CAN A PHYSICAL THERAPIST GIVE NUTRITION ADVICE? WHAT THE LAW SAYS ABOUT A PT COUNSELING ON NUTRITION

Public health recommendations for lifestyle interventions, including diet, nutrition advice, and physical activity, have been widely publicized for the treatment and prevention of diseases, including chronic pain (1).

One vital component of lifestyle, functional, and integrative medicine is nutrition. Nutrition education and counseling have steadily worked its way into the scope of practice of many licensed health professionals.

But does nutrition fall within the scope of practice for physical therapists?

The short answer is YES… but read on for the whole story.

nutrition advice - Can a PT give nutrition advice?

With obesity, diabetes, and other non-communicable diseases at an all-time high, the need for nutrition education is paramount. The evidence for all licensed health professionals to include nutrition in practice, including physical therapists/physiotherapists, has been building for over two decades. A 2014 study in the American Journal of Clinical Nutrition noted:

  • Understanding and applying nutrition knowledge and skills to all aspects of healthcare are extremely important, and all health care professions need basic training to effectively assess dietary intake and provide appropriate guidance, counseling, and treatment to their patients.”
  • “Physicians, physician assistants, nurses, nurse practitioners, pharmacists, dentists, dental hygienists, occupational therapists, physical therapists, speech and language pathologists, and others can positively affect patient care by synchronizing and reinforcing the importance of nutrition across all specialty areas.”
  • Nutrition is also an important component of education, training, practice, and research for PAs, physical therapists (PTs), occupational therapists (OTs), and speech and language pathologists (SLPs). These graduates are ideally positioned to serve as health coaches promoting lifestyle modifications, especially during the rehabilitative continuum.”

With sufficient evidence regarding both the positive and negative influences of diet and nutrition on health, more and more licensed practitioners are implementing nutrition into the care plan. 

Physical therapists are now actively implementing nutrition into practice and recognize it as an essential part of optimizing movement, physical function, and improving health. Nutrition advice is an important intervention to help people overcome chronic noncommunicable diseases, including many chronic pain syndromes.  

What is the Link Between Nutrition and Pain?

Practitioners are using nutrition as an evidence-based intervention to improve physical function and quality of life (3). Optimizing nutrition has a positive influence on recovery while an individual is under a physical therapist’s care; therefore, it follows that physical therapists would be concerned with and address diet and nutrition in practice (4).

In the profession of physical therapy, the treatment of chronic pain is a hot topic. 

Fueled by the APTA’s #ChoosePT campaign, patients are looking to physical therapists for:

  • A non-invasive way to alleviate pain. 
  • The non-pharmacologic treatment of pain.
  • A trusted and licensed practitioner to counsel and provide information.

Optimizing nutrition is a game-changer for those with non-communicable diseases and pain (5). 

For example, osteoarthritis is a painful condition that affects millions of Americans (6).  Studies have demonstrated a positive relationship between nutrition and pain management in patients with OA (7). Nutrition advice combined with physical activity is a proven way to help patients with OA and other chronic pain syndromes including fibromyalgia, autoimmune diseases, pre-diabetes, diabetes, complex regional pain syndrome, neuropathy, and spinal pain (8,9).

There are 5 ways diet influences pain and pain perception:

  1. A healthy diet is associated with a normal BMI and the alleviation of chronic pain (10).
  2. Certain foods and food components have proven antinociceptive, analgesic, and anti-inflammatory functions (11).
  3. A poor diet leads to significant negative changes in the gut microbiome, shifting the human organism toward a chronic proinflammatory state. This is associated with many chronic diseases, including chronic pain syndromes (12). 
  4. Proper nutrition prevents both intestinal permeability as well as the permeability of the blood-brain barrier—both of which influence peripheral and central sensitization (13).
  5. Proper nutrition positively influences mood disorders such as anxiety and depression common comorbidities in ~50% of those with pain (14).

All are important to the practice of physical therapy and the effective treatment of pain.

nutrition advice and physical therapy

Why are Physical Therapists Implementing Nutrition Into Practice?

Physical therapists are experts in the non-pharmacologic treatment of pain. They understand the research regarding the treatment of chronic pain and are translating evidence to practice. A multimodal approach to pain management is the most effective way to manage pain.

As the link between nutrition, disease, and overall health becomes much harder to ignore, physical therapists have been seeking freedom to incorporate nutrition into their practice. Counseling on exercise and providing manual therapy, may not be enough to help people cope with pain and improve quality of life. Nutrition is often the missing link to reverse pain.

