WEBVTT 00:00:00.009 --> 00:00:01.149 Welcome to Orthostatic, 00:00:01.189 --> 00:00:02.511 a podcast brought to you by 00:00:02.531 --> 00:00:04.051 the Academy of Orthopedic 00:00:04.091 --> 00:00:04.753 Physical Therapy. 00:00:04.793 --> 00:00:06.674 Patrick Berner is on the show today. 00:00:06.753 --> 00:00:07.815 Patrick, welcome to the program. 00:00:08.435 --> 00:00:09.195 I appreciate it. 00:00:09.236 --> 00:00:09.897 Thanks for having me. 00:00:10.297 --> 00:00:11.217 You're no stranger to 00:00:11.278 --> 00:00:12.718 talking about the topics 00:00:12.739 --> 00:00:13.458 we're going to get into 00:00:13.519 --> 00:00:14.480 today because you have, 00:00:14.740 --> 00:00:15.441 and I remember the first 00:00:15.480 --> 00:00:16.722 time we met in person, 00:00:17.702 --> 00:00:18.923 you have an interesting background. 00:00:19.283 --> 00:00:20.984 How do you explain to our 00:00:21.024 --> 00:00:21.745 audience or how would you 00:00:21.765 --> 00:00:22.907 explain to people you've 00:00:22.946 --> 00:00:24.228 got this sort of cool 00:00:24.628 --> 00:00:26.530 mashup of backgrounds? 00:00:27.129 --> 00:00:27.971 Help people understand that. 00:00:28.722 --> 00:00:30.243 Yeah, so, you know, 00:00:30.283 --> 00:00:31.245 it probably originally 00:00:31.285 --> 00:00:33.246 stems from me being born 00:00:33.265 --> 00:00:34.286 and raised in New Orleans 00:00:34.347 --> 00:00:35.328 and being surrounded by 00:00:35.368 --> 00:00:36.848 people living with, you know, 00:00:36.908 --> 00:00:38.210 systemic chronic disease. 00:00:38.689 --> 00:00:42.713 So a food around passion started up, 00:00:42.792 --> 00:00:42.953 right? 00:00:42.972 --> 00:00:43.512 So that's where my 00:00:43.552 --> 00:00:44.914 professional journey started, 00:00:44.973 --> 00:00:46.174 was looking at what people 00:00:46.234 --> 00:00:47.375 ate and how it impacted 00:00:47.515 --> 00:00:48.517 their health and outcomes. 00:00:49.395 --> 00:00:51.475 But I started to learn that 00:00:51.695 --> 00:00:52.536 there was a movement 00:00:52.576 --> 00:00:54.097 component to people's outcomes. 00:00:54.158 --> 00:00:55.137 And that's what led me to 00:00:55.158 --> 00:00:56.719 the profession of physical therapy. 00:00:57.439 --> 00:01:00.762 But then I realized that most PTs, 00:01:01.161 --> 00:01:02.942 and especially your orthopedic PTs, 00:01:03.523 --> 00:01:05.123 only look at the movement component, 00:01:05.263 --> 00:01:06.484 only look at the pain or 00:01:06.545 --> 00:01:08.486 functional deficit. 00:01:09.246 --> 00:01:10.507 And it was frustrating. 00:01:10.606 --> 00:01:11.927 So I actually went back and 00:01:11.947 --> 00:01:13.909 did an internship and sat for boards. 00:01:13.989 --> 00:01:15.390 So I was able to become a 00:01:15.450 --> 00:01:17.010 registered dietician in 00:01:17.051 --> 00:01:18.471 addition to being a physical therapist. 00:01:20.218 --> 00:01:20.679 That's great. 00:01:20.778 --> 00:01:22.861 And you get to look at, you know, 00:01:22.881 --> 00:01:23.802 we talk about this clinical 00:01:23.841 --> 00:01:24.722 toolbox a lot. 00:01:25.263 --> 00:01:26.243 And there is a cliche that 00:01:26.284 --> 00:01:27.665 says when all you have is a hammer, 00:01:28.225 --> 00:01:29.566 the world is full of nails, right? 00:01:29.606 --> 00:01:31.948 So maybe just always only 00:01:31.989 --> 00:01:33.069 looking at movement and not 00:01:33.109 --> 00:01:33.890 considering some of the 00:01:33.930 --> 00:01:35.531 other things like nutrition 00:01:35.871 --> 00:01:38.034 or sleep or mental health or stress. 00:01:38.433 --> 00:01:38.554 Hey, 00:01:38.573 --> 00:01:39.935 we might be missing some of those things. 00:01:40.236 --> 00:01:41.277 So this episode is really... 00:01:41.936 --> 00:01:43.438 Just a reminder, 00:01:43.617 --> 00:01:44.599 and you're going to give us 00:01:44.638 --> 00:01:45.840 some tactical information 00:01:45.879 --> 00:01:47.180 of maybe if I don't have 00:01:47.221 --> 00:01:48.201 the background of Patrick, 00:01:48.302 --> 00:01:49.543 how do I begin to sort of 00:01:49.722 --> 00:01:50.743 ask some of those questions 00:01:50.884 --> 00:01:51.984 and why it's important? 00:01:52.426 --> 00:01:54.606 So how important is 00:01:54.667 --> 00:01:56.528 nutrition in orthopedic 00:01:56.588 --> 00:01:58.069 physical therapy outcomes? 00:01:58.209 --> 00:01:59.251 Where would we start there? 00:02:00.132 --> 00:02:02.112 Yeah, I think, you know, the thing, Jimmy, 00:02:02.153 --> 00:02:03.355 is I'm super biased, 00:02:03.775 --> 00:02:05.036 but it's extremely important. 00:02:05.558 --> 00:02:07.299 You know, if you look at those outcomes, 00:02:07.638 --> 00:02:08.378 whether you're an 00:02:08.459 --> 00:02:09.800 orthopedic therapist trying 00:02:09.819 --> 00:02:11.060 to facilitate improvements 00:02:11.099 --> 00:02:12.760 in strength or you're 00:02:12.781 --> 00:02:14.221 trying to facilitate wound 00:02:14.241 --> 00:02:16.262 healing versus some type of surgery, 00:02:16.342 --> 00:02:16.641 you know, 00:02:16.681 --> 00:02:18.323 you're thinking all your post-op patients, 00:02:18.402 --> 00:02:20.282 joint replacements, ACL repairs, 00:02:20.364 --> 00:02:20.783 et cetera. 