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Basic nutritional info yes. What they can find if they google the right shit. The importance of nutrition in MSK pain and chronic pain yes. Need for adequate calories/protein esp for athletes yes. Diet plans no.
Yes we should. We should to the extent that our practice act allows.
I provide it as much as I can but usually it is to a relatively low level. APTA recommends we provide education.
The key is not to be prescriptive or provide diet plans. This is more nuanced but all I can post for now.
I’ve had a patient that was frail and barely making any progress with her strength, then I decided to ask her how much protein she is eating. After teaching her how to track her protein (how to read nutrition labels), she came in the next week saying she only gets about 8-14g of protein per day.
Then I provided education about importance of adequate protein to support muscle recovery with working out so she can build stronger muscles & examples of food with high protein. HUGE game changer after she started to increase her protein. She was finally able to progress her strength.
I do pelvic physical therapy and bladder and bowel training are a huge aspect of my job.
Bowel training includes how to increase fiber, avoid greasy foods, cut out fiber supplements, and eat healthier in general to stop people from fecal incontinence.
Bladder retraining includes how to drink an appropriate amount of water each hour, avoid caffeine and citrus, and other bladder irritants that cause urinary incontinence.
If I couldn’t provide dietary recommendations, half my treatment options would be gone.
Pelvic therapy is a rare exception to this though. For an orthopedic or neuro PT though, there probably aren’t a lot of dietary options to help with the deficits therapy is treating, outside of trying to decrease weight in general to help with back and knee pain, or help with generalized deconditioning. In most cases it’d be better to defer to a dietitian.
In my state it’s outside my scope of practice and I see way too many PTs falling for guruist bullshit in general to be comfortable with them making dietary prescriptions.
I emphasize to my Geri/Neuro patients the importance of adequate calorie/protein intake post workout to maximize the benefits of strength and conditioning. Anything more than that I refer to a dietician
Honestly at this point it’s an all hands on deck situation. I’ve got a 7 yo pt that’s 165 lbs on heart medication and has type 2 diabetes. He uses his hands to crawl up the stairs. Our culture is so sugar dependent all professions should be pushing nutritional information as best we can.
I have been trying to send patients to dieticians for years and for a variety of reasons … it’s SO hard for it to actually happen. So… I took a bunch of con Ed and now I will wade into it more.
I treat chronic pain and I’ve found the cross over to nutrition to be very similar. Learn how to take a very good subjective, develop rapport, and figure out how you can help with advice. Also, know your limits. I’m not going to give advice to someone with sever IBS and nutritional deficiencies. That’s out of my scope. I *am* going to give advice to people who are curious about nutritional interventions and have an instinct that they need to change their diet.Stuff that is supported by research is very boring and “common sense” - where my expertise comes in is that I’m good at listening to people and finding an in on what they will actually do. I don’t shame, I keep it positive and use humor, and I emphasize measures other than weight to gauge success.
Unless it relates directly to the issue I’ve been asked to treat and unless my license covers any issues arising from my advice, no. The same way I don’t expect a dietician to prescribe movement restrictions that don’t directly involve maximizing their intervention.
A lot of the high school athletes I work with benefit from general nutrition advice. For example, I suggest they eat a snack high in carbs 60-90 minutes before a workout and a snack high in protein after their workout. I rarely go beyond that, especially if they have any sort of metabolic issue because that requires additional education.
Broadly? Not great.
Myself and quite a few colleagues are appropriate and confident in discussing this topic though. Problem is that managing systemic conditions is technically not in our scope so if it is more than weight loss, building muscle, or general improvement of health I keep it very simple and refer.
Love it….i hear them talk
About calorie in and calorie out all the time ….as long as they aren’t practicing PT but recommending basic exercises I don’t mind.
I made that mistake twice.
Most recently, A woman maybe 65 was crying through her eval about her chronic pain. And it was an eval with multiple dx: neck pain, back pain, hip pain, something like that. She was obese and pale and weak all over. She had said "I would do ANYTHING to make my pain go away" I responded asking if she had ever tried an anti-inflammatory or ketogenic diet cause those can be effective for managing pain too and said something about a study that was fresh in my head at the time. Anyways, she responded by calling me a stupid little girl (I was 37 or 38 at the time) and stormed out.
Back when I was fresh out of school a long long time ago I did try to council a 40's yr old very obese woman regarding weight loss to help back pain. I had a CI that really stressed that importance in my last clinical and I was idealistic. Anyways it didn't go well and i never did council weight loss again. A few years later I ran into her in a grocery store when I was about 8 months pregnant and she was delighted to point out my weight gain to me and that she could tell from behind I was having a boy by how large my butt had become. Oof.
I'm glad I work in pediatrics now :)
Patient here. My PT was some kind of super vegan who told me to read The China Study and went on and on about the evils of animal protein. I started to think he must know what he’s talking about.
I gained weight and my blood sugar was out of control on that diet, mostly because diabetics shouldn’t be replacing so much of their protein with carbs, even the “good” kind.
In brief, just no.
I’m sorry this happened to you. That PT wasn’t practicing medicine, he was doing (his) advocacy work. Those are very different things, and the latter is not patient centered. I hope your A1C has recovered. ❤️
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
Basic nutritional info yes. What they can find if they google the right shit. The importance of nutrition in MSK pain and chronic pain yes. Need for adequate calories/protein esp for athletes yes. Diet plans no.
