American Academy of Physical Medicine and Rehabilitation Physicians

[Justin]

The following information is from the American Academy of Physical Medicine and Rehabilitation. Visit the AAPM&R website here.

What is a Physiatrist?

Physiatrists, or rehabilitation physicians, are medical doctors who are:

• Experts at diagnosing and treating pain

• Restore maximum function lost through injury,illness or disabling conditions

• Treat the whole person, not just the problem area

• Lead a team of medical professionals

• Provide non-surgical treatments

• Explain your medical problems and treatment plan

• Work not only on treatment but also prevention

Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

To find a rehabilitation physician in your area, search the Find a PM&R Physician database. <-- Clickable Link

Learn more about the specialty <--Clickable Link

What is physical medicine and rehabilitation?

Physical medicine and rehabilitation (PM&R), also called physiatry, is the branch of medicine emphasizing the prevention, diagnosis, and treatment of disorders – particularly related to the nerves, muscles, and bones – that may produce temporary or permanent impairment. PM&R is one of 24 medical specialties certified by the American Board of Medical Specialties. PM&R provides integrated care in the treatment of all conditions related to the brain, muscles, and bones, from traumatic brain injury to lower back pain.

[Justin]

Physical Medicine and Rehabilitation (PM&R) physicians--physiatrists--are one of the 24 approved medical specialities within the United States. The residency is 3 years long after a year long "internship."

Below is from the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Link:

A physiatrist, pronounced fizz ee at' trist, is a physician specializing in physical medicine and rehabilitation (PM&R). PM&R or physiatry is the branch of medicine emphasizing the prevention, diagnosis, treatment, and rehabilitation of disorders, particularly those of the neuromusculoskeletal, cardiovascular, and pulmonary systems, that may produce temporary or permanent impairment. Physiatry is unique among medical fields in that its area of expertise is the functioning of the whole patient, as compared with a focus on an organ system or systems.

A physiatrist treats disorders such as:

• Back Pain
• Sports Injuries
• Stroke Rehabilitation
• Spinal Cord Injury
• Chronic Pain
• Traumatic Brain Injury
• Arthritis
• Carpal Tunnel Syndrome

In addition to management used in general medical practice, physiatrists use therapeutic exercise, heat, light, water, electricity, bracing, prosthetic and adaptive devices to treat patients of all ages. Physiatrists also attend specifically to physiologic adaptation to disability and to preventing complications or deterioration secondary to disabling conditions. 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.

As people survive conditions that once would have been fatal, the field of physiatry is moving to the forefront of medicine. The specialty serves all age groups and treats problems that touch upon all the major systems of the body.

There are only two specialties that include specific training in electrodiagnostics as a substantial part of their curriculum-neurology and PM&R. Only PM&R allows enough training during residency to allow for board certification in the procedure. Electromyography (EMG) consists of inserting fine needle electrodes in muscles and observing the recorded motor unit potentials when the muscles are activated. Nerve conduction studies (NCS) use electrodes to record motor and sensory responses that are propagated by electrical stimuli. Evoked potentials (EP) are typically used to measure sensory responses more proximally in the spinal cord, brainstem, and brain. These serve adjunctive roles in the diagnosis of various neuromuscular disorders including compression neuropathies, radiculopathies, peripheral neuropathies, motor neuron diseases, neuromuscular junction pathologies, and myopathies.

In recent years, the field of physiatry has grown to incorporate the use of interventional spinal therapeutics to treat the growing number of patients with chronic debilitating back pain. Specialized training in image-guided spinal diagnostics and injections includes the use of epidural, transforaminal, and selective nerve root blocks. These techniques are being used as a nonsurgical pain-relieving intervention for our patient population. (My emphasis)

Here's a list of treatments:

The physiatrist is specially trained in management of musculoskeletal disorders and various other entities including pharmacologic control of spasticity, chronic pain, bowel and bladder management, and behavioral training in head-injured patients. Invasive techniques such as injections are options for arthritis, bursitis, tenosynovitis, overuse, and myofascial pain syndromes.

Physical medicine refers to the use of physical principles and dynamic intervention to decrease pain, improve range of motion, and maximize musculoskeletal function.

