Physical Therapy and Nutrition

[DocTAP87]

The APTA states, "the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice."

I think we put a lot of emphasis on physical activity but I believe that health is truly made by the decisions that we make in the kitchen. The physicians rarely discuss nutrition with their patients and get little to no training on the subject.

I know that it depends on the state how much counseling we can give but how do you think we can approach this issue? I know some physical therapists that run Crossfit gyms and thereby end up promoting the paleo lifestyle. Could we advertise ourselves as "PTs that promote a whole foods plant based diet" for example.

What do you think about our role in patient health concerning nutrition?

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[jesspt]

Well, unless it has been included in your PT school's curriculum, your role should probably be close to non-existent. I usually refer to our Wellness Nurse for coaching on how to implement a healthy diet.

 

[scrawnyguy]

Honestly I think it should be limited. We are often defensive we feel other professions are encroaching on our scope of practice, but if we delve too much into nutrition aren't we doing just that to nutrition SMEs such as dietitians? Perhaps I'm biased because I'm married to one.

 

[DocTAP87]

Honestly I think it should be limited. We are often defensive we feel other professions are encroaching on our scope of practice, but if we delve too much into nutrition aren't we doing just that to nutrition SMEs such as dietitians? Perhaps I'm biased because I'm married to one.

I understand what you're saying and that makes sense. My only concern is that we are seeking to improve health and well being and we have a major focus on exercise. We can promote exercise, we can recommend exercise, some of us are also personal trainers. I read that the APTA recommends that we also be RDs in order to provide nutritional information. Like I can go back and get another bachelors! I think that nutrition is key to prevention of disease and treatment of disease. I don't want to step on anyone's toes but the medical community needs to promote proper nutrition. Not the Standard American Diet either.

This link was emailed to me from a professor. Perhaps some of you might find this interesting.

APTA Launches New Nutrition Webpage

 

[yodelingyorkies]

Honestly, if a PT were marketing themselves as one who "promotes a whole foods plant based diet", I would be pretty turned off to that as a patient. I do believe in a holistic approach to health, but if I'm seeing an outpatient PT for my plantar fasciitis I wouldn't want a spiel on my dietary intake. You scoff at going back to school to become a dietician, but as far as I can tell PTs are not trained/educated to deliver a significant amount of nutrition/diet advice. Not that PTs can't have any role in the process, however, that's not what you went to school for. If you want to be more holistic in your approach at this point it seems you'd have to partner with an RD or nutritionist because they did go to school for that.

 

[DocTAP87]

Honestly, if a PT were marketing themselves as one who "promotes a whole foods plant based diet", I would be pretty turned off to that as a patient. I do believe in a holistic approach to health, but if I'm seeing an outpatient PT for my plantar fasciitis I wouldn't want a spiel on my dietary intake. You scoff at going back to school to become a dietician, but as far as I can tell PTs are not trained/educated to deliver a significant amount of nutrition/diet advice. Not that PTs can't have any role in the process, however, that's not what you went to school for. If you want to be more holistic in your approach at this point it seems you'd have to partner with an RD or nutritionist because they did go to school for that.

Would it be off putting or it could it be a niche? I don't mean to give a spiel during treating every dx, I just meant that the information could be available. Or maybe like how some PTs cater to cross fitters, maybe this PT could cater to no meat athletes. If that market even exists. I don't know.

When I go to my doctors office, he has religious stuff all over the place. He's not a preacher, but he finds it important. He doesn't discuss it unless it comes up. I didn't mean to scoff at the idea of becoming an RD...I just literally can't. I have maxed out my loans. Plus, I was thinking of getting away from the promotion of the SAD. I didn't want to put people on meal plans, I was thinking more like encouraging good nutrition with some basic facts. Refer to an RD or nutritionist for something more guided.

 

[Doc-PT]

I, for one, absolutely think it is within our scope of practice to promote a healthy diet simply because our many years of education have prepared us to know a lot more about the body and nutritional needs than your average client. However, I don't believe it is within our scope of practice to be specific in terms of caloric intake requirements or appropriate meal plans which, of course, should be left to a nutritionist to whom we could develop a referral relationship. Generally though, explaining the basics of healthy eating and why it plays a huge role in health and recovery is going to be extremely important for some of our patients and we should not shy away from guiding our patients to consuming a more healthful, plant-based diet in addition to following our exercise prescriptions.

 

[truthseeker]

next we will be prescribing herbal supplements, doing acupuncture (wait, we are dry needling) and adjustments (wait we are doing manips) do we have chiro envy? I would stay out of it completely. Yes, eat less than you burn, veggies are better than vitamins, eat something green, maybe 2-3 less beers per week and you will weigh less but that is about as deep as I get.

