Everything You Need to Know About PM&R

PM&R stands for Physical Medicine and Rehabilitation. PM&R is a medical specialty that is often called physiatry. This medical specialty was recognized by the American Medical Association in 1946 after World War II veterans began returning home with injuries and disabilities. These soldiers needed special care and therapy to be rehabilitated into civilian life again so that they could work and function.

What is a PM&R physician?

A physician who works in the PM&R medical specialty field is called a physiatrist. Sometimes physiatrists are confused with physical therapists, but there are differences between the two.

A physiatrist and a physical therapist often work hand-in-hand to provide patient care. The main difference between the two is that a physiatrist is a trained medical doctor who has completed an additional four years of post-graduate training in Physical Medicine and Rehabilitation after completing medical school.

Because physiatrists are medical doctors, they can diagnose and prescribe medications and treatments. A physiatrist looks at the overall patient health and creates a rehabilitation plan which often includes both medications for pain management as well as physical therapy.

Physiatrists often have subspecialties in brain injury medicine, rehabilitation medicine, spinal cord injury medicine, sports medicine, internal medicine, neuromuscular medicine, musculoskeletal rehabilitation, pain medicine, pediatric rehabilitation medicine, hospice, and palliative medicine.

What do PM&R doctors do?

The goal of a physiatrist is to restore mobility, reduce pain, improve quality of life, and rehabilitate individuals with physical impairments or disabilities. Their methods are always nonsurgical. Physiatrists can provide care for patients who have suffered a stroke, brain, or spinal cord injury as well as patients with pain caused by musculoskeletal injuries- meaning injuries related to the muscles, tendons, joints, and bones.

Additional medical conditions and disabilities that physiatrists treat can include cognitive problems, orthopedic anomalies, gait disorders, muscle pain, and muscle stiffness. Physiatrists can also diagnose bowel and bladder issues, feeding and swallowing problems, and speech/communication issues.

Since physiatrists address the overall health of the patient, they not only take into account the pain or injury, but also the patient’s emotional and social needs during the rehabilitation process. A physiatrist may prescribe treatment with a physical therapist, occupational therapist, speech-language pathologist, or athletic trainer. They may also bring a social worker into the patient’s rehabilitation team. These physicians address caregiving, the ability to dress, bathe, eat, and also educational and vocational issues.

A good way to look at it is the physiatrist is the physician who makes the diagnosis, creates a plan of treatment, prescribes the medication needed, and creates the overall plan that may include physical or speech therapy. The physiatrist directs the professionals who help the patient with more hands-on treatments and therapies.

What tests and diagnostics are used in the PM&R field?

While some patients visit a physiatrist as a referral from a physician who has already diagnosed the condition, other patients visit a physiatrist to obtain their first diagnosis. Either way, the physiatrist can develop a plan and course of action to control pain and maximize movement.

A physiatrist can perform a physical test to check flexibility, strength, and general movement. Beyond physical testing, there are additional tests that can be done. An EMG, or electromyogram, and nerve conduction studies may be done. The electric activity of the muscles and nerves in the body is measured. This electric activity can help identify a nerve or muscle condition such as a pinched spinal nerve, peripheral neuropathy, ALS, and carpal tunnel.

Musculoskeletal ultrasounds can also be done. This test is a non-invasive technique that can capture images of muscles, ligaments, tendons, and joints. Physiatrists can use this test to diagnose sprains, tears, and other soft tissue injuries.

Another test that can be done is a spinal cord stimulator trial. During this test, electrodes are placed to deliver electric pulses to the spinal cord. If the electrical signals override pain signals and reduce pain, a stimulator device can be implanted to help control pain.

What treatment falls under PM&R?

