A Visit to the Physiatrist

Hi, I’m Thyme, and I get injured a lot. When my future in-laws recommended that I see a physiatrist, my first reaction was “physia-what-now?” I had never heard of this medical specialty, and judging from reactions when I’ve mentioned it to others, I’m not alone. Heck, spellcheck doesn’t even recognize the word! My online research revealed that a physiatrist (pronounced fiz-EYE-a-trist) is an M.D. who specializes in “physical medicine and rehabilitation.”

Physiatrists take a holistic approach, evaluating the body as a system, looking at functional movement, and devising treatment plans that incorporate pain management, physical therapy, occupational therapy, and/or medications as appropriate. Unlike most orthopedists, physiatrists tend to focus on non-surgical solutions. They often collaborate with other practitioners, like physical therapists, to implement rehabilitation plans for patients.

This all sounds great, but I still wondered: I’ve had my fair share of running injuries. Why haven’t I heard of these doctors before?

A bit of backstory

Ten months ago, I was diagnosed with a labral tear in my hip. In college, I had surgery for the same issue, but due to femoroacetabular impingement (a.k.a. weirdly shaped hip bones), I suffered the same injury again, likely due to the repeated stress of running. The orthopedist who diagnosed the tear recommended that I try physical therapy first to strengthen my core and the muscles surrounding the hip. If the pain persisted, he said, I might consider surgery.

After hundreds (thousands?) of clamshells, single-leg RDLs, and lateral resistance band walks, my hip was feeling almost back to normal. I was comfortably running a few times a week with minimal pain and was looking forward to ramping things up after my wedding in May.

The infamous MRI of my hip. What does it really say, and do I even want to know?

Then, a month ago, I decided to wear a new pair of shoes during a strength-training session and I irritated the plantar fascia in my right foot (one of the only injuries I hadn’t yet encountered in 20 years of running!). The pain in my heel and arch didn’t go away, even when I stopped running and tried most of the classic plantar fasciitis remedies.

Given this development—combined with my history of soft-tissue running injuries—my pro-physiatry family members suggested I get checked out to see if there were any larger structural issues that might make me prone to getting injured. I wasn’t sure about the whole thing, but they were persistent. I have good insurance that would cover it, so I figured it couldn’t hurt.

My first appointment

As I took the elevator from the parking garage into the medical office building for my appointment, I immediately felt self-conscious. Almost every other patient I saw had significant mobility impairments, whether they were in a wheelchair, using a walker, or simply walking slowly and laboriously. From my research, I know physiatrists treat a wide range of issues, from severe spinal trauma to minor sports injuries, but based on my observation (at least in this office) it seemed skewed toward the extreme end.

The office visit was fairly typical. I was escorted into an exam room, waited for ten minutes, then had a nurse come in to ask some initial intake questions and take my blood pressure. She left, and after another ten minutes, the doctor came in. I immediately noticed that her bedside manner was excellent. She was patient, empathetic, and listened attentively as I recounted my history. Anyone who has seen an orthopedist or sports medicine doctor knows that such traits are not the norm in those specialties, so her warmth was a relief.

What she said next, however, was less welcome. “You’re not going to like this, but I really don’t think you should be running.” Something on my hip MRI report—inflammation on the bone—alarmed her (strangely, the orthopedist never mentioned this when he viewed the MRI). I asked what the worst case scenario would be if I continued running. “I don’t like to do worst-case scenarios, but [fancy language for a piece of your hip bone could die and fall off and then you would need surgery].” Could I run at all, ever? “You can run for short distances, like if you’re playing a pick-up basketball game or something. But you shouldn’t use running as a primary form of exercise.”

Oh. Cool.

As I tried to avoid breaking down in tears at this unexpected prognosis, the doctor did a brief physical examination. She checked my knee and ankle reflexes, looked at my back as I bent over, had me take off my shoes to examine my arches, and finally assessed my hip mobility and pelvic alignment. The most useful thing she told me was that my pelvis was misaligned such that my right leg was functionally longer than my left. This meant my right foot – the one with plantar fasciitis – was hitting the ground first as I walked, placing undue stress on that side. She gave me a prescription for PT for my foot and recommended some over-the-counter arch supports.

Will this ever be me again?
Now what?

I left disappointed and demoralized. But after a few hours of feeling sorry for myself, I was able to gain some perspective. While this is her professional opinion, it’s not the last word. Haven’t we all heard a story of a fellow runner hearing a dire diagnosis, only to recover and run for years?

I wonder if her response was indicative of the difference between physiatry and orthopedics. From my understanding, physiatrists prioritize avoiding surgery and place a premium on long-term quality-of-life issues. By contrast, my orthopedist’s response was essentially, “I want you to reach an activity level you’re satisfied with, whether we do that with or without surgery.” Perhaps the physiatrist didn’t understand the important role that running plays in my life? Or is she just willing to tell runners things they don’t want to hear?

This got me thinking. Of course, I don’t want to do anything to sacrifice my long-term health. But what about the quality of life I lose if I can’t run? How do you measure the absence of something that makes me happy? Right now, each day I can’t run feels just a little bit worse. Should I try to take some risks, at age 31, knowing that any number of things could prevent me from running as I get older? Or in 20 years will I look back at this moment with frustration, wishing I had taken a more conservative approach?

I’m still figuring out the answer. My fiance pointed out that treatments and surgeries are only getting better as the years go on. Who knows what they’ll be able to do to hips in 20+ years? And I know I will likely seek an additional opinion to help me clarify how much damage I might be doing and whether surgery is the right path to fix my labral tear.

Ultimately, this experience made me wonder if this is why no one I know has seen a physiatrist: perhaps their holistic approach does not mesh well with the stubborn mindset of most runners!

If you’ve seen a physiatrist, what was your experience like? Have you ever been told to stop running?

I am a museum curator, a former competitive high school and college runner, and a track nerd. I've struggled with chronic injury throughout my career and hope to shed light on the physical and mental challenges of being frequently injured. I live in the Washington, DC, area with my fiancé and black lab mix.

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1 comment

  1. never seen a physiatrist and I would imagine that their holistic approach does play a part in their outlook/treatment of the situation just like an ortho might lean toward a more aggressive surgical approach. I would probably get another opinion or if you end up doing PT, ask the PT what their thoughts on it are. I saw 3 doctors for my foot issues and it was money well spent. As runners, we do want the kind of doctors who will tell us what we want to hear (that we can keep running) but I think the best doctors have also been athletes themselves and “get it”.

    Side note- I had plantar fasciitis for months and months and tried almost everything with no luck. What helped me was custom orthotics and strengthening at PT. The orthotics took time and I saw about a 20% improvement with my PF for each month I wore them. Ive also had friends who did Shockwave therapy on PF and it worked 100% for them. It costs a lot because insurance doesn’t cover it.