By Debbie Rocket, PT
Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation MDs or “Physiatrists” are Doctors whose 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.
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
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 exit after leaving the spine. Levels from the upper spine (cervical or neck) supply the arms, and the 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 nerve’s amount of pressure. Typically, If the stenosis is in the lumbar spine, symptoms come on gradually. There can be cramping in the legs, buttocks, and feet. Symptoms of spinal stenosis worsen when walking.
Common causes include herniated or bulging discs, degenerative changes/arthritis. The age of the patient is usually older, more than 50 years. In rare cases, 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. It 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 resolving the symptoms. In cases where conservative therapies fail, or the stenosis is too severe, surgery may be considered.
Pain and numbness can be felt down the back of the thigh and leg and sometimes into the foot. The sciatic nerve emerges from several low back levels, 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 several causes. A bulging or herniated disc creates a narrowing of the foraminal space and affects the nerve.
Treatment conservatively includes medications for pain/inflammation and sometimes muscle spasms. An epidural injection will reduce pain. 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. Core strengthening exercise will prevent future injury.
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.
Image of Book An Appointment with a JOI Physician Button.By: Robert Savarese, MD