The many advantages of nutrition delivered by a physical therapist include:

  • Accessibility and convenience for the patient.
  • Allows DPTs to practice at the highest level in a primary care capacity.
  • Enhances the therapeutic relationship between provider and patient.
  • The efficient use of time with one provider focused on the entire plan of care.
  • The ability to track complete biopsychosocial outcomes in one episode of care.
  • Cost-effective care, eliminating multiple providers, copayments, and other costs.

Physical therapists realize nutrition, combined with other treatments, can help people return to function. But are you ready and know enough about nutrition to begin screening for and providing information? There are many factors to consider, but your personal scope may be the first place to begin.

Nutrition and Your Personal Scope of Practice as a Physical Therapist

Nutrition advice plus physical therapy has become such a hot topic that it spawned an entire debate at a 2018 APTA conference; however, at the end of the debate, most nearly everyone agreed that physical therapists are qualified to give nutritional advice (15).

Nutrition education is included as a required element in the curricula of doctoral physical therapy programs established by the Commission on Accreditation in Physical Therapy Education (CAPTE), the official accrediting agency for entry-level physical therapists and physical therapist assistants. 

  • CAPTE standards 7A, 7C, 7D16, 7D24, 7D28, and 7D34 all apply to nutrition education.
  • Graduate-level doctor of physical therapy programs now include one, often two, and sometimes three classes on health and wellness promotion. Foundational nutrition is often covered in these courses. The education of a physical therapist prepares them with the skills to screen for and provide nutrition education and counseling. 
  • Some physical therapist assistant (PTA) programs also include nutrition, and a PTA may be required to follow through on a plan of care that includes nutrition education.

Finally, the research and evidence clearly support a physical therapist’s ability to counsel with regard to lifestyle medicine including physical activity, nutrition, weight loss, stress management, cognitive-behavioral interventions, and even smoking cessation. 

  • A 2012 systematic review in the Journal of Physiotherapy Theory and Practice asked the question: Can physical therapists counsel patients with lifestyle-related health conditions effectively? A systematic review and implications. The study concluded by stating that “physical therapists can effectively counsel patients with respect to lifestyle behavior change, at least in the short term. They can be effective health counselors individually or within an interprofessional team.”
  • A 2016 study found that physiotherapists are confident and consider the incorporation of dietary counseling very important and of high priority in their daily clinical work.

Just as you would with dry needling, manual therapy or pain science education, further training in nutrition may improve a professional’s confidence and competence. 

As a physical therapist, you may pursue further continuing education to sharpen this skill.

We each have our own personal scope of practice based on university training, affiliations, continuing education, and life experience. Your personal scope is important to reflect upon in addition to your state practice act before incorporating nutrition into your practice.

Now that you have an overview of the evidence, does the American Physical Therapy Association support the inclusion of nutrition as part of the physical therapy scope of practice?

nutrition

The American Physical Therapy Association’s Position on Nutrition

The professional scope of practice for physical therapists is ever-evolving. The good news is that APTA has officially released a position statement supporting the inclusion of nutrition as part of the scope of practice for physical therapists (House of Delegates P06-15-22-17).

Per the APTA website:

“Diet and nutrition are key components of many conditions managed by physical therapists. What’s more, nutrition can directly affect recovery and function while an individual is under a physical therapist’s care. It makes sense, then, for physical therapists to be concerned with and address nutritional intake and eating patterns of their patients and clients. Nutrition is part of the professional scope of practice for physical therapists.

APTA’s position is that it is “the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice.” 

The addition of nutrition to the scope of practice for physical therapists was a positive step by the APTA. As primary care providers of neuromusculoskeletal care, this makes sense. 

Last, let’s look at what PT state practice acts say.

What Does My State PT Practice Act Say About Nutrition Advice? 

As a physical therapist, your state PT practice act regulates your scope of practice.

Even though the APTA has officially added nutrition to our scope of practice, there is no “rule” that state PT boards are required to adopt APTA recommendations. States have the option to officially adopt the guidelines, modify or ignore them. 

State practice acts should now adopt this terminology. This will require PTs to organize, galvanize, and contact their state boards urging them to take action. 

But it may not be necessary…

Per the APTA, physical therapy services to promote health, wellness and fitness are considered within the scope of practice for physical therapy whether or not the state in which you are providing or plan to provide services is included below. However, applying state law to specific programs or services varies based on a number of factors including the specific legal language describing physical therapy services in your state licensing law, specific inclusions or exclusions, additional formal interpretations made by your state Board of PT, and the existence and level of direct access.

Currently, not one PT state practice act prevents a physical therapist from educating and counseling on nutrition. This is excellent news!

