Physiatry

Physical Medicine and Rehabilitation (PM&R), also called physiatry, (pronounced fizz ee at´ tree or fizz eye´ uhtree) is the branch of medicine emphasizing the prevention, diagnosis and treatment of disorders—particularly those of the musculoskeletal, cardiovascular, and pulmonary systems—that may produce temporary or permanent impairment.

Physical Medicine and Rehabilitation is one of the 24 medical specialties certified by the American Board of Medical Specialties. Physiatry provides integrated care in the treatment of all neurologic and musculoskeletal disabilities from traumatic brain injury to lower back pain. The specialty focuses on the restoration of function to people with problems ranging from simple physical mobility issues to those with complex cognitive involvement.

M&R began in earnest in the 1930s with the physical treatment of musculoskeletal and neurological conditions, and broadened its scope during World War II when thousands of veterans came home with catastrophic disabilities. The goal of restoring veterans to productive lives triggered expansion of the field into a specialty that deals with all functional aspects of people with disabilities. The Advisory Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947.

Today, physiatry is a diverse specialty. Physiatrists practice in major rehabilitation centers, in acute care hospitals, and in outpatient settings. Their approach to patients requires listening and observing, but also employs state-of-the-art technological support to assist in the healing process. In recent years, physiatry has seen an increased focus on musculoskeletal medicine and industrial medicine, pain management, sports medicine, and electromyography (EMG).

What is a Physiatrist?

A physiatrist, (pronounced fizz ee at' trist or fizz eye' uh trist) is a physician specializing in physical medicine and rehabilitation. Physiatrists are physicians who treat a wide range of problems from sore shoulders to spinal cord injuries. They see patients in all age groups and treat problems that touch upon all the major systems in the body. These specialists focus on restoring function to people.

Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists' patients include people with arthritis, tendonitis, any kind of back pain, and work- or sports-related injuries.

Physiatrists also treat serious disorders of the musculoskeletal system that result in severe functional limitations. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists coordinate the long term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations and multiple sclerosis. Physiatrists practice in rehabilitation centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury, or many other special interests.

Why a Physiatrist?

Physiatrists are specialists in diagnosing and treating problems of the musculoskeletal system. They perform thorough histories and physical examinations to find the source of your pain, injury or disability, even when standard diagnostic tests don't reveal specific problems. In addition, physiatrists direct your treatment team. If you need any other services, such as those of a physical therapist or athletic trainer, your physiatrist supervises, collaborates with and coordinates the other health care professionals. The result is a specially designed treatment program tailored for you.

Because physiatrists offer an aggressive, non-surgical approach to pain and injury, these physicians are the ideal choice for the treatment of a wide variety of diseases and conditions. Here's a listing of just some of the conditions that physiatrists have extensive training in diagnosing and treating:

* Low back pain
* Neck pain
* Fibromyalgia/Myofascial Pain
* Spinal cord injuries
* Brain injuries
* Acute and chronic pain
* Arthritis
* Cancer
* Burns
* Stroke and Neurological Disorders
* Multiple Sclerosis
* Cardiac Disorders
* Osteoporosis
* Musculoskeletal Disorders
* Work injuries

Most importantly, physiatrists treat the whole patient, not just the patient's symptoms. Physiatrists share their medical knowledge to help patients understand their condition and provide the tools and resources to manage it. They employ a variety of treatment methods to reduce or eliminate your problems and to decrease the possibility of a recurrence. This comprehensive approach produces not only cost-effective results, but also a high degree of patient satisfaction.

Through integrated focused care and comprehensive diagnosis and treatment, physiatrists add quality to the lives of millions of patients each year. The goal: getting you back into the game—not just back on the sidelines.

Education and Training

To become a physiatrist individuals must successfully complete four years of graduate medical education followed by four additional years of postdoctoral residency training. Residency training includes one year spent developing fundamental clinical skills and three additional years of training in the full scope of the specialty. There are currently 80 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional advanced degrees (MS, PhD) or complete fellowship training in a specific area of the specialty. Fellowships are available for specialized study in such areas as musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine.

To become Board certified in physical medicine and rehabilitation, physiatrists are required to successfully pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). The ABPM&R also has agreements with each of the boards of pediatrics, internal medicine, and neurology to allow special training programs leading to certification in both specialties.

Scope of Practice

As medicine becomes more sophisticated, and as life expectancy for Americans increases, the goal of good health has spawned a new theme: quality of life. Physiatry is often called the quality of life profession because its aim is to restore optimal patient functioning. The job of a physiatrist is to treat any disability resulting from disease or injury involving any organ system. The focus is not on one part of the body, but instead on the development of a comprehensive program for putting the pieces of a person's life back together—medically, socially, emotionally, and vocationally—after injury or disease. The problems that physiatrists manage span the entire spectrum, from the most complicated multiple trauma to injury prevention for athletes. Physiatrists can function as specialists or as primary care physicians.

