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Frequently Asked Questions About PHYSICAL MEDICINE & REHABILITATION (PM&R) Here are some answers to questions frequently asked about the specialty of physical medicine and rehabilitation:

  • What is physical medicine and rehabilitation?
  • What is a Physiatrist?
  • What kind of training do Physiatrist have?
  • How do physiatrist diagnose?
  • What are the scope of the Physiatrist’s practice?
  • What kinds of treatments do physiatrist offer?
  • Are Physiatrists refer to surgeons?
  • What kinds of differences do physiatrists make? /Why it is important to see a physical medicne & Rehabilitation specialist rather than other specialty regarding the musculoskeltal problem?
  • How many centers are performing all these type of procedures in Bangladesh?
  • How should you prepare for Interventions(to avoid surgery)?
  • What are my limitations after minimally invasive spinal Intervention,and how long will I be out of work?
  • What are my options for a ruptured disc?
  • What does it mean to have Degenerative dise Disease?
  • What is the value and status of ozone Neucleolysis in minimally Invasive Spaine Surgery?
  • What are minimally Invasive Procedures?

Q1:What is physical Medicine and Rehabilitation? A:Physical medicine and rehabilitation (PM&R), also called physiatry, is the branch of medicine emphasizing the prevention, diagnosis, and treatment of disorders – particularly related to the nerves, muscles, and bones – that may produce temporary or permanent impairment. PM&R is one of 24 medical specialties certified by the American Board of Medical Specialties. PM&R provides integrated care in the treatment of all conditions related to the brain, muscles, and bones, from traumatic brain injury to lower back pain. Link-\AAPM&R - Frequently Asked Questions About PM&R.mht

Q2:What is a physiatrist (phizz-ya-trist)? A:Specialist in Physical Medicine & rehabilitation-are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. They are sometimes referred to as PM&R physicians or physiatrists. They treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. To learn about some of the conditions rehabilitation physicians treat,

Q3:What kind of training do Physiatrist have?
A:To become a Physiatrist, individuals must graduate from medical college followed by four additional years of postdoctoral training in a physical medicine and rehabilitation residency. Many Physiatrist choose to pursue additional advanced degrees (PhD or post fellowship training).
To become Physiatrist (FCPS or MD), Physiatrists are required to take written exam for entrance and both written and oral examination for completing degree administered by BCPS (Bangladesh College of Physicians & Surgeons) or Dhaka University.

Q4:How Physiatrist do diagnose?
A:Diagnosis is the main credit of Physiatrist to manage patient. As firstly Physiatrist diagnose grossly systemic disease(eg. Rheumatoid arthritis) then pinpoint regional diagnosis(eg. secondary knee osteoarthritis or adhesive capsulitis) for fine treatment. Physiatrist uses specific diagnostic tools are the same as those used by other physicians (medical histories, physical examinations, investigations and imaging studies), with the addition of special techniques in musculoskeletal ultrasound, electrodiagnostic medicine like electromyography (EMG), nerve conduction studies and even usg guided diagnostic injections. These techniques help the physiatrist to diagnose conditions that cause pain, weakness, and numbness.

Q5:What are the scope of the Physiatrist’s practice?
A:Musculoskeletal problem of rheumatological, non surgical orthopedic conditions, Neurological & brain injury & spinal injury, sports injury, paediatric condition, geriatric medicine etc. Musculoskeletal problem of rheumatological disease-
In rheumatoid arthritis or Spondyloarhtropathy, if Physician donot concentrate following problem, patient will not satisfy and physician also may misguide and searching cause of pain or disability though biochemically normal or persistently raised titer due to failure of management of particular joint.
Hand joint involve in Rheumatoid arthritis means small joint may be swelled or partially fix or partially bending or little muscle wasting or unable to do daily work etc.
Shoulder joint involve in Rheumatoid arthritis means unable to combing or raise hand or wearing cloth on that side or muscle wasting or pain during lifting weight or associated mid back pain.
Knee joint involve in Rheumatoid arthritis means swallowen knee joint or difficulty during walking orcannot squat during toilet or pray, pain in specific point of knee joint or slightly bending of knee joint or muscle wasting etc.
Musculoskeletal problem of non surgical orthopedic conditions- Simply post traumatic_any joint pain, tendinitis, ligament injury, tendon injury,
Osteoarthritis, post fracture stiffness, muscle wasting, any joint problem after removal of plaster, spinal problem like neck pain, low back pain, mid back pain etc.
Musculoskeletal problem of neurological conditions- Any neurological disease either brain cause or nerve cause always present as a musculoskeletal problem like-
In Stroke-
Weakness, paralysis, muscle wasting, tightness/spasticity, tendon/ligament shortening, joint stiffness, joint pain, tingling sensation, difficult to do daily activities, sitting problem, difficulty in walking.
In spinal injury-
Paralysis, muscle wasting, unable to move, joint stiffness, tightness/spasticity, tendon/ligament shortening, joint stiffness, joint pain, tingling sensation, difficult to do daily activities, sitting problem, difficulty in walking.

Q6:What kinds of treatments do physiatrists offer?
A:Physiatrists offer a broad spectrum of medical services. They do not perform surgery. Physiatrists prescribe drugs in combination with physiotherapy (implemented by physiotherapist) with or without minimally invasive interventions.

Q7:Are Physiatrists refer to surgeons?
A:Yes, We, physiatrists are the first physician who refer to surgeon for genuine indication. As we provide highest degree of conservative treatment to prevent surgery, our number of referral are very few but most of the physicians depend on only drugs or only physiotherapy and their referral to surgery is very high. So, Patient have to decide to choose physician for getting highest level of conservative treatment.

Q8:What kinds of differences do physiatrists make?/
Why it is important to see a physical medicne & Rehabilitation Specialist (Physiatrist) rather than other specialty regarding the musculoskeletal problem?
The differences the Physiatrist make can be dramatic-
A high profile official came with the complains of sever back pain with radiating to right leg, MRI confirm Disc Prolepses (not sequestrated), the physiatrist may star transforaminal epidural with or without c-arm guided ozone neucleolysis for acute pain relief and early recovery followed by physiotherapy for complete recovery. Physiatrist also teaches the patient how to prevent the injury in the future. So, No surgery at this stage, few prescription need, few working hour loss otherwise patient may confuse with dynamicity of different advice.
A 68 year old Lady came with severe buttock pain withradiation along right side with the previous diagnosis of chronic kidney disease. MRI confirm mild disc prolapsed that was actually not clinically related that was actually Piriformis syndrome. Physiatrist can do MSK-USG guided diagnostic & therapeutic injection for acute pain relief followed by physiotherapy. Otherwise patient may be falsely treated as a disc prolapsed.
A stroke patient come to physiatrist after 5 months physiotherapy with minimal improvement with the complains of pain in the shoulder & hand joint of hemiparetic side. Physiatrist diagnose CRPS that was previously not diagnosed. For prevention of this type of sufferings and also for proper stroke rehabilitation, patient must come to physiatrist after stabilization of stroke.
A university student, come to physiatrist with acute knee pain during football play-after giving first AID, he is advised for x-ray to see bony injury and musculoskeletal ultrasound for soft tissue injury in lieu of MRI(for reduce cost) and treated accordingly.
A businessman, diabetic come to physiatrist with the complains of pain in right shoulder after taking 3 times injection in same joint with no pain relief. Physiatrist can perform musculoskeltal USG for accurate rotator cuff injury and manage accordingly.
A baby is born with cerebral palsy. The physiatrist is called in as the expert who advises on the correct treatment and rehabilitation plan in collaboration with paediatric neurologist that can affect the rest of the child's life.

Q9: How many centers are performing all these types of procedures in Bangladesh?
A: No one. Only few centers are performing few procedures without comprehensive rehabilitation.These state-of-the-art procedures are specialized and perfected by drZaman'sFCPS Interventional Pain, Arthritis & Spine center . These type of interventions employ advanced medical technology, and it is at the forefront of this movement.

Q10: How should you prepare for Interventions (to avoid surgery)?
A: If a patient is planning to have Intervention he or she must discontinue all anti-inflammatories, multivitamins and herbal supplements 14 days prior to this procedures.. If a patient is taking anticoagulants, such as Pladex/Ecosprin/pre-clot /odrel/anclog, he or she must obtain a clearance from the prescribing physician prior to discontinuing those medications. drZaman'sFCPS Interventional Pain, Arthritis & Spine center provides a medical consultation prior to arrival for International Patient or patient from outside the Dhaka city over phone or by Email.

