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WHAT IS A PHYSIATRIST?

physiatristA physiatrist, pronounced fizz ee at’ trist, is a physician specializing in physical medicine and rehabilitation. As the population of America ages, as people survive conditions that once would have been fatal, and as quality of life is an increasing concern, the field of physiatry is moving to the forefront of medicine. The specialty serves all age groups and treats problems that touch upon all the major systems in the body.

HOW DID THE SPECIALTY DEVELOP?

THE FIELD OF PHYSICAL MEDICINE AND REHABILITATION (PM&R) began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The Advisory Board of medical Specialties granted PM&R its approval as a specialty of medicine in 1947.

WHAT TYPES OF CONDITIONS DOES A PHYSIATRIST TREAT?

PHYSIATRISTS ARE PHYSICIANS WHO TREAT a wide range of problems from sore shoulders to spinal cord injuries. The focus of the specialty is on restoring function to people. Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a -knitter who has carpal tunnel syndrome. Physiatrists’ patients also include people with arthritis, tendonitis, any kind of back pain, and work- and sports related injuries.

Physiatrists treat very serious disorders of the musculoskeletal system that result in severe functional limitations as well. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists also treat people with spinal cord injuries, brain injuries, strokes, amputations, cancer, and multiple sclerosis. All require a-long-term rehabilitation process.

WHAT IS THE PHYSIATRIST’S ROLE IN TREATMENT?

A PHYSIATRIST MAY TREAT PATIENTS directly, lead an interdisciplinary team, or act as a consultant Here are some scenarios that illustrate the varied roles of. a physiatrist:

A carpenter is lifting some heavy wood when he feels pain in his lower back and down his leg. He sees a physiatrist who does a thorough history and physical examination and performs all the testing needed to make the diagnosis. a herniated disc. The physiatrist develops an appropriate treatment program, monitoring and adjusting it as needed. With this treatment and rehabilitation program, the patient does not need surgery.

A woman in a diving accident has a spinal cord injury and is paralyzed below the waist. The physiatrist assesses her injury and with the patient and a team of health care professionals determines the course of her rehabilitation. The physiatrist treats the array of medical issues that occur as the result of a spinal cord injury, and also leads the interdisciplinary team to enable the woman to reach the highest level of functioning possible. The team varies in composition depending on the needs of the patient In addition to other physicians, the team may include health care professionals such as nurses, physical therapists, occupational therapists, social workers, neuropsychologists, and vocational counselors.

A baby is born with cerebral palsy. The physiatrist is called in as the expert who advises on the correct treatment and rehabilitation that can affect the rest of the child’s life.

HOW DO PHYSIATRISTS DIAGNOSE?

PHYSIATRISTS’ DIAGNOSTIC TOOLS ARE THE same as those used by other physicians, with the addition of special techniques in electrodiagnostic medicine like electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. These techniques help the physiatrist to diagnose conditions that cause pain, weakness, and numbness.

WHAT KINDS OF TREATMENTS DO PHYSIATRISTS OFFER?

PHYSIATRISTS OFFER A BROAD SPECTRUM OF medical services. They do not perform surgery. Physiatrists may prescribe drugs or assistive devices, such as a brace or artificial, limb. They also use diverse therapies such as heat and cold, electrotherapies, massage, biofeedback, traction, and therapeutic exercise.

WHERE DO PHYSIATRISTS PRACTICE?

PHYSIATRISTS PRACTICE IN REHABILITATION centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury, and many other special interests.

WHAT KINDS OF DIFFERENCES DO PHYSIATRISTS MAKE?

SINCE IT IS THE CONCERN OF PHYSIATRISTS to restore patients to maximum function, the difference they make can be dramatic. In the case of the herniated disc, the physiatrist not only takes care of the acute problem, but also treats the patient until he returns to optimal functioning, usually without surgery. The physiatrist also teaches the patient bow to prevent the injury in the future.

