Low Back Syndromes: Integrated Clinical Management.

Low Back Syndromes: Integrated Clinical Management Morris CE, ed. New York, NY 10121, McGraw-Hill, 2006, hardcover, 768 pp, illus, ISBN: 0071374728; $90.

This textbook presents an interdisciplinary and seemingly exhaustive evidence-based approach toward the understanding of low back pain, pain syndromes, and the clinical intervention for patients who have these syndromes. What appears on the surface to be a chiropractic approach to the patient with low back pain is, in fact, a multidisciplinary approach to understanding this clinical challenge.

This textbook is arranged into 6 parts. The chapters within each part effectively utilize tables, charts, and illustrations to augment the reader's understanding of the content. Each chapter begins with a content outline containing learning objectives and ends with a summary highlighting the important content and concepts covered. "Clinical Pearls" located throughout the chapters focus the reader on important concepts and enhance their understanding of these concepts. The references that are included at the end of each chapter seem to be both current and exhaustive. The writing style is clear and thorough, and the content is well organized.

Part 1, "Overview," includes chapters that cover the evolution of low back syndrome, functional anatomy, biomechanics, epidemiology, and functional control of the low back. Part 2, "Low Back Syndromes," groups the low back syndromes under the following categories: disk syndromes, stenotic syndromes, posterior joint syndromes, myofascial pain syndromes, and nonspecific and chronic low back syndromes. This section also includes a chapter on how to identify "red flag" indicators for more serious diseases that can mimic low back pain syndromes. Each chapter addresses the relevant anatomy and tissue mechanics, the pathophysiology, and the examination, assessment, and the management of the patient who has that particular syndrome. The intent of these chapters is to develop the reader's understanding of the syndrome and his or her ability to recognize the patient who has that syndrome. A brief overview of patient management also is included, but intervention is not the focus of this part.

Part 3, "Assessment of the Low Back," presents the history and physical examination, the functional examination, various outcomes assessment procedures, mechanical diagnosis (McKenzie) protocols, diagnostic imaging, minimally invasive diagnostic procedures, neurodiagnostic procedures, and biopsychosocial factors relevant to this patient population. Considered as a whole, the chapters in this part present a comprehensive and multifaceted approach to examination and evaluation for patients with low back pain.

Part 4, "Conservative Techniques for Low Back Syndromes," includes chapters on spinal manipulation techniques and biomechanics, McKenzie treatment protocols, mobilization techniques, and minimally invasive procedures. The chapters on spinal manipulation cover the indications and therapeutic effects of these techniques as well as patient selection criteria for their use, but specific techniques are not discussed. The chapter on mobilization techniques does include some select techniques for addressing joint, soft tissue, and neural structures but is by no means exhaustive. One chapter focuses on typical McKenzie syndrome treatment protocols through the use of patient case studies. Review of the syndrome definition also is provided to reinforce the reader's understanding of these syndrome classifications, but the review should be considered only as a primer on this clinical approach.

Section 5, "Rehabilitation of the Low Back," offers more specific guidelines for the rehabilitation of patients with low back syndromes and includes chapters on rehabilitation strategies, rehabilitation of the patient who received surgery, functional stabilization, and management of the athlete with low back pain. Although these chapters include examples of exercises and exercise progression and protocols, the clinical application of these concepts will require more than simply following a script. The content serves to suggest appropriate treatment choices as well as addressing typical patient issues encountered in the clinic; they are by no means prescriptive in content.

In the final part of this textbook, "Clinical Management," chapters cover evidence-based treatment, clinical decision making in the recommendation of surgery, management of occupational low back injuries, clinical management of disabling low back syndromes, and risk management when dealing with patients with low back syndrome. These capstone chapters serve to enhance the reader's awareness of the principal factors that guide clinical decision making and evidence-based practice.

In summary, this interdisciplinary textbook does an exceptional job of incorporating Current evidence and understanding of what has been a clinical challenge into a syndrome classification approach. In addition, this is one of the first textbooks to combine the contributions of all relevant clinical specialties into a single work. This textbook would serve the practicing clinician well but might be overwhelming and too advanced for the student or clinician who is just beginning clinical practice. Nevertheless, in this reviewer's opinion, this is a must-have reference for all practicing clinicians.

[DOI: 10.2522/ptj.2006.86.12.1712]

Michael Buck, PT, ATC 

Ithaca College 

Ithaca, NY

Buck is Clinical Associate Professor in the Department of Physical Therapy. In addition to teaching responsibilities in the musculoskeletal track, he maintains an active practice focused on spinal pain and disability.