Continuous muscle or skeletal pain can substantially affect your daily life. Luckily, today’s medical specialists have many techniques to eliminate, or significantly minimize this pain. One such specialist is a physiatrist, also known as a physical medicine and rehabilitation doctor (PM&R doctor), who specializes in healing techniques for the muscles, ligaments, joints, bones, nerves, and tendons of the body. Though similar and more common specializations exist, such as orthopedists and physical therapists, a physiatrist is a valuable resource to explore, as they are often praised for their abilities to tailor treatments to patients’ individualized needs.

What Is a Physiatrist?

A physiatrist is a medical doctor (MD) or doctor of osteopathic medicine (OD) specializing in the treatment of the musculoskeletal system (all body parts relating to the muscles or bones). Unlike orthopedists, they don't perform surgery; rather, they help increase mobility and manage pain by prescribing stretching and other less invasive treatments. Physiatrists pride themselves on their holistic approach, treating the whole person and not one part of the body. They may also focus on improving localized function after an accident or health event. These doctors can work in an in-patient, out-patient or in a consulting role.

One common misconception about physiatrists is that they perform the therapies they prescribe. Physiatrists complete residency training which qualifies them to diagnose and manage medical conditions and subsequently prescribe treatment. This residency training differentiates physiatrists from physical therapists, who are responsible for providing the treatment prescribed. Basically, your physiatrist makes sure you are in the right medical condition for certain therapies and keeps track of your progress, while your physical therapist follows orders from the physiatrist based on that assessment.

Reasons to See a Physiatrist

You may see a physiatrist in the aftermath of a significant health event or accident. In some cases, these doctors treat you therapeutically as a substitute for surgery. They may also serve as part of your long-term care team. You may want to explore the help of a PM&R physician in the case of:

  • Illness that has made it more difficult to exercise
  • Stroke that leaves limited mobility on one side of the body
  • Chronic pain from arthritis or old injuries
  • Recovery after a surgery
  • Brain injury that changes function capabilities
  • Excessive weight gain leading to mobility challenges
  • Nerve damage from an accident
  • Other disorders or injuries that result in limited mobility and function

What Physiatrists Do

Physiatrists collaborate with other physicians to create practical treatment plans. Individually they create holistic treatments, meaning they work with the whole body to improve function. They coordinate with your general physician, physical therapist, speech pathologist, and other doctors as a part of your comprehensive care. For their part of your health plan, a physiatrist is likely to prescribe treatment using:

  • Therapeutic exercise
  • Spine injections
  • Ultrasound-guided procedures
  • Nerve stimulators
  • Joint injections
  • Use of prosthetics
  • Muscle biopsies
  • Prescription medication
  • Alternative treatments like acupuncture

Subspecialties

While all physiatrists seek to improve their patients' overall health, they may undertake a specialty. A subspecialty makes the doctor uniquely qualified to offer specialized treatment for certain areas of the body. Subspecialties available to physiatrists include:

Spine treatment: This specialty can relate to nerve pain like sciatica or recovery from back injuries. They may also work as a part of the team that manages a herniated disk or spinal cord injury.

Brain injury: Physiatrists who specialize in brain injury often work with stroke patients or people who have had traumatic brain injuries.

Sports medicine: Athletes who suffer ligament tears or broken bones may benefit from the expertise of a physiatrist who works in sports medicine.

How Physiatrists are Trained

Physiatrists usually begin their road to licensing by engaging in pre-medical coursework during their undergraduate training. They continue their education with four years of medical school. The final year of medical school overlaps with a residency program, typically at a teaching hospital.

During residency, physiatrists spend one year on fundamental clinical skills and three years studying physical medicine and rehabilitation. At the end of their four-year residency, physiatrists may decide to do a fellowship, adding one to two years to their study, and giving them advanced training in a specialty of their choice. For certification, physiatrists must pass a written and oral test.

How to Get Referrals to and from a Physiatrist

You can get a referral to a physiatrist from your general physician. Depending on the type of treatment needed and the timeline, you may want to interview several physiatrists before finding one that is a good fit. Doctor reviews can be a valuable resource when looking for a specialist. If the need arises for surgery, a physiatrist may also be able to refer you to a qualified surgeon whom they have familiarity working with during the recovery period.

Questions to Ask a Physiatrist at the First Visit

Even after searching health care reviews, you should show up to your first appointment prepared with questions. These common questions will help ensure a good doctor/patient fit:

  • Do you commonly treat my condition? A physiatrist who has proven successes treating the patient's particular condition may be able to offer the best treatment. It will also put a patient's mind at ease to know the doctor is well-versed in the available treatment options.
  • Are you fellowship trained? Fellowship training lets physicians hone in on an area of expertise. It can be helpful to find out which, if any fellowships, a physiatrist completed.
  • Which non-surgical options do you recommend? Physiatrists explore non-surgical options by nature. Still, it is beneficial for the patient to find out how invasive the suggested treatments will be. At this point, the physiatrist can also reveal if he or she believes surgical intervention may realistically be needed.

For more information on surgical intervention, check out these articles on orthopedists, who specialize in musculoskeletal surgery:

Your Orthopedist: A Musculoskeletal Specialist
What You Need to Know About Same Day Hip Replacement
5 Questions You Need to Ask Before Getting Surgery