Another example is that of a broken hip in the elderly. Physiatrists can provide aggressive rehabilitation so patient can walk and even exercise again.

And because the physiatrist is concerned with all areas of rehabilitation -social, vocational, and medical-the quality of life is significantly increased for patients.

Seasonal Tips: Enjoying Youth Sports

sportsrehab

Preventing injuries is a growing area of concern for physicians specializing in sports medicine management of young athletes. Physical conditioning including aerobic training and muscle strengthening is different for the skeletally immature child athlete than for adult or older teen sports participant.

Weight training should stress lightweight free weights rather than more strenuous machines designed for adult users. Gradual, slow increases in exercise targets or goals can reduce injury risks.

Pain is common in joints undergoing rapid growth and care must be taken to limit stresses through greater emphasis on flexibility and range of motion exercises rather than strenuous resistance training. Alternate day regimens for training specific muscle groups and resting others must be encouraged to reduce injury. Training throughout the year rather than just seasonal workouts must be encouraged.

Tips for Enjoying Youth Sports:
1.Participate at a level appropriate for age, maturity, size and skill development.
2.Insist on qualified adult supervision for training, practice and actual competition.
3.Let children play as children without adult expectations or adult pressures.
4.Utilize specific stretching, conditioning and strengthening exercises chosen for the sport of choice.
5.Always wear properly fitting safety equipment that is in good condition.
6.Be aware of special needs and accommodate them.
7.Warm up before all sports activities.
8.Respect pain warning signs in children by not trying to play through pain.
9.Know safety rules and follow them.
10.Have fun.

Hot or Cold:

Following injury, therapeutic application of ice or a cold pack is usually advised for the first 48-72 hours following injury to limit swelling and reduce pain. An exception is pain from prolonged cold exposure resulting in frostbite. In those situations efforts should be made to warm the affected areas while avoiding excessive rubbing or pressure over the injured, exposed skin. While a warm hot tub might help loosen and stretch tight muscles, one should exercise restraint if there is a history of traumatic injury to a joint which may have an increase in swelling with heat exposure.

Stretching:

Daily stretching is needed to prevent muscle strain and improve flexibility. Specific stretches may be prescribed by your doctor for particular sports and to help participants with physical problems avoid further injury. In general, stretches need to be maintained for at least a count of five or ten at the extreme of the stretched position to obtain maximal benefit. Stretching should include not just the legs but also the arms, neck and back for most athletic activities.

Cardiovascular Fitness:

Physical fitness demands a regular exercise program at least three times a week for around 45 minutes per workout session for conditioning the heart and lungs. Those over 30 or with a history of heart or lung disease in themselves or their family should consult a physician for clearance prior to any vigorous exercise program. Suggested aerobic exercise activities might include low impact swimming, bicycling, cross country skiing, walking and stair climbing. Running requires excellent joints in the hips, knees, ankles and feet. To achieve a training benefit, the selected exercise must allow the participant to achieve and maintain around 70% of the maximal predicted heart rate which should be maintained for about 30 minutes.

Strengthening:

To achieve improved strength, one should exercise the target muscles at least twice a week with a schedule allowing for at least a day or more of recovery time between sessions. Maximal benefit occurs from exercise to the point of fatigue. One may prefer low resistance, high repetition exercise to minimize injury or adopt a high resistance, low repetition regimen to shorten the time required to complete the training program. Creatine and androstendione have not been proven safe and other enhancing agents such as anabolic steroids and growth hormone have known adverse effects on those individuals attempting use of performance altering drugs without medical prescription.

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Ease Your Pain

Pain Concept.More than 50 million Americans suffer from chronic pain. Each year another 25 million experience acute pain from injury or surgery. Although pain can be greatly eased with pain management, it frequently goes untreated, under treated or improperly treated.

Failure to adequately manage pain can lead to sleep disturbance, decreased physical activity, stress, and disability. Pain can delay recovery from injury or surgery.

