Physical medicine and rehabilitation (PM&R)

Overview

Physical medicine and rehabilitation (PM&R), also known as physiatry, is a medical specialty that seeks to promote healing and rehabilitation of patients who have suffered injury or disability. Physiatrists treat patients following a stroke or brain or spinal cord injury; they also diagnose and treat acute and/or chronic pain and musculoskeletal injuries suffered in falls, sports, and the workplace. Many specialize in treating back and neck pain.

What is PM&R?

Physiatrists treat the whole person. They address the patient’s physical, emotional, and social needs during rehabilitation. Physiatrists direct a rehabilitation team that may include physical or occupational therapists, speech-language pathologists, social workers, and athletic trainers.

PM&R doctors work in clinics, hospitals, and rehabilitation centers.

How can PM&R help me?

PM&R doctors can help patients with chronic disease, pain, or disabilities progress toward optimal function. Rehabilitation involves the use of physical agents and therapeutic exercise to help patients:

• reduce pain
• improve quality of life
• recover from temporary or severe impairment
• learn how to use assistive devices, such as braces, wheelchairs, and walkers

Medical management

PM&R doctors are trained to treat and control acute or chronic pain with medications and holistic approaches that include mindfulness, Yoga, Pilates, dry needling, and anti-inflammatory diets.

Acute pain is directly related to tissue damage and has an obvious source. Chronic pain, whose origin can be difficult to pinpoint, is persistent and can last for months. In some cases the brain will continue to receive pain signals even after an injury has healed. Chronic pain also is frequently present in ongoing conditions, such as arthritis or cancer.

• Self care: Patients can protect their back by using correct posture, by keeping their spine in alignment, and by following through with physical therapy or a regular exercise program. When you are in pain, you need to change the way you approach daily activities. You may need to make adjustments to your workspace and your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend.
• Electromyogram (EMG) and nerve conduction studies: These tests measure the electrical activity of the muscles and nerves of the body, usually to an arm or a leg. The tests can help identify a nerve or muscle condition such as carpal tunnel syndrome, a pinched spinal nerve, peripheral neuropathy, myositis, or ALS. The presence or absence of injury can be helpful in determining further treatment.
• Braces: Wearing a back or neck brace may be advisable while the muscles are being strengthened following surgery or an injury. The brace can decrease muscle spasm and pain as well as help immobilize the spine during the healing process.

Injections and procedures

PM&R doctors perform a variety of minimally invasive tests and treatments to help patients recover from painful conditions. These include:

• Epidural steroid injection (ESI): The treatment involves an injection of corticosteroid and numbing medicines directly into the space around the spinal nerves. X-rays are used to help guide the needle to the correct location. Pain relief may last a week to a year. The goal is to enable you to work, resume daily activities, and perform physical therapy.
• Facet joint injection: This treatment involves an injection of a corticosteroid and numbing medicines into a painful facet joint in the back or neck. The injection can relieve inflammation and pain; it also can be used as a diagnostic test to determine which joint is causing the pain.
• Joint injections: During this procedure, corticosteroid and numbing medicines are injected into the knee, hip, ankle, shoulder, elbow, or hand. The injection is likely to provide a temporary reduction in pain that could enable you to work, resume daily activities, and perform physical therapy.
• Sacroiliac (SI) joint injection: During this procedure the doctor injects a corticosteroid and numbing medicine into the large joint in the area of the lower back and buttocks. The injection relieves pain and help determine whether the SI joint is causing your pain or whether the pain is originating from another location.
• Nerve block injection: This test is used to determine whether your pain is coming from a nerve or joint. An injection of anesthetic is delivered on or near a pain receptor. Over the next couple hours, patients log their pain relief. If the block is successful, then a radiofrequency ablation may be recommended.
• Radiofrequency ablation (rhizotomy): This procedure may be recommended if you have had a successful nerve block. The physician applies a radiofrequency current to burn the sensory nerves surrounding a painful joint and prevent pain signals from reaching the brain. The expected benefits of radiofrequency ablation include pain relief that may last from 6 months to more than 2 years, allowing you to work and engage in daily activities comfortably.
• Spinal cord stimulator trial: This test involves the temporary placement of electrodes that deliver electrical pulses to the spinal cord. The electrodes are attached to a small device that resembles a pacemaker. If the electrical pulses successfully override pain signals, thereby reducing pain, the trial is considered a success. The electrodes and stimulator device can then be surgically implanted.

PM&R doctors offer a variety of treatments. These range from non-invasive (such as physical therapy, massage, exercise, and braces) to minimally invasive interventions for pain (such as steroid injections, nerve blocks and ablations, and spinal cord stimulation). If conservative care does not resolve the problem, your PM&R physician transitions your care to a Mayfield neurosurgeon so that further treatment options can be discussed.

PM&R Services

• Epidural Steroid Injections
• Electromyogram (EMG) & Nerve Conduction Test
• Facet Injections
• Nerve Block Injections
• Sacroiliac (SI) Joint Injections
• Joint Injections
• Trigger Point Injections

If you get into a car accident, there’s a good chance you or your passengers might suffer an injury. The National Safety Council estimates there were 5.7 million drivers involved in 3.1 million car crashes in 2019. Those accidents resulted in 4.5 million “medically consulted injuries.”

Personal injury protection (PIP) can cover injuries to you and your passengers, no matter who caused the accident. But variations in state laws can make PIP tricky to pin down. Many states require PIP as part of their “no-fault auto insurance” laws, which limit your ability to sue someone for car crash injuries.

While each state sets its own “threshold” for when you can sue, no-fault insurance laws typically require that you make smaller injury claims on your own PIP insurance.

PIP insurance generally covers:

• Medical expenses from a car accident.
• Wages lost due to the injuries.
• Rehabilitation costs.
• Replacement services for things you can’t do for yourself or your family, because of the accident, such as house cleaning and child care.
• Funeral expenses and survivor benefits.

A goal of PIP is to provide prompt payment for car accident injuries. Because PIP claims are paid regardless of who caused the accident, there’s no waiting around for a liability lawsuit against someone else to be resolved.

Get Checked by a Medical Professional (Even if You Don’t Have Immediate Car Accident Symptoms or Pain)

While it’s common to have neck pain after a car accident, many people refuse to see a doctor because they don’t notice any visible injuries or think they don’t think their symptoms are severe. This is a serious mistake because while many car accident symptoms may not show up until days, weeks, or even months after the crash, they may have just as serious long-term effects as broken bones or a dislocated joint. Whiplash and concussions are prime examples of this. Other car accident symptoms that may not show up until much later include:

• Headaches
• Numbness
• Abdominal swelling and pain
• Loss of physical function
• Personality changes
• Post-traumatic stress syndrome

Just because some of these injuries don’t appear right away doesn’t mean that you won’t have lifelong problems from them. By visiting a medical professional shortly after the accident, you can determine such things as soft tissue injuries as well as have a written record of your visit. This is important to establish credibility if the lawyer for the at-fault party claims your injuries couldn’t have been that serious if you didn’t even visit a doctor for them.

Keeping a diary of any doctors, physical therapists, chiropractors, caregivers, or any other medical professional you receive treatment from, as well as itemizing any related expenses, will help your insurer, your attorney, and the court understands the full extent of your injuries and any related costs.