests may serve as valuable tools to help clarify clinical presentation and support treatment planning, when used within your scope of practice or as part of a collaborative care model.

In particular, functional medicine testing is traditionally used in the treatment and monitoring of neuromuscular disorders, an area in which chiropractic care excels.

Functional tests can offer a window into internal drivers of chronic musculoskeletal symptoms, provide objective, quantitative data for decision making, and help chiropractors bridge the gap between subjective symptoms and measurable markers of pathophysiology.

The labs a chiropractor can order may be limited by the state in which they practice. It’s imperative that chiropractors ensure they aren’t working outside their scope of practice or violating state guidelines by ordering lab tests.

In many cases, using a collaborative model in which the chiropractor works as part of an integrated team is the safest and most convenient way to ensure compliant and collaborative care.

Nutritional and Metabolic Panels

Some of the most common labs ordered by chiropractors look at nutrition and metabolism, including:

• Vitamin D, specifically the D (25(OH)D), levels are useful in determining a number of health factors including bone health, musculoskeletal function and cardiac health.
• Magnesium is one of the most important elements in the human body and has been linked to immune health, inflammation, response to healing, and depression.
• Calcium levels can impact muscular contractions, bone health, and cardiac health.
• Electrolyte balance is essential for nerve conduction, proper muscle contraction and release, and stable cardiac rhythms.
• Glucose regulation is critical for metabolic health and energy accessibility.
• HbA1c and fasting glucose can shed light on energy imbalances.
• B12 and folic acid are closely linked to neurological health, fatigue, and brain fog.
• Homocysteine and methylmalonic acid (MMA) are often functional markers that show how well other nutrients are being absorbed and used. This is especially true in B12 deficiencies.
• A comprehensive micronutrient panel is useful in noting nutritional deficiencies or chronic fatigue, as well as showing biomarkers for gastrointestinal disorders such as celiac disease.

Inflammation and Immune Activity

Another area of significant importance and focus is that of inflammation and blood markers for immune activity. Those tests include:

• C-reactive protein (CRP) is a reliable indicator of systemic inflammation and has become one of the most requested lab tests in every type of medicine for determining immune system response.
• Erythrocyte sedimentation rate (ESR) is a complimentary test to CRP that can show not only general inflammatory responses to several diseases but also act as an indicator of an autoimmune disorder.
• Antinuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP) tests and related panels are essential for ruling out underlying drivers of joint pain, especially rheumatoid arthritis while also indicating potential autoimmune diseases.
• Food sensitivity and gastrointestinal (GI) inflammatory testing, such as immunoglobulin G and immunoglobulin A (IgG/IgA), zonulin, and calprotectin, may be useful in uncovering gut-related inflammations affecting systemic health.

Infectious and Environmental Contributors

Testing for Lyme disease may be beneficial when dealing with patients who present with musculoskeletal pain. Not only can Lyme disease mimic numerous musculoskeletal disorders, but chronic Lyme disease can make existing disorders significantly worse.

According to the CDC, about 476,000 people are diagnosed and treated for Lyme disease each year in the United States. Lyme disease, along with other reactivated viruses, viruses that can lay dormant in the system for years, have been implicated in the rise of chronic fatigue and fibromyalgia diagnosis.

Providers must remember that Lyme disease can give false results, both false positive and false negative, using traditional tests. Current guidelines suggest using two-tier testing including ELISA and Western blot tests repeated after several months for confirmation.

Emerging evidence suggests that indoor mold exposure may contribute to certain inflammatory or neurological symptoms in susceptible individuals. When taking a patient history, providers should remember to discuss possible mold exposure and, if necessary, test for mold using an IgG panel.

Musculoskeletal Diagnostics and Bone Health

With any musculoskeletal or neuromuscular disorder, testing the structural integrity and strain-to-load levels of the skeletal muscles and bones is a vital step in diagnosis and treatment. Basic indicators of bone health, such as dual-energy x-ray absorptiometry (DXA), sometimes called DEXA, are an easy, non-invasive first step.

DXA is particularly important in elderly patients, where the simple scan can give critical insights into bone density, osteopenia, and osteoporosis as they relate to individual parts of the skeleton as well as the skeleton as a whole.

The software-based trabecular Bone Score (TBS) can be used as an advanced indicator of bone health. It’s an especially useful tool in DXA scans that are not readily clear as to the levels of bone loss indicated.

In addition, bone turnover and remodeling markers (BTMs) are proving to be a reliable emerging tool in the diagnosis and treatment options for osteoporosis. C-telopeptide of type 1 collagen (CTX), N-telopeptide of type 1 collagen (NTX), and bone-specific alkaline phosphate (ALP) are all reliable markers of bone health and remodeling.

Frequently Asked Questions (FAQs)

Can chiropractors order lab tests in every U.S. state? 

Each state is different in which tests a chiropractor can order. Many chiropractors who want to use functional lab testing find it best to partner with a physician or healthcare team for lab orders.

What functional labs are most useful for back pain and fatigue? 

Inflammatory marker tests, such as IgG panels, vitamin D, and basic tests such as a comprehensive metabolic panel (CMP).

How do chiropractors interpret bloodwork for musculoskeletal complaints? 

Primarily as a means of confirming or ruling out underlying systemic issues, especially when symptoms aren’t fully explained by musculoskeletal factors alone.

Do chiropractors need a supervising MD to order labs? 

This is determined by state. Any provider should become fluent in their state’s laws concerning ordering tests and partnering with other medical professionals.

How do I talk to patients about out-of-pocket lab costs? 

It may be helpful to let patients know that insurance coverage for lab tests can vary and may not always apply. By paying out-of-pocket, patients can often access a broader range of testing options without delays or restrictions.

Key Takeaways

• Evidence-informed diagnostics can enhance clinical decision-making, support personalized care strategies, and foster stronger interdisciplinary collaboration for improved patient outcomes. 
• Functional medicine lab testing, when used appropriately and within scope of practice, can offer chiropractors valuable insights into systemic factors that may be contributing to patient symptoms.
• Collaborating with licensed healthcare providers may ensure lab testing is integrated safely and effectively into patient care.