 

[DocTAP87]

next we will be prescribing herbal supplements, doing acupuncture (wait, we are dry needling) and adjustments (wait we are doing manips) do we have chiro envy? I would stay out of it completely. Yes, eat less than you burn, veggies are better than vitamins, eat something green, maybe 2-3 less beers per week and you will weigh less but that is about as deep as I get.

I understand what you're saying but I have to completely disagree with you. Especially your first few points. For one, taken at face value, it seems to me that you want us to not do anything beyond what a personal trainer would do. I think we should be doing every evidence based thing that we can that benefits the patients. Because our health is so heavily influenced by what we eat, of course we should promote healthy eating. That goes beyond less beer and eating something green. It goes beyond eat less than what you burn. What we eat will influence how we heal. Research backs this as an intervention and an important aspect of our physical health. Do you apply US? Please tell me you don't do diathermy. That's lacking evidence yet PTs do it every single day. Nobody is promoting nutrition. You mention chiro envy. You know what I noticed about chiros? They are sought after and they are respected and PTs are deserving of that and more.

We could fill a gap short of prescribing meal plans and I think that's beneficial for patients and for the profession.

 

[Doc-PT]

I understand what you're saying but I have to completely disagree with you. Especially your first few points. For one, taken at face value, it seems to me that you want us to not do anything beyond what a personal trainer would do. I think we should be doing every evidence based thing that we can that benefits the patients. Because our health is so heavily influenced by what we eat, of course we should promote healthy eating. That goes beyond less beer and eating something green. It goes beyond eat less than what you burn. What we eat will influence how we heal. Research backs this as an intervention and an important aspect of our physical health. Do you apply US? Please tell me you don't do diathermy. That's lacking evidence yet PTs do it every single day. Nobody is promoting nutrition. You mention chiro envy. You know what I noticed about chiros? They are sought after and they are respected and PTs are deserving of that and more.

We could fill a gap short of prescribing meal plans and I think that's beneficial for patients and for the profession.

I could not agree more

 

[truthseeker]

wow, I do not agree. there is something called a scope of practice. we are "Physical" therapists, not physicians. Chiro's are respected? it seems that you and I travel in different circles considering the amount of woo that is traditionally in their practice. No I don't do US, or Diathermy or hot packs or dry needling, or manips, or suction cupping, or aura treatments, or passive food allergy tests, or ART. I look at how people move, why they don't move where they are supposed to and why they move too much where they are not supposed to. I educate people on pain concepts and help them learn to deal with what they have, change what they can but you can't fix everything. Nutritional research is probably sound science but then again I don't read that because there is plenty to read in my own scope of practice. If someone needs nutritional counseling I will refer them. IMO that is what we should all do other than giving very basic nutritional advice which is all we are trained for.

 

[jesspt]

For one, taken at face value, it seems to me that you want us to not do anything beyond what a personal trainer would do.

Trainer's don't discuss nutrition?

Nobody is promoting nutrition

A lot of people/professions are. I think that you could argue that few are doing it effectively. You think, given your education on the subject, and while staying within the confines of your practice act, that you can do it better than the professions currently educating patients on nutrition?

You know what I noticed about chiros? They are sought after and they are respected and PTs are deserving of that and more.

I don't know where you are practicing, but I wouldn't say that the chiropractic profession has a great reputation, particularly among allopathic physicians.

We could fill a gap short of prescribing meal plans

How are you going to get paid for filling this gap? I think your employer will be interested in your answer to this question.

 

[Doc-PT]

"Diet and nutrition are key components of primary, secondary, and tertiary prevention of many conditions managed by physical therapists. It is the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice. This includes appropriate referrals to nutrition and dietary medical professionals when the required advice and education lie outside the education level of the physical therapist." https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/RolePTDietNutrition.pdf

If, for example, my patients complain of knee and/or hip pain during my initial examination and is overweight or obese, I will discuss nutrition and weight-loss with them when I discuss my examination findings because their weight, and likely nutrition, will need to be addressed in order to sufficiently lessen said joint pain. I will also seek to incorporate healthy eating and regular aerobic exercise into our overarching therapy goal. I will recommend they see a nutritionist and will refer them should they agree because a nutritionist can provide them with more specific and individualized nutritional recommendations than I can. Thus I, as a physical therapist, will play a very different role than a nutritionist in that my input will be an educational adjunct to the exercise prescriptions I provide.

 

[Doc-PT]

Nutrition has been specifically laid out by the APTA as within our scope of practice and can be billed for but we have to check our own states practice act to be certain it is allowed there.