The majority of state PT practice acts include “health and wellness promotion,” which is defined as promoting and advocating for healthy lifestyles to reduce the burden of disease and disability on individuals and society (see your state practice act below) (16).

For example, the PT practice act of North Carolina clearly addresses health and wellness promotion, stating that part of the scope of practice of physical therapy includes “preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations.”

On the opposite end of the spectrum, the state of West Virginia PT practice act includes no language with regard to nutrition or health and wellness promotion.

Most states PT practice acts fall somewhere in the middle, citing health and wellness promotion, but are silent about nutrition or nutritional supplements. 

nutrition advice

What If My State PT Practice Act is Silent?

A silent state practice act means your state has no official ruling.

A silent state practice act is void of any language or terminology on a particular topic.

In this case, you would refer to:

1) your personal scope of practice, and 
2) your state nutrition laws.

State Nutrition Laws—What Do They Say About Physical Therapists Using the Term “Nutritionist” and “Dietician”?

Nutrition laws vary from state to state. The terms “registered/licensed dietician” and/or “nutritionist” are governed by state nutrition laws. You can only use this term if you meet the requirements set forth by your state nutrition law. 

Some states do not allow any person to give nutrition advice other than a registered dietitian. Others allow any person to give nutrition advice.

In some states, you may be able to call yourself a “nutritionist” but the use of the term “registered” or “licensed nutritionist” may require a certain degree and/or examination. PTs should check their state’s laws on nutrition for confirmation.

Since nutrition is part of the scope of practice for physical therapists it is not necessary to call yourself a nutritionist or go back to school for another degree. There is plenty you can do within your scope of practice to educate and counsel patients about diet and nutrition. As a physical therapist, you should not advertise your services as medical nutrition therapy.

What About Nutritional Supplements and Physical Therapy? 

Most state practice acts are silent on the topic of nutritional supplements, with one exception. Currently, the only state that limits a physical therapist from selling nutritional supplements in North Carolina. PTs in the State of North Carolina are currently taking action to overturn this. 

The PT practice act of North Carolina specifically mentions nutritional supplements, stating that “promoting an unnecessary device, treatment intervention, nutritional supplement, product, or service for the financial gain of the practitioner or of a third party as determined by the investigative committee.”

There are evidence-based supplements that provide a clinically meaningful treatment effect on pain and function, as well as associated symptoms such as anxiety and sleep (17). 

As we move away from pharmaceuticals and invasive procedures for the treatment of chronic pain, diet along with evidence-based nutritional supplementation will be an important part of pain care and one that physical therapists can incorporate into practice (18). 

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A Complete List of State PT Practice Acts Regarding Health and Wellness, Nutrition Advice, and Nutritional Supplements

Alabama Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Related to conditioning or to providing education or activities in a wellness setting for the purpose of injury prevention, reduction of stress, or promotion of fitness.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Alaska Physical Therapy Practice Act

  • Health and Wellness Promotion: “The physical therapy and other services referred to in subsection (a), which may be performed without prescription or referral, include and are limited to the following: “Physical Therapy” means the examination, treatment and instruction of human beings to detect, assess, prevent, correct, alleviate and limit physical disability, bodily malfunction, pain from injury, disease and other bodily or mental conditions and includes the administration, interpretation and evaluation of tests and measurements of bodily functions and structures; the planning, administration, evaluation and modification of treatment and instruction including the use of physical measures, activities and devices for preventive and therapeutic purposes; the provision of consultative, educational and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction and pain.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act! 

Arizona Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Practice of Physical Therapy’ means…Reducing the risk of injury, impairments, functional limitations and disability by means that include promoting and maintaining a person’s fitness, health, and quality of life”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Arkansas Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Practice of physical therapy’ means..Preventing injury, impairments, functional limitations, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

California  Physical Therapy Practice Act 

  • Health and Wellness Promotion: “The practice of physical therapy includes the promotion and maintenance of physical fitness to enhance the bodily movement related health and wellness of individuals through the use of physical therapy interventions.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Colorado Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Connecticut Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Physical therapy” includes the establishment and modification of physical therapy programs, treatment planning, instruction, wellness care, peer review, [and] consultative services and the use of low-level light laser therapy for the purpose of accelerating tissue repair, decreasing edema or minimizing or eliminating pain”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Delaware Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Practice of physical therapy means…Reducing the risk of impairments of body structure or function, activity limitations or participation restrictions in physical movement and mobility, including the promotion and maintenance of fitness, health, and wellness in populations of all ages”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

