What is physical medicine?

Physical Medicine is defined as the management by medical practitioners of acute or chronic musculoskeletal injury, disease or dysfunction. Its aim is to address somatic dysfunction; impaired or altered function of related components of the somatic (body framework) system. This involves skeletal, arthrodial and myofascial structures with related vascular, lymphatic and neural elements. (Hospital Adaptation of International Classification of Diseases, 2nd Edition, 1973). Treatment includes the application of physical modalities including manual therapies. Other therapies, such as pharmaceuticals or injection techniques, are also used to restore normal function. Travell & Simons trigger point injection with lignocaine followed by PNF releases, the "Blomberg" technique and prolotherapy are examples of the injection techniques utilised.

Physical Medicine relies upon a very detailed physical examination. The object of the physical examination is to localise a complaint to a specific region and, if possible, a specific anatomical structure, and to define its relationship to movement and function. The physician then makes a logical analysis and application of the information obtained from the patient’s history and physical examination. There is a growing evidence base for musculoskeletal medicine and this is an important part of our training.

Physical Medicine Doctors formulate a very specific diagnosis, thereby delivering very specific treatments with very high success rates.

Doctors trained in Physical Medicine are qualified Medical Practitioners that have undergone extensive university postgraduate training followed by Fellowship certification with the Australian College of Physical Medicine.

Fellows apply a biopsychosocial assessment, particularly with an emphasis on avoiding the development of chronic pain syndromes by appropriate early intervention. There is a greater emphasis on the "bio" in biopsychosocial. Highly skilled manual examination and postural examination skills are used as part of an integrated management. Fellows instruct the patient in self management of their condition using very specific exercises to mobilise and release shortened musculature, and to strengthen weakened musculature. The prescription of medication plays a reduced role as gentle manual therapy, injection of normal saline or lignocaine to muscle tender points and specific exercise prescriptions are the mainstay of most treatments. Rarely would they need to refer to a psychiatrist, pain clinic, rheumatologist or other practitioner or therapist. However, Physical Medicine Doctors are well qualified to recognise that a small minority may require referral to other specialist medical colleagues. Occassionally, advanced imaging is required to exclude serious disease. Accurate diagnosis by clinical examination including palpation (scientifically supported eg palpation to find a symptomatic facet joint) does not require diagnosis by exclusion using multiple often expensive investigations (also scientifically supported).