A comprehensive overview of the most current research related to spinal control and rehabilitation from back and pelvic pain.
Back pain is one of the most common ailments for which patients seek medical intervention and physiotherapy thus the condition is associated with high health-care costs. Given the multi-faceted nature of low back pain, rehabilitation of patients with that affliction can be challenging. Even turning to the evidence to inform our practice can seem overwhelming, given the wealth of (sometimes conflicting) information. This book pulls together evidence from expert scientists and expert clinicians to summarize the current state of research related to back rehabilitation from the perspective of spinal muscle control.
This 300+ page book features 29 contributors and began life as a summit meeting of experts in 2009 and was eventually revised into the current format. The book is split into six parts; 1) Models of the spine, 2) Motor control of the spine, 3) Proprioceptive systems, 4) Clinical evidence of control approach, 5) State-of-the-art reviews, and 6) State-of-the-art approach to clinical rehabilitation of low back and pelvic pain. In several chapters, the contributors discuss the concepts of stability and instability, clarifying what these terms actually mean and suggesting alternative words that may be more appropriate. As per the format of the summit in 2009, the book focuses on four questions for each theme;
- What is known?
- What are the main issues?
- What are the areas of convergence and divergence of opinion?
- What are the key questions that need to be answered?
This book has many features that make it an important read for anyone involved in the treatment and/or research of back pain;
- It clearly highlights areas of convergence of opinion i.e. where evidence and experts agree and thus areas we can confidently base our practice on
- It discusses areas of divergence, in particular a fairly public difference of opinion between Paul Hodges and Stuart McGill in terms of the need to address control in deeper trunk muscles such as transversus abdominis and lumbar multifidi
- It mostly uses clear and concise language (see Weaknesses below)
- It makes good use of graphs, tables, photographs and flow diagrams to help the reader understand research methods and findings
- The final chapter (Integrated clinical approach to motor control interventions in low back and pelvic pain) is the longest at 62 pages and had six contributors (Paul Hodges, Linda Van Dillen, Stuart McGill, Simon Brumagne, Julie Hides and Lorimer Moseley). It covers assessment and exercise techniques, building on the preceding chapters to provide a comprehensive guide for physiotherapists to recognise and address motor control issues in their patients with back pain. This chapter is also full of helpful images and tables to summarize the information.
By the complex nature of the subject, the associated research is likewise complex. This can make for a slightly daunting read at times, particularly when discussing theoretical models of the spine. However, it is important to understand where the current evidence relating to back pain comes from therefore it is worth persevering with the more dense chapters to better understand the integrated clinical approaches discussed in the final chapter.
This book would also benefit from case examples and associated online content (e.g. videos) for further clinical integration of the discussed concepts.
Both for the novice and experienced practitioner, this book provides useful information regarding the most up-to-date research and how we can integrate these findings into our assessment and treatment programs for those with back pain. A must-have for clinicians interested in evidence-informed practice.