District of Columbia Physical Therapy Practice Act 

  • Health and Wellness Promotion: “A physical therapist or any person so authorized under the Act to perform physical therapy may perform the following functions…Preventing injury, impairment, functional limitation and disability, including the promotion and maintenance of health, wellness, fitness and quality of life in all age populations.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Florida Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Georgia Physical Therapy Practice Act 

  • Health and Wellness Promotion: “The practice of physical therapy means…reducing the risk of injury, impairment, activity limitations, participation restrictions, and  disability, including the promotion and maintenance of health, fitness, and wellness in populations of all ages” 
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Guam Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Hawaii  Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Patient’ means an individual who is the recipient of physical therapy examination, evaluation, diagnosis, prognosis, and intervention and who has a disease, disorder, condition, impairment, functional limitation, or disability and also includes a person who may engage the services of a physical therapist, who can benefit from the physical therapist’s consultation, interventions, professional advice, prevention services, or services promoting health, wellness, and fitness.” 
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Idaho Physical Therapy Practice Act 

  • Health and Wellness Promotion: “’Practice of Physical Therapy’ means…to reduce the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Illinois Physical Therapy Practice Act 

  • Health and Wellness Promotion: “’Physical therapy’ means reducing the risk of injury, impairment, functional limitation, or disability including the promotion and maintenance of fitness, health, and wellness”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Indiana Physical Therapy Practice Act 

  • Health and Wellness Promotion: “’Physical therapy’ means reducing the risk of injury, impairment, functional limitation, or disability, including the promotion and maintenance of fitness, health, and wellness”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click to here read your state practice act!

Iowa Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Kansas Physical Therapy Practice Act 

  • Health and Wellness Promotion: “’Physical therapy’ means examining, evaluating and testing individuals with mechanical, anatomical, physiological and developmental impairments…including the promotion and maintenance of fitness, health and quality of life in all age populations and engaging in administration, consultation, education and research”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Kentucky Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Louisiana Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Physical therapy services may be performed without a prescription or referral under any of the following circumstances:… Related to conditioning or to providing education or activities in a wellness setting for the purpose of injury prevention, reduction of stress, or promotion of fitness.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Maine Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Physical Therapy. “Physical therapy” means ….the provision of consultative, educational and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction and pain.
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Maryland Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Massachusetts Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act! (Sections 23A-23D)

Michigan Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Practice of physical therapy” means the evaluation of, education of, consultation with, or treatment of an individual by the employment of effective properties of physical measures and the use of therapeutic exercises and rehabilitative procedures, with or without assistive devices, for the purpose of preventing, correcting, or alleviating a physical or mental disability. It includes treatment planning, performance of tests and measurements, interpretation of referrals, initiation of referrals, instruction, consultative services, and supervision of personnel.
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Minnesota Physical Therapy Practice Act  

  • Health and Wellness Promotion: “The 90-day limitation of treatment by a physical therapist without an order or referral does not apply to prevention, wellness, education, or exercise…”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Mississippi Physical Therapy Practice Act 

  • Health and Wellness Promotion: “A physical therapist licensed under this chapter may perform physical therapy services without a prescription or referral under the following circumstances:Related to conditioning or to providing education or activities in a wellness setting for the purpose of injury prevention, reduction of stress or promotion of fitness.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Missouri Physical Therapy Practice Act 

  • Health and Wellness Promotion: “A physical therapist may provide educational resources and training, develop fitness or wellness programs for asymptomatic persons, or provide screening or consultative services within the scope of physical therapy practice without the prescription and direction of an approved health care provider.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Montana Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Physical therapy evaluation includes the administration, interpretation, and evaluation of tests and measurements of bodily functions and structures; the development of a plan of treatment; consultative, educational, and other advisory services”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Nebraska Physical Therapy Practice Act  

  • Health and Wellness Promotion: “Physical therapy means…Reducing the risk of injury, impairment, functional limitation, or disability, including the promotion and maintenance of fitness, health, and wellness”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Nevada Physical Therapy Practice Act  

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

New Hampshire Physical Therapy Practice Act  

  • Health and Wellness Promotion: “‘Practice of Physical Therapy means…reducing the risk of injury, impairment, movement dysfunctions and disability, including the promotion and maintenance of health, wellness, and fitness in populations of all ages.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

New Jersey Physical Therapy Practice Act  

  • Health and Wellness Promotion: “’Physical therapy’” and “’physical therapy practice’” also include the screening, examination, evaluation, and application of interventions for the promotion, improvement, and maintenance of fitness, health, wellness, and prevention services in populations of all ages exclusively related to physical therapy practice.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

New Mexico Physical Therapy Practice Act  

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

New York Physical Therapy Practice Act 

  • Health and Wellness Promotion: “If the services are of a prevention or wellness nature, no referral is needed” “Physical therapists take your health history, observe your posture and movement, evaluate your injury, and develop a plan of care.  Treatment may include, but is not limited to, the following:…patient/client education in health, wellness, and safety”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

North Carolina Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent
  • Prohibited Practice: “Promoting an unnecessary device, treatment intervention, nutritional supplement, product, or service for the financial gain of the practitioner or of a third party as determined by the investigative committee.”

