Let Food Be Thy Medicine?

I ask my PT colleagues all the time, do you talk about diet and nutrition with your patients? Most of the time I hear, “no it’s not within our scope of practice”. I will give my personal bias (but not really since it is backed by the physical therapy governing bodies), that yes I believe it is very important to discuss the topic of nutrition with patients. However, my opinion doesn't matter, the evidence does.

This post is dedicated to answering the question- is diet and nutrition apart of the physical therapy scope of practice?

Well folks, the quick answer is yes, discussing nutrition is within our scope of practice. In 2015, the American Physical Therapy Association (APTA) provided a document with a statement discussing the role of the physical therapist in diet and nutrition:

HOD P06-15-22-17: 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. (Link to document here)

The APTA has now taken a stance that nutrition is within our scope of practice since it is a key component to many conditions that we manage. Nutrition can directly affect a patient’s function and recovery from injury. It is considered reimbursable under patient education and self-care. (However, always check your third party-payers). The APTA also states that PTs should refer onto a dietitian when information is outside of information found in public domain. APTA suggests using the dietary guidelines from the US Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. (Summary of guidelines here… this is a really good reference guys)

The Academy of Nutrition and Dietetics provides a resource that can be used to find local Registered Dietitian Nutritionists. (Link here). I suggest finding your local dietitians and building relationships with them. 

In addition to the APTA’s scope of practice, we also need to make sure that we are following our own states practice act.

Here is California’s stance on nutrition:

The Physical Therapy Practice Act does not mention diet and/or nutrition. A document titled Statutes Outside Physical Therapy Practice Act (Link to document here) states:

Division 2- Chapter 5, Article 3, 2068:

This chapter shall not be construed to prohibit any person from providing nutritional advice or giving advice concerning proper nutrition… For purposes of this section the terms ‘providing nutritional advice or giving advice concerning proper nutrition’ means the giving of information as to the use and role of food ingredients, including dietary supplements.

Any person in commercial practice providing nutritional advice or giving advice concerning proper nutrition shall post in an easily visible and prominent place the following statement in his or her place of business: 

(See link for exact wording of “NOTICE” that must be visibly placed on no smaller than an 8 1/2 in by 11 in paper with lettering no smaller than 1/2 in length (except “NOTICE” is not to be smaller than 1 in length)

If you aren’t sure of your states practice act, APTA has a resource that will connect you to your state (click here)

Lastly, remember that we each have our own personal scope of practice. Just because your state practice act says that it is within your scope of practice, if you do not know enough about that topic then don’t practice it. Meaning, don’t practice what you don’t know. 

Here is a link to APTA’s resource on Personal Scope of Physical Therapy Practice. 

We are lucky, we get 30 minutes to an hour with our patients. Most health care providers do not get that time. We have the time. Let’s not side step the topic of nutrition with our patients/clients. It is our job to discuss lifestyle, health and wellness with our patients who are trying to recover from an injury and/or illness. Diet and nutrition have affects on inflammation, obesity, arthritis, autoimmune diseases, diabetes, and chronic/persistent pain. If you still aren’t convinced that you should be discussing nutrition with your patients, check out Dr. Joe Patta's blog post on the APTA website here for additional reasons why pain and nutrition go hand in hand.

Many of the top physical therapy continuing education institutes are starting to add nutrition based courses to their programs. Here are a few examples:

• Herman & Wallace: Nutrition Perspectives for the Pelvic Rehab Therapist. 
• Medbridge: Nutrition in Sports
• Progressive Therapy Education: The Changing Paradigm of Wellness- The Role of Nutrition and Fitness in the Prevention of Chronic Disease

Hopefully you now at least somewhat agree that nutrition isn’t outside of our scope of practice as physical therapists. But you may now be thinking that you don’t want to step on another professions toes, anger your local dietitians that may be sending you patients. I fully believe that PTs discussing general nutrition topics will not in any way take away from the importance or referrals to dietitians or nutritionists. If anything, it may help to open the door between patients and dietitians. In California and most states, we now have direct assess to patients, meaning this may be the first time nutrition has been brought up to a patient in regards to it’s affects on healing the body. We can help assist patients and physicians to find the right dietitian for them. We can be a link between other healthcare providers and patients. I hope that you start asking your patients about their dietary habits, just as I would hope a dietitian would ask their patients/clients about their exercise habits. That way, we can work together as a team to best help our patients.

Additional resources:

Dr. Joe Patta, DPT, CNS is an excellent resource. His focus is treating persistent pain, and you bet nutrition is a part of that. He has a blog and a podcast, and is currently working on a functional nutrition and pain science training for healthcare practitioners. Check out his website here.

