Is Physical Medicine the same as Physical Therapy?

While physical medicine and physical therapy may seem like they are the same thing, they are quite different disciplines. The two often go hand-in-hand for treatment, but each plays a different role in the process of rehabilitation and treatment. We have provided key information for determining the difference between the two and also tips to help you decide which route is best for you.

What is physical medicine?

Physical medicine is a specialty practiced by physiatrists. A physiatrist is a fully trained medical doctor who has also completed four years of post-graduate training in Physical Medicine and Rehabilitation after completing medical school. This is completed through a residency or an internship with an accredited program. This training provides an in-depth study of medicine, biomechanics, musculoskeletal function, anatomy, and disordered associated with the musculoskeletal system and neurological system.

Physiatrists treat patients who have suffered injuries or have disabilities that affect physical and/or cognitive function. Physical medicine, or physiatry, is a type of rehabilitation medicine that treats and prevents disabilities regarding the brain, nerves, bones, and muscles. With the use of physical therapy and pain treatments, physiatrists help their patients avoid surgery while improving their physical functioning, alleviating pain, and more. Since they are medical doctors, they are able to prescribe medications and treatments, as well as make and manage any diagnosis.

What is physical therapy?

A physical therapist differs from a physiatrist in that they are not medical doctors. A good way to look at it is the physiatrist diagnoses the problem and prescribes the treatment that the physical therapist will help the patient with during physical therapy. Physical therapists are experts in providing hands-on care and helping the patient with exercises meant to improve the patient’s movement and rehabilitation.

Typically, a program to become a physical therapist takes three years to complete. Some schools require students to have a bachelor’s degree before entering the physical therapy program. Physical therapists can only provide holistic treatment since they are not medical doctors and cannot prescribe medications.

The chart below sums up the differences between physical medicine and physical therapy:

 Physical MedicinePhysical Therapy
Medical DoctorX 
Prescribe MedicineX 
Make DiagnosisX 
“Hands-On” Care X

Physical medicine testing & treatments

In order to make a diagnosis, a physiatrist can perform or prescribe a number of tests. Some of these tests include EMG (electromyography), NCS (nerve conduction studies), and Musculoskeletal ultrasounds. Of course, physiatrists often start with a basic physical exam and test the movement of the affected part of the body.

A physical medicine doctor can perform or prescribe a variety of treatments for physical medicine and rehabilitation purposes. Many times they prescribe therapeutic exercise to the patient and make a referral to a physical therapist to help with that. Physiatrists can prescribe pain medications, soft tissue injections, joint injections, and spine injections to help with pain management.

Physical therapy testing & treatments

The first visit with a physical therapist is usually spent completing an assessment. The physical therapist will ask a variety of questions relating to the patient’s health, the condition which has brought the patient to physical therapy in the first place, as well as a physical exam to test joint mobility.

Once the assessment is complete, the physical therapist will guide the patient through the prescribed physical therapy. This therapy often includes exercises that increase flexibility and movement, such as stretching and strengthening exercises. Manual exercise, manipulation, massage, heat or cold therapy, hydrotherapy, and ultrasound may be used.

Common medical conditions treated by physiatrists

If someone seeks out care from a physiatrist, it’s likely that this person is experiencing pain or limited mobility that affects everyday life. Some of the reasons a patient may seek treatment from a physiatrist include back pain, neck pain, multiple sclerosis, herniated discs, degenerated disc disease, pinched nerves in the back or neck, frozen shoulder, rotator cuff injuries, plantar fasciitis, carpal tunnel, concussion, sports injuries, strokes, brain injuries, neuromuscular disorders, Parkinson’s disease, sciatica, fibromyalgia, spinal cord injuries, arthritis, pelvic floor disorders, and cancer rehabilitation.

Common conditions treated by physical therapists

There are many reasons a patient may seek the help of a physical therapist. There’s a common misconception that physical therapy is just to help patients rehabilitation following an accident or surgery. However, physical therapists can be helpful in alleviating pain or improving range of motion, among other things.

