Noncommunicable diseases typically span long periods of time and have a slow progression. Examples include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Physical therapists are likely familiar with the health burden of noncommunicable diseases (NCDs), and many will even say that the physical therapy profession has a role in addressing that burden. But as 5 APTA Catherine Worthingham fellows would point out, saying that PTs have a role is not the same as living out that role—and if the profession wants to achieve the latter, it has a lot of work to do.
Back in June, I had the pleasure of speaking at the Physical Therapy NEXT Exposition Conference on the topic of nutrition and its implication for musculoskeletal pain. It was a lot of fun and I spoke to a sold out room of about 600 physical therapists who were excited and really impassioned about learning how they can integrate nutrition into their practice. I want to thank everyone who attended and provided such positive feedback to the APTA about my presentation and my talk. I’m forever grateful to you. As many of you have inquired via email and through my Facebook page, yes, I am a building a continue education course specifically on this topic. If you’re a physical therapist or a chiropractor or a physician or anyone else interested in learning more about how nutrition can impact and change the course of chronic pain, make sure to go the Integrative Pain Science Institute website, www.IntegrativePainScienceInstitute.com. You can sign up for the mailing list there and stay connected to all that I have going on. I have a number of courses coming out on a variety different topics related to chronic pain. You can also go to my website at DrJoeTatta.com and click on the Practitioners tab in the top Menu.
While I was at the conference, I also brought along my podcast equipment and I had the opportunity to interview two great physical therapists on really important topics. The first one, I had the pleasure of speaking with Dr. Lisa Saladin who is the Vice President of the American Physical Therapy Association Board of Directors. I spoke with Dr. Saladin about the societal issue of non-communicable diseases on a topic that really greatly interests me since nutrition can have such a dramatic impact on diseases such as diabetes and obesity. We covered which non-communicable diseases physical therapists can have the most opportunity to treat and change in the communities in which they live in practice, and the notion of chronic pain as a non-communicable disease and how much attention that either gets or does not get in our greater healthcare system. It was a great topic, I love talking to Dr. Saladin about this. It’s an interview I enjoyed very much. It’s great to see the physical therapy profession talking more about how we can play an active role in preventing and treating chronic disease. I want to thank Dr. Saladin for joining the podcast and of course, the APTA for setting this interview up.
Why Physical Therapists Must Take On The Challenges of Noncommunicable Diseases with Dr. Lisa Saladin
Dr. Saladin, welcome to the Healing Pain Podcast. It’s great to have you here.
Thanks very much, Joe.
This year at the PT NEXT Conference and Exposition, you spoke about the societal issue of noncommunicable diseases, a topic that greatly interests me because I integrate nutrition as well as exercise and physical therapy into practice. I think the best place to start our talk today is what is a noncommunicable disease and why is this important considering where we are as a nation regarding our health?
Noncommunicable diseases are diseases that are not transmitted, not infections but they are typically chronic diseases. Examples of NCDs are strokes, heart disease, respiratory lung disease, diabetes. Those types of conditions are referred to as NCDs.
When we look at our healthcare problem, what percent of our population has one of those diseases? How big of a problem is this really?
It’s a worldwide epidemic. It is the number one killer across the world of individuals. When you think of it, if you put all those things together: diabetes, heart disease, lung disease, cancer is one, they actually are going to contribute to all deaths. The really sad thing is most of them have risk factors that make them preventable or at least you can reduce the impact and the mortality and morbidity of those diseases.
I think that’s the important point is that we can reduce the impact of this disease. Sometimes we can actually halt it in its place or actually reverse it in certain people. Where does chronic pain fit into this NCD?
Arthritis, one in twenty individuals in the United States has disability related to arthritis. That’s a very painful condition. It is considered one of the NCDs. Arthritis is one of the noncommunicable diseases. That’s just one example of a painful condition that is in this category that we can do something about.
You are the Vice President of the American Physical Therapy Association. We’re here at PT NEXT Exposition and Conference. I have to ask you, what is the physical therapist’s role in their practice, in their community in targeting and treating these types of diseases?
We have multiple positions on this as far as our documents go, but I want to get away from just the words. Physical therapists are in key pivotal roles to increase physical activity and we know what physical activity can do to reduce pain, to reduce diabetes, to reduce blood pressure, to reduce obesity. We can if we so choose, we can play a pivotal role in reducing the mortality and morbidity related to NCDs.
