Manual of Combined Movements: Their Use in the Examination and Treatment of Mechanical Vertebral Column Disorders.

The purpose of this book is to "draw attention to the use of combined movements when examining and treating mechanical disorders of the vertebral column." The author clearly intends this text to be used in conjunction with Maitland's Vertebral Manipulation and Grieve's Common Vertebral joint Problems. Indeed, it would be difficult to utilize this book without a basic knowledge of manual therapy and a familiarity with the works of Maitland and Grieve.

This is more a book for clinicians who have some experience than for students or novices. The information presented is fairly technical and requires an understanding of the language of kinematics and biomechanics. The level of detail is comprehensive. Edwards shows with excellent photographs, and detailed explanations, the procedures that are used to assess and treat mechanical vertebral column disorders. Included are techniques of active and passive physiologic movements, combined movements, and intervertebral movements. If any fault can be found with the scope of the book, it is that there is too much detail: The experienced clinician may not require it; the novice may be overwhelmed by it.

The data on the kinematics of intervertebral movement patterns are not overly documented. There are only about a dozen references cited in the entire book. The most recent references, with the exception of the Maitland and Grieve texts, are from 1978. In addition, the author states many of his own observations that are intended to be taken at face value, but are not referenced. The lack of a thorough reference list is a serious oversight that I would like to see corrected in any future editions.

The book is organized into seven chapters. Chapters 1 and 2 are brief overviews of subjective and objective examination of the spine. Chapters 3 through 5 are organized by spinal region: lumbar, upper cervical, and mid-cervical to thoracic spine. Chapters 6 and 7 examine common movement patterns and treatment planning. The regional chapters, 3 through 5, are not well organized. For the lumbar spine, Edwards presents assessment of active range of motion, assessment of combined movements, treatment techniques, assessment of accessory movements in combined positions, and passive intervertebral motion testing. This order is not clearly adhered to in the other regions. Furthermore, it is not clear in what order the tests are to be performed. This may create some confusion for the clinician as he or she attempts to use this text to structure an evaluation.

An excellent convention in the chapter on the upper cervical spine is the use of photographs that depict the intervertebral motion alongside an illustration of the technique. This practice would have been helpful throughout the book to illustrate the complex biomechanics that are only described.

The short chapter on movement patterns has useful examples. The final chapter uses box diagrams to illustrate patient problems and treatment planning, These diagrams are well explained within the body of the text. There is not, however, an explanation or key for the movement diagrams. It would be difficult for the inexperienced clinician to understand the graphic shorthand used to illustrate the progression of accessory movements.

This text is a useful adjunct to a clinician's manual library. As the author states, this is not a stand-alone tool. Nor is it meant for the inexperienced clinician or entry-level student, as the text assumes a familiarity with manual assessment and treatment techniques. It would, however, serve well as a reference for the physical therapist who has some experience in the evaluation and treatment of spinal disorders.