Orthopedic Rehabilitation Science: Principles for Clinical Management of Nonmineralized Connective Tissue.

Lundon K. St Louis, MO 63146, Butterworth-Heinemann Inc, 2003, paperback, 206 pp, illus, ISBN: 0-7506-7347-8, $49.95.

The book's major focus is the basic science that underpins the physical therapist management of orthopedic conditions related to selected dense, nonmineralized connective tissues. Intended as a reference for both physical therapist students and clinicians, the book addresses in detail the fundamentals of the development, morphology, pathophysiology, biomechanics, and function of articular cartilage, ligaments, tendons, and joint capsules. The book contains 7 chapters--5 written by Katie Lundon and the other 2 written by Pamela Houghton and Harpal Gahunia. Lundon and Houghton are professors of physical therapy at 2 prominent Canadian universities, and Gahunia is a senior scientist at an orthopedic company in the United States.

Chapter 1 provides a very, brief overview of the structure, function, and metabolic properties of connective tissues. Chapters 2 through 5 cover the basic science of nonmineralized connective tissues--which encompasses structure, function, and metabolic and biomechanical properties of tendons, ligaments, joint capsules, articular cartilage, and intervertebral disks--in great detail. The information in these chapters is supported by numerous references to the published work of many well-known scientists, researchers, and clinical investigators in orthopedic medicine. These chapters provide ample information on the molecular and cellular processes involved in connective tissue biology, and offer notes of clinical importance to physical therapy in boxes that are located immediately after the basic science aspects of the matter under study. This feature makes the chapters particularly useful to those students and clinicians who specialize in orthopedic physical therapy and who need an up-to-date, comprehensive, and concise reference on many related subjects.

The last 2 chapters focus on the pathologic dynamics and therapeutic modalities used in the physical therapist management of selected orthopedic conditions. Chapter 6 provides discussions of biomechanics and the connective tissue response to injuries, immobilization, and joint hypomobility and hypermobility as well as pharmacologic management of major soil tissue injuries. Chapter 7 provides a detailed overview of the effects of therapeutic modalities used in physical therapist management of orthopedic conditions. The effects of modalities--such as hot and cold agents, electrical stimulation, electromagnetic fields, lasers, and ultrasound--on blood flow, pain, inflammation, edema, tissue repair, and joint range of motion have been well discussed and supported by references to primary literature. This chapter also has a section devoted to the evidence-based clinical management of typical conditions such as ankle sprains, periarticular inflammatory conditions, shoulder tendinitis, and acute and chronic low back and neck pain.

The book is well written, provides ample, recent references on each subject, and is well organized because of the progression of its content areas. It also uses clear, simple, black-and-white illustrations, charts, tables, and figures to enhance the comprehension of complex materials. Many of the microscopic images, however, although generally of good quality, offer insufficient details because they are too small or use a low magnification. These weaknesses should not be considered major drawbacks of this text. Indeed, this book is of basic science and clinical relevance to all physical therapists, particularly those in orthopedic physical therapist practice.

Kamran Tavakol, PT, PhD

Howard University

Washington, DC

Dr Tavakol is Associate Professor in the Department of Physical Therapy where he teaches basic science courses in pathology, pharmacology, and cardiopulmonary management. His current research interests include changes in blood lipids in response to aerobic exercise, effect of aerobic exercise on the immune system and memory, and the pharmacodynamics of cardiovascular and musculoskeletal medications.