Rational Manual Therapies.

Basmajian JV, Nyberg R, eds. Baltimore, MD 21202, Williams & Wilkins, 1993, hardback, 484 pp, illus, $49.

The editors state in the preface that Rational Manual Therapies is designed to be a comprehensive resource for any practitioner interested in manual therapy. through a multidisciplinary authorship, the editors have attempted to present a critical view of many forms of manual therapy that are common to clinical practice. Although the book contributes to the existing literature, it does contain several limitations. The primary concern is that the book only addresses the spinal column and excludes any detailed coverage of manual therapy for the extremity joints.

The first chapter introduces the general topic of manual therapy and correctly details the placebo effect as a possible source for the apparent success of such procedures. Although the author mentions the necessity of controlled research studies to substantiate any actual benefits from treatment, he fails to provide any information on, or examples that would help in, the construction of such studies. The second chapter presents a history of the Hippocratic, osteopathic, chiropractic, and orthopedic approaches to manual medicine, but fails to include the contributions made to the field by physical therapists.

Chapters 3 through 6 present a concise review of the basic principles of spinal manipulation, spinal kinesiology, and the clinical assessment of low back pain. The editors very nicely review the general aspects of specific versus nonspecific treatment; grades of manipulation; the various criteria for manipulative techniques; cervical, thoracic, and lumbar spine anatomy and biomechanics; intake information for the subjective examination; and measurement procedures to objectify the clinical examination process. This material would effectively complement any basic text on physical therapy diagnostic procedures for the spinal column.

Chapter 7 addresses dynametric testing of the trunk and covers most of the relevant topics in this area, although the section on data interpretation is limited to a single form of equipment. Chapter 8 addresses the use of biofeedback for the assessment and treatment of lower back pain and includes a partial meta-analysis of the existing research literature. Chapters 9 through 14 present information on many forms of manual therapy, specifically soft tissue mobilization, myofascial release, proprioceptive neuromuscular facilitation (PNF), muscle energy, strain and counterstrain, and functional technique. Each chapter addresses the general philosophy, biological rationale, and clinical usage of each treatment form in clear and concise terms but, with the exception of chapter 11 on PNF, fails to provide much information on the specific application of each technique to actual patient problems. Also, there is no coverage of craniosacral therapy and neurological mobilization.

Chapter 15 is presented in four parts that cover the topic of therapeutic exercise for patients with spinal injury. The specific topics are movement awareness and stabilization training, flexibility exercise, strength training, and aerobic conditioning. In contrast to chapters 9 through 14, each section includes many examples of specific treatment procedures, most of which are based on the philosophy of patient self-care. The presentation is limited, however, by the failure to include information on the McKenzie approach to patient self-care.

Chapter 16 presents a very general overview of ergonomics, including basic work demands, workstation design, material handling tasks, and National Institute for Occupational Safety and Health guidelines, in only superficial detail that cannot translate effectively into clinical practice procedures. Finally, chapter 17 presents a rationale for the use of manual therapy procedures with various spinal disorders, such as disk herniation and facet joint syndrome. The chapter reads, however, more like a summary than as a distinct section of the book. The information could have been incorporated into the previous chapters in order to depict how each specific form of manual therapy would have addressed each distinct spinal problem.

Overall, this book would interest any practitioner of manual therapy, but might frustrate the student or clinician who wishes to advance his or her practical skills, because of the general lack of information on specific application procedures and because of the failure to address manual therapy for the extremities. The book would effectively complement texts that detail spinal treatment procedures if used for formal education. Although relative limitations do exist, the editors and authors are commended for their attempt at presenting many areas of manual therapy in an objective and scientific manner.