Physical medicine and rehabilitation (PM&R), also known as physiatry, is a medical specialty that promotes the healing and rehabilitation of patients who have been injured or disabled.

A physiatrist, also known as a PM&R physician, addresses various medical disorders affecting the brain, spinal cord, bones, joints, ligaments, muscles, and tendons.

Their purpose is to improve mobility and overall quality of life. PM&R doctors treat the patient as a whole person, not just one body part.

Let’s get in-depth, learn more about PM&R, and answer the most asked question: “What is Physical Medicine.”

 What is PM&R?

PM&R, or physiatry, is a medical specialty that focuses on reducing patients’ functional impediments to independence. Medical professionals in physiatry collaborate closely with therapists — often those in physical therapy, occupational therapy, and/or speech therapy — to help patients improve their functional levels before they leave an inpatient hospital setting.

Patients of rehab physicians in the inpatient setting are individuals who have at least two therapy criteria and yet require the assistance of a physician in managing their acute medical needs. This “medical requirement” depends on each patient’s circumstances.

For example, a patient with a brain injury may require pharmaceutical management for new onset agitation and irritability. In contrast, a patient with a spinal cord injury may have autonomic instability that inhibits their ability to participate in therapy exercises.

Patients who have had strokes or been in vehicle accidents that resulted in many orthopedic fractures, new amputees, or those with acute neurological disorders such as multiple sclerosis or Guillain-Barré syndrome are also popular rehabilitation patients. Outpatient rehab physicians assist patients (and their families) in maintaining and improving their functioning. It frequently refers to continuing care for patients previously hospitalized in a PM&R ward. Still, it also refers to managing patients who have only been seen in an outpatient setting.

How can PM&R help me?

PM&R specialists can assist individuals suffering from chronic disease, pain, or limitations in achieving optimal function. Physical agents and therapeutic exercise treat patients during rehabilitation to:

• Reduce pain
• Enhance one’s quality of life
• Recover from a severe or momentary impairment

What does a PM&R physician do?

PM&R physicians can address physical medical issues affecting any part of the body.

PM&R physicians create treatment strategies for patients of all ages. They will assess your condition, needs, and goals; determine whether there is a severe medical basis for your problems, and build a treatment plan to assist you in achieving your objectives.

 Medical supervision

PM&R physicians get educated to treat and manage acute and chronic pain with pharmaceuticals and holistic therapies such as mindfulness, Yoga, Pilates, dry needling, and anti-inflammatory diets.

Tissue injury causes acute pain and has a clear source. Chronic pain is continuous and might endure for months; its cause is difficult to pinpoint. In some circumstances, the brain will continue to receive pain signals even after an injury has healed. Chronic pain is also common in long-term diseases such as arthritis or cancer.

Self-care

Patients can safeguard their backs by maintaining proper posture, keeping their spine aligned, and completing physical therapy or a regular exercise regimen.

You must alter your approach to daily activities when in pain, and you may need to modify your workspace and regular standing, sitting, and sleeping habits. You may also need to master proper lifting and bending techniques.

Nerve conduction and electromyogram (EMG) studies

These tests examine the electrical activity of the body’s muscles and nerves, usually in one arm or leg. The tests can aid in diagnosing nerve or muscle disorders such as carpal tunnel syndrome, a pinched spinal nerve, peripheral neuropathy, myositis, or ALS. The presence or absence of damage can aid in determining subsequent treatment.

Braces

Wearing a back or neck brace may be recommended while muscles are being strengthened after surgery or injury. The brace can assist reduce muscular spasms and pain while immobilizing the spine throughout the healing process.

What are the conditions that a PM&R physician treats?

PM&R Doctors deal with issues arising from an injury, sickness, or chronic condition. Conditions commonly treated by a PM&R physician are as below:

• Medical rehabilitation
• Pain-neuromuscular medicine rehabilitation
• Musculoskeletal medicine
• Rehabilitation of central nervous system disorders
• Pediatric rehabilitation

How does a physician treat medical conditions?

PM&R physicians use several minimally invasive tests and therapies to assist patients in recovering from painful disorders. These are some examples:

Epidural steroid injection (ESI)

The procedure entails injecting corticosteroids and numbing medications directly into the area around the spinal nerves. To help guide the needle to the correct position, X-rays are employed. Pain alleviation might last anywhere from a week to a year. The goal is for you to be able to work, resume everyday activities, and receive physical treatment.