00:02:21.443 --> 00:02:21.963 If you're trying to 00:02:22.003 --> 00:02:25.044 facilitate the system to recover, well, 00:02:25.064 --> 00:02:25.765 you've got to fuel the 00:02:25.825 --> 00:02:28.907 system appropriately in order to do so. 00:02:28.926 --> 00:02:29.567 Thank you. 00:02:30.393 --> 00:02:31.995 That's where nutrition comes into play. 00:02:32.294 --> 00:02:32.515 You know, 00:02:32.556 --> 00:02:34.377 it really helps support the 00:02:34.418 --> 00:02:35.278 interventions that that 00:02:35.318 --> 00:02:36.539 therapist is implementing 00:02:36.580 --> 00:02:38.282 in their plan of care to 00:02:38.401 --> 00:02:39.223 get the person where they 00:02:39.242 --> 00:02:41.164 need to be more efficiently. 00:02:41.925 --> 00:02:43.487 And I think really set the 00:02:43.508 --> 00:02:44.949 patient up for other 00:02:44.990 --> 00:02:46.611 success as well in their 00:02:46.632 --> 00:02:47.592 overall health outcomes. 00:02:48.234 --> 00:02:49.234 All right. 00:02:49.253 --> 00:02:50.694 So let's ask this next 00:02:50.754 --> 00:02:51.914 question a couple different ways. 00:02:52.395 --> 00:02:52.695 First, 00:02:53.116 --> 00:02:55.877 what specific nutritional advice can 00:02:55.937 --> 00:02:58.717 PTs provide to patients with, 00:02:58.978 --> 00:03:01.038 we'll call it musculoskeletal issues, 00:03:01.318 --> 00:03:03.759 bread and butter, orthopedic issues? 00:03:03.840 --> 00:03:05.020 So what nutritional advice 00:03:05.099 --> 00:03:07.100 can PTs provide to their patients? 00:03:07.920 --> 00:03:09.062 Yeah, so, you know, Jimmy, 00:03:09.081 --> 00:03:10.002 that's a good question. 00:03:10.182 --> 00:03:11.524 And what happens is, though, 00:03:11.824 --> 00:03:13.284 is there's nuance across 00:03:13.324 --> 00:03:14.425 the country because of 00:03:14.466 --> 00:03:15.567 practice acts and what a 00:03:15.646 --> 00:03:16.987 physical therapist can do. 00:03:17.788 --> 00:03:19.528 So for most of us across the country, 00:03:19.568 --> 00:03:20.150 if you keep that 00:03:20.189 --> 00:03:21.230 information and that 00:03:21.350 --> 00:03:23.072 education relatively broad, 00:03:23.572 --> 00:03:24.372 you're in a good spot. 00:03:24.973 --> 00:03:26.554 So you're looking at general 00:03:26.593 --> 00:03:27.935 healthy intake, you know, 00:03:27.974 --> 00:03:29.616 an adequate consumption of 00:03:29.776 --> 00:03:31.798 fruits and vegetables, good whole grains, 00:03:32.419 --> 00:03:34.740 things that facilitate, you know, 00:03:34.860 --> 00:03:37.062 a reduction in systemic inflammation. 00:03:37.998 --> 00:03:39.080 And with that reduction in 00:03:39.139 --> 00:03:40.180 systemic inflammation, 00:03:40.199 --> 00:03:41.401 you're gonna see healthier 00:03:41.461 --> 00:03:43.081 tissue function, right? 00:03:43.102 --> 00:03:44.401 You're gonna see irritation 00:03:44.443 --> 00:03:45.782 to tendons and ligaments 00:03:45.862 --> 00:03:47.144 kind of come down a little bit. 00:03:47.584 --> 00:03:48.824 You're gonna see performance 00:03:49.004 --> 00:03:50.104 increase when there's 00:03:50.265 --> 00:03:52.006 adequate supply of nutrients. 00:03:53.026 --> 00:03:55.207 I think also within an orthopedic setting, 00:03:56.248 --> 00:03:57.508 if you're thinking of your 00:03:57.849 --> 00:03:58.789 post-op patients, 00:03:59.711 --> 00:04:01.431 protein is one of the 00:04:01.471 --> 00:04:02.512 biggest conversations we 00:04:02.551 --> 00:04:03.733 need to be having because 00:04:03.793 --> 00:04:06.114 if you wanna facilitate healthy muscle, 00:04:07.342 --> 00:04:08.304 And that healthy muscle 00:04:08.383 --> 00:04:10.187 turning into improved 00:04:10.266 --> 00:04:12.028 strength and function, well, 00:04:12.049 --> 00:04:13.491 you got to fuel it with an 00:04:13.550 --> 00:04:14.532 adequate amount of protein. 00:04:16.242 --> 00:04:18.665 So it sounds as if the safe 00:04:18.764 --> 00:04:20.045 route or the appropriate route, 00:04:20.086 --> 00:04:21.728 depending on your state practice act, 00:04:21.747 --> 00:04:21.887 right? 00:04:21.908 --> 00:04:22.848 And there's more than a few 00:04:22.869 --> 00:04:23.548 of those in the country. 00:04:24.629 --> 00:04:25.511 It seems like staying on the 00:04:25.591 --> 00:04:27.232 education side keeps people 00:04:27.673 --> 00:04:29.634 safe in terms of liability, 00:04:30.055 --> 00:04:32.235 but also accurate in terms of scope. 00:04:32.776 --> 00:04:34.617 Is there a resource that you'd recommend? 00:04:34.999 --> 00:04:36.279 I could see a PT saying, well, 00:04:36.339 --> 00:04:38.581 according to this organization, 00:04:39.523 --> 00:04:40.163 this is what they would 00:04:40.182 --> 00:04:41.704 recommend for someone who 00:04:41.803 --> 00:04:43.485 is living with your condition. 00:04:44.334 --> 00:04:45.755 Yeah, so, you know, 00:04:45.795 --> 00:04:48.257 you think of the national organization, 00:04:48.298 --> 00:04:50.139 the Academy of Nutrition and Dietetics. 00:04:50.860 --> 00:04:52.081 So their consumer-facing 00:04:52.141 --> 00:04:53.762 website is eatright.org. 00:04:54.483 --> 00:04:56.084 So that's going to be one source to go to. 00:04:56.444 --> 00:04:57.264 And that's, again, 00:04:57.464 --> 00:04:59.185 it's very similar to like the APTA, 00:04:59.586 --> 00:04:59.766 right? 00:04:59.807 --> 00:05:01.288 But it's for the dietetics 00:05:01.468 --> 00:05:02.709 and nutrition professional. 00:05:03.389 --> 00:05:04.790 Outside of that, you know, 00:05:04.970 --> 00:05:07.232 choosemyplate.gov is a good 00:05:07.312 --> 00:05:09.072 option as well because it's 00:05:09.112 --> 00:05:10.975 got a lot of helpful resources 00:05:12.105 --> 00:05:13.947 handouts and resources for patients, 00:05:13.987 --> 00:05:14.226 you know, 00:05:14.286 --> 00:05:15.408 how to add more fruits and 00:05:15.447 --> 00:05:16.528 vegetables to your day, 00:05:16.908 --> 00:05:18.149 how to get more whole grains, 00:05:18.170 --> 00:05:19.891 what are your protein sources, 00:05:19.930 --> 00:05:21.572 how to add more protein to your day. 00:05:21.932 --> 00:05:23.194 They have some of those nice, 00:05:23.334 --> 00:05:25.696 easy resources to provide to patients. 