Spinal Rehabilitation.

Spinal Rehabilitation Stude DE, ed. Stamford, CT 06912, Appleton & Lange, 1999, hardcover, 581 pp, illus, ISBN: 0-8385-3685-9, $85.

The editor has compiled a text geared toward medical professionals who use an "active component" in the management of patients with spine-related impairments. Stude's definition of "active component" extends beyond therapeutic exercise; therefore, the scope of this text covers issues related to clinical management and spinal manipulation. Nonetheless, the core of this text is devoted to the principle that therapeutic exercise is an effective and low-risk method that, when used judiciously and with careful evaluation, can help most patients with back pain.

The text is divided into 5 sections. The first section, "Introduction: Foundation Principles," is really a potpourri of topics. This section contains a well-constructed review of the literature on exercise in spinal dysfunction and a chapter that advocates a muscle imbalance approach to exercise in an effort to integrate active and passive care. Other chapters in this section are less clinical in focus and cover database management, patient education, and technology. A somewhat misplaced chapter on emergency principles rounds out the first section.

The second section describes approaches to patient evaluation. The approaches were selected with an eye toward using evaluation to determine appropriateness of exercise for the patient. The 2 lead chapters of this section provide a basic scheme for evaluating patients with back pain and ruling out organic disorders. The two approaches used in these chapters are a focused orthopedic evaluation and the McKenzie approach. In these 2 chapters, similarities between chiropractic and physical therapy techniques are quite obvious. The remaining chapters in this section deal with radiologic examination, functional capacity evaluation, psychosocial profiling, and cardiac evaluation.

The third section is devoted to the topic of computer-aided testing and rehabilitation. Chapters in this section cover triaxial dynamometry, isometric dynamometry, isokinetic dynamometry, and 3-dimensional spinal kinematics. Much of the material of this section extends beyond the technological scope of a typical clinic. In fact, the chapter on triaxial dynamometry is really a discussion of one particular dynamometer, whereas the chapter on spinal kinematics presents a variety of techniques that are mostly used in, and more applicable to, research settings.

The fourth section includes chapters covering the topic of manual treatment methods, all of which are chiropractic techniques. The lead chapter is a critical review of the literature on chiropractic manipulation and its efficacy when integrated with exercise. The section includes only 2 other chapters, one covering mechanically assisted mobilization and the other covering soft tissue assessment. It is clear that this text is not devoted to the topic of manipulation because references to the importance of exercise are embedded in each of these chapters.

The culminating fifth section of this text, "Exercise Methodology: Principles and Applications" includes chapters on exercise physiology, spinal stabilization, and aquatic rehabilitation. It ends with 2 chapters on older adults as a special population with different considerations. The chapters in this section explain techniques and provide a clear overview of the varying interventions.

To his credit, Stude has an impressive list of contributors, including chiropractors, physicians, physical therapists, exercise physiologists, and engineers. The editorial approach of using the research literature to validate the concepts of each chapter is manifested in lengthy and comprehensive bibliographies at the end of each chapter. The book is illustrated by black-and-white photographs that enhance descriptions of technique application. Although the text is directed to the chiropractic community, it would be a nice addition to the reference library of physical therapists who treat patients with spinal disorders. At a minimum, it could help to open the eyes of physical therapists to both the similarities and differences in thought between the 2 professions.

Julia Chevan, PT, OCS Springfield College Springfield, Mass

Ms Chevan is Associate Professor in the Physical Therapy Program where she teaches courses on musculoskeletal examination, evaluation, and intervention. She is also involved in the management of patients with orthopedic conditions at a local clinic.