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As healthcare practitioners of every discipline know, sometimes what the patient is presenting with does not tell the whole story of what is triggering their health issue. And sometimes, there’s a root cause yet to be discovered. Even more, patients can struggle to heal if other parts of their overall health and wellness are not being addressed.

This understanding is what compelled Pranjali Sathe, PT, DPT, OCS, cert-MDT, FMCHC, a board-certified orthopaedic physical therapist at MetroHealth Rehabilitation Institute who has been in practice for 20 years, to think more deeply about her patients. Being certified in Mechanical Diagnosis and Therapy (MDT), Pranjali has worked with patients with all kinds of neuromusculoskeletal conditions that have resulted in pain and mobility issues in the neck, shoulders, back, arms, hands, legs and ankles.

After reading Immune Resilience: The Breakthrough Plan to Protect Your Body and Fight Disease, Pranjali—a lifelong learner—realized her patients could benefit from her having a more holistic approach to their physical therapy. Shortly after, she began the year-long certification process in functional medicine.

“Functional medicine takes a science-based approach to whole health,” she explains. “It’s a behavioral change specialty that focuses on five key areas that directly affect how well a patient heals and recovers from an illness or injury.”

The five areas are:

  • Sleep
  • Exercise
  • Nutrition
  • Stress
  • Relationship

In early 2024, Pranjali became MetroHealth’s only functional medicine-certified health coach. She regularly brings the principles of functional medicine into her physical therapy practice with ortho patients. These principles she incorporates include functional medicine, functional nutrition, positive psychology and
mind-body medicine.

“It’s very applicable to the work we do in physical therapy,” she explains. “By adding this specialty, I’m bringing a more science-based holistic approach that, at times, helps get to the root cause of what a patient is experiencing.”

Case in point: Pranjali was providing physical therapy to a patient with persistent knee pain. Pranjali was treating her mechanically but still felt like there was an underlying cause of the pain that wasn’t being identified. Pranjali began to inquire about some of the lifestyle factors that she knew could affect her patient’s progress.

During that discussion, she learned the patient had started having knee pain about the same time she’d switched her diet, which now included more red meat and pasta. Together, they brainstormed how the patient could modify her diet to see if it impacted her pain at all.

“Through my motivational interviewing, the patient decided to refrain from red meat, switch to whole grain pasta and add in more vegetables,” Pranjali says.

At the next PT visit two weeks later, the patient reported no pain.

Pranjali saw similar results in another patient dealing with shoulder pain. Again, Pranjali led with the MDT approach and determined the shoulder pain was coming from a neck   issue. She gave the patient some exercises to do until their next visit. By the third visit, the patient was doing a little better, but Pranjali thought there seemed to be something else they needed to address. She inquired about the key lifestyle factors, which prompted the patient to share that she only slept two to three hours a night—and it had been that way for years.

They talked about the patient’s habits before bed: eating dinner and snacks right before trying to sleep, doing puzzles beforehand, being on her phone late, and sleeping with the TV on all night. While Pranjali knew none of those habits were good sleep hygiene, she also knew that she needed to guide the patient to that understanding—and a solution—instead of just telling her that.

“I asked, ‘What do you think you can do about the TV?’ and she replied, ‘Turn it off.‘ Then I asked, ‘What do you think you can do about eating food so late?’ and she replied, ‘Eat a couple hours earlier.’ One by one, I went down the list of negative habits and asked her how she thought she could address it. The solutions were all hers, which is necessary for sustainability,” Pranjali says.

At her next visit a couple of weeks later, the patient reported she was sleeping six hours a night—the first time in years. Pranjali says she was amazed how the solution to her chronic sleep deprivation was so simple yet so effective.

“The functional medicine mindset is changing the way I practice. It is so satisfying to see the results,” Pranjali says. “There are tremendous benefits for patients when physical therapy and functional medicine are brought together. Patients feel more holistically seen and heard—and so many factors affect recovery. When they are part of the solution, the result is more sustainable.”