00:05:26.416 --> 00:05:27.456 So that's been the first 00:05:27.497 --> 00:05:28.899 place that I would look for 00:05:28.918 --> 00:05:31.480 those two major websites. 00:05:31.620 --> 00:05:33.201 And as an orthopedic physical therapist, 00:05:33.221 --> 00:05:34.682 you might not necessarily 00:05:34.723 --> 00:05:35.403 need to go to the lengths 00:05:35.423 --> 00:05:36.103 that Patrick did, 00:05:36.124 --> 00:05:36.805 which is to become a 00:05:36.845 --> 00:05:37.605 registered dietitian. 00:05:38.788 --> 00:05:40.430 These organizations are vetted. 00:05:40.750 --> 00:05:42.531 They're, you know, you mentioned a.gov, 00:05:42.591 --> 00:05:43.791 which is usually we can 00:05:43.831 --> 00:05:44.773 assume of higher quality. 00:05:45.093 --> 00:05:46.574 They've done sort of the work. 00:05:46.894 --> 00:05:48.334 And now by suggesting those, 00:05:48.795 --> 00:05:50.096 you sort of stay on the 00:05:50.137 --> 00:05:52.617 side of education and not prescription, 00:05:52.697 --> 00:05:53.038 correct? 00:05:53.798 --> 00:05:53.939 Yeah, 00:05:53.978 --> 00:05:55.439 because all you're really doing is 00:05:55.500 --> 00:05:56.461 you are bringing the 00:05:56.480 --> 00:05:57.422 awareness to the patient 00:05:57.461 --> 00:05:58.442 that these things exist. 00:05:58.841 --> 00:05:59.122 You know, 00:05:59.202 --> 00:06:00.783 they could certainly access them 00:06:01.444 --> 00:06:01.925 on their own, 00:06:02.504 --> 00:06:03.225 but you're just creating 00:06:03.245 --> 00:06:05.187 that awareness in that 00:06:05.226 --> 00:06:06.127 you're not trying to build 00:06:06.187 --> 00:06:08.449 out a meal plan or dive into the 00:06:08.973 --> 00:06:10.613 the nitty gritty of what 00:06:10.713 --> 00:06:11.973 specifically they need to eat, 00:06:12.014 --> 00:06:12.694 but you're creating 00:06:12.713 --> 00:06:14.555 awareness to what healthier 00:06:14.595 --> 00:06:15.334 intake looks like. 00:06:15.654 --> 00:06:16.755 And it's that healthier 00:06:16.795 --> 00:06:17.475 intake that's going to 00:06:17.555 --> 00:06:19.096 drive improved recovery. 00:06:19.596 --> 00:06:19.877 Right. 00:06:20.156 --> 00:06:22.937 So generic and so big picture, which is, 00:06:22.997 --> 00:06:23.197 hey, 00:06:23.257 --> 00:06:24.538 you should maybe consider eating a 00:06:24.559 --> 00:06:25.139 little healthier. 00:06:26.677 --> 00:06:27.718 We kind of know that, right? 00:06:27.978 --> 00:06:28.658 Now you want to go from 00:06:28.718 --> 00:06:29.819 strategy to tactics. 00:06:29.918 --> 00:06:30.920 And it sounds as if the 00:06:30.980 --> 00:06:32.461 resources you suggested 00:06:33.180 --> 00:06:35.081 have those opportunities to get tactical. 00:06:35.182 --> 00:06:35.663 But again, 00:06:36.182 --> 00:06:37.043 you're not prescribing those 00:06:37.084 --> 00:06:38.084 particular things you're 00:06:38.144 --> 00:06:39.225 educating and suggesting. 00:06:40.365 --> 00:06:40.605 Yeah. 00:06:41.065 --> 00:06:42.026 And you know, that's again, Jim, 00:06:42.067 --> 00:06:44.427 where the state nuance comes into play. 00:06:44.468 --> 00:06:48.110 Because realistically, if possible, 00:06:48.630 --> 00:06:50.291 as an orthopedic physical therapist, 00:06:50.372 --> 00:06:51.492 you want to find that 00:06:51.572 --> 00:06:55.355 opportunity to dive in deeper if able. 00:06:56.226 --> 00:06:57.807 Because you can educate 00:06:57.848 --> 00:06:58.769 people to your blue in the 00:06:58.809 --> 00:06:59.709 face that they should eat 00:06:59.750 --> 00:07:00.850 more fruits and vegetables. 00:07:02.011 --> 00:07:03.091 Most people know that. 00:07:03.752 --> 00:07:04.713 It's really trying to get 00:07:04.752 --> 00:07:06.053 into the conversation into 00:07:06.113 --> 00:07:09.375 finding out why that person doesn't eat X, 00:07:09.576 --> 00:07:09.637 Y, 00:07:09.677 --> 00:07:12.197 and Z. And that takes a little bit more 00:07:12.278 --> 00:07:13.059 skill and a little more 00:07:13.098 --> 00:07:14.060 knowledge to do so. 00:07:14.480 --> 00:07:16.180 But it also involves a 00:07:16.221 --> 00:07:17.062 conversation around the 00:07:17.101 --> 00:07:18.702 environment that that person lives in. 00:07:19.583 --> 00:07:19.884 But again, 00:07:19.903 --> 00:07:21.345 the nuance and what you can do 00:07:21.425 --> 00:07:22.365 and what rabbit hole you 00:07:22.425 --> 00:07:24.607 can dive into is state-dependent. 00:07:25.153 --> 00:07:26.615 Yep. 00:07:26.795 --> 00:07:28.014 How does, you know, 00:07:28.576 --> 00:07:29.675 you mentioned wound healing, 00:07:30.036 --> 00:07:33.137 you mentioned, you know, building muscle. 00:07:33.677 --> 00:07:34.038 Obviously, 00:07:34.057 --> 00:07:35.218 there's a nutrition component to 00:07:35.259 --> 00:07:35.699 those things. 00:07:35.978 --> 00:07:37.459 How else does nutrition 00:07:37.500 --> 00:07:38.540 interact with other forms 00:07:39.161 --> 00:07:40.721 of physical therapy, treatment, 00:07:40.742 --> 00:07:41.562 or rehabilitation? 00:07:43.262 --> 00:07:43.622 Yeah. 00:07:43.702 --> 00:07:45.004 So, you know, 00:07:45.024 --> 00:07:46.285 we talked about that systemic 00:07:46.324 --> 00:07:47.605 inflammation component. 