Click here to read your state practice act!

North Dakota Physical Therapy Practice Act  

  • Health and Wellness Promotion: “‘Practice of Physical Therapy’ means… Engaging as a physical therapist in reducing the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and wellness in populations of all ages.” 
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Ohio Physical Therapy Practice Act  

  • Health and Wellness Promotion includes:
  • 4755.481 (a): The evaluation, treatment, or services are being provided for fitness, wellness, or prevention purposes.

    4755-29-01 (1) The physical therapist is seeing the patient for fitness, wellness, or prevention purposes; or

    “If the physical therapist determines, based on reasonable evidence, that no substantial progress has been made with respect to that patient during the thirty-day period immediately following the date of the patient’s initial visit with the physical therapist, the physical therapist shall consult with or refer the patient to a person described in division (H)(1) of section 4755.48 of the Revised Code, unless either of the following applies:… The evaluation, treatment, or services are being provided for fitness, wellness, or prevention purposes.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Oklahoma Physical Therapy Practice Act  

  • Health and Wellness Promotion: “Nothing in the Physical Therapy Practice Act shall prevent a physical therapist from performing services that are provided for the purpose of fitness, wellness, or prevention that is not related to the treatment of an injury or ailment.” 
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Oregon Physical Therapy Practice Act  

  • Health and Wellness Promotion: “‘Practice of Physical Therapy’ means…Reducing the risk of injury, impairment, functional limitation and disability by physical therapy interventions that may include as a component the promotion and maintenance of health, fitness and quality of life in all age populations.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Pennsylvania Physical Therapy Practice Act  

  • Health and Wellness Promotion: “‘Physical Therapy’ means any of the following…Reducing the risk of injury, impairment, functional limitation and disability, including the promotion and maintenance of fitness, health and wellness in populations of all ages as well as engaging in administration, consultation, education and research.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Puerto Rico Physical Therapy Practice Act  

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your territory’s practice act!

Rhode Island Physical Therapy Practice Act 

  • Health and Wellness Promotion: “Practice physical therapy” means….the provision of consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, physical dysfunction and pain.
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

South Carolina Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

South Dakota Physical Therapy Practice Act 

  • Health and Wellness Promotion: “The practice of physical therapy is the examination and evaluation of patients…including the promotion and maintenance of fitness, health, and quality of life in all age populations; and consultation, education, and research.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Tennessee Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Practice of physical therapy’ means…Reducing the risk of injury, impairments, functional limitations and disability, including the promotion and maintenance of fitness, health and quality of life in all age populations”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act! (starts on page 22)

Texas Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Utah Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Physical therapy’ or ‘physiotherapy’ means…promoting and maintaining health and fitness”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Vermont Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Practice of Physical Therapy’ means…reducing the risk of injury, impairment, functional limitation, and disability related to physical movement and mobility, including the promotion and maintenance of fitness, health, and wellness related to movement and function”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

US Virgin Islands Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Practice of physical therapy’ means…Reducing the risk of injury, impairment, functional limitation and disability, including the promotion and maintenance of fitness, health, and wellness in populations of all ages”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your territory’s practice act!

Virginia Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Washington Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Physical Therapy’ means…Reducing the risk of injury, impairment, functional limitation, and disability related to movement, including the promotion and maintenance of fitness, health, and quality of life in all age populations”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

West Virginia Physical Therapy Practice Act 

  • Health and Wellness Promotion: Silent
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Wisconsin Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Physical Therapy’ means…Reducing the risk of injury, impairment, functional limitation, or disability, including by promoting or maintaining fitness, health, or quality of life in all age populations.”
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Wyoming Physical Therapy Practice Act 

  • Health and Wellness Promotion: “‘Physical therapy’ or ‘physiotherapy’ means…Reducing the risk of injury, impairment, functional limitation or disability, including the promotion and maintenance of fitness, health, and wellness.
  • Nutrition: Silent
  • Nutritional Supplements: Silent

Click here to read your state practice act!

Moving Nutrition Advice Forward for Physical Therapists

To date, no PT state practice act or state nutrition law prevents a physical therapist from using nutrition. If you find conflicting information email me at [email protected] and I will update this blog.

