It’s Time for a Credentials Check! PT/DPT vs CPT and RDN vs Nutritionist

Hey there! So this blog post kind of grew off of a tweet I made yesterday,

“If we tryin to ‪#prevent, why are the 2 powerhouse professions of ‪#Move & ‪#Fuel not collaboratin? ‪#NNMchat ‪#GetPT1st ‪#PT ‪#RDNday ‪#FreeTheYoke”

     I’m talking about the professions of Physical Therapy and Dietetics, which truly are powerful professions that unfortunately go unrecognized for all they can do. With chronic lifestyle diseases continuing to rise, why are we not collaborating? Why are we not giving patients or clients the best of both worlds? Diet and exercise have been proven over and over again to help prevent disease and improve the quality of life, yet I rarely see a PT and an RD working together or even know what the other has to offer. The typical response being that a PT helps the elderly woman walk down the hall while the RD is making their meals. This just isn’t the case. The amount of education, training, and quality control that goes behind earning these credentials is extensive.

     To really highlight how extensive their training is, I’m going to compare them to the public’s immediate response when asked, “who do you go to for help with diet and exercise?” Well a personal trainer or nutritionist, duh! And I want to say that I’m not putting these professions down because there are certified personal trainers (CPT) who do a tremendous job. However, from a consumer’s perspective, I would want an individual that comes highly qualified. I’m going to keep these comparisons brief enough to make my point; otherwise, this post could get more complicated than it needs to be.

Physical Therapist (PT) - All new PTs are now required to hold a Doctor of Physical Therapy (DPT)

Requirements (1):

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• Complete a 4-year bachelor’s degree
  • The major of the degree doesn’t matter as long as requirements are met for PT school application, appropriate courses in anatomy, chemistry, physics, etc.
• Complete a Doctor of Physical Therapy degree from an accredited CAPTE (Commission on Accreditation in Physical Therapy Education) program, typically 3 years to complete
  • “curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal.”(1)
  • Along with roughly 1,200 hours of clinical experience
• Pass a national examination, which is given by The Federation of State Boards of Physical Therapy (FSBPT), to become board certified
• Become licensed in the state of practice
• Practice under a code of ethics, set forth by the American Physical Therapy Association (APTA)
• Complete approximately 30 hours of continuing education every 2 years, depending upon the state
• Can hold certification in specialized areas, such as orthopedics, neuro, sports, pediatrics, etc.

Certified Personal Trainer (CPT)

Using the National Strength and Conditioning Association’s (NSCA) certification requirements (2):

• 18 years old
• High school diploma
• CPR/AED Certified
• Possibly a background in exercise science 
• Pass a written examination
  • Focused on fitness assessment, program planning, exercise, and safety

Registered Dietitian (RD) or Registered Dietitian-Nutritionist (RDN)

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Requirements (3):

• Complete a 4-year bachelor’s degree in dietetics from a program that is accredited by ACEND (Accreditation Council for Education in Nutrition and Dietetics), which is a part of the Academy of Nutrition and Dietetics (AND)
  • The degree is heavily geared towards food science, biochemistry, medical nutrition therapy, food management, and much more
• Complete an ACEND accredited dietetic internship, roughly 1200 hours, distributed among healthcare facilities, community health, and foodservice distribution
• Pass a national examination, which is given by the Commission on Dietetics Registration (CDR)
• Become licensed in their state of practice
• Practice under a code of ethics, set forth by AND and CDR
• 75 hours continuing professional education (CPE) every 5 years
• Can hold certifications in specialized areas such as geriatrics, sports, diabetes, renal disease, cancer, etc.
• Most states nationwide require an RD credential, along with state licensure, to perform nutritional counseling and prescribe diets. 
  • Check out this Link for more information

Nutritionist

Requirements:

• Having a passion for nutrition.
• There is no legal protection over this term, as there is with RD and RDN.
• This individual could potentially have a degree in food science or nutrition.
• Not much else to say about this one.

     As you can see, these two professions are truly powerful in the field of human movement and nutrition, providing the keys to preventative healthcare. Both of these professions go to extreme measures to ensure highest quality of care and competency. These credentialed individuals have thousands of hours of education and training under their belt with the ability to do more than walk someone down the hall and cook up some food. So I ask you again, why are these professions not collaborating to provide the best approach to a preventative lifestyle?

Thanks for reading.

- Patrick Berner, SPT

(Soon to be DPT graduate with a degree in dietetics ready to make a change!)

References:

1.  Clark M. Physical therapist (PT) education overview. American Physical Therapy Association. http://www.apta.org/PTEducation/Overview/. Accessed March 10, 2016.

2.  National Strength and Conditioning Association. CPT certification - certified personal trainer - personal trainer certification. https://www.nsca.com/Certification/CPT/. Accessed March 10, 2016.

3. Academy of Nutrition and Dietetics. What is a registered Dietitian Nutritionist? http://www.eatrightpro.org/resources/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist. Accessed March 10, 2016.