"Is nutritional education a reimbursable physical therapist procedure?
If the information a physical therapist provides is substantial in content and time, falls within the patient's plan of care, and is documented, it is possible that nutrition education reasonably could be charged as patient education (for example, self-care). However, check their state's laws on nutrition and contact your third party-payers to confirm."
Nutrition and Physical Therapy

 

[Doc-PT]

"For instance, a PT should refer out when the required education is beyond general information that can be found in the public domain, or involves information that is outside of dietary guidelines who require extensive meal planning, specific values for any macro- or micronutrients should be referred out, as should patients with specific disease processes or who are on specific medications that are directly affected by dietary manipulations. "

Nutrition and Physical Therapy

 

[truthseeker]

I had one nutrition class in undergrad as an athletic trainer. I don't remember anything beyond a very cursory mention of nutrition in any of my PT classes. I think its a reach. Maybe the APTA has better things to do like functional direct access, marketing our profession, etc . . .

 

[Doc-PT]

We can generally provide education regarding nutrition but we can't advertise our services as "nutrition services"...which of course we don't. However many PTs, myself included, will incorporate these discussions and guide our patients toward healthy eating and exercise regimens because we seek to take a more holistic approach with our patients, which for many extends beyond diagnosis and treatment of the specific musculoskeletal problems. As long as we aren't touting ourselves as nutritionists and providing specific meal planning or suggesting specific supplements we are simply using the knowledge we've gained through many, many years of education and, for a lot of us, experience in the health field to guide our patients toward a healthier, active and more pain-free lifestyle.

"May a physical therapist advertise nutrition services or use the designation "nutritionist"?
Unless you or someone on staff is licensed or holds a certificate in diet and nutrition, and is covered by professional liability insurance, it would not be advisable to advertise services that you may not be eligible to deliver."

 

[Doc-PT]

I had one nutrition class in undergrad as an athletic trainer. I don't remember anything beyond a very cursory mention of nutrition in any of my PT classes. I think its a reach. Maybe the APTA has better things to do like functional direct access, marketing our profession, etc . . .

I completely agree that the APTA should address those issues too.

 

[Doc-PT]

I just ran across this article that I thought was very good. If any of you have a real interest regarding the importance of addressing lifestyle and nutrition with our patients its definitely worth taking a few minutes to read:

The Link Between Nutrition and Pain Is too Strong to Ignore in Your PT Practice

 

[jesspt]

I will discuss nutrition and weight-loss with them when I discuss my examination findings because their weight, and likely nutrition, will need to be addressed in order to sufficiently lessen said joint pain.

And what dietary guidelines would you provide to this patient?

 

[truthseeker]

besides eat less than you burn?

 

[Doc-PT]

For each patient my discussion will be different but for this particular example it would incorporate something along the lines of "your joints and especially your knees are your body's shock absorbers during upright activity and when it is carrying extra weight they can't function effectively and, thus, eventually break down and fail. Many studies have concluded a link between extra body weight and knee pain which is caused by the development of OA." If my patient was curious and wanted to know a little more about the development of OA in the overweight population I could also site the association between increased BMI and the release of the hormone leptin which is thought to be another contributor to cartilage degradation in addition to the degradation caused by the increased load and friction that the joint must overcome as an overweight person moves. I could also, of course, site the fact that excess lipids cause the release of inflammation inducing factors, tumor necrosis factor alpha and interleukin-1, that influence the actual cartilage damage seen in OA. I could also discuss the fact that because being overweight places undue pressure on lower extremity joints, overweight people need joint replacements more often. However, being overweight, especially obese, makes them riskier candidates for surgery and can produces less successful surgical outcomes. I would ask that they keep track of what they eat, that they become familiar with counting calories in order to help them better understand the significance of their eating habits, that they eat smaller meals more frequently, that they consume plants and protein over carbohydrates and processed foods when they can and that they, yes, consume fewer calories than they burn in order to create a caloric deficit which will, ultimately, lead to weight loss. This of course would be combined with the recommendation that they participate in some aerobic activity everyday in addition to strength training within a safe level for their age and condition. Health and nutrition information is readily available for us to digest and disperse at our discretion. I advocate that physical therapists make the attainment of an active lifestyle with a big emphasis on nutrition an important, albeit smaller, part of their therapy practice. I do not, however, advocate that any therapist do this if they are not comfortable disseminating this information or believe it is not within their scope of practice to do so.