Treatments in the PM&R field can vary depending upon the injury or reason for care. Some treatments involve medications while others do not. Here are some of the treatments that fall under PM&R:

  • Pain medication
  • Physical therapy
  • Occupational therapy
  • Recreational therapy
  • Passive physical therapy
  • Massage
  • Spinal injections
  • Epidural injections
  • Peripheral joint injections
  • Trigger point injections
  • Facet joint block injections
  • Sacroiliac joint injection
  • Spasticity management
  • Nerve block injection
  • Radiofrequency ablation (rhizotomy)
  • Acupuncture
  • Prolotherapy
  • Platelet-rich plasma injections
  • Autologous stem cell treatments
  • Health psychology
  • Assistive devices
  • Back/neck braces

What is PM&R in Neurology?

Neurologists and physiatrists often work hand-in-hand on the patient’s rehabilitation team. While a Neurologist can determine the cause of the neurological symptoms that a patient is experiencing, a physiatrist will work with the patient to prevent and treat pain associated with the neurological condition.

What do PM&R physicians prescribe?

Physiatrists can prescribe both medications, treatments, and invasive procedures. The specific medications that are prescribed can vary, but physiatrists prescribe medications for many different issues including pain, sleep issues, attention and memory issues, bowel and bladder problems, respiratory problems, gastrointestinal issues, and behavior.

While we have already listed common treatments that physiatrists often prescribe, there are also prescriptions needed for equipment. Physiatrists can prescribe wheelchairs, walkers, lifts, bath benches, crutches, braces, splints, and prosthetics.

Where do PM&R physicians practice?

Physiatrists often have their own private offices, work in rehabilitation centers, or provide their services in hospitals. Some physiatrists work as part of a pain clinic.

Why visit a PM&R physician?

If you want to avoid having surgery, starting with a PM&R physician will be your best course of action. Since they take the whole body into account to make a diagnosis and create a plan of treatment, you can be assured they will identify the source of your pain or discomfort rather than just treating the symptoms.

What conditions can PM&R help with?

If you have issues with mobility, you may want to visit a PM&R physician. People who have been in accidents and suffered injuries often visit a physiatrist not only to regain mobility but to control their pain. Many times people who are being treated for cancer or other major illnesses will visit a PM&R physician to help increase energy, move better, and manage pain. Survivors of strokes or nerve damage can also benefit.

Additional reasons to consider a PM&R physician include those who are obese and find it difficult to exercise, elderly people who don’t want to lose mobility, new mothers, and those who have arthritis or other joint problems.

Additional conditions that can receive help from PM&R physicians include automobile accident injuries, repetitive motion injuries, pinched nerves, concussions, back pain, neck pain, sprains, whiplash, occipital neuralgia, hip impingement, plantar fasciitis, tendonitis, bursitis, and work-related injuries. These are just some of the conditions that can benefit from care from a physiatrist.

Can a PM&R physician help with self-care concerns?

Yes, physiatrists can teach you ways that you can improve your condition on your own. They can help you learn how to have good posture, and provide advice on how you can adjust your daily life to help you deal with pain. For example, adjustments can be made to your workspace to ensure you are using proper posture or moving enough to keep your body from getting stiff and sore. They can also provide recommendations on creating a sleeping environment that won’t add pain. There are ways to lift heavy things so that you don’t injure your back as well as a proper way to bend over when gardening, or performing other activities where bending is involved.

What can a patient expect at a first PM&R appointment?

At your first appointment with a physiatrist, you can expect a physical exam and go over your medical history with the doctor. Since physiatrists take the whole body into account, they will want to get to know everything about you so they can get a full picture of what’s going on with you so they can provide the best care. The doctor will evaluate your symptoms and determine what you want to achieve, whether that’s improving or gaining mobility, or controlling pain.

The physiatrist will create a treatment plan that will be designed specifically for you and your concerns. They may prescribe medications for pain, physical therapy, or even prescribe additional testing.

Will I need surgery?

The goal of PM&R is to obtain an accurate diagnosis of your symptoms to pinpoint the cause of your pain or mobility issues. From there, it is a priority to avoid surgery. If your concern is something that can be fixed with therapy or other methods, this will be done rather than surgery. Physiatrists identify the source of the pain rather than just treat symptoms. However, sometimes surgery is inevitable. If this is the case, we work with great surgeons so that you continue to receive the best care. If you need additional care following surgery, we can help you rehabilitate.