Care of the Low Back: A Patient Guide.

Russell GS, Highland TR. Philadelphia, PA 19103-1493, FA Davis Co, 1991, paperback, 196 pp, illus, $19.95.

Care of the Low Back is a self-help manual, written by two physicians, that describes a multidisciplinary approach to care for the lower back. The focus of the book is on individuals with minor but recurring backaches, who are candidates for progressively more severe and frequent bouts of back pain, unless they begin to assume responsibility for their own well-being. The messages are clear: There is no simple solution; a person can prevent back pain, but may need to change his or her lifestyle.

The book is divided into two parts, which cover prevention and treatment. The section on prevention addresses anatomy; lifestyle; physical fitness; nutrition and weight control; stress management; posture; and lifting, pushing, and pulling. The section on treatment covers home management, medical evaluation, pain management, rehabilitation, activities of daily living, and sex. There is also an appendix that describes surgical procedures, defines medical terminology, lists commonly prescribed medications, and describes stretching and strengthening exercises for the lower back.

With an abundance of self-care materials for treatment of low back pain available to the consumer today, I looked for features in this manual that would make it stand out from its competitors. The authors' common-sense approach and statements of the obvious are perhaps the strong points of this book. In the chapter on activities of daily living, for example, advice on making a bed includes straightening the covers while lying in bed so that there is little to do after getting up, or simply leaving it unmade and closing the door.

Weaknesses of this text may be found in its generalizations, oversimplification, and lack of consistency. The chapters on treatment and management of pain and on rehabilitation address medication, transcutaneous nerve stimulation, exercise, acupuncture, hypnosis, and surgery, but they do not mention physical therapy. The authors have a flexion bias when describing proper posture and advocate using a pelvic tilt when sitting, standing, walking, or running. The use of a lumbar roll in sitting to maintain the normal 1ordosis is illustrated, however, and good posture is described as "maintaining the natural curves of the spine."

As the tide indicates, this book is intended for patients; it will not provide new information to health professionals already involved with spine care. Positioning of the spine during activity is an unsettled, often controversial topic, and this book does little to educate patients about problem solving for their specific dysfunction. Although some of the illustrations and parts of the text would be helpful to some patients, I recommend finding a guide that addresses back care with a less dogmatic approach.

Maggie Fillmore, PT

Berkeley Physical Therapy

Berkeley, Calif