I know you’re on top of the research in this area and you presented on it. The average physical therapists, is it on their radar yet as something they can not only treat in practice, but as private practice owners, they’re looking for groups of people to serve to market to?
I think it is but it’s growing. There are individuals where this is the whole purpose and mission of their practice. It is community based. It is population health. It is getting at reducing risk factors. It’s out there. What I’m finding is that it’s growing. The presentation we just did this morning, there was over 150 people in the room. There was energy, people wanted to talk about it. We’re developing networks and communities that really would like to partner to really move this forward as an initiative for physical therapy and the profession.
I think it’s a great opportunity for the profession, right?
Yes, very much.
Traditionally, noncommunicable diseases are defined as one that is not passed from a person to a person and typically in long duration and slow progression. It’s not something like a cold or a flu virus that you can pass to someone through sneezing or touch. We are learning through genetics and epigenetics that if something changes in your body, let’s say a gene may be switched on that sometimes that genetic expression can be passed down to your offspring. That makes what we do in this topic even more important. How do we deliver that message in a way that’s deeper so physical therapists will understand that we can obviously change someone’s health right now today, the way they look, their weight or their disease or their pain, but also you may impact the generations after that?
I think we need to even step back from that. Even though I said there are some people and more and more individuals really paying attention to this area, we don’t have enough yet, even paying attention to it for their individual patients. We really need to get people to understand the impact of these risk factors and disease and mortality. Then I think we take it one step further and say, “You can literally improve health through physical activity.” Pure physical activity can improve genetic health. We know that, then we can actually improve not only this generation but the generations to come.
There are some recent new language around the adoption of nutrition as part of the scope of physical therapy practice. How does that add to a physical therapist toolbox in addressing this type of issue?
It’s really important that a physical therapist screen for diet, weight issues that might require either us providing them information or referring them on to another individual. The important thing to recognize is that screening is critical. We can’t ignore. We can’t just say a patient comes to you and they have knee pain and they’re 100 pounds overweight. You don’t just treat the knee pain, it’s just going to continue. That’s not in the patient’s best interest. We really then need to address, what can we do? What’s within our scope to have a conversation with them about weight management and diet and nutrition? What might we need to refer out to a nutritionist, a specialist?
A PT can look and say, “This may be in my personal scope or may not be. If it is, I can at least assess it and address or I may need to refer out.”
It’s really important that physical therapists look at their State Practice Act because there’s really big differences in what is allowable by different state laws. The basic information about screening and providing information that you can get on a website, to just help educate, that should be part of all of our scopes of practice.
As an expert in this area, what are the top three recommendations you can give a listener because I talk to practitioners as well as people that are struggling with chronic disease? What are some tips you might afford them to help them with their health?
Let’s just start with physical activity, walking. It might be all it takes. The recommended guidelines say you should get 150 minutes of exercise every week. Are you doing that? If not, what are your barriers? Can you start small? You don’t have to start with 150 minutes. What can you do to just take a walk? Take a walk for five minutes and see how it feels. Start maybe with five minutes one day, ten minutes a couple of days later and see how you feel. One thing we can all do is increase our level of physical activity and that’s a really important concept. The next thing you can do is start looking at reducing salt and sugars in your diet. Just basic information, we know that salt has a role in hypertension and high blood pressure. What can we do to reduce the really high level of salt intakes that we have in the US population? What can we do to reduce just refined sugars, which we know are also a culprit in weight and managing weight. Those are some of the key things. Stress management is critical. We can also look at alcohol consumption, tobacco consumption. All of those are preventable risk factors that contribute to this massive epidemic that we’re facing in these diseases.
I read a pivotal research paper by Dr. Elizabeth Dean who is a physical therapist in Canada. She wrote a great paper that talked about all the different lifestyle approaches that a physical therapist can screen for and provide information for. What you’re talking about is a lifestyle approach to helping people with their problem.
I’m a big proponent of meditation and the concept, because now we know and there’s more literature coming out. There’s a great scientist in Wake Forest, North Carolina who’s a Neurobiologist, really looking at brain imaging and pain reduction purely just by meditation. I don’t know if you know his work. You can literally take untrained people who don’t know how to meditate and actually have them reduce their pain to a zero just through mindfulness meditation.
