As a doctor of osteopathic medicine (DO) with a specialty in physiatry, also known as physical medicine and rehabilitation (PM&R), I often find a little explanation of terminology is in order.
How Is a D.O. different from an M.D.?
Osteopathic physicians (DO) undergo similar training to allopathic physicians (MD), but have a philosophical difference with a focus on the health of the whole body while treating existing diseases. We are also trained in musculoskeletal manipulations to assist in a holistic approach to health and healing. For more information, please visit https://osteopathic.org/what-is-osteopathic-medicine/what-is-a-do/.
As a physical medicine and rehabilitation specialist, I focus primarily on musculoskeletal rehabilitation for a range of purposes. I see individuals for functional rehabilitation, such as activities of daily living, sports medicine, exercise medicine, general health and wellbeing, and recovery from any injury, head to toe. For more information, please visit https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry.
Also, an interventional pain management specialist, I treat many different types of pain with nonsurgical methods for decreasing or stopping the primary pain complaint, while focusing on eliminating the cause or source of the pain. For more information, please visit https://psadocs.com/what-does-a-pain-management-doctor-do/.
What Is the Role of Physiatry in Orthopedics?
Physiatry is the first-line approach for any dysfunctions and/or injuries that do not require immediate surgical intervention. At EmergeOrtho, our ultimate goal is to have patients seen by a nonsurgical provider for their initial evaluation to determine whether rehabilitation is the most appropriate intervention. This approach can reduce the number of visits a patient needs and assist in formulating long-term plans for the patient’s health and wellbeing.
Because physiatry is an ever-evolving specialty, PM&R specialists have broad and extensive training in musculoskeletal medicine, brain injury, spinal cord injury, stroke recovery and electrodiagnostic medicine, as well as a long list of alternative, experimental and creative approaches and nonstandard treatments for achieving functional goals.
For example, for individuals with chronic pains either from injuries or prior surgery, there are technologically advanced non-medication treatments that can be highly effective. One of the more common involves direct stimulation of nerves and/or the spinal cord. Spinal cord stimulators have been around for more than 50 years, but in just the past seven years, we have seen significant hardware and software advancements.
Spinal cord stimulators may be used to treat post-surgical chronic pain, pinched nerve pain, peripheral neuropathy, diabetic peripheral neuropathy, radiculopathy, post-traumatic pains, and many other nerve-related pain issues. Similarly, peripheral nerve stimulators can be used as a more focused and targeted area of pain relief, such as chronic knee or shoulder pain, chronic post-joint replacement pains, and direct damage to a nerve.
What Is Orthobiologics?
One of the most exciting advancements in medicine in the past 15 years is the advent of orthobiologic treatments. Orthobiologics is a generally accepted term for injecting one’s own body materials (such as fat or blood) at a site of injury to promote a healing response or into a degenerated joint (arthritis) to reduce symptoms or pain.
Orthobiologic treatments are commonly performed for arthritic joints, tendinitis, tendinopathy, degenerative joint disease and traumatic joint arthritis. There are many other conditions where these treatments could be successful.
In our clinic, one of the most effective treatments we perform is to take both concentrated adipose tissue (the patient’s fat spun down in a centrifuge) and platelet-rich plasma (PRP) from the patient’s own blood, and combine the two substances together. We then inject this mixture into arthritic joints for symptom reduction and damaged soft tissue structures such as ligaments and tendons.
This treatment triggers an inflammatory cascade (the body’s natural healing response) through the PRP, as well as some building blocks through the stem cells in the adipose tissue to promote possible healing and repair of damaged tissues.
These approaches are near and dear to my heart, as I have had concentrated adipose and PRP injections both to my knee and shoulder many years ago with fantastic results. These treatments allowed me to continue pursuing exercise and sports, as well as being a father to very active children. In my clinic, these injections are among the most powerful interventions we perform, yielding dramatic improvements.
Please be aware that the terms regenerative medicine injection and stem cell injection have been inaccurately used to describe orthobiological procedures.
What Is the Future of Physiatry?
An important hallmark of a good provider is the ability to keep up with growth and changes in modern medical care. Pain management and musculoskeletal medical practices look quite different today than even 10 years ago when I started to practice.
There has been an evolution of more pain management interventions and a better understanding of the human body. We have been able to move away from primarily medication management used to cover up symptoms. Instead, we are trying to repair and recover from injuries, and better manage symptoms of age-related degenerative changes to reduce surgical interventions.
I am very hopeful for the next 10 years and beyond that we will continue to augment and amplify the body’s natural healing capacity and rely less and less on pharmaceutical treatments for pain management.
Despite the growing use and popularity, and numerous published studies; most insurance companies do not cover Orthobiologic techniques. These companies deem this use as “experimental” and not approved. Discuss this with your provider for more information.