Ask the Expert: Dr. Castellano Answers Your Questions on When to See a Physiatrist
Q1. Can athletic injuries be addressed effectively through non-surgical management?
Various athletic injuries, such as runner’s knee and tennis elbow, can be effectively treated with conservative management. A physiatrist may aid in diagnosing injuries that are likely to respond to non-surgical care as opposed to those in need of immediate surgery. Often a trial of physical therapy is prescribed. At times, injections can help in reducing pain and inflammation. However, surgery may be a reasonable next step if the above care fails to achieve the desired results.
Q2. Is physical therapy prescribed by a physiatrist different than that of other providers?
Physiatrists, also known as physical medicine and rehabilitation doctors, work closely with physical therapists throughout their medical training. This allows for an understanding between the doctor and therapist intended to optimize patient care. However, these relationships can be equally as strong with other specialty doctors such as orthopedic surgeons, rheumatologists and neurologists.
Q3. Can a physiatrist recommend complimentary care beyond physical therapy for a lumbar disc herniation?
Lumbar disc herniations and the lower back pain that results can be challenging to treat. Physical therapy may be an essential part of an individual’s care. However, other complementary services may aid in alleviating pain as well. For example; acupuncture, massage therapy, chiropractic care, and Pilates can complement the physical therapy. A physiatrist may help in better organizing your care. The Hospital for Special Surgery’s Integrative Care Center is an example of a facility dedicated to offering various types of complimentary care conveniently under one roof.
Q4. What approaches are available to treat lumbar degenerative disc disease?
Lumbar degenerative disc disease can result not only in pain, but it may also affect an individual’s function. Therefore, treatments are intended to both address the pain and improve function. At times, medications and injections can help in alleviating pain. However, such treatments may only offer short term relief unless an individual’s core strength is improved as well. This can be accomplished with the appropriate physical therapy. In addition, maintaining a healthy weight will reduce the stress onto the spine. For those who sit at a desk all day long, try to get up and move around every 30 to 45 minutes. Lastly, make sure that your work site’s ergonomics are correct for your body. Current research in rejuvenating therapies offers some hope that additional treatments may be available soon.
Q5. Do procedures such as intradiscal electrothermal therapy (IDET) and nucleoplasty really work for lower back pain?
Intradiscal electrothermal therapy (IDET) and nucleoplasty are outpatient procedures that can help in reducing lower back pain. Both interventions attempt to reduce pain by altering a disc under fluoroscopic guidance. The key is to pick the right procedure for the right patient. An interventional physiatrist trained in such procedures can help in determining whether either is appropriate for you. The use of platelet rich plasma (PRP) for disc-related pain is another treatment that is currently being studied. Ongoing research at Hospital for Special Surgery is attempting to determine the effectiveness of PRP for certain disc injuries.
Dr. Vincenzo Castellano is a board certified Hospital for Special Surgery physician specializing in Interventional Spine and Sports Medicine. He treats disorders of the back, neck, joints, and muscles.