Facet joint injection

A corticosteroid and numbing medication are injected into a sore facet joint in the back or neck as part of this treatment. The injection can reduce inflammation and pain while simultaneously serving as a diagnostic test to establish which joint produces the discomfort.

Injections into the joints

During this operation, corticosteroid and numbing medications are injected into the knee, hip, ankle, shoulder, elbow, or hand. The injection will likely temporarily reduce pain, allowing you to return to work, resume everyday activities, and participate in physical treatment.

Injection of the sacroiliac (SI) joint

During this surgery, the doctor injects a corticosteroid and numbing drug into the big joint in the lower back and buttocks. The injection relieves pain and aids in determining if your pain is coming from the SI joint or somewhere else.

Injection of a nerve block

This test determines whether your pain is caused by a nerve or a joint.

An anesthetic injection is administered on or near a pain receptor. Patients log their pain relief during the next few hours. If the block is successful, radiofrequency ablation may be advised.

Ablation with radiofrequency (rhizotomy)

This operation may be recommended if you have had a successful nerve block. The doctor uses a radiofrequency current to burn the sensory nerves surrounding a troublesome joint, preventing pain signals from reaching the brain.

Radiofrequency ablation is predicted to provide pain relief that lasts from 6 months to more than two years, allowing you to work and engage in daily activities comfortably.

SCS trial

The temporary insertion of electrodes that send electrical pulses to the spinal cord is used in this test. The electrodes are connected to a tiny pacemaker-like device. The trial is successful if the electrical pulses overcome pain signals, lowering discomfort. After that, the electrodes and stimulator device can surgically get inserted.

Reasons to consult a PM&R specialist

If you have had physical trauma, discomfort, or mobility issues, seeing a PM&R physician may be your next step.

They can identify and treat disabilities-related medical disorders such as:

• Cognitive problems
• Orthopedic issues
• Mobility concerns
• Bowel and bladder problems
• Conditions that affect your walking
• Feeding and swallowing problems
• Trouble with communication
• Pain
• Muscle stiffness or poor muscle tone

You should also consult a PM&R specialist if:

• You require rehabilitation following an injury, illness, or surgery;
• You suffer from chronic pain.
• Obesity or aging has made it more difficult for you to engage in physical activity.

Depending on your needs, a PM&R physician may collaborate with a team of neurologists, orthopedists, neurosurgeons, physical therapists, occupational therapists, speech therapists, and primary care doctors.

Top differences between physiatrists and physical therapists

Suppose you have mobility issues due to an injury or medical incident. In that case, your healthcare team may advise you to see a physiatrist and a physical therapist to get you moving again. “What’s the difference between the two?” you could ask. Can I go to one or the other rather than both?

Physical therapists and physiatrists utilize their medical skills to restore movement, prevent injury, and promote general health. Though the final aim is identical, the variations between the two professions are significant and include distinct forms of treatment.

Five differences between a physiatrist and a physical therapist

Education

The first significant distinction between physiatrists and physical therapists is their medical education. A physiatrist is a qualified, board-certified medical practitioner who has completed medical school, internship, and residency requirements. A physical therapist must obtain a three-year postgraduate degree in physical therapy and be certified.

While both medical doctors are intimately familiar with the body’s musculoskeletal system, a physiatrist’s more comprehensive training provides them with an even more in-depth understanding of the structure and function of the human body. They also comprehend how the neurological, cardiovascular, and other systems interact with the musculoskeletal system.

As PM&R practitioners, physiatrists can also administer medication and perform non-surgical procedures such as injections, which physical therapists cannot. Physical therapists employ advanced techniques such as traction and transcutaneous electrical nerve stimulation (TENS), but they must refer you to your physiatrist, who can perform prescription-level therapy. If you have complex medical needs, a physiatrist will come in handy.

Role

A physiatrist is responsible for diagnosing, treating, and managing musculoskeletal problems. Based on their findings, your doctor creates a detailed treatment plan, supervises its implementation, and evaluates its success. Throughout your inpatient stay, they will check in with you and your physical therapist to ensure that their strategy is functioning.

Your physical therapist is responsible for carrying out the treatment plan recommended by your physiatrist. The majority of the actual physical rehabilitation approaches, such as specialized exercises and hands-on procedures, will be performed during physical therapy sessions.

Initial visit

Your physiatrist appointment comes before physical therapy in your treatment plan. During your first appointment, your physiatrist, as a member of your care team, gathers extensive information from your medical history, physical exam, and diagnostic testing to develop a treatment plan.

