Last week, I slammed the Journal of Orthopedic and Sports PT (JOSPT) for not including nutrition in their CPGs regarding concussions. This week, I want to laud them for including a great meta-analysis on knee, hip, and spine osteoarthritis (OA) in relation to weight loss in this month's journal.

As physical therapists (PTs), we know that musculoskeletal disorders like knee, hip, and back OA account for a huge portion of healthcare spending. We also know that OA of these joints greatly impacts quality of life, function, and ultimately long-term disability. Physical therapists do their best to offer cutting-edge treatment like exercise and patient education.

Current research shows that people with arthritis can greatly reduce their pain, improve their movement, and restore their strength with physical therapy. Often the best treatments are active exercises, education, activity progression, and manual therapy to initially help to reduce pain. Dry needling has been shown to...

 _{Image Puzzle Brain by Raquel Mela CC by 1.0}

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

Last month the Journal of Orthopedic and Sport Physical Therapy (JOSPT) published a lengthy Clinical Practice Guidelines (CPG) specific to physical therapy and concussion management. Here's a link to the authors' summary. The authors of the CPG offered a long list of references, well-thought out discussions, and clear evidenced-based recommendations. However, our team at Nutritional Physical Therapy feel the CPG did not go far enough for physical therapists (PTs). 

Managing patients with concussions, or mild traumatic brain injuries (TBIs), involves a multidisciplinary and multi-faceted approach. Concussions involve disruptions in cognition, planning, executive function, balance, physical performance, speech, vision, and even sleep. As such, the authors do a fabulous job outlining the need for PTs to screen for cognitive, vision, speech, and sleep issues....

_{CC by 2.0 by Marco Verch}

Intro

No meat. No eggs. No milk. Such has been the way at many groceries stores across our nation during the Coronavirus pandemic. The virus which causes COVID-19 has exposed the underbelly of our food system. Is our nation doing its best to promote an ecological and sustain food system? Let's dive deeper.

Ecology

Ecology is a science that explores the mutual relationships of varying organisms and their interactions with their environment. In a way it is like studying the interactions between humans, animals, and the various weather, plants, and natural disasters that can occur. Organisms interact with each and the environment in a sort of three-way interaction. Importantly ecology can and does impact human health, which should obviously be concerning for physical therapists (PTs) and other healthcare providers.

Most PTs are aware of the biopsychosocial model as a great template for delivery care. Another more advanced model known as the...

Nutrition Guidelines for Corona Virus

The European Society for Clinical Nutrition and Metabolism, also known as ESPEN, have released pre-published guidelines for clinicians to consider for patients with COVID-19 (novel Corona virus). The guidelines offer a great breakdown of evidenced-based statements related to managing patients in the intensive care unit (ICU), outpatient and those in quarantine.

Relevance to PT Practice

Physical therapists (PTs) are considered essential during the COVID-19 crisis. Physical therapists are being utilized in ICUs to help position patients, particularly in prone, which helps to improve lung perfusion. Moreover, PTs are helping mobilize and get those stronger after being infected. Let's look at the ESPEN Statements and see how they impact PT practice.

One of the first pieces of guidance ESPEN offers is that patients with COVID-19 should be screened for malnutrition. Some PTs are trained in nutritional screening, which will facilitate the immediate...

Novel Coronavirus SARS-CoV-2 by NIAID licensed by CC 2.0 with no changes made.

Physical Therapists and Corona Virus: What to do?

Our world has changed drastically in the last month with the progression of the novel Corona virus, also known as COVID-19. A stock market crash, travel halting, to thousands of people dying, COVID-19 is taking its effect rapidly. Many business owners and workers across the world, physical therapists included, are being impacted by this virus. What are physical therapists to do with all of this time and lack of productivity? My response is to keep learning!

I was having a great chat with Erson Religioso (aka The Manual Therapist) last week. He too was frustrated with being at home. Sitting idle does not suit either Erson's or my personalities. So we discussed what could we best do with our time? We both agreed that this is the time for us to take those online courses we have been putting off. 

Many physical therapists are sitting at home waiting for...

Image: Obesity by Jesper Sehested using Creative Commons - (CC BY 2.0) 

Physical Therapists Should Be Promoting Weight Loss

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

Physical therapists (PTs) specialize in movement, exercise, and rehabilitation. Our role as healthcare providers extends into many facets  of life and wellness. From stress reduction to nutrition, PTs ought to consider interventions beyond the basic modalities.  Diet can have a substantial impact on weight loss and its commiserate reductions in pain and inflammation, and improvements in function. Regardless of what setting (e.g. outpatient, nursing home, acute care), PTs can educate patients on the benefits of weight loss and even provide simple steps to reducing weight. 

What are the best nutrition methods PTs can provide patients to reduce or even prevent obesity in the first place? A simple answer can be found in the literature centered on the Whole Food Plant-based Diet...

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

Are you a physical therapist (PT) in Florida and want to offer the most modern, holistic physical therapy care by including nutrition? Who wouldn’t, right? But before you dive into offering nutrition advice you might need to know the requirements of PTs offering nutrition in Florida.

Before we jump too far ahead it’s important to understand that two different types of nutrition counseling exist: 

1.) general advice/recommendations for health/wellness; 

2.) nutritional advice specific to treat disease. 

1.) General Advice

Any healthcare provider, even PTs in Florida, with the proper education and training can offer general advice/guidelines for health and wellness. In other words, if you are a practicing PT in FL and a client asks you what a “healthy” diet looks like, you can certainly provide them general nutrition education and resources such as NutritionFacts.org,...

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...

Population Health and Nutrition: A Tool to “Transform Society”

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

Recently our editor of the Physical Therapy Journal (PTJ), Alan Jette, highlighted a recent article that took a focus on a Framework for Population Health for physical therapists (PTs). Population health considers the health and outcomes of a group of people, and how those health outcomes are distributed within the population. The view of population health is much broader and encompasses not just quality of life and health but also the interplay of the social determinants of health (SDOH), such as individual behavior, healthcare, physical environment, genetics, and social environment. Before we dive into how PTs, using such a framework, can transform society, here’s a great diagram to demonstrate the encompassing view and interplay of population health:

Source: ...

Insurance physical therapy at your hospital or local clinic is steeped in tradition: find the one problem, focus on it, and fix it. The services are reimbursed based on a fee-for-service model. The more care the more payment that is given, regardless of outcomes or future setbacks. Physical therapist (PT) education skews also towards the model of problem-based learning, exam, and intervention. Lost in the mix of the insurance and educational maelstrom is the patient: what other issues are lurking, how do they address the "whole" patient and not just the one body part or pain, and how can they continue living healthy and happy?

Fortunately a new model of PT practice emerged. The Health-Focused Therapy Model (HFPTM) promotes PTs to recommend notions like smoking cessation, regular physical activity, and even nutrition, when/where appropriate. Researchers at the University of Alabama at Birmingham produced the new model which hopes to only enhance what PTs currently offer.

Learn about...