Musculoskeletal Pain and Disability.

Musculoskeletal Pain and Disability

Kaplan PE, Tanner ED, eds. East Norwalk, CT 06855, Appleton & Lange, 1989, hardback, 353 pp, illus, $45. The stated purpose of the editors was to produce a book that included the perspective of many health disciplines regarding the rehabilitation of patients with pain and disability from musculoskeletal disorders. The book has 15 chapters and an index. The first chapter discusses tendinitis, bursitis, and fibrositis; the second chapter addresses arthritis, radiculitis, and neuritis. The next 7 chapters discuss the regions of the spine and the joints of the upper and lower extremities. The last 5 chapters cover psychological factors, electrodiagnosis, electrotherapy, orthotics, and geriatrics, respectively. The editors (a physician and a physical therapist) authored, in tandem with each other or with one of the other contributors, chapters 1 through 9 and chapter 15. The chapters on the body regions are presented through a discussion of the commonly associated disorders of those regions. The chapters on the foot and ankle, shoulder, and wrist and hand are the most comprehensive of those on the regions of the body. The chapter on electrodiagnosis is an excellent presentation of the topic for those who do not perform these tests but see patients who are tested and could benefit from a better understanding of the use and interpretation of these tests. The chapter on psychological factors is brief, but insightful regarding the experience of pain by the patient and the management of patients with pain problems. The chapter on disorders in the elderly is done well but could benefit from a discussion of total joint replacements. There is no discussion, in the chapters on the knee or on orthotics, of braces used for orthopedic injuries to the knee (eg, for anterior cruciate ligament injuries and postsurgical cases). Particularly inadequate are the chapters on the low back and the neck and upper back. For example, the discussions of disk mechanics in pathological cases are incomplete and questionable; some of the literature by Twomey would have been useful to consult. There is no discussion of local and referred discogenic pain, and the studies by Cloward, among others, would have been useful here. There is also no discussion of referred pain patterns and the structures responsible for them. The discussion on differential diagnosis does not encompass enough material to be of significant clinical help. The discussion of exercise is not up-to-date, and the possible problems associated with traction for acute disk problems are not mentioned. There are numerous instances of unsubstantiated and highly questionable statements, especially regarding manual therapy, traction, cervical collars, transcutaneous electrical nerve stimulation, and back schools. There are numerous examples of poor sentence structure in several of the chapters by the editors that confuse the message and make for a difficult read. The figures of exercises are an incomplete, inappropriate, and misleading collection if they are presented as exercises to use with all patients with problems involving a particular body region. Some exercises are inadequately depicted and explained, with respect to how and why to perform the exercises, the level of difficulty and physical prerequisites necessary to perform them, and the protection and control of spine position necessary. In addition, there is no discussion or representation of what have come to be popularly known as trunk and neck stabilization exercises. The book does, however, make plentiful use of tables and flow charts. On the average, almost one third of the references listed are books. This is of little help to readers who wish to review the original articles and makes for discussions that lack substance, detail, and criticism. In general, I found the book to be limited in depth, detail, and new information. Certainly, there are many books already covering the same topics, which the editors and contributors of this book point out. The challenge is to present similar material in a more useful and interesting format, with more clear, indepth, and timely information. Overall, this book did not meet the challenge. In my opinion, this book does not add significantly to the current body of knowledge, nor does it present material more clearly or eloquently than other books; it is inadequate both as a reference and as a guide to the experienced clinician and is of doubtful benefit for insight and preparation to the new professional or student of physical therapy. David M Selkowitz, PT Oakland, Calif