The physiatrists at Hospital for Special Surgery perform non-operative treatment procedures on patients who have spinal and sports-related injuries as well as other musculoskeletal problems. These procedures are combined with medically supervised exercise therapies to restore mobility and function in patients who might otherwise require surgery.
Several members of the Department of Physiatry also perform electrodiagnostic studies such as nerve conduction and electromyography. These diagnostic studies help to determine whether patients may have nerve or muscular disorders such as lumbar or cervical radiculopathy, carpal tunnel syndrome, and other debilitating conditions.
The Department is not only involved with the development of new non-invasive procedures, it also employs innovative research techniques to better understand and validate many non-operative or minimally invasive interventional procedures to treat spinal and sports-related injuries.
Physiatry – also known as physical medicine and rehabilitation (PM&R) – is a medical specialty focused on the nonsurgical treatment of musculoskeletal conditions that cause pain and/or physical weakness. Physiatry first emerged as a medical specialty shortly after World War II, when veterans returned with spinal cord injuries, traumatic brain injuries, loss of limbs and other musculoskeletal impairments. The specialists who emerged from this specialty are called physiatrists and they combine their knowledge of anatomy and biomechanics with the goal of restoring function to individuals with these types of injuries.
Many people who experience pain or dysfunction in their bones, joints or soft tissues are confused about which type of medical specialist is appropriate for them. The trend in medicine toward specialization had made this an increasingly difficult task. People wonder, “Do I have a serious condition that requires surgery or will simple rest and exercise can fix the problem?” In many cases, especially when a spine injury is suspected, a physiatrist is the appropriate doctor who can help treat or determine the appropriate level of care.
Regardless of which type of practitioner you consult first, people who think they may have a bone or joint injury of any kind should find a doctor at an institution that emphasizes collaboration among disciplines and which specializes in every aspect of musculoskeletal treatment and recovery. Patients with a musculoskeletal injury can be assured that at HSS, non-operative care is provided whenever possible and appropriate.
Read more about What is a Physiatrist?
Not everyone necessarily needs to see a physician or a surgeon for their first visit. Although HSS is well-known for orthopedic surgery, the majority of our outpatient visits result in nonsurgical, medical and rehabilitative care. All medical and surgical departments at HSS share the goal for each patients to see the right practitioner for the right treatment at the right time.
The Department of Physiatry places a strong emphasis on triage – a process in which the severity of a condition and the urgency of treatment is assessed – and on facilitating access to appropriate care. With proper assessment by a nurse practitioner or a physical therapist, the patient can often get the attention he or she needs promptly. This is also the best way to avoid progression to a chronic problem or one that is more difficult to treat.
To illustrate how HSS determines the right path of care, these are three hypothetical scenarios in which a person might contact the Hospital to seek treatment for back pain.
HSS has many ways to help the unsure person get immediate care by booking online or speaking to one of our physician referral specialists. Depending on the nature and severity of the injury, a spine specialist will then determine if the patient needs immediate referral to a physiatrist or to a different specialist.
Another option is the Direct Access Physical Therapy program. Experienced physical therapists, who have already passed rigorous qualifying tests for certification, can diagnose and treat a patient without a doctor’s prescription.If needed, they can escalate the care to a physiatrist or other appropriate specialist.
Regardless of the path, once treated, the patient's progress is tracked continually by the spine specialist. If the patient achieves relief, then the focus of treatment turns to prevention. If not, then the spine specialist ensures that the patient receives the next level of care as appropriate for the injury or disorder. After the patient has recovered, HSS specialists provide direction on maintaining wellness.
At HSS, collaboration between physiatry and other orthopedic specialties is easier because oftentimes, they are under the same roof. If a physiatrist believes a patient is in need of surgery, a simple referral to one of the surgeon's at the same location can be made, and vice versa. This arrangement allows for an easy transition for patients and improved communication among physicians.
In addition to acting as partners with other specialists in the delivery of care, HSS physiatrists take an active role in collaborative research, such as conducting surveys to clearly identify patient expectations and goals of care. Areas of study include regenerative medicine, a discipline in which platelet-rich plasma, bone morphogenic proteins and/or stem cells may be used to repair and restore damaged and diseased musculoskeletal tissue.
HSS research teams include members of multiple departments in order to bring together different points of view, which then increases the understanding of what the research shows and which patients may potentially benefit from it.
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:
The Department provides a one-year Spine and Sports Medicine Fellowship, with four fellows accepted each year. Two fellows are ACGME accredited Primary Care Sports Medicine fellows and two are recognized by NASS. The fellowship program focuses on the comprehensive diagnosis and management of musculoskeletal conditions with a focus on Spine and Sports related conditions. This includes comprehensive radiology interpretation, biomechanical and functional assessments, diagnostic and therapeutic interventional spine procedures (cervical, thoracic and lumbar), diagnostic and interventional ultrasound, electrodiagnostics and regenerative medicine. There are daily didactics and a research requirement.
The Department also takes part in the training of Physical Medicine and Rehabilitation residents from New York-Presbyterian Hospital (Cornell/Columbia) and Rutgers (New Jersey Medical School/Kessler) residency programs and is involved in the education of medical students from Weill Cornell Medicine as well as visiting health profession students from across the globe.
