Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain, ed 2.

Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain, ed 2 Richardson C, Hodges PW, Hides J. Edinburgh, United Kingdom, Churchill Livingstone Inc, 2004, hardcover, 271 pp, illus, ISBN: 0-443-07293-0, $49.95.

The first edition of this text, published in 1999 and rifled Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain, produced a true paradigm shift in the physical therapy approach to prevention and management of low back pain (LBP). The stated goal of this second edition is to provide an updated overview of the exercise interventions to increase lumbopelvic stability, which is based on the authors' ongoing research and clinical practice in this area. The stated target audience for this text consists of physical therapists and other health care professionals involved in designing exercise interventions for patients with LBP. The 3 authors have been involved in much of the research available in this area of practice and, therefore, succeed in providing a comprehensive coverage of this topic.

The book is divided into 5 sections. Section 1 provides an introduction to the topic. Section 2 discusses anatomy and biomechanics related to lumbopelvic stability, and it introduces a novel delineation of muscle function based on a motor control perspective into local, weight-bearing, and non-weight-bearing muscles. Section 3 discusses 3 neurophysiological concepts (ie, deloading, joint injury, and pain) relevant to impairment in joint protection mechanisms. Section 4 describes the impairments in abdominal, paraspinal, and weight-bearing joint protection mechanisms in patients with LBP. Section 5 provides the reader with well-described and clinically usable diagnostic tools, and a 3-phase model to increase lumbopelvic stability.

This second edition is, in fact, a totally new book. The authors have not only expanded the scope of the first edition by including discussion of the pelvic region, they also introduce a new theoretical model of muscle function that ties in their ongoing research with existing clinical hypotheses in physical therapy, such as those advocated by Rood and Janda. The book contains 220 illustrations including line drawings, photographs, and imaging studies. References throughout are very up-to-date; however, in sections 4 and 5, the extensive use of research data that has yet to be published in the peer-reviewed literature could be considered a drawback. In section 5, the authors provide an extensive and clinically useful description of 4 clinical tests of local segmental control. However, they only provide peer-reviewed research data on aspects of validity for the prone corset action test and the segmental multifidus test; the qualitative data provided on concurrent criterion-related validity for the latter test in patients with chronic LBP again have yet to be published in the peer-reviewed literature. The authors provide no data on reliability for these clinical tests.

This text certainly succeeds in presenting the authors' hypotheses and clinical applications related to lumbopelvic instability and its management, while acknowledging and addressing competing hypotheses in this area. The text provides only limited coverage of the "form and force closure" model of pelvic stability as developed by the Musculoskeletal Research Group at Erasmus University; the interested reader will likely want to review additional literature on this topic. Outcomes research on the exercise interventions described in this book is currently limited, but the authors provide an extremely plausible and comprehensive interpretation of the available studies.

In summary, this text will be a very relevant addition to the library of physical therapist students and clinicians. It also presents researchers with a wealth of possible topics. The hypothesis presented in this book on muscle function based on a motor control perspective provides a contemporary research basis for existing clinical hypotheses in neurological physical therapy. The research presented on the influence of pulmonary conditions on the lumbopelvic stabilizing mechanisms will be of interest to therapists in the cardiopulmonary practice area. This will likely expand the relevance of this text beyond the orthopedic physical therapy community to include cardiopulmonary and neurological practice areas.

Peter A Huijbregts, PT, DPT, OCS 

University of St Augustine for Health Sciences

St Augustine, Fla

Dr Huijbregts is Assistant Professor of Online Education, teaching courses in orthopedic basic science and spinal instability. He also is a consultant and OMPT Residency Coordinator at Shelbourne Physiotherapy in Victoria, BC, where he primarily manages patients with spine-related conditions.