Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach.

Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach

Richardson C, Jull G, Hodges P, Hides J. Philadelphia, PA 19106-3391, Churchill Livingstone Inc, 1999, hardcover, 191 pp, illus, $39.95.

Therapeutic exercises are commonly prescribed for patients with low back pain on a trial-and-error basis and often there is little understanding of why some exercises are more effective than others. The authors of this text present an evidence-based approach for treating patients with low back pain that focuses on assessing motor control of the low back musculature and managing deficits through specific stabilizing exercises.

The text is divided into 5 sections. The first section serves as an introduction; the second section begins by exploring the link between low back pain and lumbopelvic stabilization. A review of the evidence regarding low back musculature and its role in spinal stabilization is provided, with a strong emphasis placed on transversus abdominis and lumbar multifidus muscle dysfunction in patients with low back pain.

The third section discusses the motor control involved with normal joint stabilization and the influence that joint pain and pathology may have on motor control. In the context of this discussion, the authors provide an overview of the proposed assessment and rehabilitation approach. The fourth section begins with a discussion of an evidence-based approach to motor control assessment followed by a detailed description of the proposed spinal stabilization treatment program, including motor skill training of the lumbar musculature and incorporation of this skill into functional tasks. The fifth section discusses potential areas for future research and clinical practice.

The authors have created a well-written and clinically useful text that bridges the gap between research and practice concerning dynamic muscular stabilization of the lumbar spine. The text is well referenced and contains excellent figures. Much of what the authors have presented in this text is, in fact, evidence-based. However, as they point out, more work is needed to increase knowledge in this area. This text is highly recommended for professional and experienced clinicians who work with patients with low back pain. In addition, it would be useful as a textbook for the orthopedic or therapeutic exercise components of physical therapist education programs.

Michael Ross, PT, OCS United States Air Force Academy Colorado Springs, Colo

Capt Ross is an instructor in the Department of Biology, where he teaches classes in general biology and biomechanics. His research interests include outcomes assessment and the reliability and validity of clinical measurements.