Myofascial Manipulation Theory and Clinical Application.

Manual medicine was first recorded by Hippocrates around the year 400 BC. Since Hippocrates, manual medicine has been cultivated by many influential philosophies. These very philosophies have altered the evolution of manual medicine, including both clinical techniques performed by its practitioners and the proposed mechanisms of action underlying its art form. The purpose of the authors for this extremely credible book is to integrate cognitive knowledge with psychomotor skill in the area of myofascial manipulation. The textbook blends the current body of myofascial research with clinical theory and technique.

The book is divided into three, wellorganized parts. The first part outlines the historic nature of manual medicine, from ancient times to modern connective tissue research. The informative style of this section puts into perspective the evolution of osteopathic and chiropractic medicine, as well as the views on manual medicine that were exposed by Edgar and James Cyriax, Ralph Ghormley, James and John Mennell, Freddy Kaltenbom, Stanley Paris, and Geoffrey Maitland.

An entire chapter is devoted to modern theories and is indicative of the book's depth and comprehensive scope. The purpose of this chapter is to provide a fundamental knowledge of various theories and educate the medical practitioner as a consumer in a growing education market. Modern theories of manual medicine are categorized into autonomic, mechanical, and movement approaches. Autonomic theory includes Bindegwebbsmassage, or connective tissue massage, and Hoffa massage. Mechanical approaches are Rolfing, or structural integration, and the Trager system. Movement approaches involve Alexander and Feldenkrais techniques.

Part 2 covers topics not found in most texts on manual medicine. Histology and biomechanics of myofascia, including connective tissue, muscle, and junctional zones (tendon, ligament, and joint capsule), are reviewed in sufficient detail with up-to-date references. On this groundwork of histology and biomechanics, the text unfolds into a discussion on response of myofascial tissues when subjected to immobilization, trauma, and remobilization. An attempt is made throughout the text to balance the intuitive aspects of myofascial manipulation and the understanding of tissue response when the clinician applies hands-on treatment.

In the clinic, most practitioners are guilty of applying terms such as "fibrositis," "myofascitis," "myalgia," and so forth when describing myofascial pain syndromes. The highlight of this text is the distinction of myofascial pain syndromes from diffuse, nonspecific pain to more discernible pain that presents itself through clearer objective findings. Fibromyalgia, myofascial pain syndrome, and soft tissue lesion/mechanical dysfunction are discussed together with specific etiology, medical presentation, and therapeutic management for each category.

The last part of the book focuses on evaluation and treatment of the myofascial system. This part of the book is not meant to be a comprehensive journal on evaluation and treatment of somatic dysfunction. it does, however, provide a well-structured view of patient history, postural and structural evaluation, movement analysis, palpatory examination, and passive motion analysis. An atlas of therapeutic techniques is provided covering both spinal and peripheral soft tissue mobilization techniques. The atlas gives the reader the purpose for the particular technique, patient position, therapist position, hand position for therapist, execution of technique, and a corresponding photograph of the technique being applied.

The scientific basis of myofascial manipulation is difficult to validate in either a laboratory setting or a clinical atmosphere. This text provides a compilation of myofascial manipulation techniques that, in the opinion of the authors, show clinical effectiveness. The authors review the most recent connective tissue research and the principal effects that myofascial manipulation might have on these tissues. More research is needed, however, to document the actual clinical effects of these techniques.

Myofascial Manipulation Theory and Clinical Application is highly organized and can be used as a reference book for connective tissue histology and muscle biomechanics or as a quick reference for therapeutic techniques. It is one of the most precisely organized medical books I have ever read. The content of the book is strongly supported by figures, photographs, and condensed outlines of subject matter.

It is relevent to all physical therapists, master practitioners, and novices in the field of somatic dysfunction.