Which Physical Therapists Should Get Nutrition Education?

Which Physical Therapists Should Get Nutrition Education?

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CNPT, CSCS, NSCA-CPT, Cert-DN

The role of doctors of physical therapy (DPTs) is getting larger and larger. Many States and countries outside of the United States now offer direct access to physical therapists (PTs). Such immediate access requires the PT to be a primary care provider with a wide range of knowledge, skills, and abilities (KSAs). Moreover, many PTs that are part of the American Physical Therapy Association (APTA) Council on Prevention, Health Promotion, and Wellness (PHPW) or that have participated in courses offered by the Institute of Clinical Excellence (also known as PT On ICE) will tell you the importance of social determinants of health (SDOH). SDOH often have a much bigger impact and role in health and functional outcomes than medical care. One such SDOH that plays a major role in disease development, prevention, and treatment is nutrition. DPTs are seeing this connection with nutrition, function, rehabilitation, and health; as such, the demand for PTs to learn nutrition is growing -- but which PTs should dive-in and learn about nutrition? Is it appropriate for all PTs? Let’s explore these questions further.

The role of the DPT is variable as it spans many settings and patient populations. Despite this variance, most PTs ought to be educated in nutrition. One of the highest priority groups of PTs that should partake in nutrition education would be educators. DPT students are demanding more from their education with many wanting modern physical therapy services, which include wellness and nutrition. As such, professors in CAPTE approved PT and PTA schools need the training and education in offering nutrition services. Our team is fortunate to have had several PhDs from several PT schools nationwide successfully take and pass our courses. Hopefully more professors and instructors will partake and we can continue to spread the knowledge and practice. 

Another group of PTs needing nutritional education are those working in cardiac rehabilitation and cardiac floors at hospitals. Heart disease continues to be one of the top killers worldwide, especially in the United States. Heart disease is largely preventable and is intimately linked with SDOH, particularly nutrition. PTs working in cardiac rehab and on cardiac floors are part of the medical team, which according to the literature, ought to be united as one to educate patients on best nutrition practices. As such, DPTs working in this arena are likely to face questions and potentially issues related to nutrition. More importantly, preventing cardiac disease is a major health promotion need for all healthcare providers, and the best way to prevent cardiac disease is through healthy nutrition.

One of the key time frames in life to prevent heart disease is in childhood! Hence why the other group of PTs needing nutrition training are those working in pediatrics. Fatty streaks become prevalent as early as adolescence. Moreover, dietary patterns that are rich in fruits, vegetables, and whole grains while low in added fat, sugar, and animal products become ingrained during childhood. As such pediatric PTs can help parents, teachers, and institutions help shape good nutrition through family education, policies, and referrals. 

Pediatric DPTs need for nutrition education doesn’t stop with the cardiac system. Children need good nutrition to promote optimal development. Children living in food deserts will be exposed to less fresh fruits and vegetables. Such environmental restrictions may require the PT to help the family find resources like farmer’s markets and urban gardens to promote healthy food consumption. Children with sensory deficits may have issues consuming foods with certain textures and limit their intake of certain essential food items. Such elimination diets can cause deficiencies, delays, and even permanent diseases. A recent case of a child with a sensory issue related to food textures lead to B12 deficiency and ultimately blindness. Consider how the case could have gone if a PT was involved with this child and could facilitate his referral to a dietitian while also working on sensory integration? Pediatric PTs face a plethora of patient cases where nutrition and the gastrointestinal system are involved; as such, they need nutritional training to optimize their patient care as DPTs.

Sport physios are also in high need of nutritional training. Physios, working with the team’s athletic trainer and medical doctor, are united to help athletes. Some unique nutritional issues can be seen in sports, such as the female athlete triad, disordered eating, and supplementation. Identifying these issues and addressing myths and pseudoscience to prevent injury are key for PTs. Pathology aside, athletes in general require substantially higher number of calories and unique changes to their nutrients to promote performance and enhance recovery. These issues and others will push the DPT to understanding how nutrition education can impact health, recovery, and performance in their athletes.

