Textbook of musculoskeletal medicine.
Article Type: Book review
Subject: Books (Book reviews)
Author: Szaraz, Zoltan
Pub Date: 07/01/2009
Publication: Name: Journal of the Canadian Chiropractic Association Publisher: Canadian Chiropractic Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Canadian Chiropractic Association ISSN: 0008-3194
Issue: Date: July, 2009 Source Volume: 53 Source Issue: 3
Topic: NamedWork: Textbook of Musculoskeletal Medicine (Nonfiction work)
Persons: Reviewee: Hutson, Michael; Ellis, Richard
Accession Number: 259590248
Full Text: Textbook of musculoskeletal medicine

Edited by Michael Hutson and Richard Ellis. 550 pages,

Oxford University Press 2006, ISBN 019 263050 4

This is a comprehensive, much needed textbook. As evidence-based therapeutics now clearly provides the framework of our practices, we are constantly searching for better, clearer, and fully supported "evidence" to incorporate into our therapeutic protocols.

This book is a superb integration of the body of knowledge from orthopaedics, rheumatology, pain control, physical medicine and rehabilitation, osteopathic medicine, psychology, physiotherapy, regretfully leaving out the now broad evidence-based chiropractic therapeutics. This is not necessarily a shortcoming of the book, just another fact-of-life, where the interdisciplinary iron curtain still surrounds chiropractic sciences. Where the strength of this book lies is drawing out the similarities and the effectiveness of dissimilar methods of evaluation and treatment methods of each discipline. Sometimes we just have to admit that the treatment advocated is only a conceptual framework and have to be weary of excessive enthusiasms for the belief system without supporting evidence.

The book is cleverly divided into four (4) conceptual Parts: Part 1 is Introduction, while Part 2 deals with Morphology; Dysfunction and Pain; Part 3 then contains Regional Disorders and finally Part 4 Management Strategies.

This text then is a comprehensive account, as the editors established in the preface, "of both structural and functional disorders of the spine, and of the extremities." The theoretical framework of the book is the differentiation of "early pathomorphological changes (which) reflect adaptive process to biomechanical stresses" and is manifested in "reversible dysfunction states" and "advanced structural pathology (which are) consequences of the failure of adaptation of the soft tissues to postural and dynamic stresses."

The chapter titled Fundamentals incorporate concepts such as the Biosocial Model, Distinctiveness of Musculoskeletal Medicine, Models of Neuromusculoskeletal Medicine, Pragmatism and Complexity, The Value of Evidence-based Medicine and its Applicability to Manual/Musculoskeletal Medicine, Reproducibility and Validity of Diagnostic Procedures and RCTs in Manual/Musculoskeletal Medicine. This chapter then sets the tone and framework of what will follow in the next 47 chapters.

Within the context of Physical Examination authored by Drs. Richard Ellis and Cyrus Cooper, both from the University Hospital of Southampton, UK, they refer to two systems used in musculoskeletal examination; selective tissue tension, originally developed by Cyriax, always used in chiropractic premanipulative manoeuvres, and functional examination. In selective tissue tension, as the authors describe "the examiner puts strain sequentially on the possible structures at fault: when the person's pain is reproduced, the structure under test is identified as the likely cause." In addition to identifying specific tissues at fault, the authors encourage "examining the whole person" with their specific sensitivities, over-reactivity and abnormal levels of anxiety associated with their condition. A neat pictorial review captures a clinical musculoskeletal examination incorporating Focus of Examination, a picture depicting the actual test procedure, a short description of the procedure, including patient instructions and typical findings and interpretation. This is a very comprehensive "table," over 35 pages, a most valuable quick compendium. These could formulate a "standardized" musculoskeletal examination.

In summary, this superb textbook is a must-read for anyone interested in diagnosis and management of musculoskeletal pain.

Zoltan Szaraz, dc, fccrs(C)

Associate Professor of Chiropractic Clinical Sciences

Canadian Memorial Chiropractic College
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.