What Sets Our San Francisco Physiatrists Apart From Typical Physicians

Physiatry is a medical specialty that permits a one stop medical visit.

Founded in the early 20th century as a medical specialty by Dr. Krusen at the Mayo Clinic and Dr. Rusk in New York, physiatrists are medical doctors trained in the treatment of nerve, muscle and bone disorders. They are experts in making an accurate diagnosis, alleviating pain and restoring lost function. They treat the entire person, not just a symptomatic region and focus holistically on all aspects of a person’s health and living situation. Drs. Irène and Robert Minkowsky have been using this approach successfully as SF physiatrists for over 30 years.

Healthcare Confusion

Individuals with musculoskeletal issues often look first to orthopedic surgeons for solutions. Frequently disappointed with the approach or the results and not knowing what to do, they anxiously turn to physical therapy, chiropractic, acupuncture and massage. Without someone guiding them, they flounder from one specialist to another, desperately seeking solutions. Bills pile up and their condition has not improved. Even worse, they may have had surgery with no resolution of their symptoms.

By making an appointment with a physiatry specialist, you see a medical doctor who combines the knowledge of orthopedics, rheumatology and neurology with a focus on conservative treatment and improvement of function.

The San Francisco physiatry specialists at the Physicians’ Back Institute can find helpful solutions. They provide effective nonsurgical treatment for complicated musculoskeletal issues.

A thorough comprehensive evaluation precedes an individualized treatment program with emphasis on restoration of musculoskeletal balance, control of pain (principally non-pharmacologic) and recovery of function. In their detailed evaluation and examination, the Minkowskys evaluate the entire musculoskeletal system looking for weaknesses and imbalances. No body part is viewed in isolation or as a single element because the relationship of a joint with neighboring joints and muscles affects how it functions. Although everyone ultimately develops arthritic changes, symptoms do not necessarily automatically follow. In fact, many individuals with arthritic joints are asymptomatic. Why is one person symptomatic and another with similar joint degeneration able to walk without pain or symptoms? The role of the physiatrist is to identify the reasons for symptoms and establish a rehabilitation program. If the entire body is not thoroughly examined and weaknesses identified and addressed, complicated problems do not resolve. This thoroughness accounts for the high rate of treatment success by the physiatrists at the Physicians’ Back Institute. In addition, besides being medical doctors, the Minkowskys have incorporated osteopathy into their SF physiatry practice, offering their patients osteopathic manipulation including visceral manipulation and craniosacral treatment as part of their approach to pain management. Their eclectic approach is responsible for their high success rate with treatment.

A Physiatrist’s Role

Patients are often complex and present with multiple complaints; back pain, hip pain and knee pain.

Where do you start?

Which of these issues is the most important and needs to be addressed first? It is very common for problems involving the hip and knee to also involve the lumbar spine and pelvis as all of these areas are connected.

The lumbar nerves supply the hip and knee, and there are important muscular connections between the pelvis, gluteal muscles, piriformis, the iliotibial bands and the knee. The psoas connects the spine (thoracolumbar junction) to the thigh. Sorting out the relevance of these connections in each individual’s situation increases the probability of successful treatment. Mobility issues involving the kidney and colon can often refer symptoms to the hips and leg, frequently masquerading as hip or knee pain or sciatica.

Although joint replacement is sometimes necessary, the results improve dramatically when rehabilitation precedes it. In fact, a good rehabilitation program guided by a physiatrist often supplants the need for surgery. With surgical techniques improving exponentially, why not postpone this intervention as long as possible. Think of your body as a car; it is important to keep the vehicle tuned up. An older car may be dented, but still can run smoothly.

Conditions Our San Francisco Physiatrists Treat

  • Back Pain
  • Neck Pain
  • Thoracic Pain
  • Rib Pain
  • Coccydynia
  • Disc Protrusion, Herniation
  • Sacroiliac Strain
  • Sciatica
  • Headache and Migraine
  • TMJ and Facial Pain
  • Neuralgia /Neuritis/ Neuropathy
  • Peripheral Joints and Tendons (shoulder, hip, knee, ankle)
  • Tendon Tears (regenerative injections, proliferative injections)
  • Spinal Stenosis and Other Spine Conditions
  • Facet Arthritis
  • Post-Surgical Pain
  • Scoliosis, Kyphosis, Abnormal Posture, Short Leg Syndrome
  • Sports Injuries