Naysayers of Nutrition and Physical Therapy

"D" in the in professional abbreviation DPT stands for Doctor, as in Doctor of Physical Therapy. Our profession has made great leaps and bounds in its stride to becoming experts in movement, the neuromuscular system, and wellness. Much of our success has been through diligent efforts to improve the educational standards of our PT students. We've also continually raised the bar by encouraging most States to enact stricter continuing education standards, licensing, and rigorous specializations and fellowships. Such training and advanced education, along with our doctorate, prepares us to provide care in direct access, primary care, wellness centers, rehab facilities, hospital, gyms, and sports complexes to name a few. We are managing simple injuries now without much of the red tape and bureaucracy, while helping those with devastating diseases and ailments get better. Despite all the progress I feel we still have a stock of PTs that are holding us back, especially in regards to adopting nutrition in our everyday physical therapy practice.

Let me begin by offering a caveat, especially for the nutrition naysayers: I am not asking DPTs to become dieticians. Dieticians spend years studying nutrition. Their clinical expertise in managing complex cases of nutrition and medical issues is amazingly capable and impactful. Dieticians, RDs, have earned their title and should be the primary nutrition specialist for many patients. Earning the DPT and/or taking some continuing education courses will not qualify you as an RD.

With that said, we must also realize that not every patient can be seen by a dietician. Data from the American Nutrition and Dietetics show graduation rates for RDs has not been able to keep pace with those exiting the profession. The ratio of patients to RDs was already high, with this number rapidly growing. As such, it is getting harder and harder for people to link up with qualified nutrition professionals. Add COVID-19 and the necessary social distancing, and we've created yet another barrier for patients to reaching RDs. Lastly, patients have to get to RDs -- this is where PT referrals to RDs can help.

Much of our initial programming in our first and second nutrition courses for physical therapists covers who is appropriate for nutrition, State laws and regulations, and resources for finding out when to refer a patient for dietary services. Getting patients to RDs requires more than simply sending every patient to an RD: it takes skilled examination, inquiry, and judgement. Gleaning such capabilities is in the wheelhouse of almost any DPT willing to learn new material, study, and be prepared to identify patterns of poor (or good) nutrition. We can gain the training and education not to supplant RDs but to work with them and to help our clients maximally.

Why then did myself and Dr Erson Religioso recently get so much pushback from so many PTs when we offered to discuss what healthy eating patterns PTs should advocate for? You can click the Facebook link and read many of the comments. In short, some felt nutrition simply wasn't appropriate for us. "Job for dieticians" a few said. Others went on their notion that nutrition is a belief and cited their own bias or recommendations for food. "I believe paleo is best," another remarked. Meanwhile, one PT in particular had vehement arguments that the NIH nutrition article and post by PTs was unprofessional and she would no longer follow the page.

Why the push back? Where is the "D" in the DPT? I can appreciate professionals that do not want to venture into a new world of learning or new techniques...not every technique or method is best for every patient nor practitioner. Many of those with big objections to our post claimed that RDs should be the primary person "advocating" for certains diets. Well, given this logic, wouldn't it make sense for PTs to know when or when not to refer to RDs? As such, PTs learning about nutrition-related conditions and disease would be prudent. For instance, B12 deficiency often presents like peripheral neuropathy, with numbness in the feet and hands. Many PTs see patients with peripheral neuropathy, wouldn't it be helpful if a DPT could screen for a B12 deficiency to refer that patient to a physician or RD? Other conditions that can respond to dietary changes include arthritis, inflammatory conditions, and cardiovascular disease, many with simple dietary changes and all conditions that PTs routinely encounter. Learning about how nutrition impacts diseases and movement does not qualify you in the category of malpractice any more than a PT learning about a hip replacement surgery or cancer resection procedure -- it's what you do (or don't do) with the information that is vitally important.

Moreover, the American Physical Therapy Association (APTA) have been a bit bold in their last 5 years, stating that nutrition is in the scope of PT practice. They also go further to say PTs should screen and offer general nutrition advice! I guess many of the naysaying PTs want to argue that the APTA is wrong? Personally, I think it's foolish if physical therapists want to push back against a profession, especially a doctoring profession, wanting to be inclusive. Guidelines, laws/regs, and professional judgement can help direct care and ensure no one is overstepping their boundaries. From the APTA to small practices, PTs can make a difference by adding even small amounts of nutrition-specific facets to their practice. Athletic trainers, chiros, and personal trainers have been doing it for years -- we were late to the game, so let's not now resist the change!

Lastly, how could a PT cause harm or overstep their professional boundaries by simply asking, "How's your diet?" or "Describe your diet?" The devil is in the detail (State laws and regs) and what the professional does with that information (committing or omitting actionable medical information). Simply asking a question starts a bigger conversation and can unite a medical team to help make positive lifelong lifestyle changes for your patients.

Most of the professionals taking our nutrition and physical therapy courses have seen such positive changes:

Better outcomes (less pain, better quality of life, improved health risks factors)
Improved communication and referral with other providers (like RDs and MDs)
Enhanced autonomy and status (knowing that you can help someone without always sending them away, or sending them away when you know they need the help (and not passing the buck!).
In the end, I am optimistic with the new wave of DPTs coming into our profession. Many are excited about adding nutrition, blood flow restriction, dry needling, and many other up-and-coming therapies. They are open to new ideas, embracing a bold step forward, and ready for modern management -- not the old methods of practicing within a box and waiting for a "doctor's order." When will you take your big leap and start embracing a more contemporary PT practice by adding nutrition training to your skills?

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!

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Via Dr. Sean Wells, DPT

Photo by Andrea Piacquadio from Pexels

Keywords: nutrition, diet, continuing education, online, weight loss, wellness, PT, physical therapy, learning, physio, rehab

Disclaimer: The above article is written as opinion piece and does not convey specific legal, medical, and/or practice act advice.

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