The Human Extremities: Mechanical Diagnosis and Therapy.

The Human Extremities: Mechanical Diagnosis and Therapy McKenzie R, May S. Wellington, New Zealand, Spinal Publications (distributed by OPTP), 2000, paperback, illus, ISBN: 0-9583647-0-2, $64.

The purpose of this book is to encourage physical therapy practitioners and other health care professionals to provide sound and effective self-management techniques to patients with mechanical disorders of the extremities. The treatment principles and techniques follow those of McKenzie's previous books on the spine, and patient education and self-management are repeatedly emphasized. This book focuses on the most commonly seen mechanical disorders of the extremities and does not attempt to be a comprehensive text by addressing all disorders that may be encountered.

Chapter 1 provides an overview of musculoskeletal problems in the general population, and it includes some interesting data on the prevalence of these disorders. It also discusses several systemic reviews of the literature on commonly used physical therapy interventions; many of these reviews suggest that exercise is the most useful intervention in the long-term management of many conditions. Chapter 2, which discusses tissue healing and repair, is skillfully written and describes the scientific basis for many of the interventions (eg, range of motion, stretching) that physical therapists provide. It would have been beneficial to divide the different tissue types that the chapter discusses into separate subchapters. This chapter also includes engravings by Sir Astley Cooper, a surgeon who practiced in the late 1700s and early 1800s. These engravings demonstrate the body's extraordinary potential for remodeling tissues after injury, and they complement the content of this chapter. Chapter 3, "Pain," looks at the different causes of pain and relates them to the various conditions of the tissues (eg, acute, chronic).

Chapter 4, "Mechanical Diagnosis," slightly expands the discussion of this topic that appears in McKenzie's spine textbook and focuses on the extremities. Postural, dysfunction, and derangement syndromes are reviewed as well as nonmechanical conditions such as acute pain. Chapter 5 is an excellent review of the patient history, even for the experienced clinician, and it ties in well with the rest of the book, especially those areas that discuss the process of establishing a diagnosis. Chapters 6 and 7 ("Physical Examination" and "Assessment of Symptomatic and, Mechanical Presentations and Responses") provide some strategies that can be used to assess patient responses to treatment and to direct interventions. These chapters include some excellent diagrams and tables that provide convenient summaries to help guide the examination, assessment, and treatment process. Chapter 8, "Patient Management," is both well written and well referenced. This chapter discusses the importance of patient education in the overall management of the patient. Although this theme is reinforced throughout the book, this chapter details the process of educating the patient, not only about their condition, but also about their active participation in the overall management of their condition.

Chapter 9, "Management and Self-treatment," provides the general principles by which different disorders as well as the different stages of a disorder should be managed. Postural syndromes, articular dysfunction, musclotendinous dysfunction, and derangement syndromes are among the areas covered. Chapter 10 discusses the management of a number of commonly seen disorders, such as tennis elbow, overuse injuries, osteoarthritis, and lateral ankle sprains. For many practitioners, this chapter will be the most intriguing, because it outlines some innovative ideas on the management of these disorders. The conditions are comprehensively discussed and the accompanying cases are well chosen to reinforce each other in the decision-making process. Chapter 11 discusses the elements of the clinical reasoning process. This chapter is a substantial contribution to the literature and should be read by all academic clinicians. It very eloquently describes a process by which clinical reasoning can occur, and it incorporates the various areas (eg, the patient's environment, contributing factors) from which the ultimate clinical decision should be derived.

This book was written primarily for physical therapy practitioners, although other health care professionals such as athletic trainers and occupational therapists will find it useful. The authors have provided a well-written and clinically useful text, which may be used as a reference in both academic and clinical settings. It is generally well referenced and includes a glossary of terms. This book effectively bridges the gap between theory and practice by providing both the fundamental information needed and the answers to many common clinical questions. It is also a book that will be useful to practitioners of varying ability, from the student to the experienced practitioner. Students or practitioners in the early stages of their careers, however, may wish for a more in-depth discussion of the conditions and, at times, may find some of the text difficult to grasp. Experienced practitioners will also gain a great deal from the insightful approach and challenging questions the cases pose.

A true strength of this book is the consistency and clarity of the writing style. The chapters flow well, and the information is easy to find. Another strength is the excellent illustrations and tables throughout, which provide convenient summaries and references. The authors should also be commended for the clear descriptions and pictures of the interventions. This book would certainly be useful as a resource for physical therapy practitioners, and it is comprehensive enough to be used as a textbook in physical therapy curricula. One criticism of this book is that some of the techniques recommended have limited scientific basis for their use; however, this is the same criticism that the authors make when discussing the use of passive modalities in chapter 9. The criticism of modalities such as ultrasound is somewhat unjust given the articles referenced; one could easily find contrasting outcomes in the literature and take the opposing viewpoint. The omission of references to Dyson's work on the use of ultrasound for acute injuries is troubling, because she has been the leader in this field for well over a decade. The statement that ultrasound is supposed to have an anti-inflammatory effect is also somewhat outdated; contemporary research has shown that ultrasound is capable of shortening the inflammatory phase of tissue repair rather than being anti-inflammatory. These criticisms, however, do not detract from the overall quality and usefulness of this of this book, which is refreshing and commendable.

David Levine, PT, PhD The University of Tennessee at Chattanooga & Erlanger Medical Center Chattanooga, Tenn

Dr Levine is a UC Foundation Associate Professor in the Department of Physical Therapy. His teaching, research, and clinical practice are in the areas of orthopedics, and physical agents and electrotherapeutic modalities.