Rehabilitation & Sports Medicine Articles
What is physical medicine & rehabilitation?
Physical medicine & rehabilitation (PM&R), also known as physiatry, is the branch of medicine that focuses on restoring physical function. The specialists in this field achieve this by diagnosing functional deficits in patients and implementing customized plans to restore function. In cases where an individual cannot improve his/her function, maintenance of the current functional level would be the goal.
What kind of training do PM&R doctors have?
Doctors specializing in PM&R, also known as physiatrists, obtain their medical degrees and then go on to postgraduate training (residency) in Physical Medicine & Rehabilitation. The residency training lasts for 4 years in total and some choose to complete subspecialty training afterwards. Certified subspecialty fields include Brain Injury Medicine, Hospice and Palliative Medicine, Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, and Sports Medicine. These are all 1 year additional training, except Pediatric Rehabilitation Medicine which is 2 years.
How do you diagnose patients?
We diagnose patients by using the same process other physicians utilize: taking a history, performing a physical examination and ordering or performing tests, if necessary. In addition to ordering blood tests, x-rays, CT scans or MRIs, in some cases we order or perform nerve conduction studies and electromyography. Some of us also perform diagnostic ultrasound scanning for musculoskeletal problems- evaluating joints, tendons, ligaments and muscles.
Are you an orthopedic surgeon or a neurologist?
Neither. Orthopedic surgeons are great at treating musculoskeletal problems and neurologists are great at treating neurological disorders and we have some overlap with both specialties in terms of the conditions we commonly treat. However, neither specialty is trained in rehabilitation and restoration of function. Our specialty may be not as well known but we have our own identity and we make valuable contributions to the lives of patients.
What is the difference between you and a physical therapist?
This is a very common question. Physical therapists assist in the rehabilitation of persons with impaired physical function (regardless of cause) by using modalities for pain, to promote healing, stimulation of movement of weak muscles and targeted exercise therapy. However, they are not medical doctors and are therefore limited in terms of what testing they can order and what treatments can be ordered. Physiatrists do not utilize the same tools as the physical therapists, with the exception of prescribing targeted exercise, but can order or perform any tests required and utilize different medications for management of pain and spasticity, among other conditions.
What kind of patients do you treat?
There are many conditions which can cause impaired function and we treat patients with:
- Patients with various types of arthritis
- Patients with brain injury- stroke, traumatic brain injury etc
- Cardiac patients with impaired quality of life
- Chronic pain after accidents
- Geriatric patients
- Musculoskeletal pain- joint pains of all areas of the body, back pain, neck pain etc
- Nerve pain- carpal tunnel syndrome, ulnar neuropathy, pinched nerves in the spine
- Pediatric patients with impaired development
- Spinal cord injuries
- Sports injuries
- Work-related injuries
- Patients with spasticity due to previous stroke, spinal cord injury, multiple sclerosis et
- All patients with impaired function regardless of etiology
How does Sports Medicine fit into your practice?
Some physiatrists, such as our doctor, go on to specialize in Sports Medicine after residency training. In this clinic, we offer the entire spectrum of non-surgical Sports Medicine care, from the preparticipation physical evaluation to management of multiple types of musculoskeletal injuries in sportspersons.
Why should someone see you instead of an orthopedic surgeon? Or a neurologist?
If you have a fracture or you need surgery, then the orthopedic surgeon is the person to see. For musculoskeletal problems not requiring surgery, the physiatrist is a great choice because he/she is skilled at diagnosis and treatment including rehabilitation (the most crucial part). While both specialties administer steroid injections to help resolve pain, some physiatrists (including our doctor) now perform these procedures under ultrasound guidance. This is more accurate, safer, more effective and likely more cost-effective than the traditional approach.
If you have a problem involving the brain or spinal cord, the neurologist should be your first stop. For pinched or irritated nerves in the spine or in the limbs, the physiatrist is equally capable of diagnosing the disorder. Both groups perform nerve testing and administer Botox injections for spasticity (tight muscles after brain or spinal cord injury) but physiatrists also can use alcohol blocks for spasticity.
Regardless of what problem you have, if you have altered physical function, you may need to see a physiatrist at some stage.
Should I see a physiatrist or a physical therapist for my shoulder pain?
In many cases of musculoskeletal pain, a physical therapist will be able to assist you with a return to good physical function. However, therapy works best when the diagnosis is accurately established. The physiatrist can help with this prior to the start of therapy. Some insurance companies will also only reimburse for therapy if you get a doctor’s referral. In some instances, once you are given the appropriate exercises, you can do your own rehabilitation. The physiatrist can assist with this as well.