At the conference, there’s a one and a half hour lecture on mindfulness-based stress reduction. It’s the first time I’ve seen one at a PT conference. To me, it’s amazing, I think it’s a breakthrough because as you said, the neuroscience behind is really powerful and it’s so easy.
It’s starting to grow. I just was at Brooks Rehab in Florida and their residents were presenting and one of their residents presented on a case where he just used mindfulness meditation to reduce blood pressure and pain in a chronic pain patient. It’s getting out.
Let me play devil’s advocate. Let’s say I’m a sports PT and I’m saying, “I treat rotator cuff repairs and ACL injuries. I see some chronic pain, but I don’t see myself teaching mindfulness-based stress reduction to my patients.” What would your response be to them?
I don’t know that you have to teach them yourselves. You can refer them and say, “By the way, do you know the positive benefits of meditation and how that might help reduce your pain? Here’s a place that you could go.” Refer them to a book, refer them to a podcast, refer them to a resource for them to help manage that if that’s not something you want to integrate into your practice personally.
So much of what we’re talking about, a lot of people are going to say, “I need to widen my toolbox and maybe put some things that I don’t have.” How would you guide a new therapist or even a therapist who’s been in practice for many years or decades into learning more about NCDs and some of the types of lifestyle interventions that might help them?
There are four key websites that are really, easily accessible. The Center for Disease Control, CDC, has an NCD unit within it that has a lot of information. The Office of Health Promotion as part of the government agencies has some very great information. They post all the physical activity guidelines there. They post the dietary guidelines there. There’s a whole prevention and wellness resource box on that website. There are some we can get from our government. There are certainly resources that we post on our website. It’s on the Move Forward website for patients. It’s really just exploring what is out there and really expanding our repertoire of what we can offer our patients. We need to never get mired down into a tradition and what we learned in school. We should always be learning. All of us can continue to learn so everyone should look to see where they can find resources for their growth in their practice.
If someone’s listening to this podcast and they like to learn more about you, can you share how they can find you?
I want to thank Dr. Lisa Saladin for being on the Healing Pain Podcast. If you enjoyed this podcast and you found NCDs to be of interest, please make sure to share this with your friends and family and make sure to give us a five-star review on iTunes. We’ll see you next week.
Thanks very much, Joe.
About Dr. Lisa Saladin
Physical therapists are likely familiar with the health burden of noncommunicable diseases (NCDs), and many will even say that the physical therapy profession has a role in addressing that burden. But as 5 APTA Catherine Worthingham fellows would point out, saying that PTs have a role is not the same as living out that role—and if the profession wants to achieve the latter, it has a lot of work to do.
Dr. Saladin is Executive Vice President for Academic Affairs and Provost at the Medical University of South Carolina. She is the Dean of the College of Health Professions at the Medical University of South Carolina where she has been a faculty member for the last 24 years. In that capacity, she provides leadership for a faculty and staff of approximately 140 individuals, directs a budget of approximately 34 million dollars and has oversight over 9 academic programs (Anesthesia for Nurses, Cardiovascular Perfusion, Healthcare Administration, Health Informatics, Occupational Therapy, Physician Assistant Studies, Physical Therapy and a PhD program in Health and Rehabilitation Sciences).
Dr. Saladin earned a Bachelor’s degree in Medical Rehabilitation (PT) and a Master of Science in Anatomy (Neuroscience) from the University of Manitoba in Canada and a Doctoral Degree in Physical Therapy from Nova Southeastern University in Florida. Dr. Saladin’s clinical expertise is in the area of physical therapy for individuals with neurological disorders and her research interests are focused on the areas of racial and gender disparities in access to care, community-based service learning and motor control and treatment outcomes for individuals with neurological disorders. Dr. Saladin has experience in curriculum development, interprofessional education, distance education, and in the development of innovative methods to engage and motivate students to learn. She has been widely recognized for her teaching excellence with three University Health Sciences Teaching Excellence Awards; a South Carolina Governor’s Distinguished Professor Award, and a 2009 MUSC Master Teacher designation.
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If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at firstname.lastname@example.org. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.