What Is Physiatry?

By Abraham Asmamaw, MD

Physiatry, also known as physical medicine and rehabilitation, is a branch of medicine that specializes in disorders of nerve, muscle and bone. It addresses acute and chronic disorders of the bone, muscle and nerves like arthritis, low back pain, stroke and spinal cord injury that impact a person's daily functionality, more commonly referred to as their activities of daily living (ADL).

Physiatry further sub-specializes in the evaluation and treatment of brain injuries, spinal cord injuries, pain medicine, pediatric rehabilitation, musculoskeletal medicine and electrodiagnostic medicine, among others.

Traditionally, physiatrists have a multi-disciplinary approach and collaborate closely with orthopedists, neurologists, internal medicine physicians, physical therapists and speech therapists. They are involved in the diagnosis and treatment of the following disorders

Orthopedic injuries
Arthritis
Low back pain
Sport related injuries
Stroke
Traumatic brain injuries
Muscle disorders like myopathy, fibromyalgia, and myositis
Nerve disorders like radiculopathy and neuropathy
Spinal cord injury and rehabilitation

Physiatrists also provide comprehensive tests that serve as extensions of a clinical exam and rule in and out questionable or challenging cases of neuromuscular disorders. Electrodiagnostic testing is one such test.

Indication for electrodiagnostic testing could be as simple as to rule out carpal tunnel syndrome from cervical radiculopathy, peripheral neuropathy, acute onset weakness, myopathy and myastenic disorder and acute/ chronic inflammatory neuropathy (gullian barre syndrome).

Electrodiagnostic testing consists of nerve conduction testing (NCV) that involves testing for the peripheral nerve and is indicated in disorders of peripheral neuropathy, radiculopathy and entrapment neuropathy. It's an essential test for a variety of nerve and radicular disorders, can aid imaging studies in refining differential diagnostics and can guide treatment options and track disease progression.

Electromyography (EMG) uses a variety of needles to test for muscular, neuromuscular junction and nerve disorders. Somatosensory evoked potential (SSEP) is testing of the spinal cord-brainstem pathways for disorders that affect these hard to reach areas.