Before implementing nutrition into your practice, first check:

1. Your state PT practice act
2. Your state nutrition law
3. Your personal scope

The APTA set the right tone with a position statement about nutrition and physical therapy practice. They cleared the path for all 50 states and for physical therapists across the country. Most states view nutrition as part of health and wellness promotion, and the evidence supports the combination of nutrition plus physical therapy as an effective intervention for treating chronic pain.

Physical therapists can now confidently broaden their scope of practice, add new programs, products, and services, and generate new streams of revenue. It also opens up new avenues for research, collaboration, and even telehealth. This deepens our profession’s ability and commitment to serve and alleviate chronic disease for individuals, communities, corporations. 

Physical therapists are combining evidence-based physical therapy, therapeutic exercise, and physical activity along with nutrition, and applying it to the prevention, treatment, and promotion of health.  

Read more on physical therapy nutrition guidance

Ready to implement evidence-based nutrition into your practice?

If you’re passionate about nutrition, consider completing additional coursework on the subject. Multimodal interventions are what required to safely and effectively treat pain, and nutrition is a key lifestyle medicine intervention. Nutrition is also on the radar of insurance companies and big EMR companies, including Web PT, and will be a critical part of value-based healthcare in the future.

Sign-up for the Functional Nutrition for Chronic Pain Practitioner Certification Program waitlist!

It is approved for PT CEUs in all 5o states!

 

Dr. Joe Tatta is one of the pioneering experts in lifestyle interventions for treating persistent pain. A unique combination of physical therapist, nutritionist, and ACT trainer, he has 25 years of experience applying integrative models of pain care, leadership, and private practice innovation. He holds a Doctorate in Physical Therapy, is a Board-Certified Nutrition Specialist, and has trained extensively in Acceptance and Commitment Therapy. In 2017 he was a key member of the APTA task force adding nutrition to the scope of practice for physical therapists.

REFERENCES

1.     Minich, D. M., & Bland, J. S. (2013). Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. TheScientificWorldJournal, 2013, 129841. doi:10.1155/2013/129841

2.     DiMaria-Ghalili, R. A., Mirtallo, J. M., Tobin, B. W., Hark, L., Van Horn, L., & Palmer, C. A. (2014). Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. The American journal of clinical nutrition, 99(5 Suppl), 1184S–93S. doi:10.3945/ajcn.113.073536

3.     Struijk, E. A., Guallar-Castillón, P., Rodríguez-Artalejo, F., & López-García, E. (2016). Mediterranean Dietary Patterns and Impaired Physical Function in Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, glw208. doi:10.1093/gerona/glw208 

4.     (2018) Nutrition and Physical Therapy, APTA

5.     Bruins, M. J., Van Dael, P., & Eggersdorfer, M. (2019). The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging. Nutrients, 11(1), 85. doi:10.3390/nu11010085

6.     Veronese, N., Stubbs, B., Noale, M., Solmi, M., Luchini, C., Smith, T. O., … Maggi, S. (2017). Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative. Clinical nutrition (Edinburgh, Scotland), 36(6), 1609–1614. doi:10.1016/j.clnu.2016.09.035

7.     Choi, K. W., Somers, T. J., Babyak, M. A., Sikkema, K. J., Blumenthal, J. A., & Keefe, F. J. (2014). The relationship between pain and eating among overweight and obese individuals with osteoarthritis: an ecological momentary study. Pain research & management, 19(6), e159–e163. doi:10.1155/2014/598382

8.     Mobasheri, A., Rayman, M. P., Gualillo, O., Sellam, J., van der Kraan, P., & Fearon, U. (2017). The role of metabolism in the pathogenesis of osteoarthritis. Nature Reviews Rheumatology, 13(5), 302–311.doi:10.1038/nrrheum.2017.50 

9.     Brain, K., Burrows, T. L., Rollo, M. E., Chai, L. K., Clarke, E. D., Hayes, C., … Collins, C. E. (2018). A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain. Journal of Human Nutrition and Dietetics.doi:10.1111/jhn.12601 

10.  Okifuji, A., & Hare, B. D. (2015). The association between chronic pain and obesity. Journal of pain research, 8, 399–408. doi:10.2147/JPR.S55598

11.  Bjørklund, G., Aaseth, J., Doşa, M. D., Pivina, L., Dadar, M., Pen, J. J., & Chirumbolo, S. (2019). Has human diet a role in reducing nociception related to inflammation and chronic pain? Nutrition.doi:10.1016/j.nut.2019.04.007 

12.  Duvallet, C., Gibbons, S. M., Gurry, T., Irizarry, R. A., & Alm, E. J. (2017). Meta-analysis of gut microbiome studies identifies disease-specific and shared responses. Nature communications, 8(1), 1784. doi:10.1038/s41467-017-01973-8