Before diagnosing or treating you, a physiatrist examines all aspects of your health. From there, your physiatrist can put together a team of healthcare practitioners, including a physical therapist and other specialists, to help you regain your physical abilities.

Following your visit with your physiatrist, you may be evaluated by your physical therapist. They may conduct tests to examine your strength, muscular balance, reflexes, and range of motion. They will then begin your first therapy session using the information from your physiatrist and their examinations.

Diagnostics

Physiatrists, not physical therapists, diagnose medical conditions. A physiatrist employs diagnostic methods such as X-rays, nerve conduction investigations, and electromyography to determine the underlying medical issues that necessitate rehabilitation.

To establish a therapy plan, your physiatrist considers your entire health picture and co-existing health concerns. They assist you and your physical therapist in dealing with illnesses such as diabetes, heart disease, arthritis, and COPD. They also provide several non-surgical pain management techniques.

A physiatrist is essential when requiring specialized care, such as diabetic limb amputation. The physiatrist provides the tools you need to regain function, including prosthetic devices and pain management.

To carry out their share of your treatment, your physical therapist relies on your doctor and physiatrist’s diagnostic information and recommendations. They can aid you in using a prosthesis or assistive device and adjust your treatment programming with your physiatrist’s approval.

Frequency of visits

Your physiatrist will most likely visit you less frequently than your physical therapist.

You should anticipate seeing your physiatrist for an initial evaluation and periodic check-ins until you’ve met your rehabilitation objectives.

Over several weeks, you’ll see your physical therapist regularly, whether that’s daily or every few days. Your therapist provides continuing assistance and serves as a liaison between you and your physiatrist.

Frequently asked questions about PM&R

What exactly is Physiatry?

Physiatry, often known as rehabilitation medicine, is a discipline of medicine that focuses on the diagnosis, prevention, and treatment of all disorders involving the brain, nerves, bones, and muscles.

Physiatry provides care in a holistic, multi-faceted manner, focusing on how a patient’s medical condition impacts every part of their life, including their role in the workplace, home, and daily activities.

Physiatrists use a combination of physical therapy and pain management to assist patients in avoiding surgery.

The purpose of physiatry is to maximize physical functionality, significantly reduce or eliminate pain, develop independence, and improve the quality of life for people who are disabled, have chronic pain, or have physical limitations.

Who is a physiatrist?

A physiatrist is a medical doctor specializing in PM&R. Physiatrists are fully qualified medical doctors who complete four years of postgraduate study in PM&R through an accredited internship and residency training program after graduating from medical school. They can bring to patient treatment a broad knowledge of medicine, biomechanics, musculoskeletal function, anatomy, and a complete understanding of musculoskeletal and neurological problems as a result of this training.

Physiatrists are specialists who treat individuals who have been injured or have disabilities that impede their physical and cognitive functioning. To treat several illnesses, physiatrists use a combination of physical therapy treatments, pharmaceutical management, and various procedures such as soft tissue, muscle, nerve, and spine injections.

How do physiatrists diagnose patients?

Physiatrists use techniques such as electrodiagnostic medicine and nerve conduction investigations in addition to the standard diagnostic tools used by physicians (physical examinations, imaging studies, and medical history).

These highly specialized diagnostic instruments aid physiatrists in diagnosing nerve diseases that cause pain, weakness, and numbness, resulting in physical handicaps, such as carpal tunnel syndrome and radiculopathy (pinched nerve) in the spine.

What is the physiatrist’s role?

A physiatrist considers the “whole person,” or all parts of a patient’s life that their disability or chronic pain may impact. The goal of treatment is to help people live more useful, pain-free lives without requiring surgery.

After diagnosing a patient, a physiatrist will develop a unique treatment plan tailored to the patient’s specific needs. To deliver seamless, patient-centered treatment, the physiatrists work closely with primary care physicians, occupational medicine physicians, orthopedic surgeons, cardiologists, oncologists, neurosurgeons, and neurologists.

What kinds of treatments and procedures do physiatrists provide?

Diagnostic tests and treatments performed and prescribed by physiatrists include:

• Therapeutic exercise
• Prosthetics/Orthotics
• Pain medications
• EMG (electromyography)
• NCS (nerve conduction studies)
• Soft tissue injections
• Joint injections
• Spine injections
• Musculoskeletal ultrasound
• Interventional spinal therapeutics
• Spasticity management

What are the most prevalent medical conditions that physiatrists treat?

