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Physiatry (PM&RF) First

At the Brain + Spine Center we try to avoid surgery for you when possible using physical medicine first, but when it is necessary we work to get you relief from your symptoms – especially pain – and return you to wellness as quickly as possible. Shelley Freimark is a Physical Medicine, Rehabilitation and Pain Management physician at our office who evaluates referred patients to determine the best conservative treatment options for their spine or back related pain. Patients or referring physicians might not realize that most people with back or joint pain do not need surgery. We treat musculoskeletal issues non-surgically, but our team is trained to know when surgery is necessary as well. Working together with you, our experts in non-surgical and surgical treatments create your individual treatment plan and then work with you to achieve the best result possible.

Treatments

EMG (Electromyography)

Electromyography is a test to determine the health of one or more muscles and the nerve that controls the muscles. It is used to help diagnose problems with extremity pain, numbness, and muscle weakness. At the beginning of the test, a small needle is placed into the muscle. The needle contains an electrode that can hear the muscle activity. The muscle is evaluated at rest and the patient is then asked to slowly contract the muscle while further readings are taken. Several muscles in one or more extremity may be tested. EMG testing can be used to help diagnose disorders of both muscle and nerves including carpal tunnel syndrome, pinched nerve in the spine, peripheral neuropathy, ALS, muscular dystrophy, myopathy, and a range of other disorders. Electromyography is frequently conducted at the same appointment as a nerve conduction study.

Nerve Conduction Studies

Nerve conduction studies are used to detect problems with the function of nerves. For this test, recording electrodes are placed over muscles and a shock-emitting electrode is placed over the nerve that controls the muscles. A mild electric pulse is sent to the nerve through the nerve electrode and the muscle electrodes record the speed, or velocity, of the muscles’ response to help determine the health of the nerve. An abnormal nerve conduction study can help diagnose peripheral neuropathy, carpal tunnel syndrome, pinched nerve in the spine, and a wide variety of other conditions. Nerve conduction studies are frequently done at the same appointment as an EMG.

Trigger Point Injections

Trigger points are painful areas in skeletal muscle that produce pain at the site and radiate pain to another area. They can often be felt as a firm knot in the muscle. Trigger points are felt to originate from repeated minor trauma to the muscle or an episode of moderate to severe trauma, causing stress on muscle fibers. Muscles with trigger points often have decreased range of motion. Trigger points may play a part in some cases of tension headache, low back pain, myofascial pain syndrome, TMJ pain, shoulder pain, neck pain and other chronic pain conditions. Trigger point injections are often effective in treating pain and poor range of motion due to trigger points.

Trigger point injections involve a needle being placed into a trigger point at an angle, sometimes with a small injection of anesthetic, steroid, or other medication. The needle may be partially withdrawn and redirected into slightly different areas of the trigger point until the muscle relaxes. Several trigger point injections may be given in one session, if needed.

Joint/Bursa Injections

Joint and bursa injections are effective treatments for a variety of conditions. Joints may become painful due to arthritis, injury, or other conditions. Bursae, which are fluid-filled sacs located between tendons and bones, may become irritated, leading to bursitis. These injections are minor office procedures. The goal of the procedure is to reduce inflammation and pain.

The injection is given into the bursa or joint. The medicine is typically injected slowly and is often a combination of a steroid and an anesthetic. Pain relief may occur quickly or take up to a week to become apparent.

Management and Coordination of Physical Therapy

Physical therapy offers many benefits. It can help the patient improve mobility, recover from illness or injury, experience significant pain reduction, improve the ability to perform self-care, and improve quality of life. Physical therapy is often called upon to treat sports injuries, preserve muscle strength, improve balance and coordination, treat diseases of aging, and help patients cope with physical challenges present from birth. Managing and coordinating a patient’s physical therapy encompasses physical therapy sessions along with occupational therapy and other needed therapies. It also involves coordinating a treatment plan with that of other physicians involved in the patient’s care. Whether physical therapy is needed for a few short weeks or many months, proper management is imperative to achieving the best possible outcome.

Management and Coordination of Spinal Injection Treatment

Spinal injections may be necessary to help treat certain types of neck or back problems. These can include epidural steroid injections, facet joint injections, medial branch blocks, or selective nerve root blocks. These injections are done at a pain clinic under x-ray guidance. The patient is usually given sedation prior to the procedure.

Managing and coordinating a patient’s spinal injection treatment involves trying to diagnose the source of a patient’s spinal pain through a thorough biomechanical evaluation of the spine. Then if a patient is not getting relief after time and other conservative treatments, a specific injection can be ordered. This hopefully keeps the patient from having to have multiple injections before gaining relief. The patients are then seen after the requested injections for follow up to determine if the injections have been helpful and if other treatments are still needed.

Independent Medical Evaluations

Independent medical evaluations are conducted by a physician who is not personally involved in an individual’s care. The physician uses her knowledge, experience, and skill to clarify clinical and medical case issues, usually related to illness, injury, or disability. She may be called upon to help determine an extent of injury, the existence or extent of disability, cause of disability, or extent of permanency. Independent medical evaluations may be performed in cases of worker’s compensation, long-term disability, automobile liability, or other issue. She may also be called upon to give a second medical opinion. An independent medical evaluation typically involves a review of the individual’s medical history, relevant medical records, and test results, as well as a physical examination, which evaluates health relative to the injury or illness in question, such as loss of strength, poor range of motion, etc. The physician may perform a functional capacity exam or conduct an examination to determine whether the individual needs future medical treatment.

Case Reviews/Utilization Review

Case review practices vary according to the organization or individual requesting the review. Typically, a physician conducting a case review is attempting to ascertain whether the patient has been given care in accordance with commonly accepted standards and practices. The physician offers her opinions on the case, utilizing her education and her experience with similar cases. Similarly, utilization review is the practice of examining the way an individual’s medical care has been handled. The reviewer compares the services and treatments rendered with current treatment guidelines and gives a report of her findings. A utilization review may be conducted concurrently with treatment or after all treatment has been rendered. Utilization review is commonly used to determine cost-effective treatment practices, which helps to keep costs down for everyone involved.

(616) 738-4420
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Have you had an MRI in the last 12 months?

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