What Is Physiatry?
Physiatry is a medical specialty that deals with the treatment of people who have a disability, chronic pain, or some other physical problem. The specialty is sometimes called physical medicine and rehabilitation. Physiatry uses physical therapy, pain medicine, and other procedures to treat people rather than surgery. It looks at the physical, vocational, and social needs of the patient. Unlike other medical specialties, it aims to treat the whole person.
What Is a Physiatrist?
A physiatrist (fizz-eye-ah-trist) is a medical doctor who specializes in physical medicine and rehabilitation. They diagnose the cause of the pain and develop a comprehensive treatment plan. They treat conditions of the bones, muscles, joints, brain, and nervous system. These could range from back pain to cancer to multiple sclerosis.
A physiatrist uses a combination of physical therapy, medicine, and other procedures such as spine injections to treat their patients. The goal is to lessen or eliminate pain and help the patient have a better quality of life.
Some physiatrists specialize in the physical medicine side, treating people with joint and back pain as well as other types of pain. Other physiatrists specialize in the rehabilitation side, treating people with injuries to the central nervous system such as strokes, brain injuries, spinal cord injuries, and multiple sclerosis.
Physiatrist vs physical therapist
Both people treat the same type of patients but there are some big differences. A physiatrist is a medical doctor who has undergone an additional 4 years of training in physical medicine and rehabilitation. They diagnose a person's medical problem, design a treatment plan, and prescribe medication if necessary. The physiatrist doesn't actually perform the therapies, such as supervising an exercise program, which is what physical therapists do.
A physical therapist is not a medical doctor but someone who has a bachelor's degree plus a doctor of physical therapy (DPT) degree from an accredited program. The DPT program usually lasts 3 years. A physical therapist cannot prescribe medication. But they can design and supervise an exercise program or apply physical treatments such as heat, cold, or TENS therapy (which uses a device that gives off a mild electrical current).
What Does a Physiatrist Do?
Many issues can cause pain. These include injury, illness, or medical conditions such as those related to the brain, spinal cord, nerves, bones, joints, and muscular system. A physiatrist can identify what’s causing pain and help a person manage and treat it, with the goal of recovering mobility and functional well-being.
A physiatrist’s treatment plan is very specific to each patient. Depending on the root of the problem, a physiatrist may focus on:
- Neurorehabilitation: Treating pain or mobility issues from a spinal cord injury, traumatic brain injury, or stroke
- Pain medicine: For chronic pain management
- Musculoskeletal care: Including symptoms of autoimmune diseases such as rheumatoid arthritis
- Sports injuries: Such as tendonitis, stress fractures, and concussions
- Postoperative care: Often needed for joint replacement, organ transplant, and heart surgery
What are the most common medical conditions treated by a physiatrist?
- Back pain
- Neck pain
- Brain injuries
- Sports injuries
- Spinal cord injuries
How does a physiatrist diagnose patients?
In addition to a physical exam, a physiatrist may order an X-ray, ultrasound, or MRI. They may also do electrodiagnostic testing, which measures the condition of your nerves and muscles, both when they are relaxed and when they are stimulated.
What Procedures Do Physiatrists Perform?
Physiatrists can perform any of the following procedures:
- Electromyography (EMG). The doctor inserts fine needle electrodes into muscles to determine the performance of muscles and nerves. This helps physiatrists decide if the problem is due to muscle weakness or nerve dysfunction.
- Nerve conduction studies (NCS). This uses electrodes to figure out the location of a nervous system injury.
- Trigger point injections. The doctor injects an anesthetic or performs dry needling (similar to acupuncture) on trigger points in your muscles to ease pain.
- Musculoskeletal ultrasound. This uses an ultrasound (an imaging test where soundwaves produce pictures) to assess soft tissue problems and to guide injections.
- Spasticity management. After a central nervous system injury, such as a stroke or cerebral palsy, the muscles often stiffen or contract and can't move (this is called spasticity). The doctor will prescribe drugs to treat this and help relieve pain.
- Other procedures such as acupuncture and stem cell treatment.
In addition, a physiatrist can:
- Prescribe physical therapy or an exercise program
- Prescribe pain medication
- Give injections in the joints or spine
Who Does a Physiatrist Collaborate With?
The physiatrist focuses on the whole body—not just a single problem area—and assembles a treatment team to provide care and recovery. These can include:
- Primary care doctors
- Orthopedic surgeons
- Occupational medicine physicians
- Physical therapists
- Occupational therapists
- Rehabilitation nurses
- Social workers
- Recreational therapists
Your physiatrist may not need to work with all these people. A lot depends on the specifics of your condition.
Physiatrist Education and Training
As medical doctors, physiatrists must graduate from medical school before continuing in their specialized training. This process involves:
- 4 years of medical or osteopathic medical school
- An additional 4 years of postdoctoral training in a physical rehabilitation residency
- Gaining board certification with the American Board of Physical Medicine and Rehabilitation or the American Osteopathic Board of Physical Medicine and Rehabilitation
The average annual salary in 2023 for physiatrists in clinical practice is $306,000, according to the American Academy of Physical Medicine and Rehabilitation. However, this varies depending on what state the physiatrist practices in, their specialty, and what type of setting they work in. For instance, private practice will pay more than working in academia or a hospital.
Reasons to See a Physiatrist
You may benefit from seeing a physiatrist if:
You struggle with everyday activities. Accidents or injuries sometimes leave us with pain or limited function, impacting normal activities such as getting up, taking the stairs, or resting comfortably.
You have limited energy due to an illness. Many illnesses and their treatments cause limited energy. Fatigue can make it more difficult to move easily, avoid injury, or reach your exercise goals.
You have a scheduled surgery or are in recovery from surgery. Surgery is traumatic for your body. Building a surgical plan with a physiatrist can prepare your body and streamline your path to recovery.
What to Expect at the Physiatrist
At your first appointment, the doctor will speak to you about your medical and family history to learn more about what may be causing a problem.
You should voice your goals for treatment, whether that’s relieving back pain or strengthening muscle performance. Physiatrists work to help you overcome personal setbacks keeping you from living a full life—and what that means to each patient guides the best course of treatment.
If a diagnosis is needed, the doctor may run tests such as X-rays, nerve conduction studies, and electromyography to identify the cause of the problem and decide on the next steps for a recovery plan. They also look at your holistic health to work around and improve symptoms of underlying conditions such as diabetes or arthritis.
They'll also suggest:
- At-home care programs
- Treatment to be carried out by a specialist, such as a physical therapist or orthopedic surgeon
- Mental health care to help you cope with a condition and respond to treatment
- Alternative therapies such as medical acupuncture
Physiatrists may also offer in-office injections, including:
A physiatrist is a medical doctor who specializes in pain management and rehabilitation. They treat problems of the bones, muscles, joints, brain, and nervous system. These could range from back pain to cancer to multiple sclerosis. Physiatrists prescribe medicine, design physical therapy programs, and perform other procedures such as spine injections. The goal is to treat the whole person.
What is the difference between a physiatrist and an orthopedist?
Both types of doctors help people with problems in their bones, muscles, or joints. The biggest difference is that a physiatrist uses nonsurgical options such as pain medication, physical therapy, and injections, while an orthopedist has the additional training to perform surgery on these body parts. The orthopedist can also do some other treatments, like prescribing medication. The two doctors often work together; so, it's possible that you may start off visiting the physiatrist, and if you don't get better, they may refer you to an orthopedist.