Precision Exercises: Exercises to Relieve Pain, Restore Posture, Improve Balance, and Regain Control of Muscles and Movement Needed for Everyday Living.

Precision Exercises: Exercises to Relieve Pain, Restore Posture, Improve Balance, and Regain Control of Muscles and Movement Needed for Everyday Living Lambert BP. Charlottesville, VA 22911, BL Enterprises LLC, 2004, spiralbound, 182 pp, illus, ISBN: 0-9748092-0-9, $25.

This book is a manual of stretching and strengthening exercises--including basic low back, advanced hip, lower-extremity and low back stretch, neck and posture, advanced abdominal, upper body, and foam roller exercises--for people with musculoskeletal dysfunction. One or more photographs illustrate each step of the exercise, with a detailed explanation on the facing page. The body areas targeted in these exercises are core muscle groups whose dysfunctions are usually at the heart of all postural dysfunctions and chronic pain syndromes. The exercises were chosen based on the author's experience and education and reflect those used most frequently in his practice.

Precision Exercises is a book that is clearly intended for a general audience, but it occasionally strays from this audience. A disclaimer states that the book should not be considered as a substitute for professional medical care or opinion. Although the message to the reader--regarding the importance of strengthening and stretching exercises in order to maintain a healthy neuromusculoskeletal system--is emphasized continuously, the terminology used to explain anatomy and kinesiology is inconsistent and sometimes contradictory. The author is inconsistent in the depth of coverage of topics and level of explanations. He writes about facet joints, joint capsule, and synovial fluid; attempts to explain sacral mechanics in forward and backward bending and in walking; and even mentions Fryette's third law relating to vertebral movement. In contrast, the author uses nontechnical language when he refers to the "tush" as the keystone of the musculoskeletal system and the main control of balance and refers to the gluteus maximus muscle as "your butt muscle."

The explanation of muscle function contains inconsistencies as well. One sentence refers to the gluteus maximus, medius, and minimus muscles as usually being very weak and not well recruited, and another states that the "tush" muscles must be strong enough to lift and control the entire body weight with each step. In order to explain the concept of muscle imbalances, the author states that a tight muscle is "spring-loaded" and becomes much more energy efficient. This is followed by an explanation that if you lose too much mobility in a muscle, the tightness itself becomes a problem. Scapulohumeral rhythm is described as a "50/50" rather than the classic 2:1 ratio. In the advanced hip exercises chapter, the author describes a gait pattern using the terminology of "heel strike," "foot flat," "toe off," and "swing." It would have been useful to include a diagram for a clearer understanding of this concept. The author also states that sloppy posture makes walking a controlled fall. Normal gait is described as controlled fall and recovery, regardless of the posture.

In the "Before You Begin" section of the introduction, the author states that the exercises progress from open chain to closed chain. He defines each type of exercise, but does not explain the advantage of one type over the other. In this same section, the author provides the absolute guideline to always avoid pain when doing the exercises. The author does not differentiate between types of pain (sharp, dull, stretch, burning, etc), nor does he advise the reader to differentiate whether the pain decreases with repetition.

In spite of the above-mentioned examples, the author does provide some excellent analogies that the layperson can easily understand (eg, sitting is a negative exercise, the buttock muscles are not designed as seat cushions, the head weighs as much as a bowling ball). If the bowling ball is not centered or balanced but tipped forward, more muscle effort is required to keep it in place.

There are 7 case reports at the end of the book. The author provides a short history of patients with pain in the low back, neck and shoulder, neck and arm, or knee and of a patient with plantar fasciitis. The patients each received manual therapy and modalities as necessary. Each patient was given exercises specific to his or her situation and adhered to the exercise program. All patients were treated for a maximum of 10 visits and were discharged with substantial improvements.

The photographed exercises and their descriptions make this book a worthwhile addition to the library of a physical therapist or physical therapist assistant. It also may be useful for an "educated" patient who can follow somewhat complex instructions. However, the author needed to be more consistent about which audience he is addressing. The introductory chapter is too simple for the health care professional, yet too complex and inconsistent for the layperson.

Roslyn Sofer PT, OCS 

Touro College

Bay Shore, NY

Ms Sofer is Assistant Professor in the Physical Therapy Program. She also is Director of Community Physical Therapy in Queens, New York.