Mechanical Low Back Pain: Perspectives in Functional Anatomy.

The stated purposes of this book are to review the functional anatomy of the lumbar region, to present a method of spinal evaluation based on the knowledge of the functional lumbar anatomy, and to promote a treatment approach directed toward the restoration of normal or optimal spinal performance capabilities. The book also advocates the contemporary clinical philosophy that the appropriate management of lumbar spinal disorders must distinguish between lower back pain and low back disability to ensure therapeutic effectiveness. The authors accomplish these goals through the course of six concise, yet sufficiently comprehensive, chapters that are well written and certainly comprehensible by students and physical therapy practitioners at all levels of the profession.

The first three chapters detail information on the principles of lumbar muscoloskeletal injury, connective tissue repair, neuromechanical aspects of lumbopelvic abnormalities, spinal mechanoreception, and lumbosacral kinesiology. The text also contains valuable information on current theories of spinal and ground-force interactions, lumbar tissue loading zones, and nerve root nourishment mechanisms. This part of the book could serve as a clinically oriented complement to traditional anatomy texts and could also be useful as a clarifying cross-reference when reading current spinal literature.

The fourth chapter presents a comprehensive revies of lumbosacral arthology. The authors provide an appropriate description of the facet joint complex, vertebral end plate, and intervertebral disk, along with a discussion of diskal pathomechanics. The chapter also includes an extensive description of sacroiliac joint structure and physiology, which is well supported by clear illustrations and cadaveric dissection photographs. Such detail on sacroiliac biomechanics is found in only a few other texts and represents a major strength of this book.

Chapter five encompasses a scheme for the functional evaluation of the lumbopelvic region, based on an orthopedic manual approach to spinal assessment. The authors have given proper attention to oral interview, observational screening; structural examination in standing, supine, and prone positions; and palpatory techniques, as well as to methods for testing the gross movement capabilities of patients who have spinal conditions. All procedures are clearly described and then reinforced with both diagrams and photographs. The lack of inclusion of objective spinal testing procedures such as inclinometry or muscle dynamometry does limit the overall effectiveness of this portion of the text to some extent.

The final chapter incorporates the authors' very practical philosophy of managing lumbar spine disorders. Rehabilitation is presented in the context of four integrated phases: Optimize the healing environment, restore normal tissue relationships, maintain normalcy of noninjured areas, and prevent excessive strain to injured tissue. The approach synthesizes many schools of clinical thought, such as spinal stabilization training, muscle fusion, joint mobilization, and functional restoration, via descriptions and illustrations that are readily transferable to patients and actual clinical situations. The chapter is not a "cookbook," but encourages professional thought for the management of individual patient cases by physical therapy practitioners.

This book is an important addition to the professional literature and would be valuable for any clinician who treats patients who have lumbar spine disorders. The book also would be useful as a textbook. I have had direct experience with such an application in an entry-level curriculum, and the authors' work was received quite well by the class of physical therapy students.