Department of Physiatry

• What do physiatrists do?
• What kind of training do physiatrists require?
• How do physiatrists diagnose?
• What types of conditions do physiatrists treat?
• What is the physiatrist's role in treatment
• How long has physiatry been a recognized specialty?

What do physiatrists do?

Physiatrists specialize in non-surgical physical medicine and rehabilitation (PM&R) for patients who have been disabled as a result of a disease, condition, disorder, or injury. They diagnose, perform thorough patient histories, treat injuries and conditions, and direct your expanded treatment team using non-surgical methods.

Physiatrists focus on a personalized method of treatment to improve their patients' quality of life -- one that involves a comprehensive approach to expand the framework of resources at a patient's disposal. As a result, a patient's recuperation involves every aspect of their lives

What kind of training do physiatrists require?

Physiatrists train for four years in medical school, followed by a one-year internship and three years of hospital residency with a specialization in physiatry. The board certified physiatrists at HSS have also received advanced degrees and fellowships in several areas of musculoskeletal specialization.

How do physiatrists diagnose?

While other specialties use similar diagnostic tools, physiatry employs the additional use of electrodiagnostic medicine in order to detect areas of nerve and muscle damage. This includes electromyography (EMG) and nerve conduction studies, which are used to measure the condition of your nerves and muscles in their relaxed and stimulated states.

What types of conditions do physiatrists treat?

Physiatrists treat a wide scope of cases - from brain and spinal cord injuries to stroke and burn victims - but the physiatrists at HSS have been specially trained and certified to help patients who have spine and sports injuries as well as other musculoskeletal problems.

What is the physiatrist's role in treatment?

Physiatrists direct a comprehensive rehabilitation team of professionals that may include physical therapists, occupational therapists, recreational therapists, rehabilitation nurses, psychologists, social workers, and others.

At HSS, physiatrists also perform several minimally invasive procedures such as IDET, nucleoplasty, radiofrequency ablation, fluoroscopic injection procedures, and shoulder and knee lavage. They combine these treatments with medically supervised exercise therapies, as well as medication and orthotics, to restore mobility and function - all without the need for surgery. In addition, several of the HSS physiatrists have special areas of specialization, such as limb lengthening and osteoporosis, which enable them to uniquely handle these specialized medical conditions from a comprehensive, multidisciplinary standpoint.

How long has physiatry been a recognized specialty?

Although physiatrists have been practicing PM&R for over seventy years, their abilities became widely known and utilized during the years of World War II, when many soldiers returned from the war with serious musculoskeletal disabilities. Recognizing the unique benefits of their specialty, the Advisory Board of Medical Specialties approved PM&R as a specialty of medicine in 1947.

The Department provides over 30,000 ambulatory care visits a year, including approximately 3,900 minimally invasive procedures and 1,100 EMG/NCV studies, attending over 17,500 returning patients and 7,500 new patients each year.

The following is a partial list of procedures performed by physiatrists at HSS:

• IntraDiscal Electrothermal Therapy (IDET) is a minimally invasive procedure  that offers an important treatment option to individuals with lower back pain caused by lumbar disc disease. The physician then passes a thermal catheter through the needle and into the injured disc in the specific area of the annulus tear. The catheter heats the collagen of the disc to shrink the protruded material and destroy the pain fibers 
• Epidural steroid injection is an umbrella term applying to a variety of techniques performed to deliver a corticosteroid preparation around a nerve exiting the spinal cord in an epidural space. This procedure decreases inflammation of the nerve roots, thereby reducing pain for several months and hopefully aiding the healing process as well.
• Nucleoplasty uses radiofrequency energy to treat patients with low back pain from contained, or mildly herniated, discs. Guided by X-ray imaging, a wand-like instrument is inserted through a needle into the disc to create a channel that allows inner disc material to be removed. The wand then heats and shrinks the tissue, sealing the disc wall. Several channels are made, depending on how much disc material needs to be removed.
• Radiofrequency ablation/lesioning uses high-frequency alternating current flow to generate heat and destroy pain sensing nerves. A narrow electrode is introduced to the affected nerve. Precisely controlled generator heat is generated to destroy the nerve.
• Nerve conduction/electromyography testing, or EMG testing, is a two-part electrodiagnostic test that is used to study nerve and muscle function, and it can provide your doctor with specific information about the extent of nerve and/or muscle injury. The test consists of a nerve conduction study and a needle exam for muscle testing. The nerve conduction study entails stimulating the nerves at different points with small electric shocks, artificially activating them so their function can be measured. The needle exam involves inserting very fine needles into several muscles with determine normal and abnormal electrical signals given off by the muscles. EMG testing usually takes anywhere from 30 to 90 minutes, depending on the condition being tested and findings of the study.
• Joint lavage procedures are arthroscopic techniques essentially meant to wash loose tissue debris and inflammatory agents away from the interior of a major joint, such as the knee. Although the lavage procedure is a short-term solution, it may assist in relieving the symptoms of those suffering from osteoarthritis for a number of years. Joint injections are performed for diagnostic and therapeutic purposes, and they can be used in two ways - for aspiration, which involves removing fluid for testing or drainage, and fluid injection, whereby medications such as corticosteroids are injected into a joint to medicate areas affected by inflammatory arthritis.

Video: Regenerative Treatments for Lumbar Disc Disease

Fellowship Training

The Department provides a one-year Spine and Sports Medicine Fellowship, with two fellows accepted each year. This fellowship program focuses on the improvement of skills in the areas of diagnosis and treatment using a comprehensive approach, including including interventional spine procedures (cervical and lumbar), diagnostic and interventional ultrasound, electrodiagnostics, regenerative medicine and concussion management.

The Department also takes part in the training of Columbia University and Cornell University's residents from NewYork-Presbyterian Hospital's Physical Medicine and Rehabilitation residency program, and is involved in the education of medical students from Weill Cornell Medicine.

Condition & Treatment Highlights

The information and articles in this section are written for physicians and other healthcare professionals.

• Histological and Molecular Structure Characterization of Annular Collagen after Intradiskal Electrothermal Annuloplasty
  Gregory E. Lutz, MD; Daniel Southern, MD; Ana Bracilovic, MD; Paul West, PhD; Mila Spevak, PhD; Nancy Pleshko Camacho, PhD; Stephen Doty, PhD
• EMG: Myths and Facts
  Joseph H. Feinberg, MD, MS
• Electrodiagnostic Corner: Cervical Radiculopathy vs Parsonage Turner Syndrome: A Case Report
  Joseph H. Feinberg, MD, MS ; David A. Doward, MD; Alita Gonsalves, MD
• Electrodiagnostics: Localization, Quantification, Prognostication
  Joseph H. Feinberg, MD, MS 
• Clinical outcomes of ultrasound-guided aspiration and lavage in calcific tendinosis of the shoulder
  Julie T. Lin, MD; Ronald S. Adler, MD, PhD; Ana Bracilovic, MD; Grant Cooper, MD; Carolyn Sofka, MD; Gregory E. Lutz, MD
• Clinical Trial: Facet Joint Intra-articular Steroid Injections versus Caudal Epidural Steroid Injections to Treat Axial Back Pain in Grade 1-2 Degenerative Spondylolisthesis
  Paul M. Cooke, MD