Color Atlas of Low Back Pain.

Mills K, Page G, Siwek R. Philadelphia, PA 19103-1493, FA Davis Co, 1990, hardback, 92 pp, illus, $39.

The stated purpose of this publication is to "present a logical approach to the diagnosis proceeding from a history to physical examination and to investigations." According to the authors, the intended audience is medical and paramedical personnel, specifically "radiologic technicians, physiotherapists, and chiropractors." The text represents the opinions of three Scottish professionals: an orthopedic surgeon, a consultant in accident and emergency care, and an assistant director of medical illustrations. These professionals acknowledge assistance from various other medical personnel, including two physical therapists. No research is quoted, and no references are cited.

The first section is entitled "Some Causes of Back Pain" and lists various causes, describing the progression of each cause from the congenital stage to traumatic, infective, vascular, visceral, degenerative, neoplastic, biochemical, and psychological stages. The list includes causes as common as a prolapsed intervertebral disk to those as obscure as adenocarcinoma of the pancreas.

Next follows a two-page section on documenting patient history, using examples of a disability index questionnaire and a pain rating scale. This section is followed by a comprehensive section on physical examination that contains 76 color illustrations. The information is presented in a logical progression, and the illustrations complement the text very, well. Both the sections on common causes and on physical examination seem to emphasize the obscure or unusual. This is perhaps appropriate for the diagnostic responsibilities of a physician, and it is beneficial for physical therapists to be reminded that there are causes of back pain that are more obscure. The problem it presents is that the examination outlined represents little more than a screening of the more common neurological and musculoskeletal causes of back pain.

The section called "Investigations" focuses on radiologic techniques including diskography, computerized axial tomography, nuclear magnetic resonance imaging, and lumbar puncture/myelography. There are 44 excellent photographs illustrating examples of spinal pathology as visualized by these various techniques.

The section on conservative treatment is the most applicable to physical therapy practitioners and, unfortunately, is very poorly done. The introduction to the subsection on physical therapy is illustrated by photographs of "bad" and "safer" methods of lifting. In my opinion, the "safer" method contains multiple errors. The photograph depicts a woman in a partial squat with her feet side by side, her back rounded, and her head down and with the object to be reached far from her center of gravity. Further information about physical therapy is primarily related to stretching and strengthening exercises, and, overall, the 13 illustrations of specific exercises are well composed.

Other illustrations in the conservative management section might have been better examples of what not to do. The picture of good sitting posture shows a woman slumped down slightly in her chair, her back rounded, her head forward, and her knees lower than her hips. The woman demonstrating good foot position for prolonged standing was weating high-heeled shoes. The importance of raising low work stations so that they are at an appropriate height is illustrated by a woman ironing at an ironing board that is at least 0.3048 m (1 ft) below her waist level.

The information on external splintage includes examination of corsets, braces, and plaster casts, but is of limited scope. The material on traction focuses on skin traction. Multiple color pictures detailing how to apply skin traction covered everything from shaving the leg to applying adhesive and seemed unnecessarily detailed compared with other more important topics. Traction, as used in physical therapy, was mentioned but did not address the option of using intermittent or static modes, variable weight capacities, or any of the relevant research.

The last section, which covers surgery, seems almost an afterthought. It contains only three pages of text and has a few sketchy surgical procedures.

In general, the book has little to offer the physical therapy practitioner. The authors tried to cover the whole scope of issues related to low back pain, including some of the more obscure causes and interventions, in 92 pages with 189 illustrations. The text would have been improved by limiting the scope, covering fewer topics in more depth, selecting topics that lend them-selves especially well to illustration as a primary means of instruction, and analyzing the content of the illustrations more critically.

Karen Yundt Lunnen, PT

Sylva, NC