Nutrition and Physical Therapy: A Powerful Combination
Estimated Reading Time: 5 minutes
Here is a situation you are bound to encounter all too often as a physical therapist (PT).
A patients comes to you seeking pain relief.
She is 50 years old. She works a 9:00 am–5:00 pm job, is very overweight, and is diagnosed with bilateral knee osteoarthritis and is mildly depressed.
She has pain when going up and down the stairs and with increasing ambulation. She notices that she is gaining weight and losing physical function. She's suffering and looking to you for help.
Where do you begin?
We know that exercise and movement is a vital part of the care plan, but is there something else you could do to help this patient live a vital, active life, and improve overall quality of life?
As future PTs, we are presented with a real opportunity here. Research shows that PTs can play an active role in lifestyle-related interventions, such as nutrition.
I full-heartedly believe that by providing evidence-based nutrition counseling you will be ahead of the curve in our profession and improve patient outcomes. Here are 5 ways to integrate nutrition into your physical therapist practice.
Explore the Evidence
As a doctoral trained practitioner, you have access to many evidence-based resources, and nutrition is a hot topic and for good reason.
Poor nutrition is a factor that adversely influences the health of many conditions commonly encountered in physical therapist practice.
A systematic review and meta-analysis in the 2017 European Journal of Nutrition found that a Mediterranean-style eating pattern exerts a protective effect on the risk of cardiovascular disease, and is associated with smaller gains in BMI and waist circumference.
Nutritional interventions are alone useful tools to improve overall health outcomes in patients, and specifically reduce inflammation. Low-grade inflammation and oxidative stress underlie chronic osteoarthritis.
Furthermore, there is substantial evidence to suggest that a healthy pattern of eating may decrease the risk of depression, whereas a Western-style diet increases the risk. Review the patient history above and notice the evidence on how nutrition can support this patient's recovery and comorbidities.
Experience the Difference
Remember when you first learned about lumbar stabilization exercises or plyometrics?
I bet you tried them out on yourself before prescribing them for a patient.
It can be just as fun to explore how a change in nutrition affects your own health.
A good exercise is to pick an evidence-based diet and for 30 days explore how it changes the way you feel and function.
My favorites are the Mediterranean diet, the Okinawan diet, and the DASH diet. All 3 have ample evidence for weight loss, lowering cardiometabolic risk factors and reducing inflammatory markers.
Not ready to shift your entire diet? How can you make one simple change to your diet? Start small by eliminating added sugar from your diet and sweetened beverages, such as soda or the spiced pumpkin Frappuccino.
Evaluate Your Readiness
Now that you're familiar with some of the evidence and have noticed how nutrition impacts your own health, is it time to jump in head first? Maybe.
Just as patients have a certain readiness for change, practitioners go through the same stages of willingness when adopting a new skill.
Nutrition is part of the professional scope of physical therapist practice, but you desire more training before intervening. You can first take a course to boost your knowledge and confidence.
Physical therapists have a deep understanding of the basic nutritional biochemistry, and a 2012 meta-analysis in the Journal of Physiotherapy Theory and Practice found that physical therapists can effectively counsel patients with regard to lifestyle-related interventions, including nutrition.
Evaluate Your Patient's Readiness
Okay, now that you've tried it and reviewed the evidence, it's time to assess the readiness of your patient.
Be prepared with a few key questions that you can ask during the evaluation. Collecting information provides a bird's-eye view of your patient's current nutritional habits, if they require a nutrition intervention and if they are ready to change their eating habits.
A skilled intake informed by strong motivational interviewing skills will strengthen the patient's personal motivation for and commitment to a specific nutrition goal.
Eat the Pain Away
Once you acquire the knowledge and your patient is ready, there are a few things needed first.
Patients will have questions about what to eat and what to avoid. They will have questions about the advantages and disadvantages of different diets, the timing of meals, nutritional supplements, and how to order from a restaurant menu. You may have to track their blood glucose levels.
As you develop and build your nutrition practice, you'll stock your arsenal with different meal plans, food plates, shopping lists, and recommendations for how your patient can stock their pantry, fill their grocery cart, and order off a menu. Remember, education is the foundation of every good nutrition intervention.
Moving Forward Combining Nutrition and Physical Therapy
Patients with poor nutrition habits may notice a decrease in pain within as little as 4 days.
You will note a decrease of inflammation, a decrease of edema, an improved metabolic profile, a decrease of nociception, and improvements in function.
When you combine nutrition with therapeutic exercise it is a powerful combination that sets your patient up for success and teaches them a valuable health skill. This combination of skills also prepares you for the future of integrative and lifestyle medicine.
To hear more about nutrition in physical therapist practice join Joe in Providence, Rhode Island, October 11-13, 2018, at APTA's National Student Conclave.
Joe Tatta, PT, DPT, is a physical therapist and board-certified nutrition specialist. He is an author, host of the Healing Pain Podcast, and founder of the Integrative Pain Science Institute, where he teaches physical therapists how to use functional nutrition and lifestyle medicine. Learn more by visiting http://www.integrativepainscienceinstitute.com.