The Lumbar Spine and Back Pain, 4th ed.

Churchill Livingstone Inc, 1992, hardback, 637 pp, illus, $148.

This is the fourth edition of a book that is often considered a primer on lower back pain for the medically related professions in the countries of the British Commonwealth of Nations. The book should have an equal status among American physical therapists who manage patients with lower back pain or who have an interest in the lumbar spine, especially because many of the contributing authors are well-known physicians, scientists, and surgeons who are based in the United States. Although there is only a general discussion of physical therapy techniques, the book is most valuable as a compilation of the anatomic, medical, and physiologic knowledge that serves as the foundation for the majority of contemporary physical therapy procedures directed toward the effective management of patients who have lumbar spine pain.

The book is divided into 33 chapters that address a wide variety of appropriate topics. Content ranges from standard reviews of lumbar spine anatomy, kinesiology, and pathology to specific discussions of problems that commonly affect the lumbar spine, to the various aspects of psychological and psychiatric factors in the treatment of lower back pain. All chapters are very well referenced and include citations of both classic works and current findings from peer-reviewed medical and scientific literature.

Although most of the chapters are important, several stand out as being exceptional. The first chapter addresses the evolution of the lower back and lumbar spine pain and traces the development of the spinal column from single-cell invertebrates, to fish, amphibians, reptiles, mammals, and humans. The presentation of this chapter centers on the biomechanical and evolutionary differences between humans and other organisms that contribute to the formation of the lumbar lordosis and to lumbar spine pain. Another unique chapter provides specific information on the biochemistry of the intervertebral disk and describes how lumbar pain of diskal origin is the product of chemical and vascular events in addition to mechanical damage. Other noteworthy chapters address facet joint syndromes, lumbar spine instability, pediatric spinal problems, and the failed back.

There are several chapters that present only superficial or incomplete information. The chapter on clinical measurement effectively addresses the uses and limitations of procedures that measure lumbar spine motion, but it does not provide operant examples for the measurement of lumbar spine function. Although the chapters on back schools and back pain in industry review the relevant international literature on these subjects, they also fail to provide examples of specific clinical procedures for patient care. Finally, the chapter on conservative treatment of back pain includes only a very basic description of common physical agents and therapeutic exercises that would be of nominal value to the practicing clinician. These deficiencies are relatively minor, however, when compared with the volume of complete and meaningful information that is presented throughout the rest of the book.

Overall, this book is a fine treatise on the complex issues of the lumbar spine and of lower back pain. It would be a worthwhile addition to any physical therapist's professional library. Because it is assumed that the reader has an entry-level knowledge, the book may not be most effective for use with basic physical therapy education. it would, however, be a fine resource for graduate-level work in orthopedic physical therapy.