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book reviews Clinical Anatomy of the Lumbar Spine and Sacrum by Nikolai Bogduk. Foreword by Lance Tworney. Churchill Livingstone, Edinburgh, 1997, 3rd edn (ISBN 0 443 06014 2). Illus. 261 pages. f20.

A third edition of this now classical text will be welcomed by manual therapists of every persuasion.

It would be difficult to name a pair of anatomists of international standing who are better acquainted with the special clinical problems of physiotherapists. Bogduk’s imm- ense scholarship, distilled into essential information, has been packed into this succinct review of the subject.

The author’s carefully controlled double-blind clinical trials show that present knowledge identifies the three most important sources of low back pain as the intervertebral disc (40%), the zygapophyseal (facet) joint (15%) and the sacro- iliac joint (15%). The restriction to a foreword of Lance Twomey’s contribution is sad, yet his sterling presence remains evident in the text.

Of particular value are the differ- ences between science and specu- lation, which are manifest through- out; the section on lumbar instab- ility; the sacrum and sacro-iliac joint; the clarity of diagrams, some revealing imaging; and the complete lack of pompous verbiage.

The author’s comments on the sacro-iliac joint are alone worth the purchase price, yet I would plead for a t least a nod t o the thorny question of anomalies - bony and soft tissue - since the book is about clinical anatomy. For the clinician, after structure