PTs working in the wellness and fitness industry must have a good working knowledge and skill set for nutrition. This seems like a no-brainer, but many PTs make arguments against physios learning nutrition. Consider the average certified personal trainer in a gym: do you think they have equivalent anatomy, physiology, and pathology training as a physio? Unlikely. Wellness and fitness PTs are uniquely positioned to help clients safely lose weight, gain muscle mass, and promote health without fad dieting and pseudoscience supplementation. Being an evidenced-based, modern PT requires you to get the nutritional training to help your wellness and fitness clients.

DPTs working in outpatient, and orthopedics in general, need nutritional training. Many of the diseases these PTs run into are also preventable, are linked to persistent inflammation, and can be reversed or diminished in many cases with the help of diet changes. Patients with arthritis ought to be counseled on weight loss, reducing added fats, and increasing fruit and vegetable consumption to reduce pain and improve function. Evidence shows how a predominant plant-based diet can reverse or eliminate rheumatoid arthritis symptoms almost altogether! Such evidenced-based data needs to be implemented in our PT practice guidelines and educational training for PTs, especially those in ortho. 

Another outpatient group of PTs that can benefit from educational training would be those working in women’s health. Women’s health PTs can help educate patients on dietary changes that can improve conditions like poly cystic ovarian syndrome (PCOS), osteoporosis, and stress urinary incontinence (high fiber diets reducing strain when defecating). Moreover, women’s health PTs can offer a huge benefit to pregnant women, many of whom need to be educated on safe supplementation guidelines and consumption of healthy, plant-based foods. Adding prevention into PT practice helps reduce healthcare costs and unnecessary tests and risks for baby and mom. Read more here about how PTs are using nutrition to optimize development and pregnancy.

The last groups of PTs we will highlight are those working in neurological physical therapy and wound care. Neuro PT requires extensive coordination amongst many team members. Nutrition is becoming more prevalent in its role in neuroinflammation, chronic pain, and recovery (see our blog post here). We also know that stroke is another top killer worldwide, so prevention of stroke is a vital role of health promotion in physical therapy practice. DPTs providing wound care know the linkage of optimal nutrition for skin health and healing. Diabetes is often a major risk factor and contributor to wound issues; as many PTs know, diabetes is diet driven and can be reversed through nutritional changes. From smoking to a diet devoid of certain nutrients that are vital for collagen growth and healing factors, wound care PTs need to have the dietary knowledge to help patients heal quickly while preventing further complications.

So which PTs is nutrition training not ideal for? Given the wide breadth of services PTs provide and the direct access nature of care in some settings, there are few PTs that would not benefit from nutritional courses. DPTs focused on a narrow area of sub-specialty practice may not benefits. For example, PTs working with adaptive equipment, inner ear dysfunction, or in non-clinical settings likely will not see the benefit of nutrition training. Some PTs working in industrial sites or in research may not have a need for nutrition. Also, clinical locations that don’t encompass whole-body health or where managers or owners don’t embody holistic ideologies may be less apt to adopting nutrition. Such work-specific issues can be tough for DPTs that want to push their practice skills to the next level. Lastly, some PTs are in States with very restrictive nutrition laws, which may limit their ability to offer nutrition services. It’s important to always check your practice act and State/local laws before offering services.

In summary, PTs of many sections of the APTA can truly benefit from nutritional training and education. From professors of CAPTE PT schools to wound care PTs in hospital, PTs of various settings and specialties can help their patients more holistically. Like the content you see here? Well, there is much more to be found in our evidenced-based, board-approved online continuing education courses for physical therapists. Enroll today and progress through our 3 course sequence starting with nutrition basics, then the assessment/prescription process, and finally a specialty focus on select populations and specialized nutrition topics. Complete all 3 courses and earn the title of the Certified Nutritional Physical Therapist (CNPT®). Enroll today and join the movement of PTs wanting to give their patients more! 

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Keywords: nutrition, continuing education, online course, PT, diet, APTA, CEH

Disclaimer: The above article is written as opinion piece and does not convey specific legal and/or practice act advice. Students and participants need to check their State laws, practice act, and other legal restrictions before implementing nutrition interventions or assessments. The consumer of this article and our courses acknowledge that the State laws, practice acts, and restrictions can and do change. The Nutritional Physical Therapy team cannot be held liable for changes to such laws: the student, PT, or person engaged in such nutrition actions are responsible for examining laws and regulations as they see fit.