Mechanical Neck Pain: Perspectives in Functional Anatomy.

The authors' stated purposes of this book are to discuss in detail the structure and function of the cervical spine and to develop a practical clinical model by which the clinician can effectively assess and treat painful disorders. They accomplish this through a well-written and comprehensive text that should be useful for clinical practice. This book follows the outline of its companion text, Mechanical Low Back Pain: Perspectives in Functional Anatomy. It effectively bridges the gap between theory and practice by providing functional information that is essential for evaluation and treatment of neck pain. Although the title of the book suggests that it addresses the cervical spine exclusively, the upper quarter is also addressed throughout the book.

The book begins with a chapter on the principles of mechanical neck disorders, including the current research on prevalence and etiological factors. it also contains useful information relative to the functions of the various tissues associated with the cervical spine and their response to stress. Chapter 2 details the various structures in the nervous system associated with the cervical spine and how they relate to mechanical neck pain. This is helpful in appreciating the role of the nervous system and its relationship to cervical spine disorders. One of the strengths of this book is the high quality of the photographs of anatomical prosections at multiple levels, and the diagrams that accompany them.

Chapters 3 and 4 encompass the articulations of the cervical spine and the associated musculature. The various muscles are reviewed in detail with excellent photographs and diagrams. The changes that occur in the individual muscles with injuries to the cervical spine are discussed from a clinical viewpoint. The numerous articulations of the cervical spine, and their mechanics, are reviewed with excellent clinical application. The ligaments of the cervical spine and their functions are also covered in detail. These two chapters are extremely valuable for physical therapy practitioners due to the logical way in which they are presented.

Chapter 5 covers functional assessment of the cervical spine, and provides a good overall scheme that is both comprehensive and practical. It reviews all common aspects of the cervical examination, including subjective and objective testing. The examination is outlined with respect to patient positioning, with the standing examination performed first, followed by the sitting, supine, and prone positions. Once again, the diagrams are an excellent enhancement to the text. Palpation of structures is covered thoroughly, and differential diagnosis of cervical spine disorders is also briefly covered.

Chapter 6 focuses on treatment of the cervical spine. To provide a more standardized approach to treatment, the authors describe four objectives in which treatment can be divided: pain modulation, generating controlled movement to promote healing, enhancing neuromuscular and musculoskeletal performance, and biomechanical counseling. All of these areas use a generic approach that should appeal to readers with different backgrounds. It avoids dwelling on any specific approaches to treatment, such as the McKenzie approach, which some readers may regard as a drawback. The section on biomechanical counseling is rather brief, considering the continued development in the field of ergonomics in past years, and provides limited clinical models.

This book should certainly be useful to the clinician involved in treatment of the cervical spine. It is also a book that is comprehensive and can be used as a textbook in physical therapy curriculums. Treatment approaches are based on sound scientific principles and incorporate many procedures, such as modalities, mobilizations, exercise, patient education, as well as some limited, more detailed information on particular approaches such as those of Maitland and Kaltenborn. The authors' writing style is clear and concise, making this book easy to read.

This book is written primarily for physical therapists and physical therapist assistants, although other health care professionals who treat the cervical spine may also find it useful. Physical therapists who are experienced in treating cervical spine disorders will find the first four chapters more useful than the last two, due to their generality. Students and physical therapy practitioners with less experience should find the entire book a valuable resource, although some of the assessment techniques are lacking in explanation and may leave them asking why they are performing a certain task. one weakness of this text is that rehabilitation of specific diagnoses such as spondylosis or postoperative diagnoses (eg, diskectomy, fusion) are not specifically addressed. These criticisms, however, are only minor when compared with the overall value of this book, which is excellent.

David Levine, PhD, PT The University of Tennessee at Chattanooga Chattanooga, Tenn

Dr Levine is an assistant professor in the department of physical therapy at The University of Tennessee at Chattanooga. His teaching, research, and clinical practice are in the areas of orthopedics