The Almanac of Back Pain Treatments.

Zimmerman J. Brunswick, ME 04011, Biddle Publishing Co, 1991, paperback, 183 pp, illus, $9.95.

The author never directly states a purpose for writing these three texts. She describes her personal involvement with low back pain and her "search for answers to [her] own condition and of learning how controversial and complicated back pain is." Based on her own research, the author expresses hope that her texts " can help those of you with acute, chronic, and recurrent back pain [to] find the ways to minimize your pain and proceed with your lives."

The texts can be viewed as a series or as individual texts. The first text focuses on three ajor areas: (1) the anatomy of the spine, as well as the neuromuscular control of the spine; (2) individuals involved in diagnosing back pain or in treating back pain; and (3) common low back diagnoses. The anatomy section is brief, offering limited information. The author's accompanying figures are elementary line drawings that offer little assistance to the reader and at times were found to be more confusing than helpful.

Chapters 2 through 5 of the first text define the roles of different traditional health professionals (physicians, physical therapists, occupational therapists, psychologists), "doctors who manipulate the spine" (chiropractors, osteopaths), and nontraditional professionals (acupuncturists, holistic practitioners). The author's information is generalized toward educational and philosophical differences between chiropractors and osteopaths, as well as between the nontraditional practitioners.

The rest of the text is devoted to the physical examination, differential diagnosis of low back disorders, and a description of the more "common diagnoses or misdiagnoses" that an individual may incur. The author should have excelled in this section. Her background as a physical therapist and her experiences as a patient with a low back condition could have provided insight into this process. The text, however, offers little more than definitions of diagnostic tools and correct diagnosis percentages for each tool. The physical examination report entailed listing the area and information gathered for each area. This leads the reader into the differential diagnosis chapter. The author attempts to inform the reader that this chapter is out of the scope of the text, then briefly presents a myriad of diagnoses that can be misinterpreted as low back pain or the source of the low back pain.

The best section of the text includes the chapters that define and describe the common diagnoses under which low back syndrome is categorized. Though the figures detract somewhat from the text, the information is adequate for the layperson; however, it is too brief for the physical therapy professional or the physical therapy student.

In general the text provides limited information for the professional and may be too narrowly focused for the layperson or patient. I found the "Key Points" section to be the most informative, as those points were more specific and delved more deeply into the topic.

The second text, Chronic Back Pain: Moving On, is described on the cover as "a complete guide to the treatment and management options for people living with back backs." The book begins with the same chapter on anatomy that is included in the first text. Subsequent chapters investigate the differences between acute pain and chronic pain and explore how pain is viewed from the professional's versus the patient's point of view. Although the differences between the two types of pain are elementary, the chapter from the patient's point of view shows the effect that pain has on relationships, activities, and feelings of self-worth. The author's use of poetry and statements from individuals (though these individuals were not identified as those suffering from low back pain) failed to add the emotional impact that was intended.

Part 2 details different treatments for pain. These chapters offer the layperson minimal information regarding the differenty types of treatments available from the medical arena. The author's use of photographs showing proper body mechanics and postural positioning added to the information given. There was no mention in the "Home Program" chapter, however, of periodically seeing a professional to ensure that the exercises or home regimen are being correctly utilized. Finally, the chapter on self-help was interesting. The author explains how patients with chronic pain can assist themselves during this process. The chapter provides the reader with suggestions as well as a recommended reading list.

I would recommend this text to an individual with low back pain primarily for the chapters on the patient's point of view and on self-help. Beyond those two chapters, I would not recommend this book for patients, students. or physical therapy professionals.

The third book, The Almanac of Back Pain Treatments, appears to be a combination of the first two texts reviewed. In fact, this text's first three chapters are from the first text reviewed. Part 2 of the text relates traditional treatments used for back pain. These include conservative treatments (ie, bed rest, traction, orthotic supports, and modalities), medications, and common surgical procedures performed. The next five chapters are devoted to the allied health realm of treatment. In these chapters, the author introduces the use of yoga and tai chi as alternative methods to traditional relaxation techniques used by physical therapists and psychologists (ie, biofeedback, muscle inhibition, hypnosis). The chapters on posture/body mechanics, physical conditioning, and manipulative therapy are taken from the previously reviwed texts. The author does include a chapter on pain clinics and work hardening programs as traditional treatment choices.

The third section deals with alternative treatments for back pain. The author expands on the section of her first text in slightly more detail here. This section informs the reader that alternative treatments are available and explains what those treatments are and who performs them. The author is concise, though basic, in the information given.

It should be noted that all three texts include a glossary of terms and a bibliography. The bibliography is diverse, including research articles, established texts, and articles written in trade newspapers (eg, PT Forum).

Though there are sections of each text that are pertinent for the patient, I would not recommend these texts individually or as a series to the layperson, patient, or student or to those currently working in the physical therapy profession.

Aimee Klein, PT Boston University Boston, Mass