Back Stability.

Back Stability

Norris CM. Champaign, IL 61825-5076, Human Kinetics, 2000, hardcover, 280 pp, illus, ISBN: 0-7360-0081-X, $34.

This book is written for the health care professional who treats problems related to low back pain. The author approaches this topic holistically, focusing on 3 key elements needed to restore muscle balance: correction of segmental control, shortening and strengthening of lax muscles, and lengthening of tight muscles.

The book is divided into 4 parts. In the first part, the author establishes a foundation for the anatomical, physiological, and neurological components of back pain, exploring both traditional and newer approaches to treatment. This section includes 3 chapters that discuss the scope of back problems, the biomechanics of the lumbar spine, and lumbar stabilization mechanisms. Chapter 1 deals with the causes of back pain, management models, lumbar stabilization (the model used in this book), and achievement and maintenance of spinal stability. Chapter 2 covers the anatomy of the vertebral column, axial compression concepts related to anatomy, and key concepts in movements of the lumbar spine and pelvis. This chapter concludes with a discussion of the mechanics and methods of lifting. Chapter 3 addresses the roles of the ligamentous, fascial, and muscular systems in lumbar stabilization, as well as the role of intra-abdominal pressure.

The second part, consisting of 4 chapters, presents the "how-to" for teaching basic exercise techniques for stabilizing the back. Muscle adaptation to injury, immobilization, training, stretching principles, abdominal muscle training, and posture correction are explored. Chapter 4 begins by teaching pelvic control and progresses to regaining correct lumbar-pelvic rhythm. From this basis, the author moves to ,teaching the identification and assumption of the neutral position, including the use of proprioceptive concepts, and teaching the use of abdominal hollowing (isolating the deep abdominal muscles) and the focused contraction of the multifidus muscles. This chapter culminates by combining these last 2 concepts for rhythmic stabilization.

Chapter 5 approaches muscle imbalance by looking at the basic differences between stabilizer (postural) and mobilizer (task) muscles (ie, those muscles that set a joint and prevent motion and those muscles that create motion). From this basis, the author discusses the way different types of muscles react to injury, immobilization, and training and the need for training specificity. This chapter concludes with a section on the assessment of stretched and shortened muscles and principles of stretching techniques, supported by practical examples of the techniques. Chapter 6 focuses on abdominal muscle training, progressing from current practices to modifications of traditional exercises. Chapter 7 covers optimal postural alignment, assessment of postural alignment, and correction of postural malalignment. The section on correction covers specific posture types and presents techniques for correcting problems.

In the third part of this book, 2 chapters address exercises for prevention and rehabilitation associated with job-related lifting and sports. Advanced stability training, weight training, and plyometrics are presented. The chapter on advanced stability training includes specific techniques in multiple positions and the use of balance boards and gym balls. The chapter on weight training addresses safety issues and machine and free-weight techniques, including examples of both. This chapter ends with a brief discussion of the use of plyometric training for power and speed.

Part IV contains 2 chapters that focus on a decision-making process for assessment and exercise prescription. Chapter 10 addresses the role of pain as the focus of initial treatments and a diagnostic triage that covers simple backache, nerve root pain, and red flags requiring referral to a specialist. The section on designing exercise programs focuses on basic principles that address back stability, degree of deep abdominal control, muscle imbalance, and posture. This chapter' concludes with tips for designing weight-training programs and several case histories that highlight key management points. Chapter 11 presents principles of lifting for use in the home and on the job.

The entire text is richly endowed with drawings of patient positions for the exercises presented. The author has included multiple body positions, progressing from simple to complex, as well as positions using no equipment to those using various types of equipment. Key points are highlighted throughout the text to summarize and reinforce important concepts, and each chapter ends with a summary of the key points that have been presented in that chapter. For example, in a key point on joint stability in chapter 1, the author describes the difference between instability and hypermobility of the lumbar spine.

The author states that "the aim of most of the training in this book is for your clients (1) to learn to move/position their muscles in such a way that their lower backs will become stable, and (2) to keep their backs in the stable position." By presenting evidence-based rationales for the theories and practical techniques, step-by-step techniques, and the importance of assessment and decision making, the author has achieved this aim. This text would be a valuable resource for biomechanical, kinesiological, and orthopedic courses, as well as physical therapy clinics. Physical therapists and physical therapist students should consider adding this text to their professional libraries.

Elaine L Bukowski, PT The Richard Stockton College of New Jersey Pomona, NJ

Ms Bukowski is Associate Professor in the Physical Therapy Program. She is a primary instructor in the kinesiology and musculoskeletal courses.