Physiatrists Play A Vital Role In Relieving Back Pain
Navagating the Peripheral Nervous System
By M. Todd Daniels, MD, and Joseph H. Kay, M.D.
Since the 1030’s, physiatry has aided in alleviating pain and discomfort in American patients. But many physicians remain unaware of this highly technical subspecialty. Yet physiatry, which focuses on peripheral nerve and muscular disorders, is both a vital complement to orthopedic surgery and, at times, a powerful, non-surgical alternative to it.
For example, patients suffering from pain, numbness, tingling, or weakness in the extremities, or from an injury that involves concomitant nerve damage - anything from a herniated disc to a major work or car accident - can benefit greatly under the care of a physiatrist.
Pinpointing Damage
A physiatrist navigates the forking paths and intricate byways of the peripheral nervous system to identify and pinpoint nerve damage. Once the damage is pinpointed, steps are taken to correct it. Physiatrists also help coordinate a patient's recovery and his or her return to everyday life. Their patients are a varied lot: someone who has strained his back working around the house, a knitter with carpal tunnel syndrome, a weekend warrior with tennis elbow (epicondylitis), or a construction worker who has suffered a jobsite accident.
At Arlington Orthopedic Associates (AOA), the physiatry staff performs three key functions: identifying and diagnosing nerve injury; administering lumbar epidural spinal injections for problems such as sciatica; and providing non-surgical treatment for mild to moderate repetitive stress disorders such as carpal tunnel syndrome and tennis elbow.
The physiatrists' first job is to pinpoint the source of nerve-related injury. Weakness in the arm, for example, could result from anything from a pinched nerve in the neck to carpal tunnel syndrome in the wrist. Using electromyography (EMG) and nerve conduction tests, which use electrodes to monitor muscle activity and detect irregular functioning, physiatrists determine the location and severities of nerve injuries.
Show Me Where It Hurts
In some cases, a physiatrist can alleviate the need for surgical treatment. If a patient is suffering from mild to moderate nerve damage in the extremities due to conditions like carpal tunnel syndrome, tennis elbow, or tendinitis, a physiatrist can diagnose the problem and recommend a conservative course of therapy, including local steroid injections, braces, or physical therapy.
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Lumbar epidural spinal injections are often an effective means to reduce the pain of sciatica. AOA physiatrists administer 25 to 30 such injections per week. Approximately two-thirds of the patients experience substantial pain relief lasting two to three months, usually enough time for the problem to resolve itself. If the patient does need to follow up with an orthopedic physician, a referral is arranged.
A physiatrists' job isn't over when the patient is treated and the pain is resolved. Work with patients continues to facilitate their return to daily life in a way that will prevent their injury from recurring. For example, a physiatrist may order a workplace analysis to determine whether a jobsite can be adapted to accommodate an individual’s needs.
The nervous system is a mystifying terrain for many physicians, but for physiatrists, this complex network is as navigable as familiar back roads. Through the understanding of this system and the focus on function, physiatry plays a vital role in reducing pain and helping patients avoid re-injury.