When Gail, a 45-year-old female, sustained injuries to her neck and low back in a motor vehicle accident, she went to her primary physician (an internist) for her initial care. Based on the history and physical examination, the internist concluded that she had a cervical and lumbar strain. He recommended a short course of bed rest and return to activity thereafter. Failing to note an improvement, Gail went to see a chiropractor. He performed manual medicine techniques, which worsened her pain.
Finally, Gail visited an MSR-supported physiatrist for an evaluation who determined that her diagnosis was more complex than a simple strain of the neck and low back. Gail required more of a diagnostic work up and treatment that was multidisciplinary and multimodal in nature. She began a course of physical therapy that included pain-relieving modalities and therapeutic exercises. She then underwent MRI studies of the cervical spine and lumbar spine, as well as electrodiagnostic studies of the upper and lower extremities. The testing confirmed a diagnosis of cervical disk herniation, cervical radiculopathy, lumbar disk herniation, and lumbar radiculopathy. The physiatrist altered her therapy to relieve her symptoms based on these diagnoses. He also prescribed anti-inflammatory medications for pain control, and referred Gail to a pain management specialist and a spine surgeon for an evaluation for more interventional pain control.
Upon completing her course of physical therapy and medications, as well as receiving epidural steroid injections from the pain management specialist, Gail reported significant relief of her pain and return to her normal employment and activities of daily living.
The ability of a specialist of Physical Medicine and Rehabilitation (PM&R) to provide multidisciplinary and multimodal care, as well as the ability to focus on patient function and the patient as a whole separates the physiatrist from other medical specialties. It is what makes the physiatrist a unique provider of medical care.
Case study by Raj Tolat, M.D.
Premier Physical Medicine and Rehabilitation, PC