History of the Specialty
The field of Physiatry, also known as Physical Medicine and Rehabilitation (PM&R) has evolved over the decades.
Two World Wars played an integral part in the birth of the specialty. During World War I, Physical modalities were used by physicians of physical therapy and strangely, radiology to help injured soldiers. At the onset of WW2, focus was broadened to include rehabilitation and recovery of the wounded soldiers. PM&R was established by the American Medical Association at the end of the war. Much early work by physiatrists was working with amputees, head injuries, spinal cord injuries. Polio epidemic in 1952 put physiatrists at the forefront of managing its sequelae. PM&R continued to broaden over the next several decades to include management and treatment of patients post knee and hip replacements, burn patients, cardiac and pulmonary rehabilitation, traumatic brain injuries, spinal cord injuries, post stroke rehabilitation, neuromuscle disorders. Pediatric physiatrists manage conditions such as muscular dystrophies, and spina bifida. Over the last 3 decades, most outpatient physiatrists concentrate on diagnosing and treating musculoskeletal injuries. Over the last ten years, the field of pain medicine is dominated by our profession.
When will my doctor refer me to a physiatrist?
Many outpatient physiatry practices focus on musculoskeletal, sports injuries, and pain management. PM&R physicians will see patients referred by doctors from all specialties, including orthopedic surgeons, neurologists, rheumatologists, and of course internal medicine, family practice, and urgent care physicians. Injuries to any part of the body, or any joint can be assessed, including shoulders, elbows, wrists, hips, knees, and ankles. Most common conditions seen however, are spinal, neck and back pain.
What will be expected on a visit with a physiatrist?
Just as any physician, physiatrists perform a comprehensive history and physical exam. At times, concentrating on a specific body part affected. Proper tests may be ordered, such as x-rays, and MRIs. PM&R physicians also specialize in EMG, nerve conductions studies. These tests may be performed at the time of the visit or scheduled for a later day, depending on the duration of an injury. EMG testing is useful in diagnosing conditions such as radiculopathies (pinched nerves in the neck or back), peripheral neuropathies (as may be seen in diabetics), and compression neuropathies (such as Carpal Tunnel Syndrome). This very valuable test should be performed by an experienced physician. Accurate results allow the physiatrist to establish a proper diagnosis, and at times prognosis. Depending on the findings, recommendations will be made. For example, depending on severity of Carpal Tunnel Syndrome, patient will be prescribed wrist splints, therapy, injections, or referred to a hand surgeon for a carpal tunnel release. Involved level found in a radiculopathy may be helpful in determining where to perform an Epidural Injection or surgical discectomy.
Physiatrists goal is to restore function utilizing all available treatment options, starting with most conservative, such as Physical Therapy, and if necessary, appropriate injections.
We also recognize the need for surgical intervention. Working closely with a team of orthopedic surgeons, allows for a team approach to conditions that may eventually require arthroscopic shoulder, hip, and knee repairs.
Spinal surgery can be avoided most of the time. A physiatrist is able to determine if and when an evaluation by a spine surgeon is needed.
A PM&R physician is an expert in Musculoskeletal and Sports Medicine. Proper evaluation, diagnosis, and management leads to recovery of lost function, improvement of pain, and patient education.
At New York Bone and Joint Specialists, we have a team of physiatrists that specialize in treatments of non-operative neck and back pain, EMG/nerve conduction testing, interventional pain management, as well as a pelvic pain specialist.