Most hospitals, nursing homes and health care facilities are now required to assess and treat pain. Patients must be informed of their right to effective pain management care. There are now pain management standards set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Facts about pain:
1.Pain is NOT something you “have to live with”.
2.Not all doctors know how to treat pain.
3.Pain medications do NOT have to cause addiction.
4.Pain medications do NOT necessarily have side effects.
5.You may prevent or limit chronic pain by prompt treatment of acute pain.
6. New pain treatment options are always being introduced.
7. Pain management is NOT just prescription medication but includes over the counter remedies, non-drug therapies and techniques.
8. Cancer pain CAN be managed effectively.

Tips for Effective Communication with your Doctor about Pain:
1.Speak up!
2.Tell where you hurt.
3.Rate your pain severity on a 0 (no pain) to 10 (worst pain) scale.
4.Describe what makes your pain better and worse.
5. Characterize your pain using adjectives like sharp, dull, burning, throbbing, aching, constant, intermittent, aching, stabbing, deep or superficial.
6.Explain how the pain affects your daily life.
7. Tell about your previous pain treatments including medications, injections, over the counter products, supplements, surgeries, physical therapy, massage, acupuncture, as well as heat or cold treatment.

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NECK PAIN REHABILITATION

neck-pain-rehabDeveloping a program that’s right for you.

Information is readily available on the way to stop neck pain. The challenge is to tailor it to the particular patient. For example, it’s said that using certain kinds of pillows are best for the neck. But which kind? And does the information apply to every kind of neck pain?

Using the telephone improperly is also said to create problems in the neck. But what is the proper way to use a phone?

And if a brace or special piece of equipment is necessary, which is the right one? The list goes on: cold or hot applications, rest or activity?

What kinds of problems might cause neck pain?

Treatment for any neck condition is recommended as soon as possible to minimize the danger of further aggravation. The following is a list of only some of the conditions that may cause neck pain and is not a substitute for a visit to your doctor:

Radiculopathy
A pinched nerve, often from a herniated, or slipped, disk. This causes pain down the arm that’s often described as an electrical feeling.

Myofascial Pain
Generally an aching pain in muscles that tends to be associated with poor posture, sitting at a computer or other job-related tasks. Patients can become sore in different parts of the body like the neck and arms, and often patients report they have difficulty sleeping or feeling restored from sleep.

Spinal Stenosis
A narrowing of the nerve openings either around the spinal card or nerve roots that can cause symptoms similar to a pinched nerve. The-pain is described either as an aching or an electrical feeling down the arm.

Tendon, Ligament and Soft Tissue Pain
Localized pain when an area is stretched or its muscles are overused. This results in tenderness.

Spinal Instability
Increased motion between vertebra, usually resulting from an injury. The pain typically feels like tingling in the neck or arms.

Non-Spinal Causes of Neck Pain
Pain imitating a neck injury, but from another cause. Shoulder and elbow injuries and gall bladder disease are examples of problems that can refer pain to the neck area.

Repetitive Strain Injury
An injury that occurs from a chronically used part of the body, either in a normal or abnormal way. These problems are often found in people who sit at desks or work at computers.

Treatment options

The rehabilitation of neck injuries occurs in three phases. during the first phase, called the acute phase, physiatrists treat pain and inflammation. After they make a specific diagnosis and develop a treatment plan, physiatrists may offer treatment options like ultrasound, electrical stimulation, mobilization, medication, ice and even specialized injections.

In the second, or recovery, phase of treatment, flexibility and strength are developed to get the body parts into their proper positions. The goal of this phase is to get you back to your usual work, sports and leisure activities. This goal is achieved through specially designed exercises that rebuild the body.

The main goal of the third phase of treatment, the maintenance phase, is to minimize recurrence of the problem and to prevent further injury. This often consists of a total body fitness program, designed to maintain body mechanics and increase endurance after the original symptoms have resolved.

These are very broad and general approaches to the treatment of neck pain. The physiatrist that you choose will develop an individual treatment plan for you.

