What is A Physiatrist?

Dr. Craig Best

What’s a physiatrist?

Patients are often surprised to hear I’m not a surgeon despite the fact that I work in an orthopedic SURGERY practice. I usually explain that my primary specialty is called Physical Medicine & Rehabilitation, otherwise known as PM&R or physiatry (say it with me, “fizz-eye-ah-tree”), and I’m the only non-surgeon at Orthopedic Specialists of Northwest Indiana. I take care of a variety of painful neurologic, musculoskeletal, orthopedic, and chronic pain conditions with non-operative treatment options such as medications, therapies, and a wide variety of injection/procedural options. This is often followed by a blank stare or quizzical look from the patients because nobody has ever heard of a physiatrist. It’s okay… most people, including my grandma, still think I’m a physical therapist, podiatrist, or psychiatrist. I’ve witnessed many blank stares after telling people what I do for a living.

Physiatry is not a cool or sexy specialty like neurosurgery, emergency medicine, or plastic surgery. I knew in medical school when I selected physiatry as my specialty and all through residency training that there was little to no chance that a character on Grey’s Anatomy, Scrubs, House, or any other physician TV show was going to be a physiatrist rushing in to save the day. However, when called upon, I think we can make a great deal of difference in a patient’s life.

According to the American Academy of Physical Medicine & Rehabilitation (AAPM&R), the specialty can be defined as follows:

“Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. PM&R physicians evaluate and treat injuries, illnesses, and disability, and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists utilize cutting‐edge as well as time‐tested treatments to maximize function and quality of life.”

During our residency training, PM&R trainees will spend time caring for patients with spinal cord injuries, traumatic brain injuries, amputations, post-operative orthopedic and neurosurgical patients, sports medicine, electrodiagnostic medicine, chronic pain, and pediatric rehabilitation issues. We are trained in nerve and muscle tests called electromyography and nerve conduction studies (EMG/NCS) to help more precisely diagnosis nerve and muscle disorders. We are also trained is use of diagnostic ultrasound for the neurologic and musculoskeletal system. Finally, we are often trained in a wide variety of ultrasound or fluoroscopic-guided injections and procedures to help treat many different painful conditions. Often after residency, and potentially an extra year of training to subspecialize, physiatrists will choose to focus on just a few segments of their specialty and grow their practice accordingly.

After four years of medical school and four years of residency training, I chose to do a one- Interventional Pain Management fellowship to add to both my knowledge base and procedural skill set. This allows me to better diagnose and more comprehensively treat a variety of painful neurologic, musculoskeletal, orthopedic, and chronic pain conditions on top of what my PM&R training provided. My practice at this point primarily consists of spine/pain, sports, and electrodiagnostic medicine. I see many patients with low back, mid back, neck, knee, hip, or shoulder pain. I also see patients with conditions such as complex regional pain syndrome, peripheral neuropathy, headaches, and vertebral compression fractures. I spend some time during my typical work week performing EMGs to help diagnose neurologic or muscular issues such as carpal tunnel syndrome, radiculopathy, peripheral polyneuropathy, or other nerve and muscle issues. Finally, I also diagnose and treat concussions (mild traumatic brain injury). Procedures that I commonly perform include epidural steroid injections, facet joint injections, radiofrequency ablation, joint (sacroiliac, knee, hip, shoulder, etc.) injections, and various nerve blocks. Additionally, I also perform more advanced procedures such as spinal cord stimulator trials for conditions such as failed spine surgery, complex regional pain syndrome, and painful polyneuropathy, kyphoplasty for vertebral compression fractures, and Vertiflex Superion for lumbar spinal stenosis. Finally, with the ever expanding field of interventional orthopedics and orthobiologics, I continue to expand the use of platelet-rich plasma (PRP) injections to treat an assortment of painful tendon, muscle, joint, and spine conditions.

If you think a physiatrist might be the right type of physician for you, please contact Orthopedic Specialists of Northwest Indiana at 219.924.3300 to book an appointment with Dr. Craig Best.

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