Diagnosis and Treatment of Movement Impairment Syndromes.

Sahrmann SA. St Louis, MO 63146, Mosby Inc, 2002, hardcover, 473 pp, illus, ISBN 0-8016-7205-8, $47.95.

Diagnosis and Treatment of Movement Impairment Syndromes is the long-awaited book by Shirley Sahrmann, who has been considered an expert in movement disorders and the musculoskeletal system. This text examines the effect of normal and abnormal movement patterns and postures on the musculoskeletal system. Various schemes for patient examination are demonstrated along with the appropriate mode of treatment. Case presentations located throughout the book further illustrate important concepts and highlight specific dysfunctions.

The text contains 8 chapters. The first 2 chapters provide the framework and support the theories that are the basis of Dr Sahrmann's work. Her premise is that the ability to maintain or restore precise movement of a specific segment (area of the body) is vital in the management and prevention of musculoskeletal pain. The author also introduces a classification system that is used to guide patient management.

The next 3 chapters cover the lumbar spine, hip, and shoulder girdle and use a similar format. Normal alignment, motions, and muscular actions of each region are covered in detail. Specific movement impairment syndromes are presented along with the diagnosis that might accompany the syndrome. A treatment plan is based on the diagnosis. Each syndrome is followed by a case study to illustrate the patient's presentation along with the outcome of the intervention. The vast majority of the tests and postures are well illustrated. An appendix at the end of each of the 3 chapters summarizes each of the syndromes. This summary includes screening methods for potential medical diagnoses that might require a referral. These appendixes are one of the strengths of the book because they allow the reader quick reference to a specific syndrome.

The sixth chapter covers movement impairment examinations for the upper and lower extremities using charts that show the test, the segment, the fault (findings), the criteria, the impairment, and the directional susceptibility to movement. This allows the therapist to examine different regions of the body in detail to develop a more comprehensive program when needed.

The seventh and eighth chapters cover the specific exercises that would be prescribed for the diagnosed condition. The seventh chapter gives more detail about each exercise including any special considerations. The eighth chapter summarizes some of the points of the previous chapter with the addition of exercise handouts that Dr Sahrmann has allowed to be copied only for patient use. If an exercise has different levels, each level is demonstrated.

This text is well written, and clinicians in need of a quick resource will find it easy to reference. The book is well illustrated, and the concepts are thoroughly explained. The one weakness in this text is that postural observation findings guide part of the examination and treatment. These findings can be subjective and their value needs to be supported by more peer-reviewed research. Nevertheless, I would recommend this book for physical therapists of all experience levels. It is clinically relevant and current and provides clinical insight in this topic area.

Jeff Yaver, PT Kaiser Permanente Medical Center Sacramento, Calif

Mr Yaver is the Assistant Manager of Outpatient Services for the Rehabilitation Services Department. His clinical interests are in the treatment of spinal dysfunction.