00:07:47.884 --> 00:07:49.485 You think of the prevalence 00:07:49.545 --> 00:07:50.747 of diabetes within this 00:07:50.807 --> 00:07:53.208 country and how that has an impact on a 00:07:53.834 --> 00:07:54.033 you know, 00:07:54.074 --> 00:07:55.956 nerve conduction and general healing. 00:07:56.915 --> 00:07:58.177 There's a good bit of 00:07:58.216 --> 00:07:59.057 research out there that 00:07:59.098 --> 00:08:00.598 looks at those suffering 00:08:00.639 --> 00:08:02.660 from neurological conditions as well. 00:08:03.281 --> 00:08:04.040 And so if you're in that 00:08:04.141 --> 00:08:05.362 outpatient orthopedic 00:08:05.401 --> 00:08:07.144 clinic that you so happen 00:08:07.163 --> 00:08:08.404 to have that patient who 00:08:08.444 --> 00:08:09.766 has a history of a stroke 00:08:09.826 --> 00:08:11.067 or MS or something, 00:08:12.067 --> 00:08:14.009 there's evidence out there that points to, 00:08:14.389 --> 00:08:14.569 well, 00:08:14.588 --> 00:08:16.290 if that person was to consume a 00:08:16.329 --> 00:08:18.372 healthier eating pattern, you know, 00:08:18.391 --> 00:08:20.934 there's severity of their symptoms. 00:08:21.821 --> 00:08:23.122 would come down a little bit. 00:08:23.843 --> 00:08:25.545 I think the other big one to mention too, 00:08:25.605 --> 00:08:26.625 that's related to the 00:08:27.007 --> 00:08:28.247 systemic inflammation 00:08:28.267 --> 00:08:30.029 component is people living 00:08:30.050 --> 00:08:31.490 with osteoarthritis or 00:08:31.511 --> 00:08:32.552 rheumatoid arthritis. 00:08:33.133 --> 00:08:34.073 There's a lot of evidence 00:08:34.134 --> 00:08:35.475 out there that looks again, 00:08:36.115 --> 00:08:37.658 if you were to consume more 00:08:37.677 --> 00:08:40.039 of an anti-inflammatory eating pattern, 00:08:40.600 --> 00:08:41.822 the symptomology comes down. 00:08:43.259 --> 00:08:45.701 seems as if it's a multifactorial approach, 00:08:45.782 --> 00:08:46.023 right? 00:08:46.102 --> 00:08:47.864 Where we're not discounting movement, 00:08:47.984 --> 00:08:48.284 obviously, 00:08:48.325 --> 00:08:49.385 as two physical therapists 00:08:49.446 --> 00:08:50.486 talking on this podcast, 00:08:50.527 --> 00:08:51.748 which is brought to you by 00:08:51.788 --> 00:08:52.828 the Academy of Orthopedic 00:08:52.849 --> 00:08:53.570 Physical Therapy. 00:08:53.889 --> 00:08:54.870 It's not saying that we're 00:08:54.931 --> 00:08:56.192 removing one of the components, 00:08:56.231 --> 00:08:57.212 but looking at this human 00:08:57.253 --> 00:08:58.394 from a couple of different 00:08:58.553 --> 00:09:00.135 aspects or a couple of different sides of 00:09:00.655 --> 00:09:02.476 that human's life and paying attention to, 00:09:02.537 --> 00:09:03.998 well, is it just movement? 00:09:04.158 --> 00:09:05.019 Is it just what I'm going to 00:09:05.058 --> 00:09:06.080 do with my patient, 00:09:06.139 --> 00:09:07.080 with my PT background? 00:09:07.600 --> 00:09:09.302 Or could I be one more touch 00:09:09.361 --> 00:09:10.482 point for a tactic? 00:09:10.562 --> 00:09:12.303 And Hey, have we considered this? 00:09:12.423 --> 00:09:12.964 Can I help you? 00:09:13.264 --> 00:09:14.345 Can I educate you on this? 00:09:15.365 --> 00:09:16.186 Yeah, a hundred percent. 00:09:16.245 --> 00:09:17.366 And it's looking, you know, 00:09:17.386 --> 00:09:19.048 it's beyond nutrition as well. 00:09:19.067 --> 00:09:20.129 Like you mentioned earlier, 00:09:20.149 --> 00:09:21.850 it's things like sleep or 00:09:21.950 --> 00:09:23.990 stress and having a greater 00:09:24.030 --> 00:09:25.451 recognition for where that 00:09:25.511 --> 00:09:26.472 person lives and 00:09:26.932 --> 00:09:27.613 and the environmental 00:09:27.653 --> 00:09:28.893 influence that they endure, 00:09:28.932 --> 00:09:30.053 how that has an impact on 00:09:30.073 --> 00:09:31.075 what you're working towards. 00:09:32.436 --> 00:09:33.596 You've been a physical 00:09:33.635 --> 00:09:35.258 therapist who looks through 00:09:35.317 --> 00:09:37.399 this lens of also looking 00:09:37.438 --> 00:09:39.419 at nutrition for a while now. 00:09:40.061 --> 00:09:40.280 You know, 00:09:40.380 --> 00:09:42.341 is there a story where you've 00:09:42.461 --> 00:09:44.163 seen nutritional changes 00:09:44.443 --> 00:09:46.264 impact someone's rehabilitation, 00:09:46.325 --> 00:09:47.225 like something that, you know, 00:09:47.264 --> 00:09:48.365 someone can picture? 00:09:49.427 --> 00:09:49.746 Yeah. 00:09:49.807 --> 00:09:51.327 So I think one of the most 00:09:51.388 --> 00:09:53.028 impactful stories I've come 00:09:53.068 --> 00:09:54.009 across as looking at 00:09:54.684 --> 00:09:55.785 And this has happened with a 00:09:55.846 --> 00:09:56.866 couple of patients, you know, 00:09:56.886 --> 00:09:58.408 that come out of surgery. 00:09:59.950 --> 00:10:02.092 I think they were both the 00:10:02.153 --> 00:10:03.254 ones I'm thinking of were 00:10:03.274 --> 00:10:03.894 drum replacement. 00:10:04.014 --> 00:10:05.096 Maybe one was a traumatic 00:10:05.196 --> 00:10:06.777 fall and ended up having to 00:10:06.797 --> 00:10:08.099 have a nailing or something done. 00:10:08.979 --> 00:10:09.919 But they were having a 00:10:10.100 --> 00:10:12.423 pretty difficult time with 00:10:12.462 --> 00:10:14.105 their recovery because the 00:10:14.164 --> 00:10:15.105 wound wasn't healing. 00:10:15.586 --> 00:10:16.427 And they were kind of 00:10:16.547 --> 00:10:18.568 entering into a state of malnourishment. 00:10:19.201 --> 00:10:21.062 where they weren't getting enough of X, Y, 00:10:21.081 --> 00:10:23.182 and Z. So the body wasn't responding, 00:10:23.222 --> 00:10:24.423 the wound wasn't healing. 