Physiatrists diagnose and treat patients with a wide range of illnesses, including:

• Back pain
• Neck pain
• Strokes
• Brain injuries
• Neuromuscular disorders
• Sports injuries
• Spinal cord injuries
• Arthritis
• Carpal tunnel
• Herniated disc
• Sciatica
• Fibromyalgia
• Work injuries
• Amputees
• Parkinson’s disease
• Multiple sclerosis
• Guillain-Barre syndrome
• Cancer rehabilitation
• Pelvic floor disorders

What distinguishes physiatrists from physical therapists?

Physiatrists are medical doctors who have finished medical school and training in PM&R. Physiatrists diagnose diseases, develop treatment plans, and prescribe drugs.

Every Physiatrist creates exercise plans that are suited to the patient’s demands and recommend treatment regimens that therapists use.

A physical therapist, who is not a medical doctor, supervises and implements exercise programs to alleviate symptoms and improve function. A physical therapist follows treatment methods established by physiatrists and other doctors.

When should you consult a physiatrist for physical medicine?

If you have any of the following symptoms, you should see a physiatrist:

• You have been injured, causing pain and impending physical function.
• You have a disease, a disability, or have been treated for an illness that has left you with reduced physical functioning and suffering.
• You have persistent back pain, neck pain, pain from a repetitive stress injury, or chronic arthritis pain.
• You have had a stroke or other nerve damage that has limited your physical functioning.
• You’re still healing after surgery.
• You’re thinking about having surgery to relieve persistent discomfort.

Do physiatrists see patients of all ages?

Patients of all ages, including children, are treated by physiatrists.

Where can you find PM&R specialists?

Physicians who perform PM&R work in several therapeutic settings, which include outpatient clinics and inpatient hospitals.

They are well-versed in musculoskeletal (bones, muscles), neurology (nerves, nervous system), and rheumatology (joints, muscles, ligaments). Some PM&R  doctors specialize in sports medicine, pediatrics, brain damage, and pain management.

Can a PM&R physician provide medications?

Like other physicians, PM&R providers give drugs for various concerns, including muscle and nerve difficulties, concentration and memory issues, and pain.

PM&R  doctors may also recommend braces or splints to improve functionality and other medical devices such as canes and walkers to increase safety. PM&R professionals use laboratory testing, X-rays, MRI or CT scans, electromyography (EMG), nerve conduction investigations, and psychiatric assessments.

Why should I consult a PM&R specialist?

Outpatient physiatrists treat non-surgical or nonoperative conditions such as orthopedic/musculoskeletal injuries such as muscle strains/tears/sprains, as well as bursitis and tendonitis of the shoulder, elbow, wrist/hand, and hip, knee, foot, or ankle. Arthritis, overuse injuries, neck or low back discomfort, and nerve disorders such as carpal or tarsal tunnel syndrome are all typical conditions.

To help you go back to living your best life, physiatrists collaborate with other medical providers such as orthopedic surgeons, neurosurgeons, neurologists, primary care doctors, physical therapists, occupational therapists, and speech therapists.

What type of education do PM&R doctors have?

Individuals must complete medical school and four years of postdoctoral training in a PM&R residency to become PM&R physicians. It involves one year of basic clinical skills development and three additional years of training in the full area of the specialization.

There are now 80 certified residency programs in PM&R in the United States. Many PM&R physicians choose to further their education (MS, Ph.D.) or undergo fellowship training in a particular specialty.

Fellowships are available for specialized study in musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine.

Rehabilitation physicians must take a written and oral test sponsored by the American Board of PM&R to become board certified in PM&R (ABPMR). In addition, the ABPMR has agreements with the boards of pediatrics, internal medicine, and neurology to enable unique training programs leading to certification in two specialties.

Subspecialty certification in Brain Injury Medicine, Hospice and Palliative Medicine, Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, and Sports Medicine is available to Rehabilitation physicians. ​

To Conclude:

Physical medicine and rehabilitation (PM&R), commonly known as physiatry, is a medical specialty that focuses on restoring function to those who have become incapacitated due to a disease, illness, or injury.

Physiatry provides comprehensive, multidisciplinary therapy to rehabilitate the whole person. It takes care of the individual’s physical, emotional, medical, vocational, and social needs.

A physiatrist is a doctor specializing in PM&R. Physiatrists provide comprehensive care for diseases affecting the brain, spinal cord, nerves, muscles, and bones. These illnesses can be uncomfortable and limit your mobility, self-care skills, capacity to work, participate in leisure activities, and perform certain family and community obligations.

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