Occupational Low Back Pain: Assessment, Treatment and Prevention.

Occupational Low Back Pain: Assessment, Treatment and Prevention

Pope MH, Andersson GBJ, Frymoyer JW, Chaffin DB, eds. St Louis, MO 63146, CV Mosby & Year Book Medical Publishers Inc, 1991, 325 pp, illus, $69. This book attempts the monumental task of consolidating the contemporary scientific and practical knowledge regarding the comprehensive management of industrial lower back pain into a single text that would be readily readable by physicians, allied health professionals, industrial engineers, insurance personnel, and members of labor and management. The editors and their contributing authors, a list that reads as a "Who's Who" of spinal experts, provide this information through five parts that are further subdivided into a total of 19 well-referenced chapters. The concise, yet appropriate, review of the multifactorial aspects of industrial lower back pain accomplishes this book's intended purpose in very fine style.

Part 1, "Basis," which contains the first five chapters, reviews the structural and functional biomechanics of the lumbar spine, presents schema for the classification of industrial spinal disorders, addresses the aspects of acute and chronic back pain, and outlines the economic factors associated with spinal pain management. Specific topics include basic spinal anatomy and physiology, the biomechanics of posture, manual materials handling, degenerative spinal disorders, nociception, and the international epidemiology of back problems. Although these sections are quite sound, the important aspect of soft tissue injury as a source of industrial back pain is almost completely absent from consideration within the text. Part 2, "Etiology," consists of chapters 6 and 7 and addresses aspects of the workplace and of the worker. Although the workplace topics of physical work factors, lifting, pushing and pulling, and cyclic vibrational loading are complete in their review of the literature, the section on psychologic work factors is surprisingly superficial in its detail. The areas of worker age, gender, spinal mobility, muscle strength, radiographic findings, and psychiatric problems are also discussed in a scope that complements the nature of this book as a review text. Another constructive concern, however, is the scarcity of information on spinal muscle endurance characteristics and any social factors that might contribute to industrial disability. Part 3, "Patient Care," encompasses chapters 8, 9, and 10 of the book and describes the facets of worker evaluation, the management of acute injuries, and rehabilitation of the patient with chronic spinal pain. The evaluation chapter is most complete in its discussion of physical, functional, nonorganic, radiographic, and electrodiagnostic assessment procedures and would serve as a valuable template for the development or refinement of any clinical evaluation program. The chapter on acute management is a bit less specific in detail but does provide recommended treatment protocols based on the authors' experiences. Rather than listing specific regimens, the chronic spinal pain chapter provides appropriate information on the stages of industrial rehabilitation and overviews the work hardening and functional restoration approaches to worker care. Part 4, chapters 11 through 15, is entitled "Selection and Workplace Evaluation" and deals with the concepts of industrial injury prevention, evaluation of the workplace, worker selection, workplace design, and industrial patient education. The information is presented in general concepts, rather than as specific methods or protocols, as is suitable in respect to the diversity of occupational demands that occur in different industrial situations. Overall, part 4 summarizes the fundamental principles of industrial ergonomics, as they are applied to the lumbar spine. The final section of the book, part 5, consisting of chapters 16 through 19, addresses the legal aspects that frequently accompany situations of industrial spinal injury. Impairment rating procedures, disability determination, the worker compensation process, worker hiring practices, and the bona fide occupational qualification defense are discussed in sufficient detail to afford an adequate understanding of the nonclinical issues of industrial medicine. Part 5 will be of particular interest to professionals who are moving into industrial practice from a more traditional health care setting. Overall, this book is well written, organized in a logical sequence of chapters, and very readable. The content and style are consistent across the different parts and are very nicely complemented by a variety of clear figures, tables, and photographs. Because the book presupposes knowledge of or experience with industrial lower-back problems on the part of the reader, its nature as a review text would make it most valuable as a reference source in an industrial setting. The work, however, could serve as a viable educational text if supplemented by either basic information on spinal physiology for entry-level students or by learning experiences with greater extent and detail for graduate students. Regardless, the book is a fine addition to the industrial physical therapy literature. Kent E Timm, PhD, PT St Luke's Healthcare Association Saginaw, Mich