Evaluation, Treatment and Prevention of Musculoskeletal Disorders, Volume One--Spine, ed 4.

Evaluation, Treatment and Prevention of Musculoskeletal Disorders, Volume One--Spine, ed 4 Saunders HD, Ryan Saunders R. Chaska, MN 55318, The Saunders Group, 2004, hardcover, 395 pp, illus, ISBN: 1-879190-12-5, $59.95.

Previous editions of this text have been well accepted by, and useful to, the orthopedic physical therapy community. Publishing a fourth edition is evidence of the commitment and tenacity of the authors. In keeping with their commitment to evidence-based practice (EBP), the authors have significantly updated the fourth edition with a comprehensive literature review, and, in some cases, they provide critical analyses of the literature. Furthermore, field experts contributed 3 new chapters: "Medical Screening," "Cervicogenic Headache," and "Soft Tissue Mobilization and Neuromuscular Training." The chapters on medical screening and headache are excellent; however, I was somewhat disappointed with insufficient evidence (eg, on validity and reliability) supporting soft tissue examination and intervention methods. I am disappointed that the authors did not provide references to what literature may exist or at least an acknowledgment that there is insufficient evidence to support the use of soft tissue examination and intervention methods. In my opinion, we as a profession continue to be proponents of techniques without evidence. I realize that evidence-based practice states that we combine the use of best evidence with clinical expertise, but at the very least we could acknowledge that we are (in the case of soft tissue work) continuing to use methods that may not be supported at the same time that we are trying to collect evidence.

This text is comprehensive and well organized into 15 chapters. Other new topics in this edition include: spinal biomechanics, evaluation of the spine, treatment by diagnosis and by problem, pelvic girdle dysfunction, temporomandibular joint (TMJ) disorders, joint mobilization, spinal traction and orthoses, basic spinal exercise, and advanced spinal rehabilitation and prevention. I would like to specifically note that chapter 14, "Basic Spinal Exercise," contains pictures and explanations that could be useful to practitioners. The table of contents provides title and page numbers for all subheadings contained in each chapter, making this book more user-friendly than most other resources. Tables, figures, graphs, line drawings, and photographs adequately complement the text, although the low quality of some photographs and the lack of color lessen the book's effectiveness. For example, the more difficult examination and treatment techniques should be illustrated by photographs from several angles, which would clearly show the therapist's body and hand position. Consequently, beginning practitioners may find this book less useful. Each chapter concludes with up-to-date references so that, as the authors write, readers can critically examine the authors' statements by locating and examining primary sources in order to draw their own conclusions. The readability and flow of the text are good.

In chapter 1, the authors provide a narrow and somewhat shortsighted definition of EBP. They stated that EBP "refers to a philosophy of choosing evaluation and treatment methods that have efficacy or effectiveness in the literature." Because of this misinterpretation, they are critical of some of the literature and do not believe that some of the present-day guidelines are congruent with their clinical experience. The authors caution readers to critically examine the literature with regard to methods used in primary studies and systematic reviews or meta-analyses. At the same time, they attempt to justify their continued use of "unproven" intervention strategies (eg, spinal traction, back supports, and specific exercises) with anecdotal rationales, which, to me, is a red flag. It is more than likely that the authors are overly critical of the literature due to their apparent shortsighted view of EBP. If we take Sackett's (Evidence-Based Medicine: How to Practice and Teach EBM) definition of EBP as "the integration of best research evidence with clinical expertise and patient values," one may view the literature and clinical experiences with a healthy skepticism while we consider our patient's goals and values in intervention planning.

In chapter 2, the authors state that the purpose of the book was "not to provide the reader with ... a detailed picture of the biomechanics or applied anatomy of the spine." Although I realize that the various models (eg, osteopathic) of spinal examination and treatment may rely on different perceptions of how the spine works, I wonder how the authors can justify presenting either only a portion of the story or some stories that may not be true. For example, their description of how the sacroiliac joint moves during gait is based on clinical conjecture, a theory that has not been supported with evidence. In addition, it would seem important to include references from anatomist Bogduk (Clinical Anatomy of the Lumbar Spine and Sacrum) when discussing the anatomy and role of superficial and deep spinal muscles, but a review of his work was not cited. Chapter 4 provides comprehensive coverage of spinal examination and evaluation, but I was disappointed that the authors, here and in other chapters, did not consistently use terminology concordant with the Guide to Physical Therapist Practice, which may make the SOAP documentation format obsolete.

In chapter 11, the authors provided some rationale and anatomical considerations for soft tissue work, but leave out a neurological rationale, and their discussion of the viscoelastic nature of soft tissue was overly simplistic. Without explicit research supporting soft tissue work, at the least, the authors need to provide readers with a stronger theoretical framework for these treatment modalities. Finally, it should be noted that many of the references cited in chapter 12, "Spinal Traction," are dated, and several are from texts or monographs and not original research.

Despite the shortcomings, there is a lot of great information in this text. I would recommend this fourth edition as a reference for physical therapist practitioners and faculty; however, because of the criticisms I have raised, I would not use it as a primary orthopedic text for students.

Gordon J Alderink, PT, PhD

Grand Valley State University

Grand Rapids, Mich

Dr Alderink is Associate Professor in the Physical Therapy Program, where he teaches kinesiology, biomechanics, orthopedics, and research methods. He also is Director of Academic Research at the Mary Free Bed Hospital Motion Analysis Center a laboratory that performs gait analyses to help manage patients with orthopedic or neurological pathologies.