Our Specialty

What is a Physiatrist?

Doctor2.pngPhysiatrist is the abbreviated name for a physician (either an M.D. or a D.O.) who has specialized, after graduating from medical school, in Physical Medicine and Rehabilitation (PM&R). Rehabilitation physician is another name used for a specialist in PM&R.

PM&R is one of the 37+ medical specialties recognized by the American Board of Medical Specialties. You are probably, however, more familiar with some of the other specialties recognized by the American Board of Medical Specialties, such as Ob/Gyn, Dermatology, or Plastic Surgery. PM&R is not as well-known because it is one of the "newer" of the recognized medical specialties. The first Physical Medicine and Rehabilitation residency training was instituted in 1936 at the Mayo Clinic. The American Academy of Physical Medicine and Rehabilitation was established in 1938, and in 1947 the specialty was officially recognized by the American Board of Medical Specialties. There are approximately 9,000 practicing physiatrists in the United States.

What does a Physiatrist treat?

Physiatrists are nerve, muscle, and bone experts who treat injuries or illnesses that affect how a person moves and functions. Their focus is on diagnosing, treating, preventing and mitigating the effects of illnesses that cause disability. The physiatrist, sometimes referred to as a muscle doctor or bone doctor, promotes quality of life by restoring/improving function which has been limited by disease, trauma, congenital disorders or pain. The physiatrist's goal is to return patients to their former medical, social, emotional and occupational states - that is, to put the pieces of a person's life back together - without surgery. The physiatrist manages persons of all ages with mild to severe physical and/or cognitive impairment and disability - conditions related to the brain, muscles, and bones, spanning from traumatic brain injury to lower back pain. Specifically, a physiatrist:

  • Diagnoses and treats pain.
  • Restores maximum function lost through injury, illness or disabling conditions.
  • Treats the whole person, not just the disease or injury.
  • Leads a team of medical professionals which may include neurologists, orthopedic surgeons, urologists, rheumatologists and urologists; and non-physician health professionals such as physical therapists, occupational therapists, speech pathologists, vocational counselors, psychologists and social workers.
  • Provides non-surgical treatments.
  • Explains your medical problems and treatment plans.

What specific kinds of conditions are treated by a Physiatrist?

Physiatrists treat both acute and chronic conditions that span the entire spectrum from the most complicated multiple traumas to injury prevention for athletes. The goal is to decrease pain and enhance function without surgery.

Some common conditions treated include work and auto injuries, pain, and musculoskeletal problems like back and neck pain, tendinitis, pinched nerves, osteoarthritis and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, traumatic brain injury, strokes, orthopedic injuries, amputations, cardiopulmonary debility, and neurologic disorders such as multiple sclerosis, polio, or ALS.

Physiatrists offer comprehensive care for people with diverse medical conditions and is often called the quality of life profession because its aim is to enhance patient performance.

What is the Training for a Physiatrist?

Upon graduation from medical school, physiatrists must pursue four (4) additional years of postdoctoral training in a physical medicine and rehabilitation residency. This includes one year developing fundamental clinical skills and three additional years of training in the full scope of the specialty. Fellowships are available for further specialized study in such areas as musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury and sports medicine. After completing their residency training, to attain board certification status, the qualified candidates take a written exam (Part 1), and after the first year of practice an oral exam (Part 2). Recertification is required every 10 years.

How do Physiatrists' diagnose?

Physiatrists take the time needed to accurately pinpoint the source of an ailment. Their specific diagnostic tools are the same as those used by other physicians (medical histories, physical examinations, lab work, and imaging studies) with the addition of special techniques in electrodiagnostic medicine like electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials.

Wouldn’t I go to see a surgeon if I have back or neck pain, a pinched nerve or herniated disc?

No, not ideally. An example of a similar situation is if you have intermittent chest pain for which you make an appointment to see your primary care physician. Does your doctor send you to a cardiologist or a cardiac surgeon? In most cases, a cardiologist of course. This is so the cardiologist can diagnose the problem, determine if the pain is or is not heart-related and if any surgery is needed.

A physiatrist spends his/her whole training learning to diagnose the cause of pain and utilize the many nonsurgical treatment options available to treat it. If surgery is needed, the physiatrist knows the correct surgeon to send the patient to for the best and safest procedure.

If I have a disc abnormality on an MRI – doesn’t it have to come out for me to feel better?

A large number of the disc “abnormalities” seen on MRI’s are meaningless – kind of like gray hair. No one tells you your gray hair must be removed, right? In fact, 90% of most people over the age of 60 will have some abnormality on the MRI – even those who experience no symptoms of any sort. The disc does not have to come out to make the patient better.

For pain problems, shouldn’t I go to a Pain Clinic or Center?

Usually a Pain Clinic or Center is staffed by physicians specializing in anesthesiology. An anesthesiologists 3 year training focuses on keeping patients comfortable during surgical procedures. A year is then spent learning injections.

A physiatrist is trained in diagnosing and treating musculoskeletal problems resulting in pain. Many physiatrists also perform a variety of injections and can determine if an injection is needed and what specific type of injection is needed. Pain can be treated in many ways, including medication, physical therapy, local injection, fluoroscopic injection, manipulation, acupuncture, yoga, education, etc. Often, once the proper diagnosis is made, a combination of the above-listed treatments is used.