00:10:25.403 --> 00:10:26.384 So they weren't able to 00:10:26.424 --> 00:10:27.445 progress in therapy, 00:10:27.485 --> 00:10:28.385 weren't able to get back on 00:10:28.405 --> 00:10:30.147 their feet as quickly as they wanted to. 00:10:30.167 --> 00:10:32.668 So what we did is when we 00:10:32.707 --> 00:10:33.749 started intervening and 00:10:33.828 --> 00:10:35.249 recognizing that there was 00:10:35.929 --> 00:10:37.129 some malnourishment going 00:10:37.309 --> 00:10:38.510 on and started having 00:10:38.551 --> 00:10:41.451 conversations with other 00:10:41.493 --> 00:10:42.873 providers and the need for 00:10:43.052 --> 00:10:44.193 protein supplementation, 00:10:45.157 --> 00:10:45.836 Once that protein 00:10:45.856 --> 00:10:47.238 supplementation kicked in, 00:10:47.857 --> 00:10:48.798 which is gonna include a 00:10:48.839 --> 00:10:50.799 variety of other nutrients 00:10:50.860 --> 00:10:52.461 as well to support wound healing, 00:10:53.601 --> 00:10:54.741 once the nutrition regimen 00:10:54.822 --> 00:10:56.923 changed and that addition was added, 00:10:57.023 --> 00:11:00.184 the wound started healing as it should. 00:11:00.225 --> 00:11:01.885 And then once that wound started healing, 00:11:01.905 --> 00:11:02.947 we were able to get back to 00:11:02.986 --> 00:11:04.086 more targeted functional 00:11:04.147 --> 00:11:06.248 activity with improved 00:11:06.307 --> 00:11:07.969 strength and mobility and 00:11:08.288 --> 00:11:09.289 really just progressing 00:11:09.309 --> 00:11:10.510 that patient where they needed to be. 00:11:12.610 --> 00:11:14.231 Nutritional changes and 00:11:14.712 --> 00:11:16.333 changes in movement and exercise, 00:11:17.075 --> 00:11:18.034 these things take time. 00:11:20.197 --> 00:11:21.437 It's less of I did this 00:11:21.518 --> 00:11:23.600 thing and I immediately saw results. 00:11:23.679 --> 00:11:25.520 So a lot of this, I imagine, 00:11:25.561 --> 00:11:26.542 has to go with things we've 00:11:26.562 --> 00:11:27.863 already talked about, education, 00:11:28.403 --> 00:11:29.764 motivational interviewing, 00:11:29.985 --> 00:11:30.865 which also comes with a 00:11:30.904 --> 00:11:31.926 component of listening and 00:11:31.966 --> 00:11:32.667 building trust. 00:11:33.267 --> 00:11:35.548 to help someone understand this concept of, 00:11:35.607 --> 00:11:36.447 Hey, you know, 00:11:36.648 --> 00:11:38.249 we've heard you are what you eat. 00:11:38.269 --> 00:11:39.609 And I think people can understand that, 00:11:39.649 --> 00:11:41.529 but what you eat or don't 00:11:41.590 --> 00:11:43.331 eat can affect this thing 00:11:43.591 --> 00:11:45.351 of movement or pain or 00:11:45.451 --> 00:11:46.971 rehabilitation or building muscle. 00:11:47.913 --> 00:11:50.173 And both of these things take time. 00:11:51.614 --> 00:11:52.274 Yeah, they do. 00:11:52.313 --> 00:11:52.653 And that's, 00:11:52.994 --> 00:11:54.475 I think probably a challenging 00:11:54.514 --> 00:11:55.796 thing for many orthopedic 00:11:55.836 --> 00:11:56.956 physical therapists out there to 00:11:58.256 --> 00:11:59.879 to grasp is that it does take time. 00:11:59.938 --> 00:12:00.798 It's not going to be, 00:12:00.818 --> 00:12:02.000 they start eating more 00:12:02.059 --> 00:12:03.181 protein this week and the 00:12:03.280 --> 00:12:04.721 next week they're going to be stronger. 00:12:05.283 --> 00:12:05.482 You know, 00:12:05.523 --> 00:12:07.144 it's going to take time for the 00:12:07.203 --> 00:12:09.426 body to respond to that, you know, 00:12:09.466 --> 00:12:11.368 for that, that muscle health to improve, 00:12:11.447 --> 00:12:12.788 to have carry over to 00:12:12.849 --> 00:12:14.409 improvements in functional strength. 00:12:15.150 --> 00:12:16.250 So it's not going to be immediate. 00:12:17.091 --> 00:12:18.673 And if you are looking at 00:12:18.712 --> 00:12:19.714 going down that road, 00:12:19.933 --> 00:12:21.414 that route of motivational 00:12:21.455 --> 00:12:22.515 interviewing and behavior 00:12:22.576 --> 00:12:24.317 change to get that person to 00:12:24.898 --> 00:12:25.899 to start eating better, 00:12:25.918 --> 00:12:27.240 that's going to take a lot 00:12:27.259 --> 00:12:28.780 of time to be successful. 00:12:29.721 --> 00:12:31.082 And so that it's long lasting. 00:12:31.484 --> 00:12:32.244 You could be looking at 00:12:32.283 --> 00:12:33.205 something that takes three 00:12:33.225 --> 00:12:35.067 to six months to change 00:12:35.086 --> 00:12:36.227 your behavior if you're 00:12:36.248 --> 00:12:37.568 trying to get a person to 00:12:37.649 --> 00:12:38.509 consume more fruits and 00:12:38.529 --> 00:12:40.812 vegetables or consume more protein. 00:12:41.631 --> 00:12:41.731 Yeah, 00:12:41.772 --> 00:12:44.414 I heard a great mentor in a clinic 00:12:44.495 --> 00:12:45.556 explain it to a patient 00:12:45.596 --> 00:12:46.797 that was sort of eavesdropping. 00:12:47.517 --> 00:12:48.998 And they very plainly said, listen, 00:12:50.053 --> 00:12:50.894 How long do you think it 00:12:51.173 --> 00:12:52.754 took your behaviors to get 00:12:52.815 --> 00:12:54.836 us to this point with your knee? 00:12:55.015 --> 00:12:55.596 And they said, well, 00:12:55.635 --> 00:12:56.615 probably a couple years. 