A type of specialist you might want to see: physiatrists

The word physiatrist is always a little awkward.  When I say the word in real life, people usually have no idea what I’m talking about, or think I’m talking about a psychiatrist at first.

But a physiatrist is different.  They are doctors (usually an MD, but also can be a DO– doctor of osteopathy.  For our purposes right now, we don’t need to get into the distinction).

And their specialty is “Physical Medicine and Rehabilitation.”

Basically, they specialize in just about everything you can do to make people with musculoskeletal conditions more comfortable… except surgery.

So whereas an orthopedist would operate, a physiatrist might offer other inteventions such as cortisone and other types of injections or prolotherapy.

Compared to other types of doctors, they have a little bit more of a holistic approach, generally leaning toward focusing on the “whole person” a little bit more.

According to the American Academy of Physical Medicine and Rehabilitation, physiatrists:

  • Focus treatment on function
  • Have a broad medical expertise that allows them 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 physician extenders to optimize patient care
  • Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons, and many others.

As one of the physiatrists I saw told me, they tend to be the most knowledgeable doctors about the SI joint, because it’s usually not a problem that’s treated with surgery.  So whereas an orthopedist might be focusing on problems that can be fixed surgically, physiatrists tend to be more aware of the other options, and some of the subtle nuances of a problem like the SI joint, and how it affects daily functioning.

***

Unfortunately, just because you happen to make an appointment with a physiatrist, it doesn’t mean they will necessarily be familiar with the SI joint.

I personally have seen three physiatrists over my time with SI joint dysfunction.

1) The first one, Dr. S., was super nice and empathetic.  He had already been my doctor for chronic pain, so I already knew him.

Unfortunately, he wasn’t really familiar with the SI joint.  He said it wasn’t something he’d studied in school.  But I liked him because he listened to me and didn’t make me feel crazy, and instead provided ideas and acted as a sounding board.

However…. I wish I had known sooner that there were, actually, other physiatrists out there who would turn out to be a little more familiar with the SI joint.   I guess it comes down to not knowing what to look for, and also not taking my right to get better seriously enough.

2) Four years into my five year problem, I consulted Dr. Joanne Borg-Stein for prolotherapy, and found she was much more knowledgeable about the SI joint than Dr. S. had been.  I didn’t continue to see her, however, because at the time, we established that I wasn’t really a good candidate for prolotherapy, so my next course of action was to keep going with aquatic therapy, anyway.

But still, it was validating to see someone who actually had seen patients with SI joint dysfunction before, and didn’t get the same blank look on her face that I’d gotten from the first doctors I saw with this problem.

3) Last spring, I consulted a third physiatrist at Mass General Hospital.  It was really just for educational purposes, because overall I was doing so much better.  However I stumbled across her online while doing research for this blog, and since she took my insurance, I decided to make an appointment.  (I am never trying to tell you guys that I’m 100% out of the woods and my SI joint issues will never flare up.  I know my ligaments will always be vulnerable to re-injury, so I figure it’s good to keep educating myself).

I decided not to list this doctor’s name here because I was giving an honest account of my appointment with her, including some of the cons.  (However you can always email me privately for recommendations).

Although my appointment with her wasn’t quite what I’d hoped for, it was still really helpful.  She was the first person I saw who truly seemed knowledgeable about the SI joint, and was actually familiar with various treatments and concepts I’d only read about.

It probably would have made a world of difference to me if I’d seen her at the beginning of this problem, not the end.  But at the time, I didn’t really know there were answers, or more knowledgeable doctors, out there.  Hindsight really is 20-20.  That’s why I’m trying so hard to let all of you know what’s actually out there.

***

So, speaking of what’s actually possible:

Here is a really amazing overview of SI joint dysfunction, presented by a physiatrist (Dr. Brian Goldberg).  

This should give you an idea of all of the different treatment options that are available, so you know what you’re looking for in a doctor.

I also recommend Part 1 in the same series, which discusses SI joint dysfunction in relation to some of the other potential causes of low back pain.   It’s a really great way to make sure you understand the full spectrum of the causes of pain.

***

How do you find a knowledgeable doctor in your area?

Unfortunately, this is probably going to take some work and some effort.  From what I can tell, the SI joint isn’t necessarily something that every doctor or PT learns about while they are in school.  Sometimes it comes down to learned experience, from treating previous patients, or developing an interest on a continuing education basis.

Neither of the doctors I mentioned above actually had the sacroiliac joint listed among their clinical interests.  So unfortunately, you might not be able to tell just from looking up doctors online.  (I’ve actually found that doctors’ online bios, in general, are unreliable and are never actually written by the doctors themselves).

But I would still start by searching online.  In addition to “SI joint” and “sacroiliac joint: you can also try keywords such as “pelvic-pain” or “pregnancy-related pain” (male readers– you can actually try this too– since SI joint problems are commonly related to pregnancy it’s just a good way to find someone who might understand the SI joint).

From there, I’d go by word of mouth.  It’s actually my first physiatrist, Dr. S., who eventually told me about the second physiatrist, who offered prolotherapy.

So, you sort of never know.

You can also get a little bit creative.  Instead of only going by doctors’ online bios, you can also look to see if any doctors (or PT’s) near you have written any publications on the SI joint.

This is going to sound a bit silly, but it took me a long time to realize that some of the people who wrote and published articles on the SI joint were actually real doctors and PT’s who had practices where they saw patients.

So you can also take a look at some of the articles I’ve cited on this blog, to see if any of the authors happen to be practicing near you.

And overall, keep going.  Definitely watch the two videos I linked to, so that you know what’s actually out there, in terms of potential problems and solutions.

I hope that is helpful!  Any questions, let me know!

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