 

[DocTAP87]

I think I may be coming off wrong. I don't understand why there's push back about discussing nutrition with our patients. I believe that everybody should be discussing nutrition. Physicians, dentists, podiatrists, optometrists, physical therapists, chiropractors, and whoever. We have a wealth of knowledge and many of us take our own health very seriously and we know that what we eat is even more important than how we exercise and we should be encouraging both. We know the connections between diet and health outcomes so we should not ignore it. If PTs can take the time to promote recreational exercise and run Cross Fit gyms, which I see a lot of, then we should be able to promote nutrition short of creating meal plans; that's a time to refer.

Chiros are often cited as sources, they are guest speakers, they are more readily accessible than PTs even in direct access states, and nobody hesitates to call them "doctor." When I was a trainer, clients would tell me how they go to their chiropractor every week and I tried to convince them to go see a PT instead to find the underlying issue and they wanted nothing to do with that idea. I once had a client tell me that she's not interested in seeing a PT because she sees me (a personal trainer) and she can't tell the difference so she'll stick with her chiro. That's a problem that needs to be addressed but that was more of a side-point. That goes beyond nutrition discussion.

You have to do what's right for you though.

 

[truthseeker]

I think I may be coming off wrong. I don't understand why there's push back about discussing nutrition with our patients. I believe that everybody should be discussing nutrition. Physicians, dentists, podiatrists, optometrists, physical therapists, chiropractors, and whoever. We have a wealth of knowledge and many of us take our own health very seriously and we know that what we eat is even more important than how we exercise and we should be encouraging both. We know the connections between diet and health outcomes so we should not ignore it. If PTs can take the time to promote recreational exercise and run Cross Fit gyms, which I see a lot of, then we should be able to promote nutrition short of creating meal plans; that's a time to refer.

Chiros are often cited as sources, they are guest speakers, they are more readily accessible than PTs even in direct access states, and nobody hesitates to call them "doctor." When I was a trainer, clients would tell me how they go to their chiropractor every week and I tried to convince them to go see a PT instead to find the underlying issue and they wanted nothing to do with that idea. I once had a client tell me that she's not interested in seeing a PT because she sees me (a personal trainer) and she can't tell the difference so she'll stick with her chiro. That's a problem that needs to be addressed but that was more of a side-point. That goes beyond nutrition discussion.

You have to do what's right for you though.

I didn't mean to imply that I don't talk about food and nutrition with my patients. I just got the impression from the early parts of this thread that it was going to be something that was marketed as a service. I envisioned a shelf in your waiting room with dozens of supplements, vitamins, and other things for sale. That is not what I think our practice should be. As far as the chiros, they are generally taught to self promote. They are trying to find things to sell. many(certainly not all) seem to have their priority as parting people with their money so they use questionable practices. they often introduce themselves as "Dr. X", heck their obituaries always say "Dr. X". I don't want to make this a rant against Chiros but I do NOT want my or our practices to resemble the worst parts of their practices and my first thought was of a gift shop of mellaluca, Ayurveda, and other products.

 

[DocTAP87]

I didn't mean to imply that I don't talk about food and nutrition with my patients. I just got the impression from the early parts of this thread that it was going to be something that was marketed as a service. I envisioned a shelf in your waiting room with dozens of supplements, vitamins, and other things for sale. That is not what I think our practice should be. As far as the chiros, they are generally taught to self promote. They are trying to find things to sell. many(certainly not all) seem to have their priority as parting people with their money so they use questionable practices. they often introduce themselves as "Dr. X", heck their obituaries always say "Dr. X". I don't want to make this a rant against Chiros but I do NOT want my or our practices to resemble the worst parts of their practices and my first thought was of a gift shop of mellaluca, Ayurveda, and other products.

No, I agree with not wanting to sell vitamins and supplements. I used the religion example of my PCP to show that he has the information available and is ready to discuss it if it comes up but he's not actively selling anything or having patients come see him just for religious advice. You and I are definitely on the same page when it comes to product sales. But maybe I would have nutrition information laid out, ready for people to read, and then be ready to discuss it with patients should it come up.

Like Doc-PT was saying, if it comes up and patients want to understand how their eating habits are affecting their health, we could give some good information about it. If a patient wants to know specifically how to eat better to control their diabetes, that might be a time to refer but we can at least tell them to consider their eating habits regarding their diagnosis. If that makes sense what I'm trying to say.

I agree about chiropractors too. I remember a client was so impressed with her chiropractors using some sort of air gun on her spine. I don't even know what she was talking about but it sounded crazy and expensive. Whatever relief it provided didn't even last a week and she had to keep going back but she thought it was so cool. I don't want to bash on chiropractors either but I think we can learn from their ability to self-promote despite using practices that are often lacking in evidence.

I found a video on what she was talking about

 

[truthseeker]

OMG he just adjusted his hand. He now needs to go get it readjusted.

I just watched it to the end. the slo-mo with the blocks is hysterical with the sound on.