The Malalignment Syndrome: Implications far Medicine and Sport.

Schamberger W. Philadelphia, PA 19106 Churchill Livingstone Inc, 2002, hardcover, 463 pp, illus, ISBN: 0-443-06471-7, $59.95.

In this text, the author, who is Clinical Associate Professor of Physical Medicine and Rehabilitation at the University of British Columbia, presents his conceptual development of the malalignment syndrome (MAS). The author assumes that readers are already familiar with malaligmnent, and he does not offer a succinct operational definition of MAS; instead, he proceeds directly into a presentation of its clinical manifestations. Because this presentation allows the reader to understand MAS, the lack of an operational definition, in my opinion, does not detract from the applicability of the text. According to Schamberger, the diagnosis of MAS is predicated on specific findings of asymmetry in any of several areas, including leg length, tension or bulk in soft tissues or musculature, weight-bearing pattern, and, specifically, asymmetry in the alignment of the hones of the pelvis, think, and extremities. The author's intent is to create a greater awareness of MAS and its clinical manifestations.

Focusing on malaligmnent of the pelvis, spine, and extremities, this text describes the more common clinical presentations and signs and symptoms of MAS and a comprehensive treatment approach for the syndrome.

Opening the book with a review of lumbo-pelvic anatomy and biomechanics, the author then identifies what he says are the 4 most common and treatable presentations of MAS: "vertebral malrotation," "sacral or ilial malrotation," "sacroiliac upslip," and "outflare/ inflare."

The author claims that conventional "sports medicine" has failed to recognize MAS as a major cause of musculoskeletal dysfunction; he therefore focuses the text on athletes, with the understanding that most of the content also applies to people who are not athletes but who have MAS. The text cites numerous references; unfortunately, the vast majority are much more than 10 years old--with only one published in this decade--and approximately half of the references come from book chapters. As a result, these factors leave the applicability and credibility of the information in question. In this manner, the information is much like that of many clinical continuing education courses where opinion and anecdotes from the presenters are loosely intermixed with scientific evidence. Despite these shortcomings, the chapters are well written and supplemented with numerous photographs, images, diagrams, and case studies.

Following a well-developed discussion of the manifestations and diagnosis of MAS, the author dedicates a major portion of the text to a logical and comprehensive plan of care. Topics such as mobilization/manipulation, exercises, orthotics, sacroiliac belts, and alternative forms of intervention (eg, injections to stimulate collagen formation and surgical stabilization) are discussed. Appendixes offer summaries of examination findings of the more common presentations of MAS.

What differentiates this text from others of its kind is the inclusion of sports-specific malalignments. The sports addressed include everything from throwing sports to rowing sports to fencing. An entire chapter is dedicated to MAS in equestrian sports, and it presents the assessment of MAS in relation to riding position, saddles, and even the postural alignment of horses.

The complexity of content is better suited for those physical therapists with some previous experience in biomechanical examination and manual therapy. As such, it is well suited to both less experienced clinicians who are looking to expand their knowledge of and clinical competency in MAS and those clinicians with more extensive experience who wish to expand or refine their practice and scope of thinking. In this context, this text is recommended primarily for rehabilitation professionals involved with manual therapy, sports medicine, and biomechanical assessment. Do not, however, let the title's specification of sports mislead you; this text is a useful resource for clinicians working with patients who are not athletes as well as athletes from numerous sporting activities.

James W Bellew, PT; EdD

Louisiana State University 

Health Sciences Center

Shreveport, La

Dr Bellew is Assistant Professor of Physical Therapy who has published numerous book chapters and articles on muscle performance, musculoskeletal examination, and rehabilitation.