Physical medicine and rehabilitation

Physical medicine and rehabilitation is a medical specialty. Its doctors are called physiatrists. They diagnose and treat problems of the nerves, muscles, bones, joints and spine that affect how you move and live.

The focus is function. A physiatrist asks what your pain or injury is stopping you from doing, then builds a plan to get that ability back. Treatment is usually non-surgical.

Physiatrists look at the whole person, not just one painful spot. Your job, your sleep, your home and your goals all shape the plan.

Physiatrists often lead a team. They diagnose the problem, order tests, prescribe therapy and medication, and perform procedures. They then work with physical therapists and your other doctors so everyone follows the same plan.

• Back and neck pain, including disc and joint problems
• Pinched nerves causing arm or leg pain, numbness or weakness
• Carpal tunnel syndrome and other nerve compression
• Peripheral neuropathy
• Arthritis and joint pain in the hips, knees and shoulders
• Muscle pain, spasm and myofascial pain
• Injuries from car accidents, falls, sports and work
• Loss of strength or mobility after an injury

Dr. Patel is board-certified in Physical Medicine and Rehabilitation and in Pain Medicine by the American Board of Physical Medicine and Rehabilitation. He is also certified by the AOA Board of Physical Medicine and Rehabilitation.

He trained in PM&R at Nassau University Medical Center on Long Island, where he served as Chief Resident. He then completed a fellowship in Interventional Pain Medicine at Penn State Hershey Medical Center.

This combination is not common, and it is useful. Some pain physicians focus mainly on procedures. Some rehabilitation physicians do not perform spine procedures. Dr. Patel does both, so the same doctor who performs your injection also plans the rehabilitation that helps it count.

Lower pain is a good result. Being able to do what matters to you is a better one. Dr. Patel sets goals with you, such as walking farther, sleeping through the night, returning to work or lifting a child.

Progress is measured by what you can do, not only by a pain score. If a treatment lowers your pain but you still cannot function, the plan changes.

PM&R training puts heavy weight on the physical exam. Dr. Patel checks your strength muscle by muscle, your reflexes and your sensation. He watches how you stand, walk and bend, and he measures range of motion.

Specific hands-on tests can point to a disc, a facet joint, the sacroiliac joint, a tendon or a nerve. Imaging is then used to confirm what the exam suggests, not to replace it.

Physiatrists are trained in electrodiagnostic testing. A nerve conduction study uses small electrical pulses on the skin to measure how well signals travel along a nerve. An EMG uses a very thin needle electrode to record how muscles respond to nerve signals, at rest and when you tighten them.

Together, these tests can show whether symptoms such as numbness, tingling, cramps or weakness come from a pinched nerve root, carpal tunnel syndrome, neuropathy or a muscle disorder. They help Dr. Patel choose the right treatment and the right place to aim it.

Testing usually takes 30 to 60 minutes. The pulses and needle can be uncomfortable, but most people tolerate them well.

• Physical therapy with exercises chosen for your diagnosis
• A home exercise program you can keep doing on your own
• Changes to posture, lifting habits and your work setup
• Bracing or splinting for a short time when it helps healing
• Non-opioid medication management
• Treatments such as heat, ice and electrical stimulation to ease pain and spasm
• Guidance on returning to work, driving and sports safely

Rehabilitation and procedures work best together. An injection or nerve block can lower pain enough for you to move and strengthen. Therapy then builds the strength and flexibility that help keep pain from returning.

Dr. Patel’s osteopathic (D.O.) training adds the same view. It emphasizes the musculoskeletal system and treating the whole person.

Because one physician manages both sides, the timing makes sense. You are not left with a procedure and no plan for what comes next.