A First Line Resource for Nutrition: Your Physical Therapist? Boost Healing AND Performance

Nutritionists and dietitians are highly trained members of the medical and lifestyle team who's skills in designing food plans aren't matched by anyone in medicine. That said, did you know that prior to seeking their Doctoral degrees, the vast majority of physical therapists earned Bachelor's level training in a health related field where they too have gained useful skills in nutrition. What many don't realize is that this is the same EXACT training that most nutritionists and dietitians have. Some practicing physical therapists actually have advanced training in nutrition. The biggest difference is that instead of seeking licensure in nutrition, we chose a physical medicine practice. So how does this info help you, the client??

Nutrition plays a large role in the way that people deal with pain and also the way they are going to heal. To be a truly complete NEW BREED PHYSICAL THERAPIST, you must address your clients' nutrition concerns and barriers to ensure that you are having an impact on all the dimensions of getting all-the-way-well.

As I practice physical therapy and strength and conditioning, clients often ask questions about how their nutrition could impact their outcomes. In most cases clients don't need to be specifically walked through a diet plan. It sure is helpful to have this kind of structure and when clients ask for it. When this happens we send them to some of the country's best nutrition pros. However, most people are making such HUGE mistakes with their personal nutrition that very basic biochemistry and physiology recommendations can be made that have a long and lasting effect.

There are a couple insights we offer to almost every client. These are the ways in which most people get their nutrition back on track for healing and performance:

Eat Frequently:

The importance of this cannot be overstated especially in people who are struggling with being overweight. The 'thermic effect' of food can account for up to 15% of your total caloric expense throughout the day.
Think of it like this:
Let's say you are eating 2000 calories per day. If you eat those calories over three meals, you may be losing out on this extra energy expended to "turn on" your digestive system. If you ate SIX smaller meals throughout the day you could effectively increase your overall caloric expenditure to 2300 calories per day (2000 + 15%). That's 300 calories you leave on the table, so to speak, if you eat the 'standard' breakfast, lunch and dinner.

Adequate lean protein:
This is an area that is ambiguous for many and can be frustrating. Protein is an essential building block for repairing tissues. Your body metabolizes proteins for many bodily functions and missing out on enough of it can seriously slow your overall recuperative ability. 
A rule of thumb for "How much protein should I eat?" is to take in 0.8 - 1.5grams of protein per kilogram of body weight. This is a BIG range but it makes sense.

IF you are exercising regularly and at a high intensity, you are going to rapidly break down your body requiring more of the building blocks to repair. This client should be on the higher end of this range.
IF you don't exercise very regularly, you still need protein but you will need less.

I know the metric system is lost on many, me included, so here is the conversion:

1 pound = 0.453592 kilograms

For example if you weigh 160lbs, you are 72.57kg 

High complex carbohydrates and fiber:
CARBOHYDRATES ARE ENERGY! They aren't fat. They don't make you fat. They are essential for fueling your body to produce the effort to do real work that makes people better... AT EVERYTHING! You've got complex carbohydrates and simple carbohydrates.

Complex  carbs = fiber, wheat, bran, oats; foods that are overall less easy to digest and therefore are broken down in such a way as to give you energy over a longer period of time.

Simple carbs are found in highly processed products, anything with added table sugar and in a lot of 'junk' foods. There are also natural foods high in sugars such as many kinds of berries. That said, there are times and situations when simple carbs are OK or advisable. At most other times, complex, high-fiber carbohydrate foods are the way to go.

When choosing the types of carbs to eat, the rule of thumb should be to ask yourself, "Am I going to use this energy NOW?" If the answer is no, you have absolutely NO reason to eat food or drink a drink that is loaded with sugar. This type of food is FUEL! Fuel up with the high octane stuff and watch your performance improve almost IMMEDIATELY!

Hydration:
Most of us don't drink enough water! It's among the most plentiful resources and by most accounts it's still almost free. Yet, we elect to drink so many kinds of fluids that contain sugar, carbonation, caffeine and overall nothing good for you. The gold standard for the amount we should be drinking varies depending upon who you ask or where you read but you'll never go wrong getting eight to ten 8oz glasses of water per day. If you are performing a good bit of high intensity exercise you should drink more. Not rocket science here. You are made up of mostly water. You should do your best to make sure that all of your tissues are properly hydrated to maximize your body's ability to heal and perform.

We don’t specifically offer nutritional guidance as a stand-alone item. That being said, we do include these basic nutritional insights to our clients as all-the-way-well care. All physical therapists have the biochemistry and physiology training to play a larger role in our patients’ nutrition and health. A major barrier to this is that most physical therapists cannot spend adequate time or effort needed to address nutrition- most of them don’t even have the hand’s-on time that they need to do their best work! This is why it's vitally important to take the extra time to find people and form relationships that are guaranteed to help you and/or your clients get all the way well.

Fad diets and the repackaging of standard diet and nutrition information come and go! There is some good to fad dieting – structure! Almost all PTs can give you excellent nutrition advice without overstepping their scope of knowledge. Some of the simple tricks will always apply: fewer "bad" calories, less sugar, more lean proteins, high fiber, etc. Once you get that foundation down you figure out the specifics based on your body and your needs.

 

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.

Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races. He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at cjberio@sparkphysio.com.