13.  Bischoff, S. C., Barbara, G., Buurman, W., Ockhuizen, T., Schulzke, J. D., Serino, M., … Wells, J. M. (2014). Intestinal permeability–a new target for disease prevention and therapy. BMC gastroenterology, 14, 189. doi:10.1186/s12876-014-0189-7

14.  Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., … Sarris, J. (2019). The Effects of Dietary Improvement on Symptoms of Depression and Anxiety. Psychosomatic Medicine, 81(3), 265–280.doi:10.1097/psy.0000000000000673 

15.  (2019) Combined Sections Meeting. APTA

16.http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/AssociationRoleAdvocacy.pdf#search=%22health%20promotion%22

17.  Liu, X., Machado, G. C., Eyles, J. P., Ravi, V., & Hunter, D. J. (2017). Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(3), 167–175.doi:10.1136/bjsports-2016-097333 

Other Useful References for Physical Therapy and Nutrition

Aweto HA, Oligbo CN, Fapojuwo OA, Olawale OA 2013 Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management. BMC Health Service Research 13:21. 

Bodner ME, Miller WC, Rhodes RE, Dean E 2011 Smoking cessation and counseling: Knowledge and views of Canadian physical therapists. Physical Therapy 91: 1051– 1062.Bodner 

ME, Rhodes RE, Miller WC, Dean E 2012 Smoking cessation and counseling practices of Canadian physical therapists. American Journal of Preventive Medicine 43: 67–71. 

Bodner ME, Rhodes RE, Miller WC, Dean E 2013 Benchmarking curriculum content in entry-level health professional education with special reference to health promotion practice in physical therapy: A multi-institutional international study. Advances in Health Science Education 18: 645–657. Canadian Physiotherapy Association 2008 Tobacco: The Role of Health Professionals in Smoking Cessation. Joint Statement. www.physiotherapy.ca/public.asp?WCE=C=47| K=222537|RefreshT=222559|RefreshS=LeftNavRefreshD= 2225592. 

Chartered Society of Physiotherapy 2012 Brief Interventions: Evidence Briefing (part of the public health and phy- siotherapy resource pack – physical activity, smoking cessation, obesity, alcohol and falls prevention). http://www. csp.org.uk/publications/public-healthphysiotherapy- resource-pack-part-4-brief-interventions-evidence- briefing. 

Council on Foreign Relations 2015 The Emerging Global Health Crisis. Noncommunicable Diseases in Low- and Middle-Income Countries Task Force. http://www.cfr.org/ diseases-noncommunicable/emerging-global-health-crisis/ p33883. 

Dean E 2009 Physical therapy in the 21st century (Part I): Toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiotherapy Theory and Practice 25: 330–353. 

Dean E, Al-Obaidi S, Dornelas de Andrade A, Gosselink R, Umerah G, Al-Abdelwahab S, Anthony J, Bhise A, Bruno S, Butcher S, Olsen M, Frownfelter D, Gappmaier E, Gylfadottir S, Habibi M, Hasson S, Jones A, Lapier T, Lomi C, Mackay L, Mathur S, O’Donoghue G, Playford 

K, Angroula K, Scherer S, Skinner M, WP Wong 2011 The first physical therapy summit on global health: Implications and recommendations for the 21st century. Physiotherapy Theory and Practice 27: 531–547. 

Dean E, Dornelas de Andrade A, O’Donoghue G, Skinner M, Umereh G, Beenen P, Cleaver S, Afzalzada D, MA Delaune, Footer C, Gannotti M, Gappmaier E, Figl- Hertlein A, Henderson B, MK Hudson, Spiteri K, King J, JL Klug, E-L Laakso, LaPier T, Lomi C, Maart S, Matereke N, ER Meyer, M’kumbuzi VRP, Mostert-Wentzel K, Myezwa H, Fagevik Olsen M, Peterson C, Petursdottir U, Robinson J, Sangroula K, A-K Stensdotter, BY Tan, BA Tschoepe, Bruno S, Mathur S, WP Wong 2014a The sec- ond physical therapy summit on global health: Developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases. Physiotherapy Theory and Practice 30: 261–275. 

Dean E, Moffat M, Skinner M, Dornelas de Andrade A, Myezwa H, Söderlund A 2014b Toward core inter profes- sional health promotion competencies to address the non- communicable diseases and their risk factors through knowledge translation: Curriculum content assessment. BMC Public Health 14: 717.

