Musculoskeletal Pain: Physical Medicine and Rehabilitation, vol. 5, no. 3.

Schwab CD, ed. Philadelphia, PA 19107, Hanley and Belfus Inc, 1991, hardback, 209 pp, illus, $32.

Physical Medicine and Rehabilitation is a series that is published triannually, with each issue dedicated to a single topic. This particular issue is dedicated to the complex problem of musculoskeletal pain.

The book is a compilation of 17 well-chosen chapters covering pathophysiology, diagnosis, syndromes, treatment, and psychology. Schwab should be commended for assembling such a comprehensive and intriguing collection of subtopics. As a physical therapist, I could not wait to get started with my reading.

The first chapter provides a review of the pathophysiology of musculoskeletal pain and is a nicely presented, concise, and well-illustrated presentation that sets the stage for what promises to be the state of the art in musculoskeletal pain management.

The chapters that follow, however, are inconsistent in fulfilling this promise. In particular, and of interest to physical therapy practitioners, is the chapter entitled "Modalities of Physical Treatment," which, unfortunately, offers no more than a basic entry-level course in modalities. Although it is presented in an extremely well-written and thoroughly referenced context, it does not add to the existing available body of knowledge on this subject matter. There is no mention of the state-of-the-art utilization of surface electromyography systems such as the Bioprompt and Myotrac. Also, the section on hydrotherapy contains nothing about the recent popularity of pool therapy and its unloading effect. The same criticism may be applied to several other chapters such as "Exercise and Rest," wherein the author writes, "Little muscle soreness has been reported following isokinetic exercise, possibly because of the absence of eccentric contraction." It seems impossible that the author is not aware of the commonly utilized isokinetic assessment and rehabilitation systems such as Biodex, KIN-COM, and the newer Cybex(R) 6000 that have enabled practitioners to use isokinetic exercise eccentrically for years. The author also cites lack of motivation as a problem for some patients using isokinetic equipment, as they do not see a" ... visible movement of a weight," referencing a 1983 article. Most of the state-of-the-art isokinetic equipment provides the patient with a realtime visual display of his or her effort, either in the form of a bold vertical bar or a torque curve.

The chapter by Jacob, entitled "Therapeutic Modalities," covers injections, vapocoolant spray, immobilization, assistive devices, and biofeedback in four pages that are too simplistic to be of any real value.

Overall, the text fails to meet basic expectations. It is more of a rudimentary presentation on musculoskeletal pain and its management than a state-of-the-art review. I do not recommend this book to physical therapists. Physical therapist assistants satisfied with a more basic review of musculoskeletal pain might find this book to be worthwhile.

Mitchell Tannenbaum, PT

Naperville, Ill.