Physical Therapy of the Low Back, 2d ed.

This text provides the reader with indepth and contemporary information concerning the lumbar spine. Practicing clinicians and graduate students in the field of spinal orthopedics will find this book both interesting and useful.

Through extensive reporting of relevant research and comprehensive references, the authors and the stellar contributors to this text succeed in providing the reader with a comprehensive picture of the current knowledge base in the area of the lumbar spine.

The 16 chapters of this book cover the basic sciences, manual therapy philosophies and techniques, rehabilitation through various exercise approaches, and several special topics related to the lumbar spine. In the basic science chapters, recent advances in anatomy, mechanics, movement, and development through the life span are presented, much of which is based on the authors' own research. Of particular note is a chapter on the anatomy and function of the lumbar musculature and fascia by Nikolai Bogduk. In this chapter, the functional aspects of these structures are made clear to the reader. Interestingly, the functions as delineated by the author are not in line with conventional thought and, therefore, encourages the reader to reconsider some previous assumptions.

In the chapter by Geoffrey Maitland, he discusses his philosophical approach to the assessment, examination, and treatment of patients. Robin McKenzie wrote the chapter that follows and also presents his philosophical approach to manual therapy. He then goes on to discuss recent research efforts that examine his techniques, and he introduces a passive motion device for the spine. Specific techniques utilizing combined movements in the assessment and treatment of the lumbar spine are clearly presented in the chapter by Brian Edwards.

Through the use of case studies, the factors that govern the selection of passive movement techniques are discussed. Although not all-inclusive, this chapter not only guides the reader in initial technique selection, but also provides examples of treatment progression for several representative patient cases.

The two chapters dealing with exercise and spinal rehabilitation by Gwendolen Jull and Joe Farrell, respectively, are particularly strong. These chapters provide rationale and specific exercise techniques that can be readily applied in the clinical setting. Additionally, the authors provide practical suggestions for progression of these exercise programs and examples of appropriate equipment used for biofeedback, resistance, and assistance, or as exercise aids.

Lumbar spinal stenosis, lifting, low back pain in the workplace, and low back pain in children and adolescents are special topics that are well covered in additional chapters. In particular, the chapter on lifting by M Scott Sullivan does a thorough job of presenting the research in this area in an organized, comprehensible manner. He also outlines the controversies in the area of lifting and gives guidelines for those things that should be considered by the clinician who is instructing a patient on lifting techniques.

The authors of this well-written text pull together in a practical and useful manner very recent advances in the knowledge base. Clinicians who are treating patients with low back pain will value this text for its presentation of current philosophies and techniques. They will also appreciate the research basis behind the management trends and techniques that are advocated.

Karen Maloney Backstrom, PT, OCS Univ of Colorado Denver, Colo