Physical Medicine & Rehabilitation (PM&R) is a specialty of medicine practiced by physicians known as physiatrists. It is also known as Rehabilitation Medicine or Rehabilitative Medicine.
Acute injury or chronic illness affects movement, communication, and operations in the home and workplace. Physiatry is a unique specialty that addresses the patient holistically, rather than specific organs or systems. There is a strong focus on patient-centered care, adapting to impairment and limitation, and maximizing independence and mobility with the aim of returning patients to their independence.
This branch of medicine focuses on the prevention, diagnosis, treatment, and rehabilitation of disorders that cause impairment in functionality and mobility, including many neuro-musculoskeletal and physiological disorders.
When Is a Physiatrist Required?
The goal of the physiatrist is to provide medical care to patients with pain, weakness, numbness, and loss of function so that they can maximize their physical, psychological, social, and vocational potential.
A physiatrist should be consulted when pain, weakness, illness, or disability interferes with the ability to perform tasks independently and adversely impacts quality of life:
- An accident, injury, or chronic condition that causes pain or limits function
- Pending or post surgery recovery
- Illness or treatment that diminishes energy or mobility
- Stroke or issues related to nerve damage
- Arthritis, repetitive stress injury, or back problems
- Excess weight that makes it difficult to exercise or causes health problems
- Life changes such as childbirth or menopause that challenge physical function
Getting started with PM&R
A PM&R physician will thoroughly assess your condition, needs, and expectations and rule out any serious medical illnesses to develop a treatment plan. A clear understanding of your condition and limitations will help you and your PM&R physician to develop a treatment plan tailored to your unique needs and goals.
PM&R physicians manage issues spanning the entire spectrum of body systems, from complicated multiple trauma to injury prevention for athletes. Some PM&R practices are broad-based and encompass many different types of patients. Others pursue subspecialty certification and focus on specific groups or problems:
- Sports medicine: sports-related injuries, programs to help athletes avoid injury, and research.
- Sports injuries: Achilles tendonitis, acromioclavicular separation, biceps tendonitis, concussion, DeQuervain’s tenosynovitis, fractures, iliotibial band syndrome, medial & lateral epicondylitis, rotator cuff pathology, and turf toe.
- Pain medicine: Arthritis, back pain, regional pain syndrome, chronic pain management, carpal tunnel syndrome.
- Neurorehabilitation: Parkinson’s Disease, spinal and traumatic brain injury (TBI), multiple and amyotrophic lateral sclerosis, or stroke.
- Musculoskeletal care: Osteoporosis, osteoarthritis, rheumatoid arthritis, sacroiliac joint dysfunction, and fibromyalgia.
- Post-operative care: cardiac/pulmonary rehabilitation, joint replacement, organ transplants, ventricular assistive devices.
- Pediatric functional and developmental disorders: Cerebral Palsy, Down Syndrome, Muscular Dystrophy, Spina Bifida,
- Specialized rehabilitation: Complementary and Alternative Medicine (CAM), fine arts rehabilitation (music, dance, vocal), cancer, caregiver training (for home care), Palliative Care and Pelvic Pain.
Physiatrists administer general medical treatment (similar to internal medicine), to maintain health stability and prevent of disability. Physiatrists perform many procedures for diagnosis and treatment, some requiring fellowship or advanced training.
- EMG (electromyography)
- Nerve stimulators and NCS (nerve conduction studies)
- Peripheral joint injections
- Trigger point, joint, and platelet-rich plasma injections
- Musculoskeletal ultrasound
- Fluoroscopy guided procedures
- Spasticity management
- Interventional spinal therapeutics
- Complementary-Alternative Medicine
- Autologous stem cell treatments
- Manual Medicine/Osteopathic Treatment
- Prosthetics and Orthotics
- Disability/impairment assessment
- Medico-legal consulting
Areas of Focus for Physiatrists
A physiatrist is trained to holistically manage a variety of disorders and diseases, although many practitioners specialize in niche areas. This broad spectrum of study and their comprehensive training position physiatrists to uniquely adapt to new technologies and trends in health care.
Conditions of the bones, muscles, joints, and central/peripheral nervous systems that affect a person’s ability to function and move are eminently responsive to a physiatrist’s skills.
The practice of PM&R is built on the “team approach,” a unique perspective on patient care. The patient’s physical, functional, emotional, and psycho-social well-being are all considered in treatment.
The physiatrist is trained to lead and coordinate care with the rehabilitation team, which might include representatives from:
- physical therapy
- recreational therapy
- social services
- internal medicine
- orthopedic surgery
- occupational therapy
- rehabilitation nursing
- speech therapy
The physiatrist prescribes exercise protocols for maintaining and increasing range of motion, strengthening muscles, improving joint positioning, muscle relaxation, and aerobic fitness, to improve function and mobility.
He may also prescribe orthoses, (upper and lower limbs and back bracing), assistive and adaptive equipment like wheelchairs, and prostheses (for amputees).
Environmental control devices, communication aids, and other tools for greater independence with safety and less effort in “activities of daily living” (ADLs), are some other tools that a physiatrist may prescribe.
PM&R is often called the quality of life profession, because it aims to enhance patient performance. These specialists treat any disability resulting from disease or injury involving any organ system. Their focus is on the development of a comprehensive program for restoring a person’s life after injury or disease in all its aspects.