Examples of these agents are listed in Table 1 below:

Type

Specific Modality

superficial

cold ice massage, ice baths

superficial heat

hot packs, heat lamp, paraffin baths, fluidotherapy

deep heat

ultrasound, short wave, microwave

electricity

transcutaneous nerve stimulation (TENS), high voltage galvanic stimulation (HVGS),
interferential current, iontophoresis, functional electrical stimulation (FES)

hydrotherapy

whirlpool, contrast baths

manual

massage, manipulation

other

traction, biofeedback, positive pressure pumping, phonophoresis,
laser, ultraviolet light, microwave diathermy

The physiatrist is also trained in writing specific exercise programs tailored to the patient's needs. The emphasis is on maintaining and increasing range of motion, muscular strengthening, improving proprioception (awareness of joint position in space) muscle relaxation, and aerobic fitness, all in the context of improving function. Examples might include strengthening and enhancing proprioception in a runner's sprained ankle, improving range of motion and preventing contracture in a spastic spinal-cord-injured patient, or providing optimal cardiopulmonary fitness in someone who has recently suffered a myocardial infarction.

Also available to the physiatrist is a host of assistive and adaptive equipment including gait and mobility aids, environmental control devices, communication aids, and various other tools to allow greater independence, optimal safety, and decreased energy expenditure in activities of daily living (ADLs).

One area of expertise is the selection and fitting of wheelchairs and appropriate seating. The PM&R physician is also specially trained to prescribe proper orthoses (e.g., upper and lower limbs, and back bracing) and to recommend prostheses to amputee patients.

Much of the practice of PM&R is built on the "team approach," a unique interdisciplinary perspective on patient care. The patient's physical, functional, emotional, and psychosocial well-being are all considered in treatment. The typical members of a rehabilitation team, in addition to the physiatrist, might include representatives from:

• physical therapy
• recreational therapy
• social services
• internal medicine
• occupational therapy
• rehabilitation nursing
• speech therapy
• neuropsychology

If patient contact is high on your list of priorities, this field offers the opportunity to work closely with individuals who have long-term disabilities and could continue to have changing needs with advancing age. This provides the satisfaction of observing the response to therapeutic intervention over a longer period of time. In a sense, the physiatrist may serve the role of the "primary caregiver" for individuals with disabilities.

I hope this helps.

[Justin]

Here's the Frequently Asked Questions About PM&R from the AAPM&R (Link):

What is physical medicine and rehabilitation?
Physical medicine and rehabilitation (PM&R), also called physiatry, is the branch of medicine emphasizing the prevention, diagnosis, and treatment of disorders – particularly related to the nerves, muscles, and bones – that may produce temporary or permanent impairment. PM&R is one of 24 medical specialties certified by the American Board of Medical Specialties. PM&R provides integrated care in the treatment of all conditions related to the brain, muscles, and bones, from traumatic brain injury to lower back pain.

What is a rehabilitation physician?
Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R). They are sometimes referred to as PM&R physicians or physiatrists.

Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. To learn about some of the conditions rehabilitation physicians treat, click here.

How do rehabilitation physicians diagnose?
Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. Their specific diagnostic tools are the same as those used by other physicians (medical histories, physical examinations, and imaging studies), with the addition of special techniques in electrodiagnostic medicine like electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. These techniques help the rehabilitation physician to diagnose conditions that cause pain, weakness, and numbness.

What is the rehabilitation physician’s role in treatment?
Once they have a diagnosis, rehabilitation physicians design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This interdisciplinary medical team may include medical professionals such as neurologists, psychiatrists, orthopedic 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. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime. To learn more about a rehabilitation physician’s role in treatment and why you might choose such treatment, click here.

What is the scope of the rehabilitation physician’s practice?
PM&R is often called the quality of life profession because its aim is to enhance patient performance. The job of a rehabilitation physician 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 rehabilitation physicians manage span the entire spectrum, from the most complicated multiple trauma to injury prevention for athletes. Some rehabilitation physicians have broad-based practices that encompass many different types of patients. Others pursue special interests and focus on specific groups or problems. For example, sports medicine has grown as a special interest. Rehabilitation physicians who focus on sports medicine treat sports-related injuries, develop programs to help athletes avoid injury, and may do research in the field.

What kind of training do rehabilitation physicians have?
To become a rehabilitation physician, individuals must graduate from medical school followed by four additional years of postdoctoral training in a physical medicine and rehabilitation residency. This includes one year 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 rehabilitation physicians 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, rehabilitation physicians are required to take both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPMR). The ABPMR 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. To find out why it is important to see a physician who is board certified, click here.

How did the specialty develop?
The field of physical medicine and rehabilitation (PM&R) began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The Advisory Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947.
To learn more about the history of PM&R, click here.

Where do rehabilitation physicians practice?
Rehabilitation physicians 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, and many other special interests.

How can I locate a rehabilitation physician?
There are more than 7,500 rehabilitation physicians practicing in the United States today. As a public service, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) provides listings of its member rehabilitation physicians by state.
Click here for our online "Find a PM&R Physician" searchable database.