Clinical Anatomy and Management of Low Back Pain.

Giles LGF, Singer KP, eds. Oxford, England, OX2 8DP, Butterworth-Heinemann, 1997, paperback, 411 pp, illus, $80.

Clinical Anatomy and Management of Low Back Pain is the first book in a series on spinal pain. It focuses on the conservative management of low back pain through mechanical treatment--the manipulation of the spine. The book is divided into five sections: "Introduction and Epidemiology," "Anatomy and Pathology," "Spinal Clinical Neuroanatomy and Neurophysiology," "Diagnosis and Management," and "Definitions and Abbreviations."

Section 1, "Introduction and Epidemiology," reviews the mechanics of normal erect posture and the congenital anomalies that may contribute to spinal dysfunction. This review is followed by a discussion about the epidemiology of low back pain.

Sections II and III review, analyze, and interpret contemporary contributions from the basic sciences. The intent is to provide the reader with information from the basic sciences that is clinically relevant to the diagnosis and treatment of mechanical back pain. Section II details the clinical anatomy and pathology of the lumbosacral spine. There are chapters on the intervertebral disk, zygapophyseal joints, blood supply, and muscles and ligaments. Section III discusses the clinical neuroanatomy and neurophysiology of the lumbosacral spine. Although there are only four chapters, the information is detailed and comprehensive.

In section IV, "Diagnosis and Management," there are three chapters on assessment and treatment approaches used in chiropractic, osteopathy, and physical therapy. In these chapters, academic clinicians from these fields explain the clinical reasoning behind the assessments and the manipulation strategies used by their discipline. In addition, they highlight their common treatment goals of minimizing pain, eliminating secondary disabilities, and preventing the recurrence of pain. Other chapters in this section discuss the advantages and limitations of imaging procedures, psychological assessment, pharmacological and surgical treatments, and contraindications for spinal manipulation.

Section V consists solely of abbreviations and definitions. This section is a useful reference for understanding the previous four sections.

Illustrations are used liberally throughout the book, from the introduction to the closing sections on definitions and abbreviations. Not only are the illustrations numerous, they are impressively varied. In addition to the usual line drawings, schematic diagrams, charts, and tables, the book contains high-quality images of dissections and histological sections, radiographs, myelograms, computed tomographic scans, and magnetic resonance images. The detailed captions that accompany every illustration make these images an integral and invaluable part of the text.

The target readers for Clinical Anatomy and Management of Low Back Pain are undergraduate and graduate students in mechanical therapy and clinicians who practice mechanical therapy. Because this book deals with a narrow subject in a high level of detail, graduate students and practitioners who specialize in spinal manipulation will find the book most suited to their needs.

Ms Ingles is Director of Physical Therapy at the Sullivan County Board of Cooperative Educational Services and specializes in school-based physical therapy. She also has a private practice that provides physical therapy to infants at risk and geriatric adults.