What is physical medicine and 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.  PM&R physicians evaluate and treat injuries, illnesses, and disability, and are experts in designing comprehensive, patient-centered treatment plans.

PM&R is often called the quality of life profession because its aim is to enhance patient performance.  These specialists treat any disability resulting from disease or injury involving any organ system.  The focus is not on one part of the body, but instead on the development of a comprehensive program for putting the pieces of a person’s life back together – medically, socially, emotionally, and vocationally – after injury or disease.  PM&R physicians manage issues that span the entire spectrum, from complicated multiple trauma to injury prevention for athletes.

 

Why Visit a PM&R Physician?

Physical Medicine and Rehabilitation (PM&R) physicians, treat a wide variety of medical conditions.  By taking the whole body into account, they are able to accurately pinpoint problems and enhance performance without surgery.

Consider seeing a PM&R physician if:

  • You’ve had an accident or you have an injury or chronic condition that has left you with pain or limited function
  • You’re contemplating or recovering from surgery
  • You have an illness or treatment for an illness that has diminished your energy or ability to move easily
  • You’re recovering from the effects of a stroke or other problems related to nerve damage
  • You have chronic pain from arthritis, a repetitive stress injury, or back problems
  • Excess weight makes it difficult to exercise or has caused health problems
  • You think you’re too old to exercise
  • Life changes such as childbirth or menopause have created new challenges to your physical function

Getting started

Our PM&R physician will thoroughly assess your condition, needs, and expectations and rule out any serious medical illnesses to develop a treatment plan.  A clear understanding of your condition and limitations will help our PM&R physician develop a treatment plan suited to your unique needs.

Understanding and identifying your goals

Do you want to strengthen an injured muscle, find relief from chronic pain, or walk up the stairs without being winded?  Our PM&R physician can work with you to determine realistic short- and long-term goals.  Along the way, she will help you to find relief from pain, achieve successes in rehabilitation or exercise programs, overcome your setbacks, and reassess your goals if necessary.

Tailoring your plan

Dr. Ilkevitch is trained in general PM&R with a focus on spine and musculoskeletal health with additional training in integrative medicine. She is not a pain specialist and does not prescribe opioid medications, but she does have many other tools that can help people who have chronic pain for various reasons improve their day-to-day function and reduce pain levels.

Dr. Ilkevitch works closely with your primary care provider as well as physical therapy and mental health colleagues to make sure that you get the best care possible.  Patients are encouraged to become a vital part of the healthcare team and take an active role in the treatment process. We work together to design an individually tailored, comprehensive care plan that considers diet, activities, and emotional well-being.

PM&R Visit Options:

  • MUSCULOSKELETAL INTEGRATIVE MEDICINE CONSULTATION

    Our Integrative Physical Medicine & Rehabilitation physician (link to more information about her specialty here) will focus on optimizing your musculoskeletal and neuromuscular health and function. We start by reviewing your whole health history in detail. During the consultation, you and Dr. Ilkevitch will develop a customized health and wellness plan to best fulfill your health needs and goals by combining complementary and conventional Western approaches.

 

  • OSTEOPATHIC MANIPULATIVE TREATMENTMT (OMT) 

What Is OMT?

Osteopathic manipulative treatment, or OMT, is a hands-on treatment. It involves using the hands to diagnose, treat, and prevent illness or injury. For example, the physician will use her hands to examine the back and other parts of the body such as joints, tendons, ligaments, and muscles for pain and restriction during motion that could signal an injury or impaired function. Using OMT, your physician will move your muscles and joints using techniques including stretching, gentle pressure and resistance. OMT can be helpful in relieving neck and back pain as well as relieving discomfort and musculoskeletal abnormalities associated with many disorders including headaches.

Who Can Benefit from OMT?

OMT can help people of all ages and backgrounds. The treatment can be used to ease pain, promote healing and increase overall mobility. OMT is often used to treat muscle pain. It may also be helpful for patients with other health problems.

Who Performs OMT?

Traditionally, OMT is performed by osteopathic physicians (DOs), but it can also be performed by medical doctors (MDs), physical therapists (PTs) and other professionals who practice manual medicine. Dr. Ilkevitch is an MD who has training in OMT.

What Are the Risks Associated with OMT?

In general, OMT is considered to be a safe treatment in the absence of contraindications when done by a trained provider, especially when compared to other treatments commonly used for musculoskeletal complaints (including anti-inflammatory drugs).

What Are the Contraindications to OMT?

Contraindications for neck manipulations include structural abnormalities of the vertebral arteries, carotid artery disease and atlantoaxial instability which can be seen in rheumatoid arthritis and genetic conditions such as Down Syndrome. General contraindications for all body regions include the following: active disk herniation, fracture, ligamentous instability, infection, primary or metastatic tumors. Relative contraindications include low bone density (osteopenia and osteoporosis); previous surgery (i.e. fusion or others); anticoagulation.

  • PROLOTHERAPY

Common conditions that can be treated with prolotherapy include knee pain, elbow pain (tennis elbow), low back and sacroiliac joint pain. Typically, a trial of prolotherapy injections may be recommended to patients who did not improve with conservative measures (rest, physical therapy, anti-inflammatory and other pain medications, etc.) and are not surgical candidates or are looking for non-surgical options. Other patients decide to try prolotherapy injections if they have already tried steroid injections or other injection treatments without lasting relief or if they are looking for alternatives to steroid injections.

Some background information about prolotherapy is included below:

What is prolotherapy?

Prolotherapy injections are an established technique for tightening of the ligaments and tendons and relieving pain. The technique requires the injection of prolotherapy solution into the affected sites. The site of the injections is where the ligaments and tendons attach to the bones and/or into the joint space.

Dr. Jose Barreto’s “What is Prolotherapy: Video on YouTube also does a great job explaining how prolotherapy works: https://www.youtube.com/watch?v=n0xXFYCCytA

What medications are used during prolotherapy injections?

Local anesthetic (lidocaine) injections are typically done first to help decrease discomfort with prolotherapy injection treatment. Prolotherapy injections typically include some or all of the following medications: local anesthetic (lidocaine), concentrated sugar water (dextrose), normal saline, and/or other solutions.

How does prolotherapy work?

When ligaments or tendons (connective tissue) are stretched or torn around the joint, the joint can become less stable and painful. Prolotherapy works by stimulating the body’s natural healing mechanisms to lay down new tissue in the weakened area. The mild inflammatory response which is created by the injection encourages growth of new, normal ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area.

What are the risks associated with prolotherapy?

Risks are similar to the risks of other injections and will be covered in greater detail if the procedure is recommended for your condition.

Is prolotherapy supported by research?

At this time, there is strong research supporting prolotherapy treatment for knee pain associated with knee osteoarthritis and also research supporting prolotherapy treatments for lateral epicondylitis (tennis elbow). Currently there are no research studies conclusively showing that prolotherapy injections work for treating pain for other body areas, such as low back, sacroiliac region, or others regions and in those cases prolotherapy injections are still considered an experimental treatment although further research is in process. Please ask your physician if prolotherapy would be an appropriate treatment choice for your health condition. Please note that prolotherapy treatments are not covered by most insurance carriers at this time, but the consultation to discuss various treatment options which may include prolotherapy should be covered. Please call our billing office or your insurance carrier if you have further questions about coverage.