What is Physiatry?

In the majority of pain disorders the diagnosis is one that is not remedial to surgical intervention. The Physiatrist is expert in assessing for structural defects such as herniated disks, but can go beyond this. He also is expert in assessing for physiologic evidence of nerve injury or performance oriented defects that impair function.

Examples of structural tests include CAT Scans, MRI, and Myelography. These tests study the “hardware”. Examples of physiologic studies include Electromyography (EMG) & Nerve Conduction Velocity (NCV) Studies and Thermography. These tests study the “software”. Examples of function-oriented tests include Computerized Motion Analysis (Lift Track) and Biodex. These tests measure “performance”.

In many cases, even in the presence of herniated disk, the Physiatrist can assess if the disk is indeed the cause of that person’s pain. If it is, he can offer many nonsurgical treatments that are effective in relieving pain.

These forms of therapy are quite beneficial for the treatment of certain muscle and ligamentous injuries, but are not always enough. While they often play an important role in the treatment of conditions where pain, weakness or numbness exist, they should not be utilized excessively. If an individual is going to benefit as a direct result of the application of these agents improvement should be substantial within a period of 2 – 4 weeks.

Often times there is involvement that exceeds simple muscle spasm or ligament strain and the use of these physical or mechanical agents alone is not enough. Anesthetic blocks are directed toward pain, weakness or numbness that is a result of nerve injury or irritation. Examples of anesthetic blocks include facet, epidural and sympathetic blocks. Injection therapy techniques are directed toward muscle, ligament or fascia. Examples of injection therapy include trigger point (into muscle) and sacroiliac (into ligament) injections.

The purpose of the anesthetic blocks is to help stabilize the nerve fibers that are irritated so as to restore them to normal. Some people also believe that these blocks stop a “pain – spasm” cycle so as to allow for restoration of normal function. Usually these blocks are repeated only once or twice, except for the case of sympathetic blocks, which are done in series (usually five – seven).

The purpose of injection therapy is to anesthetize a muscle so as to allow nonpainful range of motion and stretching or to anesthetize and strengthen a ligament so as to promote healing. These injections are frequently done in a series of three, with the physical agents used concurrently. A nonsurgical intervention for the treatment of pain, weakness or numbness is emphasized.

Kinesiology is the study of human performance and motion. The Physiatrist can utilize this information along with his diagnostic and treatment skills to determine what kind of impairment an individual may have from a particular injury and give an objective assessment of what kind of restrictions this may translate into.

Diagnostic Testing (Assessments) Offered:

1) Muscle And Nerve Disorders:

• Electromyography (EMG): for radiculpathy, myopathy or neuronopathy
• Nerve Conduction Studies (NCV): for entrapment, peripheral neuropathy or radiculopathy
• Thermography: for RSD and Sympathetic Pain Syndromes

2) Ligament Or Muscle Injuries:

• Diagnostic Musculoskeletal Ultrasound: for strains and sprains

3) Mechanical Injuries Or Abnormality of Gait:

• F Scan/Electrodynography (Gait Analysis) & Balance Testing: for sports injuries, mechanical back pain, diabetic foot ulcers and walking disorders as in polio

4) Vascular Disorders:

• Vascular Segmental Doppler Arterial Studies & Ankle Brachial Indexes (ABI’s): for physiologic assessment of vascular disorders

5) Psychologic Assessment:

• Minnesota Multiphasic Personality Inventory (MMPI): for personality profile screening
• Insight consulting: health impacts of belief systems, values and life styles)

6) Environmental Illness & Immunological Disorders:

• Urine and Hair Analysis: for chemical and heavy metal toxicity
• Skin and Blood Testing: nutritional status & immune function analysis

These nonsurgical interventions, in combination with frank physician – patient communication, can result in a reduction of pain, weakness or numbness complaints while also objectifying impairment and facilitating return to maximum function.