Myofascial Manipulation: Theory and Clinical Application, 2d ed.

Myofascial Manipulation: Theory and Clinical Application, ed 2 Cantu RI, Grodin AJ. Gaithersburg, MD 20878, Aspen Publishers Inc, 2001, hardcover, 288 pp, illus, ISBN: 0-8342-1779-1, $79.

Eight years after the publication of their first text, Robert Cantu and Alan Grodin have provided physical therapists and students of manual therapy with an updated edition of their well-known text on myofascial manipulation. In the newest edition of the text, the authors have updated their review of the literature on soft tissue injury and repair and have integrated much of the recently published research on pain and muscle pain syndromes. In addition, the section on evaluation and treatment has been expanded to include additional techniques. Overall, the text is well organized and is written in a clear manner, and it should serve as a useful aid to those who are new to these techniques. The one caveat to the reader is that, like so many texts that teach techniques, the authors have provided a scientific rationale for the approach but have provided no evidence or research on outcomes to support the use of the approach in the clinic.

The text is divided into 3 parts. In the first part, the authors provide an overview of the history of manual therapy and a chapter on the many theories and systems used in myofascial manipulation. The history chapter is comprehensive, although the information is now available in many other sources on manual therapy. The chapter on theories and systems is notable for its nice division into autonomic, mechanical, and movement approaches. The chapter's analysis, however, is incomplete as the authors have ignored the substantial historical and theoretical contributions of a number of alternative approaches, including those made by osteopathic medicine. This deficiency is surprising because continuing education offerings on different myofascial approaches have flooded the markets in the past 10 years.

The authors have made the most additions to part 2. In this part, the authors attempt to describe the scientific basis for myofascial manipulation. Assisted by an impressive list of guest authors, the authors cover topic that include histology, histopathology and biomechanics of myofascia, neuromechanical aspects of myofascial pathology, and muscle pain syndromes. These chapters are the meat of the theoretical background included in the book. They are well-written reviews of the scientific literature, providing the student with a biologically plausible rationale for the use of myofascial therapy.

The third and final part of the text is devoted to techniques for examination and intervention. The authors rely on unambiguous black-and-white photographs to support the text. Although the authors themselves do teach this content in continuing education courses, one could use the text alone in an effort to learn the techniques because the combination of descriptions and photos is quite explicit.

This is a nicely done book covering a commonly used set of techniques that have not been well tested. The book's target audience is physical therapists and physical therapist students, and, for these audiences, the book is appropriate. One can only hope that there will be a flood of published studies on the clinical outcomes of manual therapy so that the authors may consider the publication of a third edition.

Julia Chevan, PT, OCS
Springfield College
Springfield, Mass

Ms Chevan is Associate Professor in the Department of Physical Therapy, where she teaches courses on musculoskeletal examination, evaluation, and intervention. She also manages patients with orthopedic conditions at a local clinic.