Food for Thought | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Food for Thought

I have two dogs: Ainsley and Toby (we’re fans of the show The West Wing). Ainsely is a pit-bull mix that we’ve had since she was approximately 8 weeks old and 8 pounds.

She’s now seven, and seventy-five pounds, and for most of her life she’s had various stomach/intestinal issues. When we would take her to the vet, the first question from the vet invariably was, “what has she been eating?” How often have you gone to your own physician and had them ask the same question? Why such a disparity? Health and fitness experts have known for years the value and importance of nutrition. More recently, a lot more information has crept its way into the mainstream, thanks to podcasts, blogs, and an increased public general interest. However, not all of it is good information. The roles that physical therapists can play in nutrition has historically been minimal. After all, we’re spending a majority of our time addressing tissue healing, pain and movement. Should we be more involved?

Just last week I heard a checkout clerk at Trader Joe’s discussing with a patron how butter and certain kinds of saturated fats are so good for us. Now while that may be true for some, it’s certainly not true for everyone. The research is actually not clear, despite claims by certain groups. A lot depends on our own unique genetic makeup. Some people can metabolize fat or carbs very well, and some don’t. The bottom line is, it depends. Regardless, if personal trainers, coaches, bloggers, podcasters, and now checkout clerks are qualified to dispense “helpful” nutritional information, shouldn’t we be as well? I’m actually not so sure. It’s no doubt that what we eat and drink plays an important role in our overall health, especially when it comes to tissue healing and even chronic pain, something I will be going into more detail in a later post; but we might be walking a tightrope with it. Just as we yell in disgust (at least I do) when personal trainers or even physicians prescribe “core exercises” for all low back pain, so to do we run the risk of alienating not only other professions, but our consumer base as well, if we stray too far off the reservation–even if our intentions are good.

“A little bit of knowledge is a dangerous thing”—Sir Francis Bacon

In addition to business and psychology, PT school is also sorely lacking in proper nutrition education. As our role as primary MSK providers gradually expands, knowledge in this area should become increasingly important. The more we can “upserve” our customers, as Daniel Pink describes, the more value we will be regularly able to deliver. Many clinics are starting to offer “wellness programs” catering to clients who are looking for improvements in overall lifestyle or activity/sport performance. There are a lot of diet/nutrition plans out there: Paleo, Atkins, Mediterranean, Zone, South Beach, etc. Which one is best for your client? I don’t envision most of us giving recommendations for specific macro- or micro-nutrients amounts or even discussing specifics like nutrient timing. But we can serve as a guide along the path to health by providing validated basic advice and then lead them to the proper channels when we don’t have the best information. This will help increase our value and also improve our services by identifying other trusted practitioners such as nutritionists that may even lead to alternative referral sources.

“A conversation is happening whether you’re a part of it or not. Be a part of the conversation”–-Gene Shirokobrod (@therapyinsiders)

The new Medicare rules have also opened the doors for us to have the conversation regarding nutrition with our patients. We are now obligated to discuss BMI with our customers, as well as counsel them on vitamin D supplementation. However, this is where the lines get blurry. Do you know how much vitamin D someone should take? I don’t. I honestly don’t know exactly how much I should take. Blood tests and full nutritional profiles are necessary in order to make accurate recommendations. We do know that a large number of people have low vitamin D levels and that it has been linked to a variety of health issues. But it might not be that simple. As Bryan Walsh discusses in his article in Precision Nutrition, if your car’s oil light keeps coming on, do you keep simply filling it with more oil? At some point, don’t you need to take it in to the shop to see if the low level is a symptom of another problem? After all, don’t we apply this same reasoning with our MSK patients? Take the diagnosis of Achilles tendinopathy as an example. If we have tunnel vision on the foot/ankle, at some point, the issue is likely to return. During the rehab process, we must look up the kinetic chain to the knee, hip, and perhaps the lumbar spine to help identify why the issue developed in the first place, if we are going to truly treat the entire issue. Treat the cause, not just the symptoms. Treat the person, not the problem.

Taking it one step further, vitamin D levels are held in a delicate balance between Calcium, Magnesium, Vitamin K, and Vitamin A. Too much of anything has the potential to yield negative effects, and vitamin D is no exception. There is some research that indicates a link between excessive vitamin D consumption to certain health problems. So, I think we need to be careful making specific recommendations because, bottom line, we don’t yet have the proper education and training to be making these determinations. One resource I have found useful is Precision Nutrition (, @insidePN), co-founded by John Berardi, PhD. They do a great job analyzing the research and don’t have an agenda when it comes to pushing a specific diet plan. They’re also not selling products (other than their own education programs). However, they provide a lot of free information and resources and take a pragmatic view of the latest and most comprehensive research when making claims, or with what information they utilize with their clients. For an example, here’s a link to the article referenced earlier regarding vitamin D supplementation:

“Conventional wisdom is the view that serves to protect us from the painful job of thinking” —John Kenneth Galbraith

I think as PTs, especially as direct access increases and our roll as primary care MSK providers expands, we will have a growing role to play when it comes to providing nutritional advice to our patients. I think it will help improve tissue healing and recovery and ultimately the lives of our patients/customers. However, I think it is human nature to sometimes leap before looking. Most of us don’t yet have the proper training or education. We should, and hopefully we will. But for now, I believe a more pragmatic stance is appropriate. For example, a sad trend in the media these days is that being FIRST is often more highly touted than being RIGHT. I’d rather be right. I think it helps build trust, and ultimately increases our value. At the end of the day, we have to hold ourselves and our profession to a higher standard. I don’t want my patients getting inaccurate information when it comes to their health. But I certainly don’t want it coming from me.

As always, thanks for reading. Comments and discussion encouraged.

-Andrew via

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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