Let’s Talk About Food
Nick Blonski, UNM DPT ’21
As physical therapists in the world of direct access many times we are the first people to welcome physical therapists into the world of health care. One of our main jobs as physical therapists is to do a comprehensive systems screen and provide a full evaluation comprised of a subjective and objective examination. Undoubtedly at some point during your time as a physical therapist or even a student physical therapist you have been confronted with a patient that asks about nutrition or you feel would benefit from discussing nutrition. This can be an incredibly awkward situation, as it seems like something we should be able to discuss due to the effects it has on physical abilities. So the questions become what are we allowed to discuss with our patient, when should we refer a patient, and whom should we refer a patient to?
According to the American Physical Therapy Association nutrition is within our professional scope of practice as physical therapists. Our role as physical therapist in regards to nutrition allows us to screen and provide information about diet and nutritional issues to patients.1 It is also important to remember to check both the physical therapy practice act for your state, along with practice acts for nutritionists and dieticians within your state. A good rule of thumb for providing information about nutrition is using information that can be publically found. One good resource that you can refer patients to is https://www.choosemyplate.gov/. The My Plate website can help you as a clinician explain a healthy diet and also has many resources including printable free documents you can provide to patients.
When trying to figure out if you should refer a patient for further nutritional consultation a few criteria can point you in a referral direction. If you feel uncomfortable trying to provide nutritional education it is better to refer to a specialist to maintain high quality of patient care. It is also essential to refer a patient for nutritional education if the patient needs help with meal planning, or needs to talk about specific macronutrients and micronutrients. Lastly, it is important to refer a patient that has special nutritional needs. This can qualify for athletes trying to plan a nutritional plan to improve performance or a patient with diabetes that needs nutritional modification to maintain quality of life.
When choosing whom to refer to it is important to know the difference between a nutritionist and a registered dietician. A registered dietician is someone in the United States that is required to become registered with the Commission on Dietetic Registration (CDR), where as a nutritionist does not. Dieticians are regulated by government regulations whereas a nutritionist who choses to not go by dietitian or registered dietitian are typically free from government regulation.2 This again is dependent on the state you practice in and should be researched when referring a patient for nutritional consultation.
When working with patient it is important to provide the highest quality of education and service. This includes the education we provide on nutrition as it can play such a huge role in a patient’s health. Taking time to review websites such as My Plate and familiarizing ourselves with basic nutritional facts and preparing printable handouts can improve our ability to answer patients’ basic nutritional questions. Knowing when to refer a patient and who to refer to can also greatly improve the quality of care a patient receives and can improve our patients’ quality of life.
1. “Role Of PT Diet Nutrition.” APTA, www.apta.org/apta-and-you/leadership-and-governance/policies/role-of-pt-diet-nutrition.
2. “Distinguishing Between Dietitian vs Nutritionist.” Dietitian vs Nutritionist, www.nutritioned.org/dietitian-vs-nutritionist.html.
by Hannah Mullaney, SPT
Me: “What kind of exercise should I do?”
Also me: “Mmmm, it’s too complicated.”
“But I know it’s important for me.”
“Probably costs lots of money. I don’t know.”
“Just do anything, some push ups, planks, squats, jumping jacks!”
“Oh look, I’m out of time.”
These internal conversations abound when it comes to exercise. It is easy to become frustrated and overwhelmed. And the question often begins with, “what kind of exercise do I do?”
The simple answer is this: whatever you will actually do!
Strengthening the heart, building up the bones, balancing the chemicals messengers of the body and brain – a few of the direct benefits of exercise – these powerful outcomes blossom for doing things that challenge and move the body. Every person has distinct and individual interests, and effective, sustainable exercise training comes from doing something that matches someone’s interests with movement.
Guidelines start simple – move more! Take the stairs, park far away, stand on one leg while talking of the phone. But many people want to take that next step. Once people have experienced the relief of finishing a workout, the satisfaction of pushing their limits, or the sense of calm from endorphin release, they are ready for more. Officially, adults are recommended to do moderate to vigorous physical activity for 30-60 minutes, 5 days a week (HHS.gov).
At this point, the options may feel endless – gym membership, Zumba classes, rock climbing, running, biking, swimming, weight lifting, team sports league, golf….the list goes on an on. The volume of opportunities can be overwhelming. Some of these options are more expensive than others, and people need to think about their priorities and budget. Sometimes there are forms of exercise that may be easily overlooked, like roller blading, coaching a child’s soccer team, fishing (especially fishing someplace that can only be reached by hiking), a quick 10 minute circuit of squats, pushups, and planks, and dancing.
