Intuitively we know that nutrition “matters.” Many chronic diseases such as heart disease, stroke, and diabetes are directly linked to diet. Others like RA, OA, and pain are indirectly linked to the food we eat. There are a multitude of anecdotal reports of conditions improving with a change in diet, yet it is rarely the first line of treatment for any disease. One issue may be that the ability to single out one nutrient such as glucosamine, resveratrol, vitamin C, vitamin D or protein is nearly impossible…there are just too many other factors to consider. These factors include activity level, health indicators, genetics and the list goes on. Another factor is likely that once a nutrient is seen as a silver bullet, it is packaged and sold for profit and invariable comes up short in RCT’s. It may be the quality of the nutrient taken, the remainder of the person’s diet, or that when the nutrient is packaged it looses its bioavailability. We are beginning to see research linking diet to inflammatory cytokines, obesity, and pain. This research includes BMI, activity level, CRP and their effects on CLBP. While this research is promising, specific advice on antiinflamatory diets may not be appropriate, unless given in the overall context of health and in conjunction with a client’s physician. Our PT practice act allow us to advise clients on nutrition. We need to be honest about what we know and do not know so that they are not expecting a silver bullet, which will undoubtedly fail. Certainly advice on nutrition as part of an overall treatment plan for clients with MSK pain is appropriate for those that may have fallen victim to the western diet. But until we know more it must be part of a comprehensive approach to treat the entire client and, just as we avoid one specific PT treatment, avoiding one nutrient or supplement, since the track record of this method has been an utter failure. Advise on a nutritious diet that is common sense and meets the client where they are in their journey.