Physical Medicine and Rehabilitation

Physical Medicine and Rehabilitation (PM&R) is a comprehensive medical specialty concerned with the diagnosis, treatment, and rehabilitation of musculoskeletal disorders, nervous system injuries, and other functional impairments. This department aims to manage pain, resolve movement limitations, increase functional capacity, and ensure that patients return to their daily living activities independently. The Koru Hospital Department of Physical Medicine and Rehabilitation offers high-level healthcare services to its patients with its experienced specialist staff, modern physical therapy unit, and comprehensive rehabilitation programs.

What is Physical Medicine and Rehabilitation?

Physical medicine and rehabilitation is a holistic medical specialty that aims to regain physical functions lost due to illness or injury, reduce pain, and improve quality of life. PM&R specialists (physiatrists) create individualized treatment plans for their patients by utilizing a wide range of treatments, including medication, physical therapy modalities, exercise programs, injection therapies, and orthotic-prosthetic applications.

The fundamental principles of the PM&R department are as follows:

• Holistic assessment: Comprehensive evaluation of the patient's physical, psychological, and social status.
• Multidisciplinary teamwork: Coordinated work of specialists from different disciplines such as physiatrists, physiotherapists, occupational therapists, speech therapists, and psychologists.
• Individualized treatment: Preparation of special treatment programs tailored to each patient's needs and goals.
• Functional independence: Ensuring that patients achieve the highest level of independence in their daily living activities.
• Evidence-based approach: Implementation of treatment protocols in line with scientific literature and clinical guidelines.

Musculoskeletal System Diseases

Musculoskeletal system diseases are the most common reasons for admission to the PM&R department. The main diseases in this group include:

Low Back Pain and Herniated Disc

Low back pain is one of the most common health complaints in society, with a lifetime prevalence of up to 80 percent. The main causes of low back pain include lumbar disc herniation (herniated disc), lumbar spondylosis, spinal stenosis, facet joint syndrome, and muscle-ligament strains.

Approaches applied in the treatment of low back pain:

• Pharmacotherapy: Analgesics, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), and neuropathic pain medications.
• Physical therapy modalities: Hot-cold application, ultrasound, TENS, laser therapy, and interferential currents.
• Exercise programs: Core stabilization exercises, Williams and McKenzie exercises, stretching and strengthening programs.
• Manual therapy: Mobilization and manipulation techniques.
• Epidural steroid injection: Interventional treatment applied in cases of severe radiculopathy.
• Ergonomic adjustments: Providing correct posture and ergonomic recommendations in the workplace and daily life.

Neck Pain and Herniated Disc

Neck pain is the most common musculoskeletal complaint after low back pain. Cervical disc herniation, cervical spondylosis, myofascial pain syndrome, and whiplash injury are the primary causes. Prolonged computer use, poor posture, and a sedentary lifestyle increase the risk of neck pain. Treatment involves physical therapy modalities, neck exercises, posture training, and cervical epidural injection when necessary.

Shoulder Disorders

Shoulder disorders are conditions that seriously affect daily living activities due to movement limitation and pain:

• Frozen shoulder (Adhesive capsulitis): Painful movement limitation that develops as a result of the thickening and stiffening of the capsule surrounding the shoulder joint.
• Rotator cuff syndrome: Pain and weakness that develop as a result of the compression or tearing of the muscles and tendons surrounding the shoulder.
• Impingement syndrome: A painful condition caused by the compression of shoulder muscles under the shoulder bone.
• Shoulder instability: Recurrent dislocations or subluxations of the shoulder joint.

Knee Disorders

Knee joint disorders are problems that significantly affect the quality of life, especially in the elderly population:

• Gonarthrosis (Knee osteoarthritis): A chronic disease characterized by pain and movement limitation that develops as a result of the degeneration of cartilage in the knee joint.
• Meniscus lesions: Tearing or degeneration of the meniscus tissue in the knee joint.
• Patellofemoral syndrome: A condition characterized by pain and a feeling of catching around the kneecap.
• Ligament injuries: Conservative and post-surgical rehabilitation of anterior cruciate ligament, posterior cruciate ligament, and collateral ligament injuries.

Neurological Rehabilitation

Neurological rehabilitation is a critical field of treatment that aims to regain functional losses resulting from nervous system damage:

Stroke Rehabilitation

Stroke rehabilitation covers the treatment of motor, sensory, cognitive, and speech disorders resulting from cerebrovascular disease. A rehabilitation program started in the early period significantly accelerates functional recovery. Approaches applied in stroke rehabilitation:

• Neuroplasticity-based exercises: Repetitive task-oriented exercises that support the reorganization of the brain.
• Gait rehabilitation: Balance and gait training, use of assistive devices.
• Upper extremity rehabilitation: Exercises aimed at regaining hand and arm functions.
• Spasticity management: Pharmacotherapy, botulinum toxin injections, and physical therapy modalities.
• Speech and swallowing rehabilitation: Treatment of aphasia and dysphagia.

Spinal Cord Injury Rehabilitation

Spinal cord injury covers the rehabilitation of paraplegia or tetraplegia conditions that develop as a result of damage to the spinal cord due to trauma or disease. Movement, sensation, bladder-bowel functions, and the autonomic nervous system may be affected. The rehabilitation process aims to increase functional independence, prevent complications, and ensure reintegration into society.