All of these things are valid forms of exercise. The trick is to pick something that is fun and interesting and puts a smile on the exerciser’s face.
“I HATE running!” Common sentiment. Solution…don’t run! Yes, it’s important to push oneself past the comfort zone, but, if it really is such a drag, maybe find something that is more interesting. Would running or biking to the movies to meet with friends make a difference? (Then, don’t eat the entire bag of popcorn.) Maybe if running doesn’t jive well, what about dancing? What about 3 v 3 basketball games on lunch break? All of these activities will still increase the heart rate and help make the body happy and healthy.
People talk about SMART goals, and someone who is motivated to move their body more can use these techniques to make their own game-plan. Here is the breakdown of moving more SMART-ly, using the example of someone who wants to swim 800 meters on an upcoming triathlon relay. For this individual, their spouse is doing running while another friend is doing the biking.
Specific – set a narrow goal. “I will go to West Side Pool.
Measurable – set a goal with something concrete to measure. “I will go to West Side Pool for 45 minutes.”
Achievable – set at goal that can actually be reached. “I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons, when I have a shorter work day. Also, I own goggles and know a little bit about swimming, so this is a realistic goal.”
Relevant – set a goal that matters to you personally. In this example, the individual is doing swimming, so swimming is the relevant activity.
Time-based – set a goal that has a clear start and end time. “The triathlon is in 6 weeks.”
Therefore, the whole goal is would look like this. “In order to prepared for my part of the triathlon relay, I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons for the next 6 weeks in order to swim 800 meters without stopping.”
Finally, accountability takes goal-making to goal-attaining. If someone is asking us how we are doing, bugging us about going to the gym, waiting for us at the trailhead at 7am, or trying to workout 5 days a week with us, we are that much more likely to follow through with our good intentions. In the example above, perhaps the spouse can run while the swimmer does laps.
Therefore, if you are thinking about exercising more, my encouragement is to dive right in! Find something enjoyable that you actually want to do. Set a SMART goal. And, very importantly, ask someone to hold you accountable. No need to wait – let’s get moving today!
Our Physical Therapy cartoon is becoming very popular.
Have you ever needed Physical Therapy after playing the floor game called Twister?
Have a laugh with “It’s a Stretch,” our weekly physical therapy cartoon. And be sure to let us know what you think in the Comments section. Share it with friends, colleagues and co-workers.
â€œI came in hobbling,â€ explains Sophia Knight of her introduction to All-Access Physical Therapy in Shrewsbury, Mass. â€œI had a problem with my knee. It hurt a lot to do normal things in my day, driving the car.â€
All-Access Physical Therapy is more than just a PT clinic. Â With its partner All-Access Fitness Academy, the practice is a comprehensive wellness company that helps patients and clients achieve optimal health and fitness in order to live the way they want longer.
â€œAfter six weeks of therapy, two times a week, and doing exercises at home, I can now go about almost pain-free,â€ says Knight. â€œFor the most part, it was an excellent experience. Everybody worked hard, my two therapists and myself, of course.â€
When patients come in for their initial appointment, one of AAPTâ€™s therapists will perform an evaluation of their condition and then start a plan of care. As the patientâ€™s injury/condition improves, the physical therapist introduces them to an expert Wellness Trainer and discusses long-term health maintenance options, which may include a home fitness plan or perhaps membership and a program at the All-Access Fitness Academy. AAPT will also communicate with the patientâ€™s physician to let him or her know about the achievement of physical therapy goals.
â€œItâ€™s a no-brainer way of working out. Thereâ€™s always somebody there if Iâ€™m having a problem,â€ adds Knight. â€œAnd, you know, have my assessments and things like that, so, and, you know, the assessments based on my whole body and moving me forward from here on in. For the first time, after all these years, I feel like Iâ€™ve got a team with me, and I feel like Iâ€™ve got the support I need to meet my goals.â€
â€œAll-Access has been a pleasure to work with since day one,â€ explains bestPT practice success coach Lisette Acevedo. â€œI am always excited to see how well they are doing. They know the resources and tools they have and use them to their advantage. This is a practice that uses the system to the fullest extent and the results are undeniable.â€
Since my pounds are not melting away I decided to calculate calorie consumption.
Usually I’m lifting weights and using the elliptical. The elliptical is specifying how many calories I consume and it’s ~115 per 10 minutes but how much calories do I burn while weight lifting?
