By Debbie Rocket, PT
Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation MDs or “Physiatrists” are Doctors who’s job is to enhance and restore functional ability and quality of life for the patients they treat who have physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, joints, muscles ligaments, and tendons. Other Doctors focus on the medical cure instead of Physical Medicine. In the example of the Orthopaedic surgeon, surgery, when appropriate, is performed to help correct the dysfunction/pathology.
The goal of the Physiatrist is to maximize the patient’s independence in activities of daily living.
In an outpatient Orthopaedic setting, treatments include medications for pain and inflammation and injections. Referral to Physical therapy for strengthening /flexibility /balance and education on self-care.
Some common diagnoses treated include stenosis and sciatica. Below is a brief description of both, symptoms, causes, and treatment.
Physical Medicine and Spinal Stenosis
Spinal stenosis is an example of a condition commonly treated. Stenosis is an abnormal narrowing of the spinal canal ( the tube that houses the spinal cord ) or the neural foraman, formed at the sides between each vertebral level where the spinal nerves from exit after leaving the spine. Levels from the upper spine (cervical or neck) supply the arms and lower spine (lumbar or low back) supply the legs. If the narrowing is enough, the pressure/irritation of the nerve can occur.
Symptoms include pain, numbness and/or weakness depending on the amount of pressure on the nerve. Typically, If the stenosis is in the lumbar spine, symptoms come on gradually. There can be cramping in the legs, buttocks and feet. Symptoms are made worse by walking and are eased by bending forward which “opens up” the space more in the foramen and rest.
Common causes include herniated or bulging discs, degenerative changes/arthritis. The age of the patient is usually older, more than 50 years. In more rare cases, the congenital narrowing can contribute to the problem.
Diagnosis includes x-rays/ MRI and CT scans and clinical exam with your Doctor
Conservative management is the treatment for most cases and can include medication for pain and inflammation, sometimes injections to reduce symptoms and Physical therapy to address flexibility/strength/stability and education for posture, body mechanics, ergonomics and general self-management to assist with the resolution of the symptoms. In cases where conservative therapies fail or the stenosis is too severe, surgery may be a consideration.
This is a term used to describe pain and numbness that is felt down the back of the thigh and leg and sometimes into the foot. It is when the “sciatic nerve” is affected. The sciatic nerve emerges from several levels of the low back and the branches form one big nerve, the largest nerve in the body.
What causes Sciatica?
Sciatic pain/numbness and tingling, all symptoms or nerve irritation or compression, can be due to several causes. One cause already discussed in stenosis. Bulging or herniated discs can also create a narrowing of the foraminal space and affect the nerve.
Physical Medicine Diagnosis
X-rays are and possibly MRI or CT scan if needed in addition to a clinical exam by your Doctor
How is it treated?
Treatment conservatively includes medications for pain/inflammation and sometimes muscle spasms. Sometimes an epidural injection is needed. This procedure is performed as an outpatient procedure and is performed to help reduce inflammation and pain. Physical therapy is often prescribed to address the symptoms and improve. improve strength/stability around the spine. Education on posture and ergonomics is needed to help minimize or eliminate reoccurrence once the symptoms have settled down.
JOI Physicians are currently offering ASAP fracture and injury care. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. To learn more about this service, read this article about fracture and injury care. Make an appointment by calling (904)JOI-2000.
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