Knee pain stops you from walking your dog. Muscle spasms keep you getting work done. Aches in your lower back prevent you from picking up your child.
Pain, an injury, brain and spine conditions, and other issues can disrupt the way you move and function throughout the day.
That's where a physiatrist can help.
A physiatrist is a doctor who specializes in physical medicine and rehabilitation. That means they can help you manage pain, restore your movement and improve the way you function. They may prescribe medications; physical, occupational or speech therapy; braces or prosthetics; or in some cases, they may perform injections.
"Physiatrists often are also called rehab doctors or PM&R doctors," says Courtney Stefanski, MD, a physiatrist at Rush. "They have expertise in neurologic and musculoskeletal conditions with a focus on optimizing function and quality of life."
If you're wondering whether you should see a physiatrist and what they can do for you, Stefanski has some advice.
When to see a physiatrist
"Any patient who has had a decline in their ability to function on a daily basis would benefit from seeing a physiatrist," Stefanski says.
Injuries and diseases that affect your musculoskeletal or nervous system can cause changes in how you can move and function. That can make it hard to work, stay active or provide care for loved ones.
A physiatrist can diagnose these problems and form a nonsurgical care plan. Some of the conditions they can help you manage include the following:
- Cancer and cancer treatment side effects
- Chronic pain, including lower back pain and nerve pain
- Joint disorders, such as arthritis, osteoarthritis and bursitis
- Parkinson's disease
- Multiple sclerosis
- Spinal cord injury
- Stroke
- Traumatic brain injury
"PM&R doctors also specialize in the care of patients after amputation," Stefanski says. "Other patients are recovering from major surgery or prolonged hospitalization with functional decline from deconditioning."
Deconditioning means you've lost physical function from not being active for a long time. This can happen when you've been in a hospital bed unable to fully move, for example.
If you're having trouble with any of these issues or you're not sure what's causing your difficulty functioning, you can make an appointment with a physiatrist to see how they can help.
You may be able to make that appointment directly. But in some cases, you may need a referral from another physician.
"Some insurance requires a referral from a primary care doctor," Stefanski says. "Otherwise, we welcome any patient who has concerns about their function to come see us any time."
What is the first appointment like?
During your first visit with a physiatrist, you can expect to have an evaluation of any conditions you have that affect your ability to function.
"We want to know the circumstances around the decline in the function, whether it was an acute injury or a progressive decline over time," Stefanski says.
Your physiatrist will ask you about any treatments you've already tried, including physical, occupational or speech therapy; medications, especially for pain; procedures; or injections.
They'll also talk to you about what you'd like to get out of your treatment.
"It is important to understand the person's specific goals, including things they would like to return to, such as driving, working or activities," Stefanski says.
The physiatrist will perform an exam with a focus on the conditions they've learned about from your medical history. They may order imaging and other tests to form a diagnosis too.
Some of the common tests physiatrists use for diagnosis include the following:
- X-ray: This uses radiation to take images of the inside of your body, including your bones. It may be a first test of choice if you haven’t had any previous imaging, especially if you have joint concerns, such as knee or back pain.
- Electromyography/nerve conduction study, or EMG/NCS: This test comes in two parts that measure electrical signals in your muscles and nerve cells. It’s used for patients with concerns about nerve damage. One part is a nerve conduction study, which uses electrodes placed on the skin that emit small electrical pulses to measure how fast signals travel. The other is electromyography, which uses a small needle electrode placed in the muscles to record nerve activity.
- Ultrasound: This technique uses sound waves to create images of the inside of your body. It can be used to check the condition of your tendons, muscles and nerves without radiation. It can help diagnose muscle tears and sprains or nerve issues, such as carpal tunnel syndrome.
- Magnetic resonance imaging, or MRI: This test uses magnetic fields and radio waves to take pictures of the inside of your body. It can help find the cause of your function loss. This is sometimes ordered if a patient has persistent pain after trying conservative and nonsurgical treatments; if they have numbness, tingling or weakness of a limb; or during planning of a procedure.
Once you've gone through a full examination and any imaging tests, your physiatrist will work with you on your care plan.
"A treatment plan with the patient's specific goals in mind will be provided, including options for conservative treatments as the first line, followed by more invasive options depending on the diagnosis and history of failed treatments," Stefanski says.