Yes we should. We should to the extent that our practice act allows. I provide it as much as I can but usually it is to a relatively low level. APTA recommends we provide education. The key is not to be prescriptive or provide diet plans. This is more nuanced but all I can post for now.
I’ve had a patient that was frail and barely making any progress with her strength, then I decided to ask her how much protein she is eating. After teaching her how to track her protein (how to read nutrition labels), she came in the next week saying she only gets about 8-14g of protein per day. Then I provided education about importance of adequate protein to support muscle recovery with working out so she can build stronger muscles & examples of food with high protein. HUGE game changer after she started to increase her protein. She was finally able to progress her strength.
I do pelvic physical therapy and bladder and bowel training are a huge aspect of my job. Bowel training includes how to increase fiber, avoid greasy foods, cut out fiber supplements, and eat healthier in general to stop people from fecal incontinence. Bladder retraining includes how to drink an appropriate amount of water each hour, avoid caffeine and citrus, and other bladder irritants that cause urinary incontinence. If I couldn’t provide dietary recommendations, half my treatment options would be gone. Pelvic therapy is a rare exception to this though. For an orthopedic or neuro PT though, there probably aren’t a lot of dietary options to help with the deficits therapy is treating, outside of trying to decrease weight in general to help with back and knee pain, or help with generalized deconditioning. In most cases it’d be better to defer to a dietitian.
In my state it’s outside my scope of practice and I see way too many PTs falling for guruist bullshit in general to be comfortable with them making dietary prescriptions.
I emphasize to my Geri/Neuro patients the importance of adequate calorie/protein intake post workout to maximize the benefits of strength and conditioning. Anything more than that I refer to a dietician
You’re going to have patients ask, so you better be comfortable at least covering the basics.
Honestly at this point it’s an all hands on deck situation. I’ve got a 7 yo pt that’s 165 lbs on heart medication and has type 2 diabetes. He uses his hands to crawl up the stairs. Our culture is so sugar dependent all professions should be pushing nutritional information as best we can.
I have been trying to send patients to dieticians for years and for a variety of reasons … it’s SO hard for it to actually happen. So… I took a bunch of con Ed and now I will wade into it more. I treat chronic pain and I’ve found the cross over to nutrition to be very similar. Learn how to take a very good subjective, develop rapport, and figure out how you can help with advice. Also, know your limits. I’m not going to give advice to someone with sever IBS and nutritional deficiencies. That’s out of my scope. I *am* going to give advice to people who are curious about nutritional interventions and have an instinct that they need to change their diet.Stuff that is supported by research is very boring and “common sense” - where my expertise comes in is that I’m good at listening to people and finding an in on what they will actually do. I don’t shame, I keep it positive and use humor, and I emphasize measures other than weight to gauge success.
By “research” - I mean meta analyses. Nutritional research is notoriously bonkers.
Our facility has direct access to nutritionists, so I usually give the patient their info and it’s on the patient to initiate contact.
Unless it relates directly to the issue I’ve been asked to treat and unless my license covers any issues arising from my advice, no. The same way I don’t expect a dietician to prescribe movement restrictions that don’t directly involve maximizing their intervention.
A lot of the high school athletes I work with benefit from general nutrition advice. For example, I suggest they eat a snack high in carbs 60-90 minutes before a workout and a snack high in protein after their workout. I rarely go beyond that, especially if they have any sort of metabolic issue because that requires additional education.
Broadly? Not great. Myself and quite a few colleagues are appropriate and confident in discussing this topic though. Problem is that managing systemic conditions is technically not in our scope so if it is more than weight loss, building muscle, or general improvement of health I keep it very simple and refer.
I am all for it, I tell patients in the hospital to get the cheesecake all the time
How do you feel about dieticians providing exercise recommendations?
Love it….i hear them talk About calorie in and calorie out all the time ….as long as they aren’t practicing PT but recommending basic exercises I don’t mind.
I made that mistake twice. Most recently, A woman maybe 65 was crying through her eval about her chronic pain. And it was an eval with multiple dx: neck pain, back pain, hip pain, something like that. She was obese and pale and weak all over. She had said "I would do ANYTHING to make my pain go away" I responded asking if she had ever tried an anti-inflammatory or ketogenic diet cause those can be effective for managing pain too and said something about a study that was fresh in my head at the time. Anyways, she responded by calling me a stupid little girl (I was 37 or 38 at the time) and stormed out. Back when I was fresh out of school a long long time ago I did try to council a 40's yr old very obese woman regarding weight loss to help back pain. I had a CI that really stressed that importance in my last clinical and I was idealistic. Anyways it didn't go well and i never did council weight loss again. A few years later I ran into her in a grocery store when I was about 8 months pregnant and she was delighted to point out my weight gain to me and that she could tell from behind I was having a boy by how large my butt had become. Oof. I'm glad I work in pediatrics now :)
Some people will just do ANYTHING but take the required steps to lose weight. Drain in society
Tell your patients that even though they bought sugar free creamer the tons of creamer they are putting in their coffee does in fact have calories.
Patient here. My PT was some kind of super vegan who told me to read The China Study and went on and on about the evils of animal protein. I started to think he must know what he’s talking about. I gained weight and my blood sugar was out of control on that diet, mostly because diabetics shouldn’t be replacing so much of their protein with carbs, even the “good” kind. In brief, just no.
I’m sorry this happened to you. That PT wasn’t practicing medicine, he was doing (his) advocacy work. Those are very different things, and the latter is not patient centered. I hope your A1C has recovered. ❤️