What Is a Physiatrist?

Determining what kind of doctor to visit can be challenging when you have body pain or a musculoskeletal injury.

• Will self-help, exercise, and physical therapy effectively resolve the problem without seeing a doctor?
• Or is the condition severe enough to require orthopedic surgery?

For many, there is an answer. A comprehensive resource for treatment options between these two extremes is physiatrist medical doctors.

What is a physiatrist?

Physiatrists are medical doctors specializing in restoring movement and relieving pain. They focus on issues caused by spinal cord injuries, nerve issues, and muscular, skeletal, and joint conditions. Physiatrists are experts in evaluating, diagnosing, and treating these conditions.

They are also known as Physical Medicine and Rehabilitation, PM&R, or physiatry doctors. It is a relatively new medical discipline, established in 1945 after WWII.

Physiatry doctors are trained to focus on the whole patient and how each major organ system can impact function. They leverage a broad range of knowledge, including musculoskeletal, neurological, rheumatological, and exercise physiology.

Many physical medicine and rehabilitation doctors have additional expertise in pain medicine, sports medicine, and other complementary subspecialties. They can further specialize in a specific body area, like the spine, hip, knee, shoulder, foot, ankle, hand, and wrist. They may concentrate their practice on treating particular conditions or injuries.

Physiatrists use their expertise to give patients a big-picture overview of available treatments and preventive measures. They aim to help individuals remain as active as possible regardless of age. Today, physiatry is one of the most comprehensive, multifaceted, and fastest-growing areas of medicine.

What exactly does a physiatrist do?

Physiatrists specialize in assessing and addressing conditions related to the spine, sports, and neurological system. They also focus on bone and muscle issues, such as injuries, illnesses, chronic pain, disabilities, and physical impairments. They address these conditions through a combination of non-surgical therapies and medications.

They also perform a wide range of minimally invasive treatments. These include:

• fluoroscopic-guided spine and joint therapeutic injections
• trigger point injections
• radiofrequency ablations
• neuromodulation pain relief therapies
• advanced interventional spine procedures

The practice of physical medicine and rehabilitation (PM&R) is built on a personalized, interdisciplinary team approach dedicated to the whole person. This includes everything required to treat pain, restore function, and improve quality of life. Thus, physiatrist doctors frequently lead in coordinating individual patient treatment plans across multiple medical disciplines and providers beyond PM&R alone.

For example, they often collaborate closely with primary care physicians, internal medicine physicians, cardiologists, oncologists, neurosurgeons, neurologists, and physical therapists. This approach helps them provide seamless, patient-centered care. They also will refer patients to an orthopedic surgeon when advanced surgical care is deemed appropriate.

What kind of training do physiatrists require?

Physiatrists must undergo a significant amount of training to practice. This consists of four years of medical school and one year of internship. This is followed by three years of residency in a hospital specializing in physiatry. Some also receive advanced degrees and fellowships in several areas of subspecialization.

What subspecialties might physiatrists be certified in?

Many physiatrists narrow their medical practice after their board certification in Physical Medicine and Rehabilitation (PM&R). They concentrate on a more specific area of physiatry’s broad field. These subspecializing physiatrists may be additionally certified in one or more of the following seven subspecialties of PM&R:

• Brain Injury Medicine
• Hospice & Palliative Care
• Neuromuscular Medicine
• Pain Medicine
• Pediatric Rehabilitation Medicine
• Spinal Cord Injury Medicine
• Sports Medicine

How do physiatrists diagnose patients?

Physiatrists identify problems by conducting comprehensive patient histories, physical examinations, and, when necessary, radiologic imaging (MRIs, X-rays, and ultrasounds). For some situations, they may also use musculoskeletal ultrasound, electromyography (EMG), or nerve conduction studies (NCS). These tests help diagnose complex neurological or musculoskeletal injuries.

A physical medicine and rehabilitation doctor will perform a diagnostic nerve block test in advanced cases. This is used to confirm a patient’s pain source and level. That information can then predict the potential level of pain relief from some treatment options.

What common conditions do physiatrists treat?

Physiatrists provide care for a wide variety of medical conditions. This includes the more common aches and pains in the lower back, neck, shoulder, hips, and knees. It also covers more serious issues, including spinal cord injuries and neurological problems.

These conditions may involve lumbar disk disorders, knee osteoarthritis, radiculopathy, degenerative joint disease, spinal stenosis, and spondylolisthesis. It also includes peripheral neuropathy pain, complex regional pain syndrome, phantom pain, and more.

How do physiatrists differ from physical therapists?

Physiatrists and physical therapists treat patients with many of the same types of conditions. However, physiatrists are doctors who have completed medical school plus one year of internship and three years of residency training. Physical medicine and rehabilitation doctors diagnose injuries and conditions, design and execute treatment protocols, and can prescribe medications. They prescribe treatment regimens that physical therapists utilize.

A physical therapist is a healthcare professional who does not have the authority to prescribe medications or perform invasive medical procedures, unlike a medical doctor. They supervise and institute exercise programs to ease symptoms and improve function.

How do you know when to see a physiatrist?

You should seek treatment from a physiatrist if:

• You have a muscle, bone, or joint issue that is causing pain or limiting how freely you can move.
• You are experiencing chronic lower back pain. This is of particular concern if it radiates down one or both legs or worsens when walking or standing.
• You are experiencing chronic neck pain that radiates into your arms or chest.
• You are suffering from chronic arthritic joint pain.
• You have pain from a sports, work, or repetitive stress injury without a clear path for recovery.
• You have suffered a stroke or other nerve damage that impairs your physical abilities.
• You have ongoing chronic pain after joint replacement surgery.
• You have phantom pain from an amputation.
• You are considering orthopedic surgery as a solution to relieve chronic pain.

Patients often see a physical medicine and rehabilitation doctor before meeting with an orthopedic surgeon. This allows a physiatrist to evaluate a patient thoroughly and devise a plan of action. This may enable you to opt for non- or minimally-invasive treatments that may solve the problem without surgery.