LOW BACK PAIN REHABILITATION

487684641Information is readily available an the way to for you to stop back pain. The challenge is to tailor it to the particular patient. For example, its often said that swimming is good for the back. But which stroke? And how often?

Strengthening the abdominal muscles is also commonly ordered for low back pain. But how is this done? And are you exercising the right way for your back injury? The list goes on: cold or hot applications, rest or activity?

What kinds of problems might cause low back pain?

Treatment for any back condition is recommended as soon as possible to minimize the danger of further aggravation. The following is a list of may some of the conditions that may cause low back pain and is not a substitute far a visit to your doctor:

Myofascial Pain
Generally an aching pain in muscles that tends to come from poor posture, sitting at a computer, or other job-related tasks. With myofascial back pain the patient can become sore in different parts of the body like the back and legs. Often patients report that they have difficulty sleeping or feeling restored from sleep.

Spinal Stenosis
A narrowing of the nerve openings either around the spinal card or nerve routs that can cause symptoms similar to a pinched nerve. It can cause leg pain in anyone, but most often does so in older patients with spinal stenosis can have trouble walking, and the difficulty is usually relieved by sitting down or bending forward. It can cause aching or heaviness in the back and legs.

Tendon, Ligament and Soft Tissue Pain
Localized pain when an area is stretched or its muscles are overused. This results in tenderness.

Non-Spinal Causes of Low Back Pain
Pain imitating a back injury but from another cause. Appendicitis, kidney disease, uterine disorders and urinary tract infections are a few examples of problems that can refer pain to the back.

Radiculopathy
A pinched nerve, also called sciatica, usually from a herniated, or slipped, disk. This can cause a shooting pain down the leg that’s often described as an electrical feeling.

Treatment Options

The rehabilitation of low back problems occurs in three phases. During the first phase, called the acute phase, physiatrists treat pain and inflammation. After they make a specific diagnosis and develop a treatment plan, physiatrists may offer treatment options like ultrasound, electrical stimulation, mobilization, medication, ice and even specialized injections.

In the second, or recovery; phase of treatment, flexibility and strength are developed to get the body parts into their proper positions. The goal of this phase is to get you back to your usual work, sports and leisure activities. This goal is achieved through specially designed exercises that rebuild the body.

The main goal of the third phase of treatment, the maintenance phase, is to minimize recurrence of the problem and to prevent further injury. This often consists of a total body fitness program, designed to maintain body mechanics and increase endurance after the original symptoms have resolved.

These are very broad and general approaches to the treatment of low back pain. The physiatrist that you-choose will develop an individual treatment plan for you.

When Pain Persists

back-painBack pain is a common problem with at least one episode of back pain occurring in an estimated 80% of the adult population in the United States. It is the leading cause of disability from work related injury and costs over $50 billion dollars a year. While a minor muscular ache may resolve within a few days without intervention, often treatment is required for back pain to avoid surgery and prevent disability.

TREATMENTS FOR BACK PAIN

The simplest treatment is application of therapeutic heat or cold. Cold packs are recommended for new injuries for at least the first 24 to 36 hours to provide relief from muscle spasm and reduce swelling.

Bed rest needs to be monitored by a physician. Prolonged bed rest may promote disability needlessly following a recent injury.

Medications can control pain without drowsiness or physical addiction. Newer once a day medications have been developed which can be safely used by most individuals even for extended periods of time.

Physical measures available for treatment include back supports, physical therapy and alternatives to medication for pain control including transcutaneous nerve stimulation (TNS).

Risk factors have been identified which can be modified to decrease problems with back pain including weight reduction and general measures to promote improved physical health.

Surgery is generally a last resort for musculoskeletal back pain. A majority of those with back pain due to disc disease can be successfully managed without surgical intervention.

Modern pain management can control pain, restore physical fitness, prevent recurrent episodes of back pain, and limit disability. There are sophisticated pain management programs throughout the country affiliated with local medical schools and teaching hospitals.