00:12:56.676 --> 00:12:57.297 They said, well, 00:12:57.856 --> 00:12:58.596 do you think you're ready 00:12:58.636 --> 00:12:59.756 to devote a couple months 00:13:00.157 --> 00:13:01.577 to a few changes to see 00:13:01.597 --> 00:13:02.557 some improvement to start 00:13:02.597 --> 00:13:03.599 to work our way out of this? 00:13:04.078 --> 00:13:05.739 And I think when it was framed that way, 00:13:05.859 --> 00:13:07.340 not just do this and it 00:13:07.399 --> 00:13:08.340 will get better in this 00:13:08.480 --> 00:13:09.801 indefinite amount of time. 00:13:09.821 --> 00:13:11.520 If I don't see results quickly, 00:13:11.541 --> 00:13:12.782 I sort of check out as well. 00:13:13.501 --> 00:13:15.464 And framing it that way, listen, 00:13:15.724 --> 00:13:16.404 we're going to do some 00:13:16.445 --> 00:13:17.566 things in terms of movement. 00:13:17.865 --> 00:13:19.427 We're asking about sleep and nutrition. 00:13:19.447 --> 00:13:20.307 We're asking about stress 00:13:20.327 --> 00:13:20.908 and mental health. 00:13:21.428 --> 00:13:23.250 And this is sort of the 360 to a human. 00:13:23.450 --> 00:13:24.671 When it was put that way, 00:13:24.691 --> 00:13:25.892 it was almost a very 00:13:26.373 --> 00:13:27.494 educational light bulb 00:13:27.553 --> 00:13:28.634 moment for that patient saying, 00:13:29.174 --> 00:13:30.596 it did take me a long time 00:13:30.655 --> 00:13:31.437 to get to here. 00:13:31.636 --> 00:13:32.398 So yes, 00:13:32.977 --> 00:13:34.980 I don't think a quick fix is 00:13:35.019 --> 00:13:35.780 actually possible. 00:13:35.860 --> 00:13:37.162 So I'm willing to invest and 00:13:37.201 --> 00:13:37.682 commit to that. 00:13:39.003 --> 00:13:40.442 Yeah, everything takes time. 00:13:40.923 --> 00:13:41.443 And, you know, 00:13:41.484 --> 00:13:43.783 I think the other thing to consider, too, 00:13:43.823 --> 00:13:45.104 that takes time from a 00:13:45.183 --> 00:13:46.104 physical therapist 00:13:47.485 --> 00:13:49.764 perspective is it takes 00:13:49.924 --> 00:13:54.005 time for you to learn how 00:13:54.046 --> 00:13:55.806 to start implementing it into practice. 00:13:55.966 --> 00:13:56.285 You know, 00:13:56.405 --> 00:13:58.006 what does that conversation look like? 00:13:58.466 --> 00:13:59.846 How do you start screening people? 00:13:59.947 --> 00:14:02.528 How do you provide education information? 00:14:02.567 --> 00:14:03.768 You know, what's your flow? 00:14:04.389 --> 00:14:06.309 of how you integrate, that takes time. 00:14:06.970 --> 00:14:08.750 It's not gonna be you do it 00:14:08.890 --> 00:14:09.831 well next week. 00:14:09.931 --> 00:14:11.192 It takes time for you to 00:14:11.251 --> 00:14:12.131 start being able to 00:14:12.231 --> 00:14:13.692 practice more holistically. 00:14:13.712 --> 00:14:15.013 And what's it look like for 00:14:15.033 --> 00:14:16.033 you to do it compared to 00:14:16.094 --> 00:14:16.793 another therapist? 00:14:17.559 --> 00:14:18.019 Well, 00:14:18.139 --> 00:14:20.441 you've educated clinicians on this 00:14:20.500 --> 00:14:21.981 previously in different facets, 00:14:22.542 --> 00:14:24.201 presenting it at various conferences. 00:14:25.743 --> 00:14:27.344 At what touch point in the 00:14:27.384 --> 00:14:29.403 patient life cycle does this come in? 00:14:29.464 --> 00:14:30.245 Is this something they fill 00:14:30.284 --> 00:14:31.544 out before they come to the clinic? 00:14:31.664 --> 00:14:32.706 Is this something you ask in 00:14:32.745 --> 00:14:33.826 initial evaluation? 00:14:33.865 --> 00:14:35.245 Is this something you ask on 00:14:35.346 --> 00:14:36.067 follow-up visits? 00:14:36.647 --> 00:14:39.908 Where are the opportunities 00:14:40.128 --> 00:14:42.089 to bring this into practice? 00:14:44.229 --> 00:14:46.029 Yeah, so it's a good it's a good question. 00:14:46.090 --> 00:14:47.730 And sometimes it's a large it depends. 00:14:47.929 --> 00:14:48.909 But I think there's two ways 00:14:48.929 --> 00:14:49.711 you can go about it. 00:14:49.990 --> 00:14:51.030 And it may depend on the 00:14:51.051 --> 00:14:52.171 patient that's in front of you. 00:14:52.890 --> 00:14:53.091 You know, 00:14:53.110 --> 00:14:54.211 if you've got someone that's 00:14:54.251 --> 00:14:55.412 coming into the clinic for 00:14:55.432 --> 00:14:56.831 their initial evaluation 00:14:57.192 --> 00:14:58.393 and they're coming to you 00:14:58.432 --> 00:15:01.793 with a condition or their post-op and, 00:15:01.994 --> 00:15:03.374 you know, right out the gate, 00:15:03.413 --> 00:15:04.434 nutrition is going to 00:15:04.534 --> 00:15:06.054 impact their recovery. 00:15:06.772 --> 00:15:07.692 I'm likely going to start 00:15:07.753 --> 00:15:09.594 screening initially, right, 00:15:09.634 --> 00:15:10.715 with that initial eval. 00:15:10.855 --> 00:15:11.956 I'm going to use some type 00:15:11.995 --> 00:15:13.096 of food frequency 00:15:13.256 --> 00:15:14.677 questionnaire or just ask 00:15:14.758 --> 00:15:15.999 simple questions in terms 00:15:16.038 --> 00:15:17.620 of what their eating pattern looks like. 00:15:17.760 --> 00:15:19.022 Are they getting enough of X, Y, 00:15:19.081 --> 00:15:20.562 and Z to support it? 00:15:20.582 --> 00:15:21.803 So I might do that out the gate. 00:15:22.904 --> 00:15:23.684 But if I'm dealing with a 00:15:23.725 --> 00:15:25.647 patient where after a couple visits, 00:15:25.866 --> 00:15:26.626 maybe it's something 00:15:26.668 --> 00:15:28.129 related to chronic pain or 00:15:28.208 --> 00:15:30.429 some other type of inflammatory condition, 00:15:30.470 --> 00:15:31.912 they got a nagging tendon 00:15:31.951 --> 00:15:34.813 that's not recovering, I might start to 00:15:35.464 --> 00:15:36.485 early on, you know, 00:15:36.505 --> 00:15:37.407 work on building my 00:15:37.447 --> 00:15:39.850 relationship and start 00:15:40.751 --> 00:15:42.114 educating that patient on 00:15:42.214 --> 00:15:43.716 how nutrition is applicable 00:15:43.735 --> 00:15:45.077 and important potentially 00:15:45.458 --> 00:15:46.340 to what's going on. 00:15:46.360 --> 00:15:47.822 And then once that 00:15:47.881 --> 00:15:49.423 relationship is established 00:15:49.484 --> 00:15:50.365 and there's trust, 00:15:51.259 --> 00:15:52.159 because that patient's 00:15:52.220 --> 00:15:53.100 likely going to be more of 00:15:53.139 --> 00:15:54.461 a behavior change, right? 