What Is Physical Medicine and Rehabilitation? FAQs

The medical field of Physical Medicine and Rehabilitation is a mystery for some people. Its heritage dates back to 1928 when it was first founded as a Department at Temple University Medical School, and then shortly thereafter at the Mayo Clinic. It was established as an independent Board of Medicine Specialty in 1947.

Yet many patients who could significantly benefit from the Physical Medicine and Rehabilitation medical specialty know nothing about it. Others are confused about how it can help many patients avoid major orthopedic surgery. Or restore the quality of life and alleviate pain for those with a wide array of musculoskeletal and neurologic disorders.

There are more than twelve-thousand board certified physical medicine and rehabilitation specialists in practice today. But patients and even physicians in other specialties continue to struggle to grasp the full scope of its programs and patient care activities.

Here are some common questions that can make this growing medical field easier to understand.

What is Physical Medicine and Rehabilitation?

Physical Medicine and Rehabilitation is a medical specialty that treats a wide variety of musculoskeletal and neurologic disorders. These include conditions that affect the spinal cord, brain, nerves, bones, joints, ligaments, tendons, and muscles.

Physical Medicine and Rehabilitation is grounded in comprehensive, integrated, and multidisciplinary patient-centered care. It focuses on the whole person, not just an affected body area. It seeks to recover function, reduce pain, and restore an individual’s quality of life from impairments caused by injury, disease, or malformation.

One of the core components of Physical Medicine and Rehabilitation is the design of treatment-plans based around a care team. Physical Therapists and other medical providers are often integrated into those plans.

The preferred goal from the outset is to use non- and minimally invasive, cutting-edge procedures to manage complex spine, musculoskeletal, and neurologic conditions. But if major surgery becomes an appropriate option for a patient, a Physical Medicine and Rehabilitation doctor will often bring other medical specialists into the mix.

Physical Medicine and Rehabilitation is also known as Physiatry or PM&R. A doctor specializing in physical medicine and rehabilitation is called a Physiatrist.

Required Training

Physiatrists must complete medical school and an internship, followed by residency in a hospital specializing in Physical Medicine and Rehabilitation. Some physiatrists also receive additional advanced degrees, participate in fellowships, and qualify for additional certification in one or more PM&R subspecialties.

What medical services are offered by Physical Medicine and Rehabilitation?

Physical Medicine and Rehabilitation offers a wide range of medical services customized for the needs of each individual patient. These may include:

• General Physiatry: Helping patients with chronic pain, disabilities, or physical impairments regain quality of life and avoid major surgery.
• Comprehensive Spine and Musculoskeletal Medicine: Treating a wide range of problems that affect the spine and musculoskeletal system, including sciatica pain, muscle and ligament injuries, joint problems, osteoarthritis, spinal cord and disc injuries, and more.
• Pain Management: Diagnosing and treating patients experiencing acute or chronic pain problems.
• Sports Medicine: Working with athletes and active individuals on the prevention, diagnosis, and treatment of injuries related to participating in sports and exercise.
• Neuromuscular Medicine: Evaluating and treating patients with disorders of nerves, muscles, or neuromuscular junctions.
• Brain Injury Medicine: Preventing brain injuries, and the evaluation, treatment, and rehabilitation of individuals with acquired brain injuries.
• Pediatric Rehabilitation Medicine: Diagnosing and managing congenital and childhood-onset impairments and disabilities.

You may find the full array of these services in the PM&R department of a large hospital system. However, typically, individual Physical Medicine and Rehabilitation clinical practices and individual practitioners will specialize in a subset of the services listed above.

How are conditions and injuries diagnosed in Physical Medicine and Rehabilitation?

Physical Medicine and Rehabilitation diagnostics combine physicians’ normal diagnostic tools with specialty procedures and tools. These may include:

• Comprehensive patient histories
• Physical examinations
• Imaging (MRIs, CT Scans, X-rays, and ultrasounds)
• Musculoskeletal ultrasound
• Electromyography (EMG)
• Nerve Conduction Studies (NCS)
• Diagnostic nerve block tests
• Collaborative input from neurologists, orthopedists, neurosurgeons, other physiatrists, physical therapists, occupational therapists, speech therapists, and primary care physicians

What are the kinds of treatments used in Physical Medicine and Rehabilitation?

Depending on the injury, illness, or disabling condition, Physical Medicine and Rehabilitation treatments may use one or more of the following procedures:

• Therapeutic exercise (Physical Therapy)
• Fluoroscopy (X-ray) and ultrasound-guided spine and joint, diagnostic and therapeutic injections
• Trigger point injections (TPI)
• Radiofrequency ablations (RFA)
• Neuromodulation pain relief therapies (Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, Peripheral Nerve Stimulation)
• Spasticity treatments
• Prolotherapy
• Osteopathic treatment
• Prescriptive medications
• Biotherapeutics
• Advanced interventional spine procedures

The list above is by no means exhaustive. The field of Physical Medicine and Rehabilitation is vibrant, with new therapy alternatives emerging on a frequent basis.

When is it appropriate to see a Physical Medicine and Rehabilitation doctor?

Physical Medicine and Rehabilitation is appropriate for patients suffering from musculoskeletal and neurologic disorders – and who are seeking treatment options to avoid major orthopedic or neurologic surgery.

Conditions may include:

• General orthopedic and musculoskeletal injuries
• Back, spine and joint injuries
• Sports injuries
• Work injuries
• Musculoskeletal injuries sustained from accidents
• Chronic pain, including in the neck, lower back, and joints
• Muscle tears, strains, and sprains
• Bursitis and tendonitis when related to the shoulder, elbow, wrist/hand, knee, foot, and ankle
• Osteoarthritis
• Overuse injuries
• Nerve disorders, including carpel or tarsal tunnel syndromes

Physical Medicine and Rehabilitation doctors work with other medical providers – including neurologists, orthopedists, neurosurgeons, other physiatrists, physical therapists, occupational therapists, speech therapists, internal medicine and primary care physicians – as they determine the best-customized treatment plan for each patient.

What is the difference between Physical Medicine and Rehabilitation vs Physical Therapy?

Physical Medicine and Rehabilitation physicians are licensed doctors who have completed medical school and a required internship and residency. They lead the diagnosis, treatment, and management of musculoskeletal and neurological issues. They design a comprehensive treatment plan based on their findings, can perform invasive medical procedures when appropriate, and can prescribe medications.

Physical therapists are responsible for executing the therapeutic exercise portion of the treatment plan provided by the Physical Medicine and Rehabilitation physician. They play a key role in the Physical Medicine and Rehabilitation extended team.

More on -> What Is a Physiatrist? FAQs