The Pelvic Girdle: An Approach to the Examination and Treatment of the Lumbo-Pelvic-Hip Region ed 2.

The Pelvic Girdle: An Approach to the Examination and Treatment of the Lumbo-Pelvic-Hip Region, ed 2 Lee D. Philadelphia, PA 19106-3399, Churchill Livingstone Inc, 1999, hardcover, 183 pp, illus, $42.

The purpose of this text is to help the clinician develop a logical approach to the examination and treatment of the lumbo-pelvic-hip region based on known anatomy, physiology, and biomechanics.

This second edition includes new information on the anatomy and biomechanics of the lumbo-pelvic-hip region drawn from the latest research, and it presents a new biomechanical model on which evaluation and intervention principles are based. This edition also describes new examination techniques for the sacroiliac joint and presents rehabilitation guidelines for instability or impaired load transfer.

The book opens with a short glossary of terms contained within the text. Eleven chapters cover historical review; evolution and comparative anatomy; embryology, development, and aging; anatomy; biomechanics; pain, dysfunction, and the healing process; clinical syndromes of the lumbosacral junction, pelvic girdle, and hip; and muscle, posture, and ergonomics.

The work pays long-overdue attention to the role of the pelvic girdle in the causation and development of back pain. An emphasis on function rather than pain and the introduction of a biomechanical model form the framework of the text. A key premise set forth is that the understanding of musculoskeletal problems requires knowledge of how loads are transferred throughout the body and how deficiencies in one part influence the function of the entire system. This model of biomechanical function leads to a biomechanical treatment approach.

The author provides a brief historical review of the evolving state of knowledge pertaining to the anatomy and function of the pelvic girdle. A short collaborative chapter on evolution and comparative anatomy describes the development of the human lumbopelvic-hip complex. The chapter on embryology and aging details age-related changes in the sacroiliac joint. It guides the reader toward an understanding of how anatomical changes influence the biomechanical model and subsequent examination and treatment procedures. The chapter on anatomy is comprehensive, very detailed, and noteworthy for its discussion of the ligaments and fascia of the sacroiliac joint. The true clinical substance of the text is first found in the biomechanics chapter. This chapter on relatively difficult subject matter includes in-depth discussions of kinetic and kinematic forces specific to the lumbosacral, pelvic girdle, and hip regions and also discusses functional biomechanics. The material is more comprehensive than traditional kinesiology texts, but such detail is necessary for a better understanding of the clinical procedures presented.

A short chapter on pain and dysfunction and the healing process describes the cellular events associated with soft tissue repair and relates this to clinical intervention. The chapter on examination presents very detailed and highly specialized information. Procedures include gait and posture assessment, functional testing, articular mobility and stability assessment, muscle function testing, neurological screening, and vascular and adjunctive testing. The functional tests and the articular mobility and stability assessments are unique in their detail, call for exceptional observational and manual skills, and are best suited to the experienced orthopedic clinician.

The remainder of the text is dedicated to the description and treatment of clinical syndromes of the lumbosacral junction, pelvic girdle, and hip. A unique organizational model classifies clinical findings according to joint mobility. The author presents common subjective and objective findings, and she demonstrates a variety of manual techniques for intervention. As in the examination phase, strong manual skills are required for the performance of treatment maneuvers. Home exercises are described briefly, and 2 case studies are presented. The final chapter details strategies for muscle stretching, joint stabilization, and postural and ergonomic retraining, and it contains many therapeutic activities that can be included in a home program.

The text is richly illustrated with photographs, essential for visualizing manual techniques and joint biomechanics. Diagrams and radiographs also supplement the text and are clear and well labeled. Summary tables organize relevant information. References, which are both plentiful and timely, are included within each chapter and are summarized at the end of the book. Contents are outlined at the beginning of each chapter and material is presented in a logical sequence. Reliability and validity' measures, however, were not generally part of the content of this work. The author believes that, although studies have not confirmed the validity or reliability of individual tests for sacroiliac joint involvement, the results of several of these tests can help form a clinical opinion of sacroiliac joint involvement. In addition, 3 videos--Examination of the Articular Function of the Pelvic Girdle, Manual Therapy Techniques for the Sacroiliac Joint, and Exercises for the Unstable Pelvis--were linked to this book.

Although the text is useful for all physical therapists who wish to increase their understanding of the lumbopelvic-hip complex, orthopedic therapists with strong manual skills will find the sections on biomechanics and the evaluation and treatment of clinical syndromes to be the most compelling features of this work. The author has succeeded in creating a timely clinical reference for the skilled orthopedic practitioner.

Eugene Pavone, PT Rockland Physical Therapy Spring Valley, NY

Mr Pavone works for an orthopedic private practice and specializes in orthopedics.