THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Friday, August 12, 1994 TAG: 9408100103
SECTION: VIRGINIA BEACH BEACON PAGE: 1B EDITION: FINAL
SOURCE: Pam Starr
LENGTH: Long : 111 lines
Did you ever have a pain shoot down your leg that was so intense you almost buckled under? Have you tried to work with a herniated disc, or carpal tunnel syndrome? Maybe you've experienced a chronic low backache that no medical professional or prescription drug has been able to relieve.
Dr. Lisa Barr has diagnosed and successfully treated such cases. She doesn't consider herself a miracle worker, but Barr is a rarity in the medical field - a physician who uses a range of unconventional treatments like hands-on manipulation, therapeutic injections, massage, electrotherapies, biofeedback and exercise to eliminate chronic and acute pain.
Barr said she believes she is the first medical doctor in mainstream medicine to perform spinal manipulation, a practice usually limited to chiropractors.
Barr is what is known as a physiatrist (not to be confused with psychiatrist), a medical doctor specializing in physical medicine and rehabilitation. Not many lay people know what physiatry is and what it can do but neither do many doctors, says Barr. Therefore, they don't even consider sending a patient to a physiatrist for specialized pain treatment.
``People have no idea what physiatry is,'' said Barr, who practices at Rehabilitation Medicine Consultants in Norfolk and on First Colonial Road with doctors Steven Gershon and Mark Rubenstein. ``We take a holistic approach in treating the patient. Most medical professionals approach something from one perspective. We have a toolbox full of tools. I'm very proud that we practice a New Age form of medicine.''
Physiatry is a medical subspecialty dating back to the 1930s and incorporates physical medicine and rehabilitation to treat a wide variety of musculoskeletal and neurologic disorders. People who suffer from carpal tunnel syndrome, bursitis, tendonitis, arthritis, sports and work-related injuries, spinal cord injuries, amputations, strokes, brain injuries and multiple sclerosis, birth defects and other disorders can all be helped by a physiatrist. A physiatrist can prescribe drugs but cannot perform surgery.
``A lot of what we focus on is muscles disorder,'' said Barr. ``Pain is a symptom of a complex problem. A lot of people will attribute pain to, say, disc herniations when it's not that so much as it is the disc herniations co-exists in the whole syndrome.''
Barr diligently worked on patient Janie Jacobson as she spoke. Jacobson, a cooking instructor, was in a car accident last year that gave her severe whiplash and a herniated disc. Barr stood behind the seated Jacobson, pressing on muscles and joints to feel for any tenderness or misalignment.
``This is an area of the back that's real hard to get to,'' said Barr, positioning herself behind Jacobson's upper middle back. ``I'm going to place the vertebrae into a position of restriction.
``When you have a joint that's restricted, the muscles and ligaments will go into spasms reflectively,'' she added.
Jacobson took a deep breath and sighed as Barr got up on the table and braced herself behind the patient. She placed one hand on Jacobson's chest, held the patient's arm up and pushed in deeply. Jacobson grimaced at first, then visibly relaxed.
``We focus on the rib cage - the first and second ribs are really important for the neck muscles,'' Barr explained, gently massaging the area she had just pushed. ``That was a really good stretch. The soft tissue already feels different.''
Jacobson is a small, trim woman who works out regularly. She used to train with free weights until Barr told her to switch over to the machines because of less neck strain.
``A lot of people aren't exercising properly,'' said Barr. ``They start out exercising in poor posture - tight muscles, slumped shoulders. Doctors may give a booklet to a patient but won't demonstrate,'' she continued. ``We'll stage the exercise program and show them how to do it.''
Barr has been treating Jacobson for nearly a year, after Jacobson heard about the physiatrist through friends.
``Lisa was very helpful and told me what to do right away,'' said Jacobson. ``I have nothing against chiropractors, but I wanted to see a medical doctor. She's terrific.''
One of the most common problems Barr and the other physiatrists see at their offices is myofascial pain syndrome. Myofascial pain is characterized by ``trigger points,'' or tender areas deep within the muscle that may spasm or twitch involuntarily.
An injury or physical stress causes muscles to knot up and patients may feel pain in other parts of the body. The physiatrists can diagnose this and other conditions with electromyography (tests of the electrical properties of muscles), nerve conduction studies and specialized motion testing.
``The key is the diagnosis part - you have to spend time and energy in the beginning to figure out the problem and then treat it,'' said Barr, an area native and a 1976 graduate of Granby High School. ``Typically, for someone with acute pain we only need to see them three times. For chronic pain - six times total. We're very focused in the treatment.''
Their practice uses a team-oriented approach to treatment, and Barr said that they are ``very comfortable'' working with other health professionals such as psychologists, orthopaedists and massage therapists. In fact, a behavioral psychologist works with them in the Norfolk office.
``There are mind-body issues with pain,'' Barr said. ``The ones with chronic pain tend to have psychological issues - put pain on top of that and they can't function.''
Patients in chronic pain who experience more psychological distress, she added, tend to have a history of abuse and/or abandonment and were raised in an alcoholic family.
``Some patients really suffer from denial and don't want to confront the origin of the pain,'' she said, shrugging.
In addition to her regular practice, Barr helped to found Spineworks, an outpatient rehabilitation program in Virginia Beach for spine-injured people. The four-week program operates five days a week, eight hours a day and incorporates physical therapy, psychiatry, vocational rehabilitation and education for patients.
``The only way to treat is to address the whole person,'' said Barr. ILLUSTRATION: Staff photo by MORT FRYMAN
Dr. Lisa Barr, right, a physiatrist, manipulates a patient's back.
by CNB