Preventative Programs Help Reduce ACL Injury

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     Injury to the anterior cruciate ligament of the knee is a very common occurrence, especially for younger adolescent females. The majority of injuries occur during sports that require running, jumping, and cutting. They occur at an estimated annual rate of 250,000, with females being 2-8 times more likely than males.(1) Females are said to have increased risk due to anatomical and hormonal differences.(2)

     The results of a meta-analysis and a systematic review, high-quality research, conclude that preventative programs are beneficial for the reduction of ACL injury. The meta-analysis found that when these programs included neuromuscular and proprioceptive training, ACL injuries were reduced by 50.7%.(1) This type of training involves increasing the awareness one has over their extremities. The systematic review concluded that preventative programs were successful when they included strength training with plyometric, balance and proprioception, and education on proper body mechanics.(2)

     The components of these preventative programs are well within the scope of practice of a physical therapist. In addition to that stated above, programs should include specific training that may be required for a particular sport, such as increased plyometrics for sports with increased jumping. Seek a licensed physical therapist for the development of an ACL preventative program.

-Patrick Berner, SPT

References:

1. Donnell-Fink L, Klara K, Losina E, et al. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. Plos ONE. December 4, 2015;10(12).

2. Michaelidis M, Koumantakis G. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: A systematic review. Physical Therapy In Sport. August 2014;15(3):200-210. 

Every Healthy Pregnancy Should Include Visiting a Physical Therapist

     As awareness continues to build on the benefits of seeing a physical therapist for low back pain, it should not be forgotten that physical therapists can help with numerous other conditions. One of those conditions being a very natural phenomenon, pregnancy. Even with pregnancy rates on a decline, the latest study shows “98.7 per 1,000 women aged 15-44” are becoming pregnant(1). That remains to be a large number of women that may experience the following symptoms during or after their pregnancy(2): 

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•    Low back pain
•    Pelvic girdle pain
•    Weight gain
•    Gestational diabetes
•    Urinary incontinence (uncontrolled bladder)
•    Preeclampsia
•    Leg Edema (swelling)
•    Deep vein thrombosis (blood clots)
•    Depression
•    Morning sickness
•    Fatigue
•    .... The list goes on

     The purpose of physical therapy intervention is to prevent or reduce the occurrence of these symptoms. A systematic review performed by Kampen et al. found physical therapy intervention to be effective in the treatment and prevention of pregnancy symptoms(2). The results indicated that the skills of a physical therapist can accurately address the following(2):

• low back/ pelvic girdle pain
• weight gain beyond recommendations
• urinary incontinence 

     These symptoms can be addressed with targeted exercises, such as Kegels for urinary incontinence. The guidance of a physical therapist should be sought to ensure proper performance of these particular activities and receive adequate education about safe movements. 

     Also, don’t forget that nutritional intake is crucial during pregnancy, for both mother and child. Seek the help of a registered dietitian for nutritional meal planning. 

- Patrick Berner, SPT

1. Fox M. U.S. Pregnancy rate hits record low, data shows. NBC NEWS. December 11, 2015. http://www.nbcnews.com/health/womens-health/u-s-pregnancy-rate-hits-record-low-data-shows-n478381. Accessed February 4, 2016.

2. Van Kampen M, Devoogdt N, De Groef A, Gielen A, Geraerts I. The efficacy of physiotherapy for the prevention and treatment of prenatal symptoms: a systematic review. International Urogynecology Journal. 2015;(11):1575. 

Say No to Drug Therapy for Chronic Pain. Choose a Physical Therapist.

     The incidence of chronic pain is on a steady rise and chronic low back pain is one of the most common contributing conditions. Studies suggest the “the global number of individuals with low back pain is likely to increase substantially over the coming decades.”(1) The World Health Organization lists low back pain as one of the most debilitating conditions worldwide, but “the causes of lower back pain are rarely addressed.”(2)

     The prescribing of opioids has long been the approach to dealing with chronic pain, and studies show that “more than half of regular opioid users report [having] back pain.”(3) The prevalence of opioid use has increased so much over the years that the Centers for Disease Control and Prevention released a document intended for those medical doctors prescribing medication for chronic pain. This document is titled the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.

     The CDC states, that “in 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.”(4) The CDC also states, that “the overall prevalence of common, predominantly musculoskeletal pain conditions that can be chronic (e.g., arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43% among adults in the United States.”(4) These are musculoskeletal conditions that physical therapists have expert knowledge of.

     The CDC guidelines endorse conservative management, stating that "based on contextual evidence, many nonpharmacologic therapies, including physical therapy… can ameliorate chronic pain.”(4) Numerous studies support the use of physical therapy for chronic low back pain and this may include the use of specifically targeted exercises, lumbar stabilization programs, physical therapy mobilizations, and many other treatment options.(5,6) A good physical therapist will aim to treat the underlying causes of pain or help put together a maintenance program, because yes some conditions may require life-long management.

     Also important to note that yes some musculoskeletal conditions may require medication intervention, but conservative treatment by a qualified physical therapist should be sought first.

- Patrick Berner, SPT

References:

1. Hoy D, Bain C, Buchbinder R, et al. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism. June 2012;64(6):2028-2037.

2. 6.24 low back pain, World Health Organization. 6. Priority diseases and reasons for inclusion. http://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf. Accessed January 23, 2016.

3. Deyo R, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ (Clinical Research Ed). January 5, 2015;350: g6380.

4. Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. Atlanta, GA: CDC; 2016.

5. Specific rehabilitation exercise for the treatment of patients with chronic low back pain. Journal Of Physical Therapy Science. August 2015;27(8):2413-2417.

6. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. Journal Of Physical Therapy Science. December 2015;27(12):3843-3846.