Low back pain and sciatica
Clinical diagnosis before routine imaging. An active, measurable plan.
Low back pain is among the top consultation motives and the leading global cause of disability. Evidence recommends against routine initial imaging without red flags and prioritizes education, exercise, and active strategies. Physiatry is particularly useful to separate non-specific low back pain from radiculopathy and to build a function-oriented plan.
NICE and ACR guidelines recommend against initial imaging without red flags. Cochrane evidence favors multidisciplinary rehabilitation for chronic pain.
Lumbar disc herniation and radiculopathy
Topographic diagnosis + selective workup + conservative or surgical plan.
When pain radiates with sensory or motor deficit, the physiatrist localizes the affected level, indicates EMG/NCS only when clinical uncertainty warrants it, and sequences conservative, interventional, and post-operative care.
MRI/CT is best reserved for persistent/progressive symptoms with intervention candidacy. Post-surgery, supervised rehabilitation improves pain and disability vs minimal care.
Post-operative orthopedic & spine care
Pain, ROM, strength, gait, and return to activity on a measurable timeline.
After TKA, hip arthroplasty, lumbar fusion, or rotator cuff repair, the physiatrist orders priorities, adjusts pharmacotherapy, prescribes rehabilitation, and tracks progress weekly.
APTA supports structured rehabilitation after TKA. Delphi consensus suggests early outpatient rehab in the first post-op week.
Stroke rehabilitation
Interdisciplinary functional recovery — motor, gait, spasticity, participation.
After a stroke, the physiatrist often leads functional recovery: integrated assessment, spasticity management, gait re-education, coordination with OT/SLP/social work, and community independence goals.
AHA/ASA and NICE recommend interdisciplinary rehabilitation with comprehensive assessment and hospital-to-community continuity.
Chronic pain
Multidisciplinary biopsychosocial approach focused on function.
When pain persists beyond 3 months impacting sleep, mood, or participation, the best strategy is rarely just pharmacologic. The physiatrist's contribution is maximizing function and participation, with shared decisions and opioid caution.
NICE recommends person-centered assessment. CDC emphasizes shared decisions and opioid caution. Cochrane: moderate evidence of improvement with multidisciplinary rehab.
Sports injuries
Multifactorial return based on functional criteria, not the calendar.
Tendinopathies, sprains, and muscle injuries respond best to progressive loading and neuromuscular re-training. Return-to-play decisions must be multifactorial: pain, strength, proprioception, confidence, and sport demands.
Systematic reviews on lateral ankle sprain and RTP emphasize combined objective/subjective criteria.