Surfing the internet I found weight lifting calculators that specified between 12 to 40 for 5 minutes of weight lifting, I wanted to get more accurate result, so I went back to physics 101…
Typical weight I’m lifting is about 130 Pound, I’m lifting it by an average of 1 feet, doing 3 sets of 15 repetitions each – this is 5,850 foot pounds (just multiply 130 x 1 x 3 x 15).
Converting to Calories this is resulting ~2,000 calories, Wow this is great! I just forgot that whenever talking Calories in connection with body metabolism, we are talking Kcal which are 1,000 calories So this set only burnt 2 Kcal, is this possible? what about the 12 – 40 from the internet? Well we are not very efficient machines and our efficiency is about 22% so to produce these 2 Kcal we had to generate ~9 Kcal, or each lift is consuming ~0.2 Kcal. Overall 5 various weight lifting exercises will result burning of 45 Kcal.
Well, physics 101 was of some help, yet this is not the whole story – while lifting weights you build more muscle mass and in rest, 1 pound of muscle burns 6 Kcal per day vs. 2 Kcal 1 pound of fat burns per day. It will take time losing weight, but at least you’ll feel much better while trying…
Different trainers, I spoke with, have different theories on this, some donâ€™t ever try to count calories burned during strength training.
What is your view – should we even try to count calories?
By Steve Messineo
How New Milon Exercise Equipment Will Help Your Patients with Long Term Wellness and Increase Your Practice Revenues
In June of 2012 I met the President of Milon USA, a company promoting a line of circuit training equipment that has become extremely popular in European health clubs and physical therapy clinics. Milon is a German company that recently decided to test the vast US Health Club Market. What they did not expect was the opportunity to bring their product to a facility that houses both a physical therapy clinic and a fitness center.
So, after some education and negotiation, my business partner and I decided to bring Milon into our facility. You may be asking what is so wonderful about this circuit training equipment as compared to the various American-made lines.
Here are several features to the Milon exercise equipment that made it attractive to us and should be attractive to all physical therapy clinics that have 600 square feet of extra space to put this circuit in:
1) The equipment is easy for everyone to use. There are no weight settings â€“ the resistance is provided electronically against both concentric and eccentric muscle contraction. This allows for a much more efficient workout and eccentric loading of muscles has been known to accelerate rehab from numerous conditions.
2) The resistance increments are offered at 2 pounds and resistance protocols are entered on a touch screen on each machine. Furthermore, because there are no weights, patients will not feel self-conscious about their resistance settings because no one else in the circuit will know what they are doing.
3) The machines automatically adjust to the userâ€™s height and position after the initial set-up using a memory chip on a smart card â€“ no more pulling knobs to adjust seat heights. This further increases the ease of use of the equipment making it perfect for PT patients.
4) The entire circuit takes less than 20 minutes to do but allows the user to get a fantastic workout. Patients who claim they donâ€™t have time to exercise have no excuses if your clinic has a Milon circuit.
5) All of the equipment is attached to a computer that automatically documents a userâ€™s progress. We can use that objective information in our reports to physicians and insurance companies documenting patient progress.
6) Finally, and most importantly, the addition of this equipment is going to create a long term revenue stream for our business as patients transition into long term exercise maintenance programs using the Milon equipment after they have been discharged. This increases customer retention and creates revenue via membership use of the equipment. We are projected to make an additional $20,000 in net revenue after the first year as a result of Milon implementation and this figure is conservative at best.
Anyways, I could go on and on about all of the fantastic benefits Milon offers both patients and physical therapy practice owners, but that would make this article extremely long. So, if you would like to learn more, email me at email@example.com and I will be happy to provide you with more information. Or you can visit www.allaccessfa.com/milon.
A recent study published in Spine shows that active physical therapy for patients with acute low back pain is associated with better clinical outcomes.Â APTA concurs on decreased use of prescription medications, MRI, and epidural injections; and lower health care costs than passive physical therapy.
The study consisted of a retrospective review of 471 patients, ages 18-60. One hundred thirty-two patients received active physical therapy and 339 received nonadherent care. Patients receiving active physical therapy experienced greater improvement in function and a decrease in pain intensity, received fewer physical therapy visits, had a shorter duration of care, incurred lower charges for physical therapist care, and were more likely to experience a successful physical therapy outcome.
