A 25-year-old woman named Glenda was involved in a motor vehicle accident and sustained low back injury, so she visited an MSR-supported physiatrist. His Initial evaluation revealed painful and restricted range of motion of the lumbar spine, with lumbar spine spasms throughout. Glenda's physiatrist placed her on a conservative course of physiatric physical therapy treatment. Her treatment plan included ultrasound and electric stimulation application to the lumbar spine, then active range of motion (as tolerated) following a review of normal lumbar spine x-rays. Throughout the course of treatment, Glenda's back pain persisted and she developed lumbar spine MRI in the course of her treatment, revealing a disc herniation of L5/S1 level.
Based on lumbar spine MRI findings, her physiatrist modified Glenda's overall physiatric therapy program to incorporate spine traction. He placed her on a muscle relaxant, Skelaxin and encouraged her to continue normal customary ADLs.
At Glenda's re-evaluation a month later, she received paravertebral steroid injections with a mixture of Marcaine and Depot Medrol to the lumbar paravertebral muscles with good results. At her next re-evaluation nine months later, she reported no further back pain - no radiating pain, numbness or tingling down her legs. At the time, she regained full range of motion of the lumbar spine (flexion 90/90 degrees, extension 30/30 degrees without pain).
Glenda's physiatrist advised her to continue with a home physiatric therapy program including McKenzie low back extension/William's low back flexion exercises and encouraged her to contact him if her back pain returned and/or if she developed radicular symptoms.
The ability of a specialist in 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 Joseph Gregorace, D.O.
Island South Physical Medicine & Rehabilitiation, P.C.