Find a local Registered Dietitian here. 

Physical Therapy Board of California laws here.

US Department of Health and Human Services- Dietary Guidelines 8th edition 2015-2020 here. 

Toss Out Those Broken Records

"Watch your thoughts, for they become words.

Watch your words, for they become actions.

Watch your actions, for they become habits.

Watch your habits, for they become your character.

Watch your character, for it becomes your destiny".

- Lao Tzu

It's pretty well known that too much stress isn't healthy for us. When we are stressed, we are more likely to make unhealthy decisions: skip out on that workout, stay up all night to study for that exam, stop at a drive-thru on the way home, have another energy drink.

Being in a stressful situation is one thing, but experts now know that even when we THINK about a stressful event it can affect our body. Meaning I don't even have to go through the physical process of being criticized by my boss to have a stress response in the body, I can merely just play it out in my head and get the same negative response in my body. For example: the big exam is coming up, senior picture day is tomorrow, you have a blind date later in the week. Then, BAM... you get a pimple, you are having a "fat" day, or maybe you even get sick. Why does our body do this to us!? How does it know!

On the simplest level: Our thoughts can affect our immune system. How we perceive our environment is directly related to our health. Where the mind goes, energy follows. It kinda seems like common sense, but think about that. Stress in itself isn't unhealthy for us, in fact it is a vital process necessary for survival. It's how we react to that stress that can be unhealthy.

The good news? When have the ability to tap into this physiological process. As I mentioned above, the mere thought about stress and/or fear can negatively affect our immune system predisposing to disease and illness. However, that also means that positive thoughts and energy can bring about a healthy balance with life stressors. When you are being mindful and positive, you cannot be overly worried and negative. You cannot have both.

Here are four ways to use your mind and thoughts to improve your health: 

PRACTICE DETACHMENT

Often times we are stuck in the past. We make important decisions off of emotions from past experiences. Fear usually comes from a past negative experience that has now left us on high alert. When we hold onto things where it is physical, emotional, mental, etc., we are making it difficult to see new experiences as opportunities rather than stressful events. Always remember the saying, "when one door closes, another one opens." As scary as change may be, rephrase the experience from a disturbance to an opportunity. Now, I'm not saying that we can't live with personal belongs, knowledge, and/or things that provide us with joy- but do not let your possessions define you. It is your responsibility to gain tools/knowledge (possessions), but do not become attached to them. Everything is impermanent. The less baggage we carry around with us, the more able we are to able to enjoy the present moment without blinders.

PRACTICE VISUALIZATIONS

As mentioned above- if you can't visualize it, don't expect it to happen. Visualizations are simply mental images. Studies show that if you imagine crossing that finish line or crushing that presentation, you increase your motivation and cognitive processes in the brain such as memory and attention- thus improving your outcomes! You literally link and strengthen the neural pathways located in your brain. There is a story that a man was in jail for 20 years. Everyday he visualized himself playing his favorite 18 hole golf course, each and every stroke. When he finally swung a club for the first time in 20 years, he pared his favorite course. Visualizations can be very powerful. Again- where the mind goes, energy follows. Many have a difficult time visualizing, I hear it all the time. I understand because I was the same way. It is awkward at first, it takes practice. You can try writing down every step of the process including the outcomes. Imagine/write down situations that may be difficult and how you can will overcome them.

PRACTICE CONTENTMENT

We can practice contentment by writing down three things that we are grateful for each day. We can sit outside with our eyes closed and listen to the life and energy around us. We can slow down, put the phones away, look around. You are who you are right now- no matter how far you are from who/what you want to be, enjoy who you are now. The journey is what is most important. There is nothing truer than this moment. Practice living using intuition rather than instinctually.  Intuition living: Instinctual living: unconscious programing, protective responses- born of the past. 

PRACTICE COMPASSION

We are all human. Humans by nature are imperfect. If you were perfect, then you wouldn't be here. Those Insta-famous moms, models, and movie stars I guarantee you all have their personal struggles. Never judge yourself for taking a step sideways, backwards, or too far forward. Do not judge yourself if you roll down the hill. Care about perfection, but know that it is never the goal. Practice compassion for others- even those who do not share your beliefs, those who are struggling, those who are sick. We are all inner-connected beings. Compassion directly leads to connection. Leave this world better than how you came into it. Be a karmic snail, leave your imprint in this world.


See a common theme? Practice. Practice. Practice. Your thoughts are so powerful. You have the ability to control your thoughts.
Create Space. Envision it. Enjoy the process. When you fail, dust yourself off and try again.

You are who you practice to be.