For pain of a â€œmechanicalâ€ origin such as low back pain, hands-on therapy to mobilize the spine and exercises designed to alleviate low back pain have been shown to be particularly effective and have long-lasting effects on patients. According to the studyâ€™s lead author Julie Fritz, PT, PhD, ATC, â€œPhysical therapists are often one of the first health care providers that patients with acute low back pain encounter â€” whether they are referred by medical doctors or visit them directly â€” which offers evidenced-based PTs a tremendous opportunity to help patients recover.â€ Fritz received funding for her research from the Foundation for Physical Therapy in 2002. Her project was titled â€œValidation of a Clinical Prediction Rule for Identifying Patients with Low Back Pain Likely to Respond to a Manipulation Technique: A Randomized Trial.â€
â€œThe findings from this research can be applied throughout all fields of medicine, not just to physical therapy,â€ said Gerard Brennan, PT, PhD, a lead researcher on the study. â€œIf all physicians and therapists adhere to their fieldâ€™s recommended clinical practice guidelines, they, too, should see a decrease in subsequent health care utilization. It is our hope that this research will help physical therapists â€” as well as all medical professionals â€” do their job more effectively.â€
Contrary to common belief, softball pitching subjects the biceps to high forces and torques when the playerâ€™s arm swings around to release the ball, according to an analysis of muscle firing patterns conducted at Rush University Medical Center.
Published in the current issue of the American Journal of Sports Medicine, the study of the â€œwindmillâ€ pitching motion appears to explain the high incidence of anterior shoulder pain seen in female softball players.
â€œThe conventional belief has been that the underhand throwing motion of softball places little stress on the arm,â€ said Dr. Nikhil Verma, lead author and a specialist in sports medicine at Rush. â€œBut that is not the case.â€
In the study, seven women â€“ three collegiate and four professional pitchers â€“ underwent motion analysis and surface electromyography to evaluate the muscle firing pattern of their biceps in the course of a windmill pitch. Electromyography detects electrical potential generated by muscle cells when they contract.
The researchers found that even though the upper arm movement in both baseball and fast-pitch softball gives the ball about the same velocity, muscle force during the windmill pitch was much higher.
Moreover, the maximum force, or maximum contraction, occurred not when the arm was cocked, as in baseballâ€™s overhand pitching, but when the arm circled around from the nine oâ€™clock position, almost fully extended back, to the 6 oâ€™clock position, perpendicular with the ground, completing its windmill motion to release the ball. Consequently, the biceps took the majority of the stress, not the elbow.
â€œThe greatest impact is on the biceps, as the muscle first accelerates the arm and then puts on the brakes, after transferring force to the ball,â€ Verma said.
Fast-pitch softball is one of the most popular female athlete team sports in America. In 2008, roughly 2.5 million adolescents competed in the game, and about 1.3 million players were registered with the Amateur Softball Association.
Despite the gameâ€™s immense popularity at the high school and collegiate levels, Verma said, there is a dearth of sports medicine research on the gameâ€™s most notable activity: the windmill pitch. Many have assumed that injury is rare with the underhand throw.
Verma launched his study in Rushâ€™s human motion laboratory when he found that female softball players from the local professional team were coming into his practice complaining of pain in the front of their shoulders. He was able to localize the pain to the biceps tendon. In one case, a pitcher had ruptured her tendon during play, which implicated the long head of the biceps tendon as the source of stress.
The study findings correlated with these clinical observations.
According to Verma, female softball pitchers are prone to overuse injury not only because of windmill pitching dynamics, but also because they pitch so many games.
â€œCompetitive female pgitchers often pitch in every game during a weekend tournament â€“ the equivalent of 1,200 to 1,500 pitches in as little as three days.â€ Verma said. â€œThis is the opposite of the baseball world, where pitchers receive three to four days of rest before returning to the mound.â€
â€œPrevious studies have shown that shoulder problems cause a significant amount of lost game time among windmill pitchers, with anterior shoulder pain being the common culprit,â€ Verma added. â€œThis study helps explain the etiology of that shoulder pain, and may help doctors devise better treatment and prevention strategies.â€
Other researchers involved in the study were Idubijes Rojas, Sanjeev Bhatia, Kharma Foucher, Dr. Bernard Bach, Dr. Anthony Romeo, and Markus Wimmer, all at Rush University Medical Center, and Dr. Matthew Provencher, at the Naval Medical Center San Diego.
bestPT by Billing Dynamix:
2857 Executive Dr Suite 200
Clearwater, FL 33762
2 Hudson Street
Marlboro, NJ 07746