Manual Therapy: Improve Muscle and Joint Functioning.

Manual Therapy: Improve Muscle and Joint Functioning Warmerdam A. Minneapolis, MN 55447-0009, Pine Publications/ OPTP, 1999, hardcover, 358 pp, illus, ISBN: 0-9657910-0-9, $62.95.

In the legal world, the lawyer who puts together a seamless case typically comes out a winner. Like a good lawyer, Ad Warmerdam has worked very hard to develop the case that manual therapy can help increase muscle strength by resolving joint dysfunction. Warmerdam has drawn on a wealth of research to defend his theory of manual therapy and the contribution of joint dysfunction to muscular weakness. He has encapsulated the premise of his text in the introduction, in which he states that "muscle weakness is a symptom" and that the goal of the astute therapist is to examine the patient to determine the exact cause of the weakness. As a manual therapy text, the etiological focus is articular, and the interventions focus on using manual techniques to produce improvements in the quality of muscular contractions.

Although not formally divided into 2 parts, the text has a clear division between the background chapters and the practical application chapters. The first half of the book has 14 chapters that provide the background for Warmerdam's theory. These chapters provide a comprehensive review of the neurophysiology that underlies joint and muscle function as well as the principles of pain and pathology. The chapters are very well referenced, and each one reads like a literature review on the given topic. Chapter topics include articular receptors, position and movement sense, articular reflexes, articulomuscular protective reflex, withdrawal reflex, dysfunction and pathology, arthritis, and arthrogenic muscle dysfunction. The chapters are a lovely marriage of orthopedic and neurologic physical therapy concepts. Anatomic and line drawings are appropriately included when needed, and each chapter ends with a summary and conclusion that helps to draw the information together.

The second half of the text focuses on clinical application and includes chapters on manual muscle testing, evaluation of spinal dysfunction, therapeutic concepts, notation, and technique procedures. This half ends with 5 case studies. Even in the application chapters, Warmerdam has made it clear that he values research concepts and methods. The chapter on manual muscle testing includes a section that details the author's thoughts on the reliability and validity concepts that researchers could use to critique his use of manual muscle testing. This half of the text also has clear diagrams and photographs to illustrate concepts and the treatment procedures described in the book. On occasion, the photographs are taken from angles that do not clarify the actions of the therapist, but the written descriptions are quite detailed and the combination of the images and text enables the reader to understand the technique.

This text would serve as a good learning tool for any physical therapist in almost any venue because muscular weakness is a common impairment encountered in physical therapy. It is targeted at the physical therapist who works with patients with musculoskeletal disorders, and its writing style allows the book to be used for self-structured and self-paced learning.

In the legal venue, a good lawyer can plead a case using circumstantial evidence and evidence that implies causation. Physical therapy, however, is not law, and Warmerdam should really see this book as only a start. He has laid down a theoretical basis for future research, and he has provided a significant body of circumstantial evidence. The time has come to take the next step, and we can only hope that either the author or other readers will initiate a program based on the theory and the techniques described this text.

Julia Chevan, PT, OCS Springfield College Springfield, Mass

Ms Chevan is Associate Professor in the Department of Physical Therapy, where she teaches courses on musculoskeletal examination, evaluation, and intervention. She also manages patients with orthopedic conditions.