Evaluation and Testing

Through modern evaluation and testing procedures, we are able to diagnose injuries and sources of chronic pain. Thorough evaluation is needed in order to prescribe a treatment plan that will lead to improved function and quality of life.


Electromyography (EMG) is a test that evaluates and records the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph. It produces an electromyogram, which appears on a screen as waveforms. These waveforms show the electrical activity occurring in muscle cells when these cells are electrically or neurologically stimulated.

When undergoing an EMG, the physiatrist first conducts a Nerve Conduction Study (NCS) to determine how quickly electrical signals move through the nerves. This is important for determining if nerves are functioning properly and diagnosing nerve damage or disease. NCS studies also produce waveform graphs that the physiatrist understands.

Additional Information

Electromyogram (EMG) and Nerve Conduction Studies
Nerve Conduction Velocity

Musculoskeletal Ultrasound Evaluation

During a musculoskeletal ultrasound evaluation, the physiatrist uses an ultrasound scanning machine that directs high frequency sound waves into the body and to create real-time images that can pinpoint sources of peripheral soft tissue injury and pain. Ultrasound shows the musculoskeletal system in motion; thus, the physiatrist can evaluate how pain is being caused by injury in a non-invasive way.

Other benefits to a musculoskeletal ultrasound evaluation are helping patients better understand their pain, safety (no radiation involved; the physiatrist can use the machine as long as it takes to evaluate), and affordability (lower technology costs translate into patient savings).

Additional Information

Musculoskeletal Ultrasound


When a physiatrist suspects that a disc is the source of a patient's pain, he may recommend a discography. CT scans and x-rays cannot always indicate whether a disc is causing pain. A disc that appears abnormal may or may not cause pain.

During a discography test, up to three discs located near the source of pain are injected, one at a time, with a fluid. If the disc is the one causing the patient pain, then the increased pressure the fluid exerts within the disc should stimulate a pain response similar to the back or neck pain reported by the patient. The procedure is performed with local anesthesia since the patient must be able to discuss the pain responses with the physiatrist.

For further diagnostic input, the fluid injected usually contains a contrast dye and fluoroscopic imaging is performed at each stage. The patient may also have a CT scan immediately after the discography.

Additional Information

Lumbar Discography for Back Pain Diagnosis

Spinal Cord Stimulator Trials

A spinal cord stimulator (SCS) is a treatment option that supplies electric pulses to the spinal cord to control chronic pain. The pulses prevent nerves from conducting pain signals to the brain. This treatment is considered in cases where more conservative treatment approaches have not been successful. A spinal cord stimulator (SCS) system includes a stimulator device (signal generator) implanted under the skin with electrodes implanted in the epidural space where they can affect the spinal cord. The system is paired with remote a charging device and controller.

A spinal cord stimulator trial is a less invasive test where a spinal cord stimulator wire is implanted for a few days to see if SCS signals will provide a patient with relief from his or her chronic back pain. Only if the trial is successful would a full SCS implant be considered.

Additional Information

How Spinal Cord Stimulation Works

Independent Medical Evaluation

At times, an unbiased, objective and completed independent Medical Evaluation (IME) is required for work related injury claims, liability claims and Long Term Disability claims. An IME must be performed by a provider who has not previously treated the patient. Questions answered by an IME include what caused the injury, are the treatment appropriate for the injury/illness, and does the patient have measureable or permanent impairment?

Appalachian Physical Medicine provides Independent Medical Evaluations related to musculoskeletal conditions.

Impairment Rating

Following a work-related injury that leads to questions of permanent impairment, an impairment rating (IR) is often required by workers' compensation case workers or attorneys to have a standard basis for evaluating a claim. Appalachian Physical Medicine can make impairment rating determinations for musculoskeletal injuries, following guidelines published in the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment.