Spine: Evaluation, Treatment, and Prevention of Musculoskeletal Disorders, vol. 1, 3d ed.

Saunders HD, Saunders R. Bloomington, MN 55439, Educational Opportunities, 1993, hardback, 396 pp, illus, $59.95.

This is the third edition of Saunders' Evaluation, Treatment and Prevention of Musculoskeletal Disorders. In this edition, the book has been divided into two volumes, one on spinal disorders and one on extremity disorders. The primary author has also invited other contributors to add to his previous material.

The first three chapters of the volume include introductory remarks, basic biomechanics, and principles of evaluation and treatment of the spine. The introductory remarks include a statement of the primary author's background and identifies the clinical philosophy underlying the text. Chapter 2 covers basic spinal biomechanics, ranging from structural considerations to movements and motion of the pelvis and spine. The biomechanics review is cursory, given the abundance of excellent information available on this topic. Chapter 3 presents principles of evaluation and treatment, including organization of the evaluation process. These two chapters lay the groundwork for the more definitive text to follow.

Section 2 contains five chapters on evaluation and general treatment of the spine. The primary author addresses evaluation of the spine in a comprehensive, well-organized manner.

Three evaluation chapters on the spinal column, pelvic girdle, and temporomandibular joint are combined with two chapters on treatment of the spine by problem and by diagnosis. The spinal column chapter is comprehensive and contains a wealth of clinical information, as does the section on evaluation and management of temporomandibular disorders. The chapter on pelvic girdle dysfunction presents an organized evaluation and treatment scheme, based on osteopathic principles and muscle energy technique. This section includes a chapter on treatment by problem and treatment by diagnosis that presents clinical approaches based upon the clarity of information available after evaluation on these two aspects of spinal pathology.

Section 3 consists of five chapters on specific treatment choices, including joint mobilization, spinal traction, spinal orthoses, exercise, and rehabilitation. Each of these chapters presents the principles of the topic being discussed, with the mobilization and traction chapters being more comprehensive than the exercise and rehabilitation chapters. The exercise chapter contains numerous diagrams and suggestions for exercise programs based upon clinical findings. This section is geared toward self-care and does not address biomechanical aspects of exercise and the spine. The chapter on spinal rehabilitation compares acute and chronic rehabilitation, while discussing the components of functional capacity evaluation and work conditioning programs.

Section 4, titled "Prevention," addresses industrial spine injury and its prevention and management. in a concise manner, the elements of industrial care are presented as well as can be expected in a short space.

This volume presents a wealth of material on spinal disorders. It is well written; however, some of the material requires some care to review adequately. The pelvic girdle chapter, in particular, must be studied carefully to use the information presented, particularly if the reader has had no prior exposure to this area. This text is a strong addition to any physical therapy library, given the depth of information relating to the organization and thought process behind the treatment of spinal pathology within the discipline of physical therapy. The text has a clear clinical orientation but gives a limited critical review of the body of literature relating to care of spinal injuries. I would recommend this book to physical therapists who treat musculoskeletal problems of the head, trunk, and pelvis, but strongly suggest that it be supplemented by other material.

Bruce Brownstein, PT SOAR New York, NY

Mr Brownstein is in private practice in New York. He bas served as a reviewer for Physical Therapy since 1991, reviewing material relating to biomechanics, and orthopedic and sports physical therapy.