One of the best, albeit unintentionally kept secrets of medicine is the specialty of Physical Medicine and Rehabilitation (PM&R, also known as physiatry) and its doctors called physiatrists (fiz.ee.at.’ trists).
These are physicians (MD’s or DO’s) who are trained experts in bones, joints, muscles, nerves and the brain, with a strong emphasis on how all of those work together to create function. For rehabilitation (rehab) physicians, the primary focus is restoring, maintaining, and optimizing function. That accounts for the breadth of patients physiatrists treat, including those with: sports injuries (professional and recreational athletes), spinal cord injuries (e.g. Christopher Reeves), brain injuries (such as reporter Bob Woodruff), neurological diseases (e.g. Michael J Fox), carpal tunnel syndrome, strokes, burns, amputations, arthritis, etc. The common denominator among all of these is loss of function.
The physiatric approach is comprehensive, relying heavily on detailed physical examinations for accurate diagnosis and determination of the appropriate treatment. Radiographs, nerve testing, and other diagnostic aides are used to supplement the examination when needed. Physiatric treatment is wholistic in the sense that it addresses all pertinent aspects of the patient: physical, medical, emotional, and vocational. To accomplish that, physiatrists employ medicines, physical, occupational, and cognitive therapies, as well as injections if/when needed. The emphasis, however, is on therapeutic exercise– i.e. exercise used specifically to treat injury, ailment, and pain–done in an effort to correct the underlying problem rather than simply apply a ‘band-aide.’ Just as specific illnesses require very specific medicines, different physical conditions require different exercises. And physiatrists have unique expertise in that realm.
Physiatrists are also trained in several procedures such as joint injections, trigger point injections, electromyography (nerve testing), and even BoTox (used non-cosmetically). Some physiatrists undergo additional training to perform various spinal procedures such as epidural injections, discography, and acupuncture. However, physiatry is a non-surgical specialty.
It is often said that physiatrists don’t save lives, they save quality of lives. So while they don’t do knee surgery, they are experts in knowing exactly what needs to be done to restore full function after surgery, how to minimize the chance of re-injury, and ideally, how to avoid surgery in the first place. Similarly, an amputee may have lost a limb, but a physiatrist will work with that person to get s/he walking or running again with a prosthetic one, back to social activites, and back to work.
The Big Picture Approach
By having a whole-body perspective, physiatrists take an unusually comprehensive approach. This means understanding not only that a sprained ankle affects that ankle, but also that it disrupts structures above and below the joint as well as the nerves which coordinate all of them. Being aware of these broader implications is particularly important because restoration of full function depends on addressing all of them. If addressed incompletely, recurrent problems are almost guaranteed.
So the bottom line is that when the goal is to restore proper function- and that should be the goal whenever possible–the approach requires a thorough understanding of body function. Who better to turn to for that than physiatrists— the “Function Doctors”?