00:15:54.500 --> 00:15:55.701 If I'm dealing with chronic 00:15:55.780 --> 00:15:57.520 pain or tendinopathy that 00:15:57.541 --> 00:15:58.140 won't get better, 00:15:58.160 --> 00:16:00.121 that I want to establish 00:16:00.162 --> 00:16:01.981 that relationship and trust, 00:16:02.581 --> 00:16:03.423 then I'm going to start 00:16:03.482 --> 00:16:05.263 screening and asking questions, 00:16:05.423 --> 00:16:07.263 maybe several visits down the road, 00:16:08.464 --> 00:16:09.903 because the responses I get 00:16:09.943 --> 00:16:10.624 are going to be very 00:16:10.724 --> 00:16:12.803 different from if I did it on day one, 00:16:12.823 --> 00:16:15.544 you know, post-op patients, 00:16:15.605 --> 00:16:16.345 totally different. 00:16:16.404 --> 00:16:18.785 They know that their life is going to be, 00:16:18.806 --> 00:16:20.265 you know, um, 00:16:20.999 --> 00:16:23.200 different after coming out of surgery, 00:16:23.240 --> 00:16:23.899 they know that they're 00:16:23.919 --> 00:16:25.240 going to have to make some changes, 00:16:25.461 --> 00:16:27.100 whether it's weight-bearing 00:16:27.162 --> 00:16:29.341 restrictions or modifying activity. 00:16:29.923 --> 00:16:32.183 It's, I think, easier early on to bring in, 00:16:32.504 --> 00:16:33.783 hey, you need to get more protein, 00:16:33.803 --> 00:16:35.485 you need to stay hydrated, et cetera. 00:16:36.325 --> 00:16:37.466 But the ones with the chronic, 00:16:37.905 --> 00:16:39.145 I'd build a relationship 00:16:39.186 --> 00:16:41.726 first because you're likely 00:16:41.767 --> 00:16:42.587 going to go down a road of 00:16:42.607 --> 00:16:43.327 behavior change. 00:16:44.307 --> 00:16:45.969 And in order for that person 00:16:46.089 --> 00:16:47.289 to buy into it, 00:16:47.669 --> 00:16:49.571 they've got to trust in 00:16:49.730 --> 00:16:50.610 where you're coming from. 00:16:52.489 --> 00:16:54.210 Good use of slipping in. 00:16:54.250 --> 00:16:55.890 It depends as well on a 00:16:55.910 --> 00:16:57.052 physical therapist. 00:16:57.211 --> 00:16:57.392 Yeah, 00:16:57.452 --> 00:16:58.753 it would not be a complete episode 00:16:59.114 --> 00:16:59.754 unless you did that. 00:17:01.054 --> 00:17:01.956 Any other resources? 00:17:02.015 --> 00:17:03.236 You mentioned some good ones 00:17:03.297 --> 00:17:04.037 early in the episode. 00:17:04.738 --> 00:17:06.179 Is there a book out there 00:17:06.298 --> 00:17:07.460 that if someone was saying, yeah, 00:17:07.519 --> 00:17:08.820 I want to get a little more educated, 00:17:08.861 --> 00:17:09.520 is there something that 00:17:09.580 --> 00:17:11.041 someone has written that 00:17:11.102 --> 00:17:12.482 you might suggest for a 00:17:12.583 --> 00:17:13.743 physical therapist who just 00:17:13.784 --> 00:17:14.884 wants to get a little bit 00:17:14.924 --> 00:17:16.266 more knowledgeable about nutrition, 00:17:16.486 --> 00:17:17.727 even for themselves or their patients? 00:17:20.055 --> 00:17:21.615 Um, you know, there's, 00:17:21.695 --> 00:17:22.977 there's a lot of nutrition 00:17:23.017 --> 00:17:23.737 texts out there. 00:17:23.777 --> 00:17:24.897 I do think some of them are, 00:17:25.377 --> 00:17:28.599 or sometimes one sided, you know, 00:17:28.640 --> 00:17:29.421 where there'll be more of 00:17:29.461 --> 00:17:31.102 an emphasis in a plant 00:17:31.122 --> 00:17:33.343 focused diet versus a carnivore. 00:17:33.423 --> 00:17:34.923 So some of that stuff gets kind of, 00:17:35.523 --> 00:17:36.605 I think, segregated. 00:17:36.625 --> 00:17:38.046 Uh, you know, 00:17:38.086 --> 00:17:40.446 we had two PTJ manuscripts 00:17:40.487 --> 00:17:41.468 that we published a few 00:17:41.508 --> 00:17:42.627 years back that kind of 00:17:42.847 --> 00:17:43.608 tried to help lay the 00:17:43.669 --> 00:17:45.769 foundation of what nutrition looks like, 00:17:46.289 --> 00:17:46.390 uh, 00:17:46.410 --> 00:17:47.651 within our profession and how to 00:17:47.750 --> 00:17:48.991 implement it into practice. 00:17:49.954 --> 00:17:50.055 Uh, 00:17:50.776 --> 00:17:52.416 we've got a textbook chapter coming out, 00:17:52.436 --> 00:17:55.878 uh, within the primary care, uh, text, 00:17:55.898 --> 00:17:56.759 the boys are not text. 00:17:56.799 --> 00:17:57.799 The fourth edition has a 00:17:57.819 --> 00:17:59.801 whole chapter on nutrition, uh, 00:17:59.842 --> 00:18:01.102 where we try and educate again, 00:18:01.142 --> 00:18:02.643 the foundation and give the 00:18:02.682 --> 00:18:05.664 tools and resources to, uh, to implement, 00:18:06.365 --> 00:18:07.365 uh, into practice. 00:18:07.445 --> 00:18:10.127 But I'm always hesitant in 00:18:10.528 --> 00:18:12.068 recommending texts because 00:18:12.088 --> 00:18:15.271 texts are typically always one-sided. 00:18:15.291 --> 00:18:15.892 Mm-hmm. 00:18:16.325 --> 00:18:17.526 And I'm not a fan of just 00:18:17.945 --> 00:18:19.186 honing in on that one thing 00:18:19.247 --> 00:18:20.228 because there's so much 00:18:20.347 --> 00:18:22.028 nuance to what a person eats. 00:18:22.849 --> 00:18:24.290 And there's so much impact 00:18:25.090 --> 00:18:25.872 to an individual, 00:18:25.912 --> 00:18:27.432 whether personal or environmental, 00:18:28.253 --> 00:18:31.336 that influences their decision making. 