What kinds of treatments do physiatrists offer?
There are many treatments available for conditions that cause pain and loss of function. Physiatrists focus mainly on options that will help you avoid surgery.
"We frequently prescribe a combination of treatments," Stefanski says. "Active treatments will include participating in physical and/or occupational therapy or structured home exercise programs. These require active patient participation to improve stability and strength, endurance, gait, and dexterity."
Physiatrists may also prescribe medications. These can include pain medications, beginning with non-opioid medications, to treat muscle, joint or nerve pain. They may prescribe muscle relaxers for muscle strain or to treat spasms.
"PM&R doctors can also perform injections, such as steroid injections, to address joint and tendon injuries and reduce pain," Stefanski says.
Nerve blocks can also be injected to prevent nerves from sending pain signals to the brain. Botulinum toxin injections, also known as Botox, can be used to treat spasticity.
Another treatment for spasticity is called baclofen pump management. It involves using an implanted pump that can be refilled with medication every month or few months. The pump is then adjusted to deliver medication as needed.
And some physiatrists with special training can perform spinal injections, like epidural steroid injections, for patients with certain conditions, like sciatica.
When do you need to see a different kind of doctor?
Sometimes when nonsurgical treatments haven't been effective enough in managing conditions, patients need surgery.
If that's the case, you may need to see an orthopedic surgeon or a neurosurgeon instead, and your physiatrist can make a referral.
For example, if you have joint issues that haven't responded to medication or therapy, and they strongly affect your quality of life, your physiatrist may recommend seeing an orthopedist for a joint replacement.
And if you have symptoms that indicate an emergency, you should seek care right away rather than waiting for an appointment with a physiatrist.
"A patient with sudden onset neurological concerns, such as new weakness, numbness or tingling, or incontinence should seek urgent evaluation at the emergency department and may need to be seen by a neurosurgeon," Stefanski says.
What is the difference between a physiatrist and a physical therapist or an orthopedist?
A physiatrist and a physical therapist may both treat issues with movement, and they often collaborate on care.
"We often work alongside physical therapists, and many of our treatment plans include referring a patient to a physical therapist," Stefanski says.
But the diagnostic tools they use, the specific conditions they treat, and the treatments they offer differ.
Physical therapists treat conditions like joint stiffness and muscle weakness. They focus on treatments that involve exercises to build strength and flexibility. They may use cold or heat, electrical stimulation, or their hands to manipulate joints and soft tissues.
Physiatrists, on the other hand, are able to diagnose and treat more complex issues. They use imaging techniques and more involved types of testing to diagnose conditions. And they can prescribe medications and use injections to treat pain and loss of function.
An orthopedist, or orthopedic surgeon, can also provide care for complex conditions that cause pain or loss of function. But unlike physiatrists, they offer surgical procedures to treat these issues.
"A physiatrist does not perform orthopedic surgery," Stefanski says. "Rather, we ensure that a patient has tried all conservative, nonoperative treatments before undergoing an elective surgery, such as a joint replacement."
If nonsurgical treatments have not provided enough relief, a physiatrist can refer you to an orthopedic surgeon for more options.
Who else do physiatrists work with?
A physiatrist provides treatment directly, but they also work together with other specialists. That way, they can help you explore all your options and create the most appropriate care plan for you.
You might think of them as the head chef in a kitchen who makes sure everyone is adding the right dishes to the order.
Though physical therapists and orthopedic surgeons are among the specialists they work with most often, physiatrists also regularly coordinate care with experts in other fields. These include occupational therapists, speech therapists, neurologists and neurosurgeons.
Sometimes they also work with specialists in internal medicine, family medicine, vascular surgery, pain management, oncology and rheumatology, among others.
So no matter what difficulties you're having with movement and loss of function, a physiatrist can help guide you to the care you need.
"We see a wide range of patients who have varying degrees of abilities," Stefanski says. "Some of our patients are looking for every treatment option available, and some just want reassurance. Whatever your mobility goal is, it is never too early or too late to come in for an evaluation."
If pain, injuries, neurological issues or any other conditions are interfering with your mobility and quality of life, you can call Rush at (888) 352-7874. You can also learn more on our Physical Medicine and Rehabilitation Services page.
