Skeletal Muscle Structure and Function: Implications for Rehabilitation and Sports Medicine.

The main theme of this text is to provide an overview of how skeletal muscle performs its function. The author presents anatomical and applied physiological aspects of skeletal muscle in a well-organized and informative manner. Lieber has written this text to include the latest scientific information about skeletal muscle structure and function, which the rehabilitation specialist should find extremely useful, and has provided a valuable resource for the physical therapy profession.

The treatment of the subject matter is in-depth and comprehensive. In addition to the presentation of the author's own extensive research findings in the area of skeletal muscle function, he presents a thorough review of the most recent literature and synthesizes the most pertinent information within each chapter. The depth of coverage of each topic is quite adequate, and the text presents, in one concise publication, most of the current, up-to-date literature available in the area of skeletal muscle function and structure. There are no other texts currently available that provide the rehabilitation specialist with this depth of information in such a readable and usable format.

The book, which is conceptually divided into two parts, has six chapters. The first three chapters present the "Foundation of Basic Science" of skeletal muscle, and the last three chapters describe the "Adaptive Capacity of Muscle." Each chapter introduces topics that set the stage for information presented in subsequent chapters.

Chapter 1 provides an overview of skeletal muscle anatomy, which includes muscle development, the latest information on the skeletal muscle cell, sarcomere structure, and the sliding filament theory. This chapter also includes discussions of satellite cells that are used in the repair of the architecture of human skeletal muscle.

Chapter 2 deals with a broad range of topics in skeletal muscle physiology. This chapter begins with an overview of excitation-contraction coupling, length-tension and force-velocity relationships, and the mechanical properties of muscle. Muscle fiber types and methodologies for determining the fiber subtypes are also very well described. The chapter concludes with topics such as the motor unit, recruitment, the physiological basis of muscular fatigue, and a brief review of electromyography.

Chapter 3 provides the reader with an overview of the production of movement. Although this chapter could be extensive, based on the volume of literature that is available, Lieber does an excellent job of providing the reader with a concise review of the factors and methodologies available to assess the production of movement. These include the interactions of muscle and tendon, physiological range of motion, the biomechanics of biarticular muscles, the gait cycle, and direct force and length measurements during gait. This chapter concludes with an "Implications for Physical Therapy" section that is concise, and provides the basis for the following three chapters on adaptation of skeletal muscle.

Chapter 4 describes skeletal muscle adaptation to increased use, with sections on adaptation to chronic electrical stimulation, chronic stretch, compensatory hypertrophy, intermittent electrical stimulation, and exercise. Much of the referenced literature in this chapter has used an animal model to describe the adaptation because there are very few investigations that have examined the human skeletal muscle adaptation to these types of stimulation and to these types of exercise, The only section of this text that could be further expanded is the portion of this chapter on the adaptation to exercise. The author has done an adequate job of presenting the basics of adaptation to exercise, but there could have been some expansion of the adaptations to both resistance training and aerobic training.

Chapter 5 discusses the adaptations of skeletal muscle to decreased use, such as adaptation to immobilization and remobilization, spinal cord transection, hindlimb unloading, and denervation. There is an excellent section in this chapter that describes the mechanism of muscle fiber atrophy in addition to muscle fiber specificity to reinnervation. Although the vast majority of the literature described in this chapter has used an animal model, Lieber has provided the reader with the transition as to how these adaptations might be seen in human muscle as well.

The final chapter deals with the skeletal muscle response to injury, degeneration and regeneration muscle properties, clinical applications to muscular dystrophy, and a final section on exercise-induced muscle injury. This chapter provides the physical therapist with valuable information about the mechanism of muscle injury and how repair occurs. The author utilizes many figures, illustrations, and tables to provide an understanding of and emphasis to the text.

Although there are no specific case studies dealing with patient problems, there are numerous discussions in the text that physical therapists can use to further relate the information in this book to their clinical work. This book is highly recommended for all physical therapists, physical therapist assistants, and physical therapy students, as it provides a much needed foundation for the understanding of skeletal muscle structure and function.