00:18:33.576 --> 00:18:34.298 In this situation, 00:18:34.397 --> 00:18:35.798 one book does not fit all. 00:18:37.220 --> 00:18:37.619 It doesn't. 00:18:38.381 --> 00:18:38.601 No, 00:18:38.661 --> 00:18:40.742 because that's one thing I do caution 00:18:40.843 --> 00:18:41.923 in looking at those type of 00:18:41.962 --> 00:18:43.084 books is it's always going 00:18:43.104 --> 00:18:44.384 to try and direct you down one path. 00:18:46.431 --> 00:18:47.731 But that one path might not 00:18:47.872 --> 00:18:49.451 be suitable for you. 00:18:50.071 --> 00:18:50.653 And we know that. 00:18:50.692 --> 00:18:51.813 The more we learn through 00:18:51.853 --> 00:18:53.054 research in nutrition and 00:18:53.094 --> 00:18:54.913 sleep and movement is if 00:18:55.134 --> 00:18:56.075 two people were to do the 00:18:56.115 --> 00:18:57.055 same diet and the same 00:18:57.115 --> 00:18:58.675 exercise routine and get the same sleep, 00:18:59.016 --> 00:19:00.355 they still, because of genetics, 00:19:00.375 --> 00:19:01.596 would get different results 00:19:01.777 --> 00:19:02.497 and environment. 00:19:02.576 --> 00:19:04.077 Those things are still variable. 00:19:04.137 --> 00:19:05.678 So this is where a skilled 00:19:05.718 --> 00:19:06.919 clinician comes in and says, 00:19:07.239 --> 00:19:08.159 these are the things I need 00:19:08.179 --> 00:19:09.480 to tease out to figure out 00:19:09.539 --> 00:19:10.339 why we're not getting the 00:19:10.380 --> 00:19:11.641 results that something else 00:19:11.661 --> 00:19:12.820 with a similar situation might. 00:19:14.627 --> 00:19:15.788 All right. 00:19:15.909 --> 00:19:16.848 Segment on the show we call 00:19:16.868 --> 00:19:17.769 The Final Thought. 00:19:17.930 --> 00:19:18.710 Anything you'd want to leave 00:19:18.750 --> 00:19:19.770 with the audience that's 00:19:19.830 --> 00:19:20.711 listening and still 00:19:20.750 --> 00:19:22.372 listening after 15 minutes and saying, 00:19:22.852 --> 00:19:23.192 okay, 00:19:23.432 --> 00:19:25.134 I now know a little bit more what I 00:19:25.173 --> 00:19:26.193 might want to learn about 00:19:26.213 --> 00:19:27.075 in terms of nutrition and 00:19:27.095 --> 00:19:27.934 bringing them into my practice. 00:19:28.234 --> 00:19:28.836 What would you want to leave 00:19:28.855 --> 00:19:29.336 with the audience? 00:19:33.438 --> 00:19:34.939 Just start having the conversation. 00:19:34.959 --> 00:19:37.380 I mean, that's really it. 00:19:37.420 --> 00:19:38.480 Just start having that 00:19:38.520 --> 00:19:40.201 conversation and start to 00:19:40.221 --> 00:19:41.342 get comfortable with having 00:19:41.382 --> 00:19:42.202 that conversation. 00:19:42.759 --> 00:19:43.980 you know, the first few patients, 00:19:44.079 --> 00:19:45.259 it's going to seem very awkward. 00:19:45.640 --> 00:19:45.861 Yeah. 00:19:45.980 --> 00:19:47.942 And you might get pushback where it's like, 00:19:48.021 --> 00:19:49.142 why are you talking about 00:19:49.182 --> 00:19:50.063 what I'm eating when I'm 00:19:50.103 --> 00:19:51.343 here because of my knee pain? 00:19:51.982 --> 00:19:53.364 So it might take, you know, 00:19:53.763 --> 00:19:55.345 empowering or not empowering. 00:19:55.625 --> 00:19:57.726 It may take you digging into 00:19:57.766 --> 00:19:59.446 some of the why, you know, 00:19:59.747 --> 00:20:00.607 what's the connection 00:20:00.667 --> 00:20:02.548 between nutrition and so 00:20:02.568 --> 00:20:03.769 that you can then empower 00:20:03.788 --> 00:20:06.049 the patient as to why it is 00:20:06.069 --> 00:20:07.790 important and give that information. 00:20:07.830 --> 00:20:09.152 But it really starts with, 00:20:09.971 --> 00:20:10.551 you just got to start 00:20:10.593 --> 00:20:11.393 having the conversation. 00:20:12.682 --> 00:20:13.722 And no matter what way, 00:20:14.083 --> 00:20:15.084 whether it's a standardized 00:20:15.124 --> 00:20:17.285 screener or you just ask them, hey, 00:20:17.325 --> 00:20:18.145 how often are you eating 00:20:18.165 --> 00:20:19.026 fruits and vegetables? 00:20:19.606 --> 00:20:20.768 What are your protein sources? 00:20:21.367 --> 00:20:22.388 How much water do you drink 00:20:22.409 --> 00:20:23.009 throughout the day? 00:20:23.910 --> 00:20:25.590 Just start the conversation 00:20:26.411 --> 00:20:27.471 is really the biggest thing. 00:20:27.991 --> 00:20:29.874 Because you don't know if 00:20:29.894 --> 00:20:31.054 you have to go down the 00:20:31.714 --> 00:20:34.416 next path of education and 00:20:34.497 --> 00:20:36.657 resources unless you start 00:20:36.678 --> 00:20:37.558 having that conversation. 00:20:38.615 --> 00:20:39.436 And it starts with you. 00:20:39.497 --> 00:20:40.637 The conversation for 00:20:40.678 --> 00:20:41.638 nutrition does not make its 00:20:41.659 --> 00:20:43.621 way into your patient interaction, 00:20:43.921 --> 00:20:44.480 most likely, 00:20:44.642 --> 00:20:45.643 unless you bring it in there. 00:20:47.203 --> 00:20:47.804 Patrick Berner, 00:20:47.865 --> 00:20:48.605 thanks for bringing some 00:20:48.625 --> 00:20:50.067 nutrition into the lives of 00:20:50.146 --> 00:20:50.967 orthopedic physical 00:20:51.007 --> 00:20:52.048 therapists and just having 00:20:52.067 --> 00:20:54.990 this very introductory conversation. 00:20:55.791 --> 00:20:56.612 Yeah, I appreciate you. 00:20:56.632 --> 00:20:57.192 Thanks for having me.