Upon graduation from physical therapy school, like most new grad PT’s, we both had ideas of the practice setting that we’d like to work within. Michelle felt most comfortable in an inpatient, hospital-based setting and enjoyed working with patients post-op, those with traumatic brain injuries, spinal cord injuries, and post stroke. Lisa was drawn to outpatient orthopedics and enjoyed gaining skills in caring for patients during pregnancy and the postpartum period.
Neither of us had an awareness of physical therapists working in eating disorder care. In school, we’d learned about the female athlete triad, osteoporosis, and a bit about pelvic health, though we didn’t know much beyond that about the rehabilitation needs–and the suffering–that present with eating disorders.
Over time, our paths both led to working with individuals impacted by these significant mental illnesses–Michelle in the development of the mobility protocol at The ACUTE Center for Eating Disorders and now her outpatient private practice, Strength Within, and Lisa in various levels of care at The Melrose Center in Minneapolis, MN. We quickly came to appreciate the vital role of PTs and other rehab providers on the ED treatment team.
Historically, and still today, common approaches to movement and exercise in eating disorder care fall into 3 main camps: 1) recommending complete abstinence from exercise–without guidance for reintegration, 2) ignoring exercise concerns and not providing information during the course of care, or 3) simply adding movement without an evidence-based plan for inclusion and progression. Some of the consequences of these approaches include increased risk of relapse, poorer treatment outcomes and longer stays in higher levels of care (Bratland-Sanda & Vrabel, 2018; Carter et al., 2004; Solenberger, 2001). In fact, “Dysfunctional exercise is commonly the first presenting and last remaining symptom of EDs” (Davis et al., 1994).
Thankfully, more and more research is affirming what we’ve observed clinically. When a graded, holistic, intentional, and collaborative approach to movement is prioritized, patients can experience both physical and mental health benefits, such as increased muscle strength and bone density, increased body awareness and responsiveness, improved function and quality of life, and improved weight gain (for those with a treatment goal of restoration) (Cook et al., 2016).
How can PT’s can support patients working toward ED recovery?
- Eating disorders thrive in a context of misinformation and half truths. With our solid understanding of anatomy and physiology, PT’s provide critical information to support our patients in fact checking and in gaining knowledge, impacting their thoughts and beliefs while challenging the ED mindset.
- Eating disorders are mental illnesses that often present with a range of physical consequences. These various symptoms, such as balance deficits, weakness, low bone density, constipation, menstrual dysfunction, vital sign instability, sleep disturbances, cognitive impairments, and pain concerns, can collectively be termed a “metabolic injury.” Providing education about injury prevention and management and the body’s energy needs is directly in the wheelhouse of PT’s.
- In alignment with injury prevention, some clients present with overuse injuries as a result of their compulsive tendencies with exercise. Not only can we provide rehabilitation for these injuries, but we can lean into our unique skill set as eating disorder informed and sensitive physical therapists to raise concerns about potential eating disorders and, more importantly, make appropriate referrals. We can create a conversation around movement habits and intent in a non-threatening, open dialogue and discuss ways to do movement differently.
- As movement experts, PT’s are uniquely equipped to support individuals who struggle with the physical components of movement due to malnutrition. From bed mobility and functional balance training, to return to work or sport training, our toolbox is full of rehab modalities and exercise prescription skills to support patients as they integrate movement throughout various stages on the road to recovery.
- We also use our knowledge and skill base to impact the mental and emotional challenges of dysfunctional movement and exercise. Eating disorders aim to disconnect the body and the mind, and we actively support patients in building mind-body connections. We work collaboratively with patients to develop intuitive movement skills and wise strategies to align their movement practices with recovery, rather than with the eating disorder. In this way, movement itself can become a recovery resource.
- Those rehabilitation providers that are able to offer pelvic health therapy additionally benefit those with ED’s by validating and normalizing the severe GI distress that they may experience before, during, and after recovery. This is just one example of what pelvic health providers offer, but tends to be one of the highest complaints. With the ability to educate and empower, pelvic health providers offer individuals with ED’s vital skills that provide an opportunity to “take control”. This can interrupt the control that an ED has instituted and offer continued hope for recovery.
- Currently, the reintegration of movement and exercise is not considered high priority and often not included as standard of care in the treatment of eating disorders. Additionally, there is limited time by other providers to fully dive in and address movement concerns in the depth that is necessary. This is exactly what we can provide to our clients. Just like a dietitian helps the client to practice their meal plan, physical therapists can help clients practice how to return to movement in a manner that aligns with their recovery goals.
In summary, physical therapists play a critical role on the eating disorder treatment team by addressing the physical consequences of malnutrition, improving strength and mobility, and supporting the restoration of life-enhancing movement practices. Our collaborative work with other members of the treatment team ensures comprehensive care for patients working toward eating disorder recovery.
