The Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy.

Readers of McKenzie's previous book, The Lumbar Spine, will not be surprised by this new endeavor. The book follows the familiar pattern, style, and even some chapter titles of the lumbar spine book. His beliefs concerning the effects of posture and movements on low back symptoms are reiterated and generalized to the thoracic and cervical areas. The text is quite readable and at times even entertaining. There are, however, very few referenced statements after the first few chapters, and most of the references concern the low back rather than the cervical or thoracic areas.

The anatomy chapter appears to be accurate. The chapters entitled "Biomechanics and Pathophysiology" and "Causes of Pain" set up McKenzie's diagnosis and treatment philosophies but do not include ideas that would counter his approach and are relatively superficial. Some controversial statements are presented as fact and are unreferenced. In the section on the lateral shift phenomenon, the author states that if a patient cannot straighten or laterally flex to the left, the patient has developed an obstruction to left lateral flexion caused by a left, posterolateral disk protrusion. This concept is unreferenced and disputable, but is stated here as fact. Similar examples can be found in the tissue deformation section of the "Causes of Pain" chapter and elsewhere in the "Biomechanics and Pathophysiology" chapter. The pain chapter ignores the complexity of the pain experience by dealing only with mechanical and chemical stimulation of nociceptors. There is no discussion of the multimodal nature of the pain experience or of ways in which pain perception can be affected by situation or circumstance.

The remainder of the book takes McKenzie's well-known ideology for the diagnosis and treatment of lumbar spine problems and applies it to the cervical and thoracic areas. The text is detailed in its description of techniques. Photographs and drawings are helpful to illustrate certain parts of the text. The reader should be cautioned, however, that most of the information in this book is the author's opinion, based on his own clinical experience, and has not been validated. Although many statements are written as fact, they are neither referenced nor supported by the literature.

The author should be commended for putting his ideas on paper and into the public domain. This public presentation should allow for his diagnosis and treatment tenets to be tested. This book will be helpful to those who practice the techniques McKenzie espouses and to those who wish to investigate methods of classifying and treating cervical and thoracic problems.