Maintaining Body Balance, Flexibility, and Stability: a Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction.

Maintaining Body Balance, Flexibility, and Stability: A Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction Chaitow L. London, United Kingdom, Churchill Livingstone Inc, 2004, spiral-bound, 209 pp, illus, ISBN: 0-443-07351-1, $29.95.

This book is intended as a guide for patients and clients in the prevention and self-treatment of musculoskeletal pain and dysfunction. The author clearly states that the book is not to be used as a substitute for professional care but rather as an adjunct to this care. The terminology used is well defined and the techniques are well illustrated. The text also includes 8 exercise cards containing illustrations, exercise parameters, and general recommendations for 52 techniques.

The book is divided into 8 chapters. Chapter 1 describes the basic forms of muscle energy techniques (METs). Although the author does not specifically define METs, many of these techniques appear to be traditional flexibility and strengthening exercises such as contact relax (which the author calls "post-isometic relaxation") and static stretching. Basic concepts such as muscle contraction, reciprocal inhibition, common mistakes, and parameters for the exercise techniques are discussed. A well-written, 5-page section rifled "Explanations and Summary of MET Methods" occurs at end of the chapter. The summary provides brief answers to several questions (eg, What is an isometric contraction?, What conditions does MET help?, How long should contractions last?, and Do these methods work?). Overall, most of the concepts discussed in this chapter should be very basic for any physical therapist or physical therapist student.

Chapter 2 describes testing for muscle shortness. The author gives the rationale for "freeing and loosening" tight muscles before strengthening weak muscles. A very brief description of type I and type II muscle fibers is given. Specific testing techniques for all of the major upper-body and lower body joints are then described. Many traditional range of motion and muscle length tests are described but numbered instead of specifically" named. As an example, "Shortness Test #12-15" describes the standard straight leg raise. Specific descriptions of tightness in the hamstrings, low back, or combination length (ie, the length of the low back and hamstring muscle as a unit) versus normal length are described for each number. In total, 32 shortness tests are described. One of the shortcomings of this chapter is that self-testing is difficult for a number of the tests described. Thus the ability to self-test and interpret the results of these techniques may be limited.

Chapter 3 describes self-treatment METs. This section contains METs for specific muscles such as the trapezius, erector spinae, iliopsoas, and rectus femoris to name a few. A total of 38 techniques are described. The description for each technique is organized into sections covering the muscle or muscle group and action, problems associated with limitation in movement, and the MET position. Specific time and position recommendations also are described.

Chapter 4 describes trigger points and pain control. The author describes types of trigger points, location of trigger points, and specific treatments. Specific recommendations on positioning and amount of pressure are given. Alternatives to manual techniques, such as "spray ice" (ie, fluromethane or ethyl chloride) and traditional icing, are briefly discussed.

Chapter 5 describes 18 self-mobilization techniques. The author notes the exercises described by osteopaths Chester Kirk and Lawrence Jones and simply describes them as Kirks' or Jones' exercises. Physical therapists will easily recognize the exercises, which include techniques such as knee-to-chest and supine lumbar rotation.

Chapter 6 describes the author's concepts for strengthening. Twenty-three exercises are illustrated, including prone hip extension (gluteus maximus exercise), isometric shoulder abduction (deltoid exercise), and prone press-ups (prone trunk extension). As in the previous chapters, a description of the muscle or muscle group, the reason for weakness, and a specific exercise are given.

Chapter 7 describes concepts related to balance, agility, and breathing. General guidelines for standing balance and stepping balance tests are given. The author reports that many of the exercises are the same as the test described; however, only 7 exercises are given. A separate section in this chapter illustrates 5 breathing exercises. These exercises emphasize proper sitting and supine posture with emphasis on slow, controlled pursed-lip breathing. The aim is to create a balanced breathing pattern that will properly oxygenate body tissues.

The final chapter introduces concepts such as positional release technique and strain and counterstrain. Definitions are included, guidelines for self-application are detailed, and 11 specific techniques are described.

This text is intended as a self-help guide for the prevention and treatment of musculoskeletal pain and dysfunction. Physical therapists would consider many of the techniques to be traditional flexibility and strengthening exercises. The author included a number of sections containing "Cautions" for the specific techniques. Although the author intends the text to be an adjunct to professional care, the description on the back cover contradicts this intent. The cover states, "those using these exercises as part of a treatment or training programme will commonly do so under the instruction and supervision of a therapist or a trainer. Others will want to use this book on their own, without professional guidance."

The descriptions of the techniques are geared toward self-treatment; however, a number of these techniques require assistance at a minimum, whereas others would require professional guidance to interpret the results. The author attempted to address the needs of both health care professionals and patients and clients. In general, physical therapists will find the information in this text to be very basic, and the average patient may find some of the techniques difficult to fully implement. No specific information is given regarding evidence for any of the techniques and recommendations.

Overall, the text is well organized and user friendly. It is best suited as an adjunct for a patient's home exercise program after an examination has been completed and specific recommendations have been given.

Edgar Torres, PT

University of Michigan, Flint

Flint, Mich

Mr Tortes is a lecturer in the Physical Therapy Department and teaches kinesiology, orthopedic therapeutic exercise, and related courses. He is also a doctoral candidate in orthopedic physical therapy at Rocky Mountain University of Health Professions.