Dean E, Söderlund A 2015 What is the role of lifestyle behaviour change associated with non-communicable dis- ease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskelet Disorders 6: 87. 

Ekpenyong CE, Udokang NE, Akpan EE, Samson TK 2012 Double burden, non-communicable diseases and risk fac- tors evaluation in sub-Saharan Africa: The Nigerian experience. European Journal of Sustainable Development 1: 249–270. 

Goodgold S 2005 Wellness promotion beliefs and practices of pediatric physical therapists. Pediatric Physical Therapy 17: 148–157. 

Gorstein J, Sullivan KM, Parvanta I, Begin F 2007 Indicators and methods for cross-sectional surveys of vitamin and mineral status of populations, p 29. Micronutrient Initiative (Ottawa) and Centers for Disease Control and Prevention (Atlanta). 

Healey WE, Broers KB, Nelson J, Huber G 2012 Physical therapists’ health promotion activities for older adults. Journal of Geriatric Physical Therapy 35: 35–48. 

Health Reform Foundation of Nigeria (HERFON) 2011 Diabetes to top cause of death in 2015. HERFON Bulletin 4: 38–39. 

Johnson ST, Bates H, Fitzpatrick J, Marshall JD, Bell RC, McCargar L 2007 Promotion of physical activity by Canadian registered dieticians in daily practice. Journal of Human Nutrition and Dietetics 20: 37–40. 

Kaner I, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gvarry E, Godfrey C, Heather N, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C 2013 Effectiveness of screening and brief alcohol interven- tion in primary care (SIPS trial): Pragmatic cluster randomized controlled trial. British Medical Journal 346: e8501. 

Laws RA, Kirby SE, Powell-Davies GP, Williams AM, Jayasinghe UW, Amoroso CL, Harris MF 2008 ‘Should I and can I?’: A mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care. BMC Health Services Research 8: 44. 

Odebiyi DO, Adegoke BO 2005. Gender distribution of phy- siotherapy graduates from Nigerian universities. Journal of the Nigeria Society of Physiotherapy 15: 45–47. 

O’Donoghue G, Cunningham C, Murphy F, Woods C, Aagaard-Hansen J 2014 Assessment and management of risk factors for the prevention of lifestyle related disease: A cross-sectional survey of current activities, barriers and per- ceived education needs of primary care physiotherapists in the Republic of Ireland. Physiotherapy 100: 116–122. 

Pignataro RM, Ohtake PJ, Swisher A, Dino G 2012 The role of physical therapists in smoking cessation: opportunities for improving treatment outcomes. Physical Therapy 92: 757–766. 

Rea BL, Marshak HH, Neish C, Davis N 2004 The role of health promotion in physical therapy in California, New York, and Tennessee. Physical Therapy 84: 510–523. 

Rose HL, Miller PM, Nemeth LS, Jenkins RG, Nietert PJ, Wessell A, Ornstein SM 2008 Alcohol screening and brief counseling in a primary care hypertensive population: A quality improve- ment intervention. Addiction 103: 1271–1280. 

Saitz R 2010 Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Review 29: 631–640. 

Shirley D, van der Ploeg HP, Bauman AE 2010 Physical activity promotion in the physical therapy setting: perspec- tives from practitioners and students. Physical Therapy 90: 1311–1322. 

Snodgrass SJ, Carter AE, Guest M, Collins CE, James C, Kable AK, Ashby SE, Plotnikoff RC 2014 Weight manage- ment including dietary and physical activity advice pro- vided by Australian physiotherapists: A pilot cross- sectional survey. Physiotherapy Theory and Practice 30: 409–420. 

World Confederation for Physical Therapy 2014 Network for Health Promotion in Life and Work (NHPLW). http:// www.wcpt.org/node/100327. 

World Health Organization 1998 World Health Assembly resolution WHA51.12 – Health promotion. http://www. who.int/healthpromotion/areas/regions/en/. 

World Health Organization 2004 Global Forum on Integrated NCD Prevention and Control. Together in Global Action. http://www.who.int/chp/about/global_ forum/en/. 

World Health Organization 2011 WHO Maps: Non-commu- nicable disease trend in all countries. Nigeria. World Health Global Report. http://www.who.int/nmh/coun tries/nga_en.pdf?ua=. 

World Health Organization 2014a Health promotion. Support to regions and countries in health promotion, strengthening national and community capacity. http:// www.who.int/healthpromotion/areas/regions/en/.

World Health Organization 2014b Noncommunicable Diseases (NCD) Country Profiles. http://www.who.int. 

World Health Rankings 2015 Health Profile Nigeria. http:// www.worldlifeexpectancy.com/country-health-profile/ nigeria. 

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