As much of mainstream medicine spends each day trying to restore health to the masses of overly sedentary Americans, a newer branch of medicine works to repair the tortured joints, bones and tissues of those on the active end of the spectrum.
Physiatry (fuh-ZY-a-tree) is a medical specialty that caters to people with athletic injuries and musculoskeletal problems who don’t want or don’t necessarily require surgery.
“The main function of physiatry is to restore function [without surgery],” said Dr. Christina Marciniak, physiatrist and medical director of inpatient services at the Rehabilitation Institute of Chicago. “We examine patients from head to toe to make a complete determination of the problem and, when possible, treat it with physical therapy.”
The specialty grew out of a need to help restore physical function to disabled veterans returning from World War II.
“It was then discovered that there was a void in the medical field when it came to people who were injured but didn’t necessarily need surgery,” said Dr. James A. Sliwa, medical director of clinical programs at the institute.
Now weekend warriors make up a large part of the corps of patients.
“Today people have become more active,” Sliwa said. “Few people used to jog or exercise 30 years ago. Now they are more health conscious. As a result we have more musculoskeletal problems, and many of these people don’t require surgery.” He added that some physiatrists are working exclusively with sports injuries.
Yet, despite the need for this specialty, few people are familiar with its name.
“We had residents out in front of the hospital with a video camera taping people being asked what a physiatrist is,” Marciniak said with a chuckle. “They guessed everything from psychiatrist to masseuse. Only one person got it right.”
There are only about 6,500 physiatrists in the United States, representing less than 1 percent of physicians.
“Medical students didn’t really start going in to it [physiatry] until about 15 years ago,” Marciniak added.
“The skills that distinguish physiatrists are the combined knowledge of neurology, orthopedics, physiology and muscles and nerves,” said Dr. Suzan Rayner, medical director at the Schwab Rehabilitation Hospital, affiliated with the University of Chicago.
Bringing all these facets of medicine to bear, the physiatrist becomes a team leader of other doctors and health professionals in formulating and executing a rehabilitation plan for a patient.
Rayner said that physiatrists must complete four years of graduate medical education and four additional years of postdoctoral residency training, with some choosing subspecialties in a variety of fields such as pediatrics or geriatrics.
Physiatry focuses on the whole person. Dr. Elliot Roth, medical rehabilitation director at the institute, described it as “holistic medicine.”
When dealing with chronic pain from arthritis, spinal injuries, Parkinson’s or amputation, he said, one has to concentrate on the bio-psycho-social aspects of the patient.
“Other medical conditions like a bad heart or diabetes don’t stop simply because a patient incurs other injuries,” he said in explaining the reason for subspecialties such as geriatrics.
Too, beyond sports injuries, some people with more serious damage can require a team that includes a speech therapist, an occupational therapist and a social worker in addition to a physical therapist.
One such example is Linda Cassady, 34, of Chicago. In a 1999 head-on collision, she suffered a broken pelvis and arm and a severed aorta and spinal cord, leaving her a paraplegic.
“When I went into physical therapy, I was taught how to strengthen my upper body through range-of-motion exercises. They [the physical therapists at the institute] also helped rehabilitate me psychologically as well as physically,” said Cassady, who remained an inpatient for three months.
Today she drives a car and manages independently in her own home.
Physiatric outpatient Claire Kelly of Chicago had been diagnosed by a physician as having a fractured vertebrae in her lower back.
“I was unable to do anything with repetitive motion. I couldn’t lift, bend or reach. Surgery was recommended by an orthopedist who decided to refer me to a physiatrist first,” she said. It was a fortuitous step.
“I was diagnosed with osteoarthritis and fibromyalgia [by the physiatrist] in addition to my original problem. That explained why my pain wasn’t going away,” said Kelly, who was put on an exercise program of slow movements and stretching. She was spared the surgery.
“I gave up the weight training another doctor had recommended. It was making my condition worse. And I was prescribed the correct medications to help with the pain,” she said, adding that even though the exercises take her two hours a day, it’s well worth it. “I can go about my life again. The physiatrist gave me my life back.”
Those seeking the services of a physiatrist can find one in the Yellow Pages or online listings under the headings physical rehabilitation, physical therapy and/or sports medicine.
One who has been there . . .
Like many people introduced to physiatry, I had no clue what it was before I needed one of its practitioners. Boy, did I need one.
While doing some overzealous hamstring stretches against a wall, something went seriously wrong. What felt like electrical shocks went jolting down my right leg. I decided to fall on the floor in agony, then head for the chiropractor’s office.
Several days of chiropractic treatment did not relieve the pain. One hip was higher than the other, and I could no longer perform any routine task, such as getting out of a chair or bending over. The floor was as comfortable a place as any.
Three chiropractors, two orthopedic specialists and four months later, I was still unable to walk or move without pain. MRIs and X-rays did not reveal the source of the problem. Ice packs, heat packs, electrical-muscular stimulation, acupuncture, anti- inflammatories and other painkillers did not bring relief.
A surgeon suggested a bone was impinging on a nerve and wanted to do surgery.
But before taking that route, I saw a newspaper ad promoting “non-surgical relief from back pain.” I called and was told the practitioners were physiatrists.
After being examined and diagnosed by a physiatrist as having a destabilized pelvis and stretched ligaments, I underwent three months of physical therapy. Now, without surgery, I am up off the floor, walking normally, even jogging just fine.
— M.N.
