Low Back Pain: Medical Diagnosis and Comprehensive Management, 2nd ed.

Borenstein DG, Wiesel SW, Boden SD. Philadelphia, PA 19106-3399, WB Saunders Co, 1995, hardback, 732 pp, illus, $70.

The main reasons for publishing the second edition of this book are that significant progress has been made in the evaluation and treatment of patients with low back pain and that advances have been made in radiological technology, allowing confirmation and anatomic identification of normal structures without invasive techniques. The book is written for the primary care expert, whether it is the surgeon, orthopedist, neurologist, osteopath, chiropractor, or physical therapist. In addition, it is also written for the internist and rheumatologist. The book fully addresses all of the needs of the intended audience but is weak in the area of physical modalities because the material is rather dated. it still serves a purpose for those interested in back care as it covers all major themes in diagnosis, evaluation, and treatment and gives a broad understanding of the diagnostic problems.

The strength of this work lies in its general conception as a manual for teaching physicians and physical therapists. The book is divided into 22 chapters under four major headings: "Anatomy and Physiology of Back Pain," "Clinical Evaluation of Low Back Pain," "Diseases Associated With Low Back Pain," and "Therapy." There is an appendix and an index. Each chapter also contains an appendix details special resources related to low back pain and a bibliography with additional suggested reading for individuals wanting more information on various aspects of low back pain and diagnosis.

Part 1, consisting of chapters 1 through 3, examines the basic science. It is well written and follows a logical sequence. The first chapter deals with anatomy and biomechanics of the lumbosacral spine. Chapter 2 describes the epidemiology of low back pain and sciatica, with all of the latest references. Chapter 3 describes the sources of low back pain. The section of pain production and transmission is, again, very pertinent to physical therapists and is precisely and concisely done.

Part 2, containing chapters 4 through 9, describes the history taking, the physical examination, laboratory tests, radiographic evaluation, miscellaneous tests, and a standardized approach to the diagnosis and treatment of low back pain, with an algorithm and evaluation forms in chapter 9. The physical examination, the radiologic evaluation, and the electrodiagnostic studies are relevant for physical therapists.

Part 3, chapters 10 through 18, deals with mechanical disorders, rheumatologic disorders, infections of the lumbosacral spine, tumors, endocrinologic and metabolic disorders, hematologic disorders, neurologic and psychiatric disorders, referred pain, and miscellaneous diseases. This part will be an invaluable reference for physical therapists who are now treating patients under direct access and will be a valuable resource for helping therapists understand that there are more than 70 diseases that are directly involved with low back pain.

Part 4, "Therapy," deals with medical therapy, surgical therapy, occupational low back pain, and pain clinics. Here again, the chapters are well written except for those on the physical modalities and exercises, which are rather outdated. This can be excused because the book is not written primarily for physical therapists.

Overall, the book is well written and easy to read. It does not contain much information about physical therapy exercises and modalities, and the information that is included, is outdated. I highly recommend this book, however, to all therapists who treat patients and teach physical therapy students. I would also recommend it for students in physical therapy programs.

The book contains all , of the aspects relevant to low back pain and is a valuable resource to physical therapists. It should be in every physical therapy library. It is definitely the most comprehensive book on this subject that I have read.

CK Fernando, PT, FAAPM Forest Hills Institute for Back Pain Downers Grove, Ill

Mr Fernando is Executive Director at the Forest Hills Institute for Back Pain, where his primary responsibilities include administration, treatment, and teaching. He has written a book and several articles on low back pain and biofeedback. He also teaches at seminars.