Tendon and Ligament Healing: A New Approach Through Manual Therapy.

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Weintraub W. Berkeley, CA 94712, North Atlantic Books, 1999, paperback, 180 pp, illus, ISBN: 1-55643-283-6, $20.

The purpose of this book, according to the author, is to counteract the high incidence of serious chronic tendon and ligament injuries that lead to severe disability and usually have unsatisfactory surgical outcomes. He states that, using his 25 years of experience, he developed a therapeutic model for treating these injuries. He further claims that people who have exhausted "standard" physical therapy and are headed for surgery now have an alternative for recovery, using the methods in his book. The author practices structural and osteopathic therapy, has a master's degree in biomechanics, and is certified in body-mind centering and acupressure. However, the author did not promote himself as a practitioner of physical therapy, allopathic medicine, osteopathic medicine, or chiropractic.

The book is divided into 7 chapters. In chapter 1, "Overview," the author describes the basic strategies of structural health and the primary techniques he uses: (1) osteopathic strain-counterstrain, (2) cranial and visceral osteopathy, (3) fascial release, (4) body-mind centering, (5) zero balancing, and (6) acupressure. Chapter 2, "Nature of Tendons and Ligaments," presents the properties and healing capacity of tendons and ligaments. Unfortunately, this chapter contains no new information about these subjects. Chapter 3, "A Manual Therapy Model for Tendon and Ligament Injuries," includes a section explaining the various methods the author uses to treat tendon and ligament injuries. He describes a technique for condensing weak and lax tendon and ligament fibers longitudinally so that the fibers will "knit" together and increase their "tone." In his description of visceral manipulation, the author recommends freeing the upper lobe of the lung to treat upper-extremity injuries and freeing the organs in the lower abdominal region, such as the sigmoid colon, to facilitate healing of an Achilles tendon.

Chapter 4, "Case Studies," presents 12 case studies of patients whose conservative treatment by physical therapists for 2 to 3 months was unsuccessful and who were eventually helped by the author after an average treatment duration of 8 months. One example is a case regarding treatment for chronic Achilles tendinitis. It included an analysis of the "electrical activity" that was purportedly determined by manual assessment, with the tendon being described as having a "jangled, uneven quality, and a sense of static." Treatment included visceral manipulation in the lower abdomen. After 5 1/2 months of treatment by the author, manual examination revealed that the electrical and magnetic activity of the patient's tendons seemed relatively normal.

In chapter 5, "Processes and Tissue Changes in Tendon/Ligament Healing--Related to Manual Therapy," the author talks about how his manual therapy techniques reduce the following: collagenous adhesions, excessive muscle and fascia tension, and inflammation. This chapter also describes how his techniques improve joint mechanics, blood flow, blood and lymph drainage, the health and abundance of ground substance, remodeling of injured connective tissue, neural function, the normalization and harmonization of electromagnetic activity, and the tone of tendons and ligaments. Chapter 6, "Self-Help Strategies," describes techniques or procedures that people with chronic tendon or ligament injuries can do at home to promote healing. Unfortunately, the advice involves general and vague descriptions that would be difficult for the consumer to follow. Finally, chapter 7, "Conclusions," summarizes the first 6 chapters.

There is nothing "new" about the approach the author uses to treat chronically injured tendons and ligaments. The techniques he uses have been taught to physical therapists for at least two decades. The "new" research that he quotes, which reportedly "goes beyond the standard medical model," was published anywhere between 7 to 15 years ago. Physical therapists reading this book are likely to be turned off by the author's writing style and his repeated lambasting of the medical and physical therapy professions.

After reading the book, I do not have a clear understanding of the author's evaluation procedures and his rationale for determining what tissue he will work on and what technique he will use. This is not a technique manual because the references to his treatments are often vague. The author recommends exercise but gives very little indication of the exercises he prescribed for his patients during the 8 months, on average, they were under his care. This book reads like an autobiography with an intended audience of consumers and non-licensed practitioners. This book will be of no value to the physical therapist who currently practices orthopedic manual therapy, and it is not structured to meet the needs of those clinicians looking for an introduction to orthopedic manual therapy.

John C Gray, PT, OCS, FAAOMPT Sharp Rees-Stealy Medical Center San Diego, Calif

Mr Gray is a faculty member of the Ola Grimsby Institute and the lead clinical specialist in orthopedic manual physical therapy at Sharp Rees-Stealy Medical Center.