Therapeutic Exercises for Musculoskeletal Injuries, ed 2.

Therapeutic Exercises for Musculoskeletal Injuries, ed 2 Houglum PA. Champaign, IL 61825, Human Kinetics, 2005, hardcover, 974 pp, illus, ISBN: 0-7360-5136-8, $119.

This book is part of the 5-textbook Athletic Training Education Series. The author's stated purpose is to provide an "educational tool for the professional student as well as a reference text for the practicing clinician." Although athletic training students are the primary audience, the text is quite applicable to physical therapist students. The scope and depth of the information presented are appropriate for the intended audience.

The text consists of 22 chapters hierarchically organized into 4 parts, with each part providing the foundation for the next. Each chapter begins with stated objectives, ends with a summary of major points, and includes a section of "Critical-Thinking Questions" designed to help the reader apply the information to realistic clinical situations. Houglum includes a series of "Lab Activities" at the end of each chapter to help the reader practice the skills outlined in the text. She appropriately and frequently references chapter content and includes a bibliography at the end of each chapter, with a comprehensive bibliography at the end of the text. The book is well indexed, and peer-reviewed journal articles make up the vast majority of bibliographical references.

Part I, "Basic Concepts," consists of 4 chapters and lays the foundation for the rest of the text. The part begins by outlining the traditional roles of various members of the rehabilitation team as well as the general principles of goal setting and program individualization. Houglum then covers the phases of healing in considerable detail and effectively demonstrates how tissue healing timelines dictate the appropriate training volume during rehabilitation. She follows this discussion with an excellent review of Newtonian physics as it relates to tissue loads during exercise. A chapter on examination and evaluation concludes this part. The author superficially outlines range-of-motion measurement, strength testing, soft tissue examination, and joint play examination, but excludes joint-specific special tests.

Part II, "Therapeutic Exercise Parameters and Techniques," delves into specific techniques for improving strength, range of motion, flexibility, and joint play. The initial chapter covering range of motion and flexibility begins with a detailed review of soft tissue components, the biophysical effects of immobilization, and the neuromuscular aspects of muscle flexibility. The chapter reviews goniometry in general and provides various examples, but does not include detailed instructions for each joint. Houglum then introduces the concepts of active and passive stretching, proprioceptive neuromuscular facilitation, low-load long-duration stretching, massage, myofascial release, and trigger-point release. She includes a detailed description of joint mobilization, with an extensive discussion of the convex-concave rule, the concepts of roll and glide, and grading of accessory motions. The scope of coverage provides an excellent introduction and the examples given are effectively presented with both photographs and text.

The following chapter on muscle strength and endurance reviews muscle structure and physiology in considerable detail as well as force-velocity and length-tension relationships. The author presents manual muscle testing as an overview with a detailed table that outlines grading. Examples are presented, but comprehensive instructions for testing each muscle are not included. Houglum discusses the advantages and disadvantages of body weight, isotonic, elastic, and isokinetic resistance training in sufficient detail to allow students to intelligently select appropriate techniques for a given clinical situation.

This part also includes chapters that cover proprioceptive training, plyometrics, and sports-specific exercise. The chapter addressing lower-extremity plyometric progression is particularly detailed, with clear photos that are especially helpful in demonstrating intelligent application of this concept. The author concludes part II with a chapter on sports-specific exercise and outlines general principles of manipulating training variables, as well as guidelines for training progression.

Part III, "General Therapeutic Exercise Applications," includes instructions on evaluating posture, walking and running gait, and body mechanics. Houglum presents normal walking and running gait in extensive detail with effective charts and diagrams that allow the reader to grasp the flow of the gait cycle in 3 planes. She then introduces the general principles behind and benefits of water exercise. Through diagrams and text, the author includes a generalized therapeutic aquatic exercise program that allows the reader to plan sound exercise programs in an aquatic environment. Interestingly, Houglum includes a chapter on Swiss ball and foam roller exercises, and presents an extensive series of suggested exercises with diagrams, photographs, and text descriptions. Taken together; the information presented in part III includes an effective and up-to-date entry-level exercise resource for new orthopedic clinicians.

Part IV, "Specific Applications," makes up the final half of the text, with separate chapters covering the spine and sacroiliac joint, shoulder and arm, elbow and forearm, wrist and hand, foot, ankle and leg, knee and thigh, and the hip. Each chapter follows the same format: Houglum presents general considerations first, followed by specific soft-tissue mobilization techniques; joint mobilization techniques; flexibility, strengthening, and proprioceptive exercises; and "special applications."

The soft-tissue mobilization sections consist of a detailed presentation of common myofascial trigger points. Much like Travel and Simons' text (Travell & Simons' Myofascial Pain and Dysfunction), Houglum uses diagrams to identify the trigger point location and pain referral pattern. The joint mobilization sections are comprehensive; they include photographs demonstrating techniques and verbal descriptions that are detailed enough to effectively instruct a student reader. These sections also would serve as an excellent reference for the experienced clinician. The exercise component of each chapter is appropriate for the new clinician and would provide the reader with an effective exercise repertoire.

The "Special Application" sections cover commonly seen clinical problems and outline suggested rehabilitation programs for each condition. These sections frequently include a variety of postoperative protocols; the most notable number of these can be found in the knee chapter.

In conclusion, this is an excellent text that serves its intended audience well. Physical therapists will find that it is an excellent instructional text for students and a solid orthopedic reference.

Todd A Forman, PT

Holliston, Mass

Mr Forman is the Senior Physical Therapist and member of the interdisciplinary team at Integrative Therapeutics in Natick, Massachusetts. He specializes in manual therapy and outpatient orthopedic rehabilitation.