Evaluation, Treatment, and Prevention of Musculoskeletal Disorder, vol. 1, Spine, 3d ed.

Saunders HD, Saunders R. Chaska, MN 65318, The Saunders Group, 1993 hardcover, 396 pp, illus, $59.95.

This textbook is an excellent teaching tool for students as well as a basic reference for practicing clinicians. The expanded third edition is divided into two volumes: spine and extremities. Volume 1: Spine, contains a comprehensive discussion of several approaches to spinal evaluation and treatment. In comparison with the second edition, the material has been reorganized and enlarged to provide treatment alternatives for both problem-oriented care and diagnosis-specific recommendations. More detailed information is presented on spinal rehabilitation, work hardening programs, sacroiliac and pelvic dysfunction, and spinal mobilization techniques.

The text is clearly written and organized logically into four sections with 14 chapters. Illustrations and photographs throughout the text are appropriately detailed, large, and clear, and enhance the reader's understanding of the written text. Information is better referenced than in most conservative orthopedic textbooks. References for assumptions are noted within each chapter at relevant points, and a complete comprehensive resource list is found at the end of each chapter.

Section 1, "Laying the Foundation," contains three chapters: "Introduction," "Basic Spinal Biomechanics," and "Principles of Spinal Evaluation and Treatment." These chapters present a very cursory review of spinal biomechanics and introduce basic terminology. The depth of this material would be inappropriate as an exclusive reference for either student or practicing clinician. A strength of this first section is the list of definitions, which includes both osteopathic and traditional medical nomenclature. The segmental discussion of spinal movement also provides a very good introduction for practicing clinicians who need to review basics in order to begin a more comprehensive study of joint manual therapy techniques. A nice addition to this section would be a thorough description of general health and disease-specific outcome measurement tools, including those developed for patients with acute and chronic spinal dysfunction, such as the Dallas Pain Questionnaire and the Oswestry Spinal Questionnaire.

Section 2 consists of five chapters covering the evaluation and treatment of the spine, sacroiliac joint and pelvis, and temporomandibular joint. Chapter 4, "Evaluation of the Spine," presents an orderly progression of evaluation procedures, including interview and physical examination protocols that consist of general and segmental mobility testing, neurological assessment, special tests, and neural tension evaluation techniques. The chapter lacks discussion of functional testing, although discussion of formal functional capacity evaluation is covered in chapter 13. The authors make efforts to strongly link the evaluation chapter to the two treatment chapters, both of which follow thorough diagnosis-oriented approaches as well as problem-focused strategies. This is a particular strength of the text and should prove beneficial to the entry-level practitioner who often has difficulty with diagnosis-driven management for patients with spinal pain and dysfunction. Allyn Woerman, PT, contributes a well-written comprehensive chapter on the evaluation and treatment of pelvic girdle dysfunction. In the following chapter, Steven Kraus, PT, OCS, introduces temporomandibular joint evaluation and treatment, with good illustrations and appropriate detail for the new clinician. Strong resource lists support both of these chapters.

Section 3, "Specific Treatment Techniques," consists of chapters on mobilization, spinal traction, spinal orthoses, exercise, and spinal rehabilitation, including work conditioning, work hardening, and functional capacity evaluations. These chapters contain basic but thorough introductions to mobilization, spinal orthoses, and work programs. Although the exercise chapter includes a very nice compilation of exercises, including those recommended by the disciples of several orthopedic experts and proponents of lumbar stabilization, the text contains little support for the use of exercise for treatment. This material should be expanded in theory, principles, and content. Section 4, "Prevention," consists of one brief chapter that addresses injury prevention in the workplace.

I remember reading the first edition of this text several years ago and being very disappointed. The material was based primarily on conjecture and was poorly referenced. Perhaps because of that early impression, I felt great enthusiasm while reading this edition. No doubt nine years of effort from several hundred clinicians and researchers have led to increased validation of several previous assumptions regarding care of patients with spinal problems. However, I applaud the authors who have taken the sincere challenge to review, study, and describe the current research and findings that support a generalized approach of physical therapy for the spine. I encourage faculty who are not currently using this text to review this edition. I also recommend this text to all practicing orthopedic physical therapists if they have received instruction primarily from one methodology or mentor. This text discusses no particular "dogma" but instead is an enriching collage of multiple philosophies and practice concepts from several teachers. Finally, as managed care makes even the most "specialized" of our profession become more "generalized," this text would be an excellent review for our colleagues who practiced outside of orthopedics and find themselves treating patients with spinal pain and dysfunction.

Elaine Thompson, PhD, PT, OCS University of Pennsylvania Health Systems Philadelphia, Pa

Dr Thompson is Associate Hospital Director for the Hospital of the University of Pennsylvania and Presbyterian Medical Center and Clinical Assistant Professor in the Department of Orthopaedics, University of Pennsyvania Medical School. Her research interests are conservative management of patients with spinal dysfunction and lower-extremity pathomechanics.