Active and Passive Movement Testing.

Petersen C.M., Foley R.A. New York, NY 10121-2298, McGraw-Hill Medical Publishing Division, 2002, spiralbound, 431 pp, illus, ISBN: 0-07-137033-1, $45.

The purpose of this manual is to provide physical therapist students and practicing physical therapists with basic examination techniques for active (physiologic) and passive (physiologic and accessory) movements of the upper and lower extremities, pelvis, spine, and temporomandibular joints and for neurodynamics (which the authors define as the relationship between normal physiologic movements and normal functional movements that place stress on neural tissues). The information in this book evolved from the authors' years of teaching and was drawn largely from well-known, respected manual therapy practitioners, including Kaltenborn, Cyriax, Mennell, Maitland, Grimsby, Paris, Stoddard, and Butler.

Material is organized into 5 chapters: "Principles of Mobilization for Examination," "Neurodynamic Principles of Mobilization for Examination," "Examination Techniques," "Principles of Mobilization for Intervention," and "Neurodynamic Principles of Mobilization for Treatment Intervention." Appendixes include tables on normal end-feels, joint close- and loose-packed positions, physiologic and accessory motion correlations (ie, treatment direction indications), and joint capsular patterns. Text is complemented with black-and-white line drawings and photographs, and each chapter concludes with a reasonably up-to-date reference list that includes books and articles from peer-reviewed journals.

The authors stated that the book would emphasize providing specific instructions for patient positioning, hand placement (for stabilization and mobilization), direction of movement (ie, force), and body mechanics. They accomplished this objective with clear written instructions and accompanying photographs either of live models or of skeletons. Several photographs, however, were of low quality because shadows obscured body parts and made visualizing hand placement difficult. The authors explicitly provided instructions on therapist positioning, but failed to describe ideal body mechanics for the operator as they said they would do.

The book's description of the principles of joint and neurodynamic mobilization for examination, including some fundamental biomechanical concepts, is comprehensive and concise; however, I disagree with the authors' assertion that pregnancy is a contraindication for joint mobilization. Pregnancy is not an absolute contraindication for mobilization or mobilization according to at least 2 well-known manual therapists--Grieve and Kaltenborn. Moreover, the authors are not consistent in this assertion--on page 16 they imply that pregnancy is an absolute contraindication, whereas on page 378 one of their statements could be interpreted as saying that therapists should proceed with caution when providing mobilization to a woman who is pregnant. Reliability of measurements is addressed briefly, but validity is not; and the peer-reviewed references used were not current. The most recent reference was published in 1998 and surely additional research has been published since that time.

The principles of mobilization for intervention described in the book appear to be influenced primarily by Maitland and Butler; however, the actual techniques of examination and mobilization are based primarily on the convex-concave rule, a concept put forth by Kaltenborn (interestingly, Kaltenborn is not referenced in either chapter). Reliability and validity of accessory motion intervention are addressed with references published in the late 1990s.

I believe the authors have achieved their stated purpose for this manual, and it is convenient to have examination and intervention techniques for the extremities, spine, pelvis, temporomandibular joint, and neurologic tissues in one volume. This book, therefore, could be useful for instruction of professional physical therapist students and physical therapist assistant students as well as beginning physical therapist practitioners, but only if it were supplemented with additional material on how these techniques fit into the larger scheme of patient management (a significant deficiency in the current text). Given a choice, however, between this text and Kaltenborn's (ie, Manual Mobilization of the Extremity Joints: Basic Examination and Treatment Techniques and The Spine: Basic Evaluation and Mobilization Techniques), I would choose Kaltenborn's, because I believe his manuals are more comprehensive.

Gordon J Alderink, PT

Grand Valley State University

Allendale, Mich

Mr Alderink is Assistant Professor in the Physical Therapy Department. He teaches kinesiology, biomechanics, and differential diagnosis in orthopedic physical therapy. He also directs clinical and research gait analysis activities at the Motion Analysis Center at Mary Free Hospital and Rehabilitation Center.