Q11: What are my limitations after minimally invasive spinal Intervention, and how long will I be out of work?

A: I recommend you lift no more than 10 pounds for at least six weeks, and that you return to normal activities gradually to allow for maximum healing. Patients who have desk jobs can normally return to work within three weeks and patients with physically strenuous jobs should wait at least four weeks, depending on the job.

Q12. WHAT ARE MY OPTIONS FOR A RUPTURED DISC?

Each of different types of disc protrusion has different implications for treatment affecting cervical & lumber spine, and different types of interventions may be

appropriate, depending upon the exact nature of the damage to the disc, and the particular symptoms which you have been experiencing. In many instances, effective relief of symptoms may be accomplished by a period of relative rest, or avoidance of provocative activities. Prolonged bed rest is, however, not generally beneficial especially regarding complete recovery . Physical therapy and medication may be helpful in reducing inflammation and easing muscle spasm.

However, protruding disc material may be toxic to the nerves, causing pain, or numbness and tingling. If the disc actually presses on the nerve roots - a so-called "pinched nerve" - the nerve may be damaged, and there may be symptoms of weakness, or even disturbances of bowel and bladder function. Please bear in mind that the various descriptions are brief, and cannot substitute for a full discussion with your doctor, who has examined you and has access to the various X-rays and tests which have been, or will be performed.

A careful clinical examination is required, and appropriate tests, such as an MRI scan, should be performed, to clearly delineate the precise nature of the "ruptured disc". You should discuss this with your doctor, so that you have a thorough understanding of the nature of your condition, and the treatment options available to you.

Lastly, I treat patient, not treat MRI that means whatever findings in MRI that MUST correlated with the patients Symptoms & Signs.

Q13:WHAT DOES IT MEAN TO HAVE DEGENERATIVE DISC DISEASE?

Degeneration of the intervertebral discs can result from a variety of conditions, including aging, trauma, and several types of arthritic conditions. As we age, our tissues tend to lose water. That's why skin wrinkles with age, and various body parts begin to sag. When this occurs in the intervertebral disc, the disc tends to shrink, becoming thinner and less cushiony. The condition is fairly common in adults past middle age, and may be asymptomatic - causing no symptoms - other than occasional lower back pain, or stiffness.

The inner portion of the disc, the nucleus pulposis, is composed of proteoglycans - chemical combinations of sugar and protein. When the disc degenerates, small cracks or tears form in the outer annulus, allowing these chemical substances to leak out into the epidural space. Proteoglycans have been shown to cause irritation or inflammation of the nerves surrounding and adjacent to the damaged disc. Minimally invasive, Transforaminal Epidural Steroid Injection procedure, designed to diminish inflammation immediately that is very helpful for early mobilization & Rehabilitation.

Under other circumstances, collapse of the disc space can lead to a condition more recently termed "vertical instability". In this case, shrinkage of the disc allows abnormal movement across a motion segment (2 vertebrae and the intervening disc), and may result in mechanical back pain - pain which arises from changes in position, or attempts at strenuous activities. In such cases, No Interventions are needed only program based Rehabilitation is enough.

Q14:WHAT IS THE VALUE AND STATUS OF OZONE NEUCLEOLYSIS IN MINIMALLY INVASIVE SPINE SURGERY?

It is evident that OZONE NEUCLEOLYSIS is a term often used to attract patients in advertising spine practices, and many practices do just that, especially over the internet. The OZONE NEUCLEOLYSIS is just a very effective and precise tool.

Q15:WHAT ARE MINIMALLY INVASIVE PROCEDURES?

Minimally invasive procedures are those which can be performed by using very thin spinal needle, usually under local anesthesia, thereby avoiding general anesthesia, and contributing to a speedier recovery and return to normative levels of activity.

There are definite technical limitations to these procedures, and they are not appropriate for all patients, or all conditions. Some of the commonly performed minimally invasive procedures are summarized below.

THE EARLIER START OF TREATMENT, LESSER CHANCE OF INTERVETNION OR SURGERY.

Thank you for your interest in the drZaman'sFCPS Interventional Pain, Arthritis & Spine center –POPULAR MEDICAL COLLEGE HOSPITAL, DHAKA, BANGLADESH leaders in Pain Management