Rehabilitation of the Spine: A Practitioner's Manual, ed 2.

Rehabilitation of the Spine: A Practitioner's Manual, ed 2 Liebenson C, ed. Philadelphia, PA 19106, Lippincott Williams & Wilkins, 2007, hardcover (with DVD-ROM), 972 pp, illus, ISBN: 0-781 7-2997-1, $99.95

The purpose of this book, according to its editor, is to provide health care professionals with an evidence-based and active approach to the care of patients with musculoskeletal spinal pain. If the reader allows for the few chapters without primary, peer-reviewed evidence and accepts that an active approach also has a role for manual techniques, the reference work succeeds admirably with its purpose. In the foreword, Waddell reports that this edition builds on the success of the now-classic first edition and features updated evidence, rewritten chapters, new authors, and a DVD that shows readers how to understand and integrate an active approach into clinical practice.

The 39 chapters, written by an international and prestigious group of 55 contributors, are organized into the following parts: "Overview," "Basic Science," "Assessment," "Acute Care Management," "Recovery Care Management," "Practical Application by Region," and "Implementing the Functional Paradigm." Each chapter is introduced with an outline and list of learning objectives. Self-check questions appear at the end of each chapter. Tables, diagrams, photographs, and information boxes appear throughout the book to clarify and expand the text. Bolded headings and subheadings enhance the readability.

The continuity among all 4 chapters in the overview is achieved because they all have the same author--the editor. The topics of musculoskeletal contribution to pain, the course of spinal injuries, and the benefits of an active approach to spinal pain management are well presented and extensively referenced with primary, peer-reviewed sources. A sampling of other well-written and well-referenced chapters in the text include "Lumbar Spine Stability: Mechanism of Injury and Restabilization" (chapter 5) by McGill, "Spinal Segmental Stabilization Training" (chapter 25) by Hodges and Jull, and "Advanced Stabilization Training for Performance Enhancement" (chapter 29) by Clark.

Theories based on careful patient observation during a long career also are evidence-based, although not above that of a case study or case series at best. The book includes contributions from Janda, McKenzie, and students of Brugger. At first glance, these contributions and chapter topics--such as breathing pattern disorders and facilitation of co-activation by reflex stimulation methods--seem misplaced, given the stated purpose of the text. But just as the DVD narrator links Janda's neck flexion performance test with later research by Jull, perhaps features of these chapter topics will be supported by primary, peer-reviewed evidence in the next edition or appropriately dropped if the level of evidence does not rise.

The DVD adds a third dimension to the book. Throughout the book, a logo is used to indicate that a test or exercise can be seen "in action" on the DVD. The first 4 sections of the DVD identify tests, movements, and exercises under the headings of "Physical Performance Evaluation," "Sparing Strategies," "Stabilizing Strategies," and "Functional Integrated Training." Clear narration accompanies demonstrations by a female model. Compensatory movements to watch for, and to correct, also are shown along with exercise progressions. An amazing kinetic skeleton graphic further clarifies correct and incorrect movements. The last third of the DVD is devoted to demonstrations of various examination and treatment techniques under the heading of "Czech School of Manual Medicine."

The continuity of concepts and terms among chapters suffers a little--not an uncommon occurrence in an edited text with multiple authors. The stand-alone nature of the chapter topics, on one hand, does allow the reader to select a chapter of interest and enjoy a full presentation of the topic. The complete development of a topic, however, can lead to a scrambling of the section distinctions. For example, basic science information appears as a part of chapters that are not in the basic science section, and a chapter in the basic science section finishes with a presentation of management strategies. With the exception of a few chapters, the extent of primary peer-reviewed references is impressive.

Clinicians who are beginning to specialize in spinal disorders may prefer this book over others because it provides evidence-based material along with therapeutic techniques and a clarifying DVD-ROM. The same reasoning would apply for its inclusion in a department library. Experienced spinal clinicians, with already well-stocked personal libraries, may find this reference work interesting but perhaps not essential.

Debra Coglianese

D Coglianese, PT, DPT, OCS, ATC, is a staff physical therapist at Mt Auburn Hospital, Cambridge, Mass.

[DOI: 10.2522/ptj2007.87.4.479]