Some conditions that cause a patient to get treatment from a physical therapist include sports injuries, back and neck pain, knee ligament injuries, muscular dystrophy, osteoporosis, vertigo, headaches, carpal tunnel syndrome, lymphedema, joint replacement, burns, sprained ankles, Parkinson’s disease, fractures, Huntington’s disease, pelvic floor disorders, and even cancer.

When to see a physiatrist versus a physical therapist

If you’re wondering whether you should see a physical therapist or a physiatrist, it’s important to note that both include a more holistic approach to rehabilitation, and surgery is not involved. If you’re experiencing high levels of pain and need medicine for pain management, it’s recommended to visit a physiatrist as they have the ability to prescribe medications while physical therapists do not.

Starting with a physiatrist is probably your best bet. The reason for this is a physiatrist will be able to design a comprehensive medical plan that includes both medicine and physical therapy. While the physiatrist will design the plan, the physical therapist will execute the plan with you during therapy sessions.

When to seek treatment from a physiatrist and/or physical therapist

If you have been told that you will need surgery to fix a musculoskeletal issue, you may want to get a second opinion from a physiatrist. It’s at least worth a shot to get an exam and the diagnosis either confirmed or perhaps try physical therapy instead. If surgery is being considered to get rid of chronic pain, a physiatrist may be able to help and you may not need surgery.

Patients who have had, or currently have, an illness or disease that limits physical function or causes chronic pain can also benefit from visiting a physiatrist and receiving treatment from a physical therapist. As previously mentioned, cancer patients often seek the help of physiatrists to help alleviate pain caused by treatments.

Nerve damage, whether from a stroke or from any other cause, can affect movement. Treatment from a physiatrist and physical therapist team can help you regain mobility and restore physical functioning.

One of the most common reasons patients visit a physiatrist or physical therapist is during recovery from surgery. Whether the patient has had a knee or hip replacement or back surgery, therapy can help. Especially with joint replacement, it’s important that the patient is actively moving the joint so that they regain mobility. Without physical therapy, the patient may have reduced mobility that would cause the patient to have another surgery.

Rehabilitation vs. medication

Both physical medicine and physical therapy take the whole body health into account. Treatment is not based solely on the location of the pain, but time is spent determining the actual cause of the pain. Pain is not seen as a condition but rather a symptom of an underlying cause. So while a physiatrist can prescribe medication to help alleviate the pain, additional work will be done to try to fix the source of the pain for rehabilitation. Physical medicine is very different from just a pain management practice.

Amputee rehabilitation & prosthetics

Another aspect of physical medicine and rehabilitation through physical therapy is prosthetics and all that is involved. This is often referred to as physical medicine and rehabilitation (PM&R) One of the reasons that the field of PM&R originally began was due to the thousands of veterans returning home with serious disabilities after World War II. The physical medicine field was tasked with helping these veterans with rehabilitation so that they could once again live productive lives. 

Physiatrists are the ones who provide the prescriptions for prosthetics. A physiatrist will often work hand-in-hand with a prosthetist because each has skills that will benefit the patient. The physiatrist can make sure the patient is fitted with a quality prosthetic, can prescribe medications for pain, and also prescribe physical therapy.

Learning to live as an amputee is a difficult road. The patient may have limited mobility in the affected limb or simply need to learn how to use a prosthesis. Physical therapists can work with the amputee to increase mobility and strength to help them rehabilitate, not only for being productive but also to be able to enjoy sports and other activities they once enjoyed.

Summary

In summary, physical medicine and physical therapy are quite different disciplines, but they work hand-in-hand to provide the patient with the best care. A physiatrist can manage the patient’s rehabilitation plan and look at the patient’s overall health to prescribe physical therapy and any medications that are needed for pain management. The physical therapist will be able to execute the physiatrist’s prescribed physical treatment plan to help the patient rehabilitate and gain mobility.