Physiatry

Physiatry/Physical Medicine & Rehabilitation

Physical medicine and rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. CoxHealth’s physical medicine and rehabilitation services are provided by both our neuroscience and orthopedics teams. Please call us if you have additional questions about our services.

Physiatrists are medical doctors who have completed training in the specialty of physical medicine and rehabilitation, and may be certified in additional sub-specialties, such as:

• Brain injury medicine
• Hospice and palliative medicine
• Neuromuscular medicine
• Pain medicine
• Pediatric rehabilitation medicine
• Spinal cord injury medicine
• Sports medicine

In general, our PM&R physicians:

• Treat patients of all ages
• Focus treatment on function
• Have a broad medical expertise that allows us to treat disabling conditions throughout a person’s lifetime
• Diagnose and treat pain as a result of an injury, illness or disabling condition
• Determine and lead a treatment/prevention plan
• Lead a team of medical professionals, which may include physical therapists, occupational therapists and/or physician assistants
• Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons and many others.
• Treat the whole person, not just the problem area

Conditions We Treat

• Neck and back pain
• Radiculopathy
• Carpal tunnel syndrome
• Post-surgical pain syndrome
• Arthritis
• Muscle and nerve pain

• Spacticity
• Torticollis
• Dystonia
• Headaches
• Sports, work place and overuse injuries

Treatments & Procedures

• EMG/nerve conduction studies
• Ultrasound guided procedures
• Fluoroscopy guided procedures
• Injections of spine
• Discography, disc decompression and vertebroplasy/kyphoplasty
• Nerve stimulators, blocks and ablation procedures (peripheral and spinal)
• Injections of joints
• Prolotherapy

• Spasticity treatment (Phenol and Botulinum toxin injections, intrathecal baclofen pump trial and implants)
• Nerve and muscle biopsy
• Manual medicine/osteopathic treatment
• Prosthetics and orthotics
• Alternative medicine (i.e., acupuncture)
• Disability/impairment assessment
• Medical legal consulting

Physiatry Services

Braces & Orthotics

Your doctor may prescribe a neck or back brace for you to wear after a spinal injury or surgery. A brace immobilizes your spine during healing, stabilizes injured areas and controls pain by restricting movement.

Chiropractic Care

Chiropractic medicine helps restore structure and function to the spine and other joints. Stress, accidents, overexertion and other injuries may cause minor displacement of the spinal vertebra. This can cause muscle tension or irritation to the spinal nerves. This can lead to pain in the neck or back, headaches, whiplash and other issues that impair health. Chiropractic care is a conservative, natural approach to health care. It can help reduce pain, muscle spasms, tightness or joint inflammation. It can also improve muscle balance and help maintain healthy discs.

Epidural Steroid Injections

An epidural steroid injection (ESI) is a minimally invasive procedure. It can help relieve neck, arm, back and leg pain caused by inflamed nerves in your spine. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis or disc herniation. Medicine is delivered to the spinal nerve through the epidural space. This is the area between the protective covering of the spinal cord and vertebrae. The effects of ESI tend to be temporary. Pain relief may last for several days or even years.

Foot Drop Treatment

When the foot and ankle muscles become weak or paralyzed and walking becomes difficult, it’s called foot drop. The condition is caused by an illness or injury. Stroke, multiple sclerosis, brain injuries, spinal cord injuries and cerebral palsy are common causes.

The NESS L300 Foot Drop System by Bioness is an advanced functional electronic simulation (FES) system that sends low-level electrical impulses to the common peroneal nerve in your leg, stimulating muscles to lift your foot. While you’re walking, it automatically senses your foot position, terrain changes and your walking speed, helping you achieve a more natural gait.

You can wear the NESS L300 under most clothing and with most shoes. The system consists of three small components that communicate with each other wirelessly. When you lift your heel, the Intelli-Sense Gait SensorTM sends wireless signals to the leg cuff which stimulates the nerves to contract the muscles that lift your foot while walking.

To be assessed for foot drop, contact us.

Joint Steroid Injections

A steroid injection can temporarily relieve pain caused by an inflamed joint. The cause of joint pain (arthritis, injury, degeneration) is not well understood. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from the joint. Second, it can be used as a treatment to relieve inflammation and pain caused by various conditions.

Nerve Block Injection Test

A nerve block injection, also called a pain receptor block injection, is a minimally invasive procedure. It can temporarily relieve joint or nerve pain. The procedure is used as a diagnostic test to determine if the pain is actually coming from the nerve or joint. The effects of a nerve/pain receptor block tend to be temporary and are rarely long term. If the block is successful, then a radiofrequency ablation may be recommended.

Radiofrequency Ablation

A radiofrequency ablation is a minimally invasive procedure. It destroys the nerve fibers carrying pain signals to the brain. It can provide lasting relief for people with chronic pain. It's especially used for pain in the lower back, neck and arthritic joints. This could be a good option if you suffer recurrent pain and experienced good relief with a nerve block injection.

Pain Management

Acute pain starts suddenly and improves over time with healing. Chronic pain persists and is often present in ongoing conditions such as arthritis or cancer. Pain management is an integrated approach to making pain tolerable by learning coping skills. This may include exercise, physical therapy, medication, holistic therapies and counseling.

Physical Therapy

Physical therapy is an important part of a nonsurgical approach to maintain, restore and improve overall physical health. Pain-free mobility is crucial for physical independence, earning a living, quality of life and well being. Working with a doctor and a physical therapist can help patients who have suffered an injury, disease or those recovering from surgery.

Platelet Rich Plasma Therapy

Platelet Rich Plasma Therapy (PRP) is a completely natural, drug-free, non-surgical treatment for pain and injury. The treatment triggers your body’s natural instincts to repair itself, and can help you heal more quickly.

This relatively simple procedure usually takes less than an hour. Some blood is drawn, and the plasma is separated. The platelet-rich plasma is then injected into the injured area. It contains a larger amount of growth factor than whole blood, giving your boosting your body’s ability to heal.

PRP may help:

• Rotator cuff tendonitis and partial tears
• Elbow tendonitis 
• Ligament sprains and tears 
• Bursitis
• Patellar tendonitis and tendinosis 
• Golfer's and tennis elbow
• Chronic tendonitis
• Sacroiliac joint pain
• Hamstring tendonitis and tears
• Chronic plantar fasciitis muscle strains and tears

Two to three weeks after your first PRP treatment, your doctor will evaluate your progress to determine if more therapy is needed. Most patients need one to four treatments, depending on the severity and duration of their injury or disorder.
 

Spinal Cord Stimulation

Spinal cord stimulation delivers low voltage current to block the feeling of pain. A small device implanted in the body transmits an electrical current to the spinal cord. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. It helps patients with chronic pain better manage symptoms and potentially decrease use of pain medications.

Sympathetic Nerve Block

A lumbar sympathetic block is an injection of a local anesthetic that can help relieve chronic leg and foot pain. This pain can be caused by conditions such as complex regional pain syndrome, reflex sympathetic dystrophy, vascular insufficiency and shingles. Medication is delivered to the sympathetic nerves along the front side of the spine. The goal is to reduce pain so you can resume normal activities and physical therapy.

Transcutaneous Electrical Nerve Stimulation

Transcutaneous Electrical Nerve Stimulation (TENS) is a noninvasive device. It's placed on the skin to help control pain. This small, battery-operated device can block pain signals from reaching the brain. This can help reduce pain medication. It's important to remember that TENS does not cure or eliminate the cause of pain. It's also not effective for every patient.