Other Areas of Neurological Rehabilitation

• Parkinson's disease rehabilitation: Improving balance, gait, and motor functions.
• Multiple sclerosis rehabilitation: Maintaining functional capacity during relapse periods and the progressive process.
• Peripheral nerve injuries: Regaining motor and sensory functions after nerve damage.
• Cerebral palsy rehabilitation: Supporting motor development and increasing functional independence in children.

Physical Therapy Modalities

Physical therapy modalities are physical agents used to reduce pain, eliminate inflammation, accelerate tissue healing, and support functional recovery:

• Electrotherapy: TENS (transcutaneous electrical nerve stimulation), interferential currents, galvanic currents, and neuromuscular electrical stimulation.
• Ultrasound therapy: Reducing pain and accelerating tissue healing by transmitting heat to deep tissues.
• Laser therapy: Reducing inflammation and supporting tissue repair with low-level laser.
• Magnetic field therapy: Treatment applied to accelerate bone healing and reduce pain.
• Hot-cold applications: Superficial heat (hot pack, paraffin) and cold (cryotherapy) applications.
• Hydrotherapy: Exercise and treatment programs performed by utilizing the buoyancy and resistance of water.
• Traction: Mechanical or motorized pulling application in the cervical or lumbar region.
• Shock wave therapy (ESWT): High-energy sound waves used in the treatment of chronic tendinopathies, heel spurs, and calcific tendinitis.

Rheumatological Diseases and PM&R

Rheumatological diseases are inflammatory and degenerative diseases that affect joints, muscles, bones, and connective tissue. The treatment and rehabilitation of these diseases are carried out comprehensively in the PM&R department:

• Rheumatoid arthritis: An autoimmune disease that affects the joints. Physical therapy, joint protection techniques, and exercise programs are important components of treatment.
• Ankylosing spondylitis: A chronic inflammatory disease that affects the spine, where regular exercise and posture training form the basis of treatment.
• Fibromyalgia: A chronic syndrome characterized by widespread musculoskeletal pain, fatigue, and sleep disturbance. Aerobic exercise, stress management, and a multidisciplinary approach are effective in treatment.
• Osteoarthritis: A chronic disease characterized by pain and loss of function resulting from the degeneration of joint cartilage.
• Gouty arthritis: Acute painful arthritis attacks that develop due to the accumulation of uric acid crystals in the joints.

Orthopedic Rehabilitation

Orthopedic rehabilitation is an important field of rehabilitation that aims to ensure functional recovery after musculoskeletal surgery or trauma:

• Post-arthroplasty rehabilitation: Regaining joint range of motion, muscle strengthening, and gait training after knee or hip replacement surgery.
• Post-fracture rehabilitation: Resolving joint stiffness, muscle atrophy, and loss of function that develop during the immobilization period.
• Post-ligament reconstruction: Progressive rehabilitation programs after anterior cruciate ligament repair and other ligament reconstructions.
• Post-spinal surgery rehabilitation: Movement and strengthening programs after disc surgery or spinal fusion.
• Amputation rehabilitation: Prosthesis training, balance exercises, and functional independence programs after limb loss.

Pain Management

Chronic pain is one of the fundamental topics of PM&R practice. A multimodal approach is adopted in pain management:

• Myofascial pain syndrome: Trigger point injections, dry needling, and myofascial release techniques.
• Neuropathic pain: Combination of pharmacological treatment and physical therapy for pain due to nerve damage.
• Joint injections: Intra-articular steroid, hyaluronic acid, or PRP (platelet-rich plasma) injections.
• Trigger point injections: Local anesthetic and steroid injection into painful points in the muscle.
• Acupuncture: Applied as a complementary method in the treatment of chronic pain.

Osteoporosis Diagnosis and Treatment

Osteoporosis is a metabolic bone disease in which the risk of fracture increases as a result of decreased bone density and deterioration of bone microarchitecture. It is especially common in postmenopausal women and elderly individuals. Within the scope of osteoporosis management in the PM&R department, bone density measurement with DEXA, fracture risk assessment (FRAX), pharmacological treatment planning, fall risk assessment, and balance-coordination exercise programs are applied.

When Should You Consult a PM&R Specialist?

It is recommended that you consult a PM&R specialist in the following situations:

• Low back, neck, shoulder, knee, or other joint pains
• Complaints of herniated disc in the lower back or neck
• Need for rehabilitation after stroke, spinal cord injury, or head trauma
• Physical therapy and rehabilitation after orthopedic surgery
• Chronic pain syndromes and fibromyalgia
• Joint involvement in rheumatological diseases
• Osteoporosis assessment and treatment
• Sports injuries and performance rehabilitation
• Movement limitations and functional impairments
• Hand and wrist diseases (carpal tunnel syndrome, De Quervain's, etc.)

In the Koru Hospital Physical Medicine and Rehabilitation department, our specialist physicians aim to maximize our patients' functional capacity and improve their quality of life by applying the most current treatment approaches in musculoskeletal diseases, neurological rehabilitation, and chronic pain management. You can apply to our outpatient clinic for your pain, movement limitation, or rehabilitation needs.