To become a physiatrist, individuals must successfully complete four years of graduate medical education and four additional years of postdoctoral residency training. Many physiatrists choose to pursue additional advanced degrees such as fellowship training in such areas as musculoskeletal rehabilitation, spine medicine and pain management. To become board-certified in physical medicine and rehabilitation, physiatrists are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). Physical medicine and rehabilitation physicians specialize in non- surgical treatment of musculoskeletal injuries and disorders. They employ a whole body approach that goes beyond the resolution of symptoms to include prevention of recurrence. Physiatrists focus on restoring function to the injured worker often using a team approach consisting of physical or occupational therapists, nurse case managers, ergonomic specialists, and vocational counselors when appropriate.

For example, a physiatrist may see a person who lifts a heavy object at work and experiences back pain, a ground maintenance worker who sprains an ankle and needs rehabilitation to work again, or a secretary who suffers from repetitive stress disorder or carpal tunnel syndrome. Common reasons to see a physiatrist include neck pain, back pain, sprains and strains to other joints of the body, arthritis, carpal tunnel syndrome and chronic pain disorders.

Physiatrists are non-surgical orthopedic specialists, experts in the treatment of musculoskeletal disorders without utilizing surgery. To put it in perspective, if you had any of the following medical problems, what kind of physician would you see first?

The vast majority of injuries to muscles, ligaments, tendons and bones are not surgical problems. Neither are most occupational injuries or pain syndromes. In fact, over 95% of occupational injuries never require surgery, and can therefore be treated in a conservative manner. Conservative treatment includes physical therapy and modalities, oral medication, and injection treatment if indicated.

Every year, more than 750,000 American workers experienced serious injuries due to overexertion or repetitive motion on the job. These work-related musculoskeletal disorders account for approximately 35% of lost workdays and cost employers over $20 billion in workers compensation costs and $45-60 billion in indirect costs. These repetitive motion or cumulative trauma injuries can result in conditions such as carpal tunnel syndrome and upper extremity tendonitis. The incidence of cumulative trauma continues to increase as computer usage grows.

Physiatrists have a strong understanding of ergonomics and can work with physical and occupational therapists to teach correct posture and behavior modification to prevent such injuries. Early stages of patient care include medication, electro-diagnostic testing (EMG and Nerve Conduction Studies) and physical or occupational therapy. For chronic problems, the physiatrist may medicate to reduce pain or improve sleep, as well as prescribe exercise to improve a patient's physical fitness.

Physiatrists are experts in industrial medicine, non-operative spine medicine, pain management, as well as injury prevention and wellness. They specialize in the use of conservative treatment utilizing oral medications, physical/occupational therapy, and use of modalities such as heat/cold, ultrasound, paraffin bath, and TENS, as well as more non-traditional types of treatment such as acupuncture. In fact, physiatrists are among the only medical specialists extensively trained in the details of physical therapy and the use of modalities. This expertise enables the physiatrist to determine the appropriate type and amount of physical therapy that is medically indicated for a given patient or diagnosis. An expert determination in this area is critical as physical therapy and or chiropractic care often accounts for a significant degree of total medical costs in soft tissue injuries.

Another area in which physiatrists have played a dominant role is in the field of pain management. Chronic pain is a complication sometimes associated with a variety of injury claims. The physiatrist offers a unique background in soft tissue disorders which adds a critical component in the diagnosis and treatment or such patients with chronic pain, utilizing a team approach. The physiatrist is skilled in performing peripheral joint injections, epidural injections, facet joint injections, sacroiliac joint injections, sympathetic blocks and peripheral nerve blocks for therapeutic or diagnostic purposes. They are also experts in electro diagnostic testing (EMG and Nerve conduction studies) that may be used in diagnosing conditions such as carpal tunnel syndrome and sciatica, often performing these studies at the time of the initial evaluation to ensure an immediate diagnosis. The physiatrist is also trained in the interpretation of x-rays, magnetic resonance imaging (MRI), computed tomography (CT), and bone scan imaging.

From a medical-legal perspective, the expertise a physiatrist offers in all these areas is important in assessing damages, costs, and long-term expectations in legal cases.

Physiatrists are best suited to handle musculoskeletal problems, not only from a clinical standpoint, but from a cost-savings one as well. In fact, they can save the healthcare system a great deal of money simply by directing patients who have injuries to the proper source for treatment, thereby preventing the injured worker from drifting from one health care provider to another, often dissatisfied with their care after making little progress with regard to their overall condition.

In summary, the physiatrist should be considered the gatekeeper and primary treating physician for all workers' compensation injuries, getting workers back on the job faster by using the most conservative treatment methods available. They can both cost-effectively and knowledgeably orchestrate a rehabilitation program that utilizes oral medications, modalities, and therapies, as well as spinal and peripheral joint injections when indicated. Surgery is always considered the last resort.