Some physiatrists have broad-based practices that encompass many different types of patients. Others pursue special interests and focus on specific groups or problems. Sports medicine is one special interest that has grown in popularity over the last decade, reflecting America's fitness trend. Physiatrists who focus on sports medicine treat sports-related injuries, develop programs to help athletes avoid injury, and do research in the field.

Pediatrics is another special interest area. A physiatrist's evaluation and treatment of, for example, premature infants or children with catastrophic injuries, results in lifetime benefits to those patients and their families. Other areas of special interest include: Acupuncture, AIDS/HIV Rehabilitation; Arts Medicine; Brain Injury; Burn Injury; Cancer Rehabilitation; Cardiopulmonary Rehabilitation; Geriatric Rehabilitation; Industrial Rehabilitation; Manual Medicine; Myofascial Pain; Neurophysiology; Osteoporosis; Pain Rehabilitation; Pediatric Rehabilitation; Prosthetic, Orthotic, Wheelchair and Assistive Technology; Rheumatologic Rehabilitation; Spinal Cord Injury; Sports Medicine; and Stroke and Neurologic Disease Rehabilitation.

When treating patients with severe physical problems, the physiatrist often serves as the leader of an interdisciplinary team. The team may include medical professionals such as neurologists, psychiatrists, orthopaedic surgeons, and urologists, and non-physician health professionals such as physical therapists, occupational therapists, speech pathologists, vocational counselors, psychologists and social workers. The team is different for each patient, and the team's composition changes during treatment to match the patient's shifting needs.

Growth of the Specialty

In 1947, when PM&R became a board-certified specialty, there were 91 board-certified physiatrists; by 1975, there were 1,164. In only ten years, that number doubled, reaching 2,377 in 1985. It more than doubled again in the next decade. In 1995, there were nearly 5,000 board-certified physiatrists.

Back Pain

Back pain affects one in four Americans and is the most common form of physical disability. An estimated 80 percent of all Americans will suffer from back pain at some point in their lives. Problems can range from minoraggravating aches to severe debilitating pain. Back pain is the second leading cause of work absenteeism. Physical medicine and rehabilitation physicians take a comprehensive approach to examining all aspects of back problems. Studies have shown that early aggressive treatment of back injuries by a physiatrist results in quicker recovery and fewer lost work days. What treatment options are available for back pain? How do the success rates compare for surgical vs. nonsurgical treatment for low back pain? What exercises are important in rehabilitating back injuries and how can recurrences be prevented?

Sports Medicine

As specialists in musculoskeletal conditions, PM&R physicians offer non-surgical intervention and rehabilitation of sports injuries. Physiatrists treat simple sprains and overuse injuries such as tennis elbow as well as more complex conditions such as anterior cruciate ligament (ACL) and rotator cuff injuries. Many PM&R physicians serve as consultants to professional and college sports teams and work with these athletes in rehabilitating injuries. They also help design exercise, strength and conditioning programs that can help prevent injuries and improve performance. At the professional level, sports injuries can have a unique financial impact. Are these highly paid athletes receiving proper medical rehabilitation? What are the most common types of sports-related injuries and how can the "weekend warrior" prevent nagging injuries?

Spinal Cord Injury

Spinal cord injuries impair about 8,000 Americans each year, and the catastrophic nature of these injuries causes complex physical and psychological effects. Yet, expectations for those with spinal cord injuries have evolved tremendously in the last 50 years. The spinal cord injured are now viewed as physically disabled but healthy people, with a productive future in society. As pioneers in the treatment and management of spinal cord injuries, physiatrists lead interdisciplinary teams of healthcare professionals in treating and rehabilitating patients with spinal cord injuries. Studies have shown that this team approach leads to improved outcomes, decreased hospitalization and long-term nursing expenses, and increased personal earnings. Are advances in technology affecting spinal cord injury rehabilitation? What new research is giving hope to patients with spinal cord injuries? What impact has violence in our society had on the incidence of spinal cord injuries?

Stroke

Strokes affect approximately 500,000 Americans per year, killing 150,000. Stroke is the leading cause of severe disability in the United States and the third largest cause of death. More than three million people who have had strokes are alive today. More than one-third of these patients have permanent disabilities, but fewer than 20 percent receive rehabilitation. PM&R physicians help stroke victims return to independent living and maximum functioning. These specialists help patients manage both the physical and emotional effects that a stroke can have on their daily lives. What exactly is a stroke and how is it diagnosed? What are the warning signs of stroke and how can individuals reduce their risk for stroke? What are the most common effects of a stroke and what role does rehabilitation play in recovery of stroke survivors? How can patients and caregivers cope with the emotional effects of a stroke?

Disability

Disability is a significant public health and social issue in this country. Some 35 million Americans have some degree of activity limitation due tochronic conditions. What medical conditions are associated with disability? What strategies are being employed to help prevent disabilities? What is theeconomic impact of disability? What new equipment and technology is beingused to assist individuals with disabilities in basic physical and life activities?

Occupational Rehabilitation

Nine million people cannot enter the work force because of a physical restriction. With rehabilitation, an estimated 350,000 people with disabilities are able to return to work each year. Close to $3.5 billion in earnings are thus attributable to rehabilitation. Workplace injuries and disabilities range from carpal tunnel syndrome and related repetitive motion injuries to sprains, dislocations, and fractures. What conditions are most associated with work disability? What types of rehabilitation therapy are effective in returning people to work? How can employers reduce the risk of accidents and injuries in the workplace? What are the direct and indirect costs of disability?

Brain Injury

Head injuries kill more Americans under age 34 than all other causes of death combined. But in the last decade the survival rate of head injury patients has increased from 50 percent to 90 percent. An estimated two million Americans will incur a head injury this year and one fourth of these individuals will require hospitalization. Traumatic head injury can be devastating and even moderate injuries can cause significant physical and emotional damage. PM&R physicians coordinate the long term rehabilitation process for brain injury patients.

Studies show conclusively that medical rehabilitation improves speed and degree of recovery, significantly reduces hospital and nursing home stays, and provides economic benefits far exceeding the cost of rehabilitation.

Pain Rehabilitation

Physiatrists treat a wide variety of patients with acute and chronic pain. Pain management typically occupies a large portion of a physiatrist's day-to-day practice. Chronic pain affects an estimated 80 million Americans and is the third leading cause of physical impairment in the United States following cancer and heart disease.

From low back pain and herniated discs to carpal tunnel syndrome and tendonitis, physiatrists seek to not only reduce and eliminate pain, but also to prevent its recurrence. They are skilled in the use of drug therapies to treat both acute and chronic pain. PM&R physicians also perform nerve blocks and utilize special injection techniques on a diagnostic and therapeutic basis.

Geriatric Rehabilitation

With aging comes an increased incidence of acute, chronic and catastrophic diseases, all of which require medical care. In addition, the likelihood of disability increases greatly with age. Seniors represent more than 40 percent of the physically challenged population. Cost of this necessary specialized care can be high, and yet many seniors are on fixed incomes with static health care benefits. Medical rehabilitation is an integral part of basic health care services, and access to inpatient and outpatient rehabilitation services is critical for all Americans, especially seniors.

Low Back Pain: Developing a Program That's Right For You

Information is readily available on the way to stop back pain. The challenge is to tailor it to the particular patient. For example, it's often said that swimming is good for the back. But which stroke? And how often?

Strengthening the abdominal muscles is also commonly ordered for low back pain. But how is this done? And are you exercising the proper way for your back injury? The list goes on: cold or hot applications, rest or activity?

What Kinds of Problems Might Cause Low Back Pain?

Treatment for any back condition is recommended as soon as possible to minimize the danger of further aggravation. The following is a list of only some of the conditions that may cause low back pain and is not a substitute for a visit to your doctor:

Radiculopathy: A pinched nerve, also called sciatica, usually from a herniated, or slipped, disk. This can cause a shooting pain down the leg that's often described as an electrical feeling.

Myofascial Pain: Generally an aching pain in muscles that tends to come from poor posture, sitting at a computer, or other job-related tasks. With myofascial back pain, the patient can become sore in different parts of the body like the back and legs. Often patients report that they have difficulty sleeping or feeling restored from sleep.

Spinal Stenosis: A narrowing of the nerve openings either around the spinal cord or nerve roots that can cause symptoms similar to a pinched nerve. It can cause leg pain in anyone, but most often does so in older people. Patients with spinal stenosis can have trouble walking, and the difficulty is usually relieved by sitting down or bending forward. It can cause aching or heaviness in the back and legs.

Tendon, Ligament and Soft Tissue Pain: Localized pain when an area is stretched or its muscles are overused. This results in tenderness.

Non-Spinal Causes of Low Back Pain: pain imitating a back injury, but from another cause. Appendicitis, kidney disease, uterine disorders and urinary tract infections are a few examples of problems that can refer pain to the back.

Treatment Options

The rehabilitation of low back problems occurs in three phases. During the first phase, called the acute phase, physiatrists treat pain and inflammation. After they make a specific diagnosis and develop a treatment plan, physiatrists may offer treatment options such as acupuncture, manual medicine, ultrasound, electrical stimulation, mobilization, medication, ice and even specialized injections. In the second, or recovery, phase of treatment, flexibility and strength are developed to get the body parts into their proper positions. The goal of this phase is to get you back to your usual work, sports andleisure activities. This goal is achieved through specially designed exercises that rebuild the body. The main goal of the third phase of treatment, the maintenance phase, is to minimize recurrence of the problem and to prevent further injury. This often consists of a total body fitness program, designed to maintain body mechanics and increase endurance after theoriginal symptoms have resolved. These are very broad and general approaches to thetreatment of low back pain. The physiatrist that you choose will develop an individual treatment plan for you