Managing Low Back Pain, ed 4.

Managing Low Back Pain, ed 4 Kirkaldy-Willis WH, Bernard TN Jr, eds. Philadelphia, PA 19106, Churchill Livingstone Inc, 1999, hardcover, 448 pp, illus, ISBN:0-443-07948-X, $85.

This book covers the anatomy, biomechanics, pathophysiology, diagnosis, and management of low back pain from the perspective of a variety of disciplines. The aim of the book is to "help all those involved in the treatment of patients suffering from low back and leg pain." The persuasive philosophy throughout the chapters encourages a holistic approach to the problem by viewing the patient as an inseparable combination of mind and body.

This book is well written and well organized, with clear, helpful illustrations, and it addresses both acute and chronic low back pain. The information is current and richly referenced. It contains 25 chapters in 3 sections: "Essential Principles," "The Clinical Picture," and "Treatment."

The first section covers the anatomy, innervation, biomechanics, and pathology of the lumbar spine. This section is thick with information and provides the fundamental knowledge required to understand the problem. Many of the illustrations are helpful for patient education.

Section 2 contains the assessment of the problem ranging from imaging studies to psychological assessment. Clinical syndromes with a range of diagnostic procedures are discussed in an easy-to-follow format. Many photos of diagnostic imaging studies are included, which present a range of pathologies.

The treatment section includes chapters discussing the surgical, chiropractic, osteopathic, educational, psychiatric, and chronic pain management of low back pain. The one chapter in this book that is written by a physical therapist discusses a manual therapy approach. Exercise therapy as a treatment modality is relatively under-represented, and no review of its efficacy is given.

This book provides comprehensive information on the problem of low back pain from a multidisciplinary perspective. It does not provide any recipes for the evaluation and treatment of low back pain, but it encourages active decision making based on knowledge of the anatomy and pathophysiology of the spine and the understanding of the individual patient as a whole. As the editors intended, this book will benefit anyone involved in the treatment of low back pain.

Harriet Wittink, PT, PhD, OCS
New England Medical Center
Boston, Mass

Dr Wittink is the clinical specialist in an interdisciplinary pain management clinic. She specializes in the management of patients with chronic pain and in outcomes research and has coauthored a book on chronic pain management for physical therapists.