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Low Back Pain: A Symptom-Based Approach to Diagnosis and Treatment

Postmus, Susan M.

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Low Back Pain: A Symptom-Based Approach to Diagnosis and Treatment.

K.S. Rucker, A.J. Cole, S.M. Weinstein, eds, Woburn, MA, Butterworth-Heinemann, 2001, soft cover, 394 pp, illus, $55.00.

Susan M. Postmus, Wayne State University

The editors state that from the start, the concept of this book has been to present a unique approach to a common problem: low back pain. The plan was twofold: first, to re-emphasize the clinical assessment, namely symptoms and signs, as the foundation of the diagnostic process and functional rehabilitation plan, and second, to assemble a group of authors whose cumulative clinical experience would exemplify the art, as well as the science, of medicine. Low Back Pain: A Symptom-Based Approach to Diagnosis and Treatment is a collaborative effort of 23 medical doctors, physical therapists, and other medical professionals.

The book is divided into four sections and has a total of 15 chapters. The four sections address the symptom-based approach, assessment, management and treatment, and disability of low back pain. Each chapter included extensive references and suggested readings.

The first section of the book, chapters 1 to 3, discusses low back pain: a symptom-based approach. Chapter 1 addresses factors contributing to adolescent lumbar spine disorders. The author indicates that low back pain in adolescents is less frequent than in adults and therefore may indicate a more serious underlying medical pathology when it does present itself. Back pain in youth is also unique secondary to skeletal immaturity. Review of medical vs mechanical back pain is thoroughly presented as is information regarding back problems that present without symptoms. Chapter 2 briefly addresses adult spine anatomy and epidemiology. Then, more extensively and with tables, charts, and graphs, the diagnostic indicators are discussed as well as history taking and physical examination. Chapter 3 specifically highlights geriatric lumbar spine disorders. Nonspinal etiologies are highlighted along with metastic, causes of osteomalacia, osteoporosis, and risk factors for low bone mass in postmenopausal women. Emphasis is on review of all systems and thorough history and physical examination secondary to other diseases and degenerative processes affecting back pain in the elderly.

Section 2 is entitled: Assessment and includes chapters 4 to 6. Chapter 4 discusses biomechanical assessment of low back pain. It presents how to objectively examine different phases of the pathologic condition, areas of greater dysfunction, and reproducing the patient’s symptoms and determination of the tissue at fault. Chapter 5 involves the radiological evaluation of the lumbar spine. It discusses not only conventional radiographs, but also myelography, diskography, computed tomography, myelography-computed tomography, magnetic resonance imaging, nuclear medicine scanning, and SPECT bone scanning. The chapter then illustrates different images of biomechanical dysfunctions. Chapter 6 relates the electrodiagnosis (EDX) of lumbosacral radiculopathy. Patients whose major complaints include back pain with parethesias, numbness, weakness, and radicular pain frequently require EDX. The authors discuss particular myths and practical anatomy. They also present the methodology of EDX and case histories. Results of the case histories are specified and lend a greater understanding of EDX presentations.

Section 3 delves into medication management of low back pain: a symptomatic approach. Chapter 7 describes clinically useful characteristics of pain, defines common pain types, presents classic and current anatomy and pathophysiology, and outlines theoretical and research models of pain to provide the context of effective pharmacologic management of low back pain symptoms. Chapter 8 relates physical therapy treatment of low back pain. This chapter discusses the rationale for treatment whether related to joints, disks, or soft tissue. Treatment approaches are briefly discussed as related to joint mobilization and manipulation and soft tissue dysfunction. Examples of clinical presentations are featured inclusive with testing and illustrations. Chapter 9 discusses injection therapy, which can provide diagnostic information about the precise pain generators and may assist with patient management. Patients, who do not respond to interventions, or those with multiple structural abnormalities, are candidates for diagnostic fluoroscopically guided injections. Again, illustrations serve a useful purpose in demonstrating specific injection techniques and spinal presentations. Chapter 10 presents with modern advances in lumbar surgery. This chapter discusses percutaneous techniques that are performed with either a needle or small stab incision and some minimally invasive open techniques. Chemonucleolysis, percutaneous nucleotomy, arthroscopic microdiskectomy, and spinal endoscopy techniques are discussed along with indications, results, complications, and conclusions. Other open techniques are discussed and contrasted.

Section 4 includes chapters 11 to 15, which discusses low back pain and disability. Chapter 11 describes risk factors for acute and chronic low back pain. It also references the U.S. Labor Department’s Dictionary of Occupational Titles. A table format is used to present a category rating system for jobs of light to heavy work, lifting, and sedentary to heavy frequencies of twisting and bending. Chapter 12 provides case presentations of industrial low back pain clients. Chapter 13 discusses functional performance evaluations including methods, procedures, and issues. This chapter describes the various evaluations and the role of the physician, evaluator, and patient. Various factors that affect evaluation are addressed as well as the characteristics of an effective functional evaluation. Chapter 14 discusses the multidisciplinary approach to the assessment and treatment of chronic low back pain. Chapter 15 relates the medicolegal issues in acute and chronic low back pain management. These issues can very well present as obstacles to management of acute pain that may then progress to chronic back pain. Federal and state laws are discussed as well as litigation and liability. Workers’ compensation, social security disability, and private disability are discussed.

This book presented a synopsis of a variety of factors associated with low back pain. It was unique in discussion of a holistic approach to low back pain. Ample references and a thorough index make up the book’s format. This book is useful as a noncomprehensive reference especially for medical doctors and for physical therapists who service adult populations. It also serves as an instructional tool for all physical therapists in relating the various aspects of the overall management of low back pain.

Copyright © 2001 Academy of Pediatric Physical Therapy of the American Physical Therapy Association