Wednesday, April 17, 2019

Nutrition and PT Practice



Diet and nutrition are vital parts of the body healing and a key component to many conditions that physical therapists manage daily.  As a physical therapist we must be knowledgeable and comfortable addressing this with our patients.  But with so many new diets, fads and supplements, where do we start?




The APTA position is that it is “the role of the physical therapist to screen for and provide information on diet and nutritional issues to patient, clients and community within the scope of practice.” Because each state has a different scope of PT practice it is important to make sure that you understand varying stances, particularly the position of the state in which you practice.  For example, some states are silent on nutrition and therefore can turn to state laws governing nutrition advice.  Some states may only allow a registered dietician to give nutritional advice while others allow health care practitioners to give advice but only allow registered dietitians to bill.

Starting them young! The Byerly boys (two of Jessie's three kids) hard at work helping prep a meal :) 

Avoiding discussion on nutrition is leaving a void in practice and healing.  Here are just a few examples:

·      Obesity leads to changes in body composition.  An increase in fat tissue, adipose, changes your body’s metabolism, ability to regulate insulin which in turn has a correlation and influence on inflammation and pain. Medicare has instituted Body Mass Index assessments.  But, how many in practice set goals, such as patient education, around those assessments? 

·      In a dehydrated state muscles will not receive the proper oxygen they need to heal.  What is happening? Our bodies pull water from skin and muscles to protect our vital organs. So, in order for our patients to heal, hydration should be a key component to their plan. 

·      Smoking, nicotine specifically, decreases the efficiency of heart and lungs thus the delivery of oxygen to the body.  Without oxygen, as discussed, muscles are dehydrated and weak. Lack of oxygen also results in slower healing and general fatigue.   There is also a study that links smoking to chronic pain.

·      There is a growing body of evidence suggesting that nutrition may play a key role in concussion management. Research supports the use of key nutrients and sufficient caloric intake to reduce the inflammatory responses that occur in post-concussion and in post-concussive disorders.  

Poor nutrition, dehydration and other poor lifestyle habits can have a direct effect on our patients’ outcomes.  It is important to not only recognize when this is occurring but take steps in optimizing the healing environment.


As the Director for Clinical Education for CORA Physical Therapy, Jessie Byerly has spent much of her career devoted to enhancing post- professional education for clinicians.  She is a Movement Links certified practitioner and instructor. She uses her specialty in movement science, and passion to teach youth about sports wellness and injury prevention. 

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References:

1. Rea BL, Marshak HH, Neish C, Davis N. (2004) The role of health promotion in physical therapy in California, New York, and Tennessee. Physical Therapy 84: 510–523

2. Morris DM1, Kitchin EM, Clark DE. (2009) Strategies for optimizing nutrition and weight reduction in physical therapy practice: The evidence. Physiotherapy Theory and Practice, 25(5–6):408–423

3. Ashbaugh, Andrew DO, MPH; McGrew, Christopher MD, FACSM. The Role of Nutritional Supplements in Sports Concussion Treatment Current Sports Medicine Reports: January/February 2016 - Volume 15 - Issue 1 - p 16–19.



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