Clinical Guide to Sports Injuries.

Clinical Guide to Sports Injuries Bahr R, Maehlum S, eds. Champaign, IL 61825-5076, Human Kinetics, 2004, hardcover (with CD-ROM), 451 pp, illus, ISBN: 0-7360-4117-6, $95.

Clinical Guide to Sports Injuries is a text and reference for those clinicians who deal with sports-related problems, including team physicians, athletic trainers, and physical therapists. This book is an English translation of Idrettsskader, published in 2002 by Gazette Bok. It consists of 15 chapters that were written by several authors, more than 400 full-color illustrations and 120 photographs, and a CD-ROM of the visual material for use in lectures and presentations.

The first 3 chapters are a comprehensive discussion of sports injuries, including types, causes, and treatment and prevention. Explanations of processes such as inflammation are concise, informative, and easy to understand. The text is packed with tables, charts, illustrations, and pictures. The illustrations throughout the book are superb and clearly show details (such as injuries) that a photograph cannot. The chapter on preventing sports injuries would have benefited from having a physical therapist as a coauthor. The author of this chapter, a coeditor of the book, does a wonderful job discussing incidence and severity of sports injuries, causes and risk factors, risk analysis, and general principles for preventing sports injuries. The discussion of prevention measures, however--although it is informative and includes progressive concepts such as hold-relax stretches and proprioception exercises--lacks the detail and improved techniques that a physical therapist could have provided. For example, the chapter author recommends only 10 to 15 seconds of static stretching after warming up and makes no mention of dynamic stretching (ie, active stretching through the entire range of motion, such as leg swings).

The other 12 chapters each focus on a region of the body (face and head, neck and back, shoulder, elbow and arm, and so on) and use a problem-oriented approach to logically guide readers through the injury management process, beginning with the problem presented by the patient and followed by the diagnoses and treatment options.

Each chapter begins with occurrence, containing recent and relevant statistics, followed by differential diagnosis, which includes a table listing injuries from "most common" to "must not be overlooked," with each injury referenced by page. This segues into diagnostic thinking, clinical history (mechanism of injury), and clinical examination (including special tests and supplemental examinations). The clinical examination section of each chapter is one of the many strengths of this book. The examination discussions, although not always comprehensive, usually include the most relevant and valid tests, they are concise and easy to follow, and they are frequently very well illustrated. Most physical therapists, though, will probably be disappointed with the lack of attention given to the sacroiliac region and spine, especially in the examination discussions. Also, the opinions of some chapter authors are off-putting. For example, during a discussion of acute low back pain in chapter 5, the author writes "Although treatment by a physical therapist is unnecessary during the acute phase...." In the section on chronic low back pain, moreover, the author states that the physical therapy treatment of first choice is "group exercise."

The largest amount of text in each chapter is devoted to the sections covering common injuries, another area in which the book excels. The most common injuries are reviewed first and include symptoms and signs, diagnosis, treatment by a physician, treatment by a physical therapist (which are very brief and consist mostly of precautions), and prognosis. Occasionally, a common injury such as a rupture of the long head of the biceps brachii muscle is omitted, but, overall, the listing of injuries is comprehensive. The illustrations are wonderful, using color and detail to great effect. Some chapters also include a section on "other injuries" or "other causes of pain."

The final section in most chapters deals with rehabilitation. Interestingly, none of the sections are written by a physical therapist, but instead are cowritten by a physical therapist and a physician or mitten by a physician alone. This section is usually just a few pages of text and illustrations. Goals and principles--including a table of interventions for each phase (acute, rehabilitation, and training), rehabilitation of painful conditions, and preventing reinjury--are the main points of emphasis in this section. Occasionally, parameters for return to sport also are included. The choice of exercises is probably not intended to be comprehensive or a complete program, but rather representative of the variety of exercises available. Open and closed chain, eccentric loading, balance, sling, pulley, and joint mobilization exercises are demonstrated at one time or another, but curiously no gym ball (Swiss ball) or swimming pool exercises are discussed.

The strengths of this book are: its generous use of illustrations (which are among the best I have ever seen), pictures and tables; its well-organized content; and its concise, effective, readable text. Overall, the information presented is very good, but would have been enhanced by stronger rehabilitation sections, more relevant text regarding North American sports, and more text devoted to the sacroiliac region. The CD-ROM is a wonderful supplement to the text, and almost by itself would make this book a welcome addition to the library of students, physical therapists, and physicians interested in sports medicine.

Gerry Van Dyke, PT, SCS, ATC 

California Orthopedic and Sports Therapy (COAST) Rehabilitation Services Inc

Aptos, Calif

Mr Van Dyke is owner of COAST Rehabilitation Services, which provides physical therapy and athletic training services to professional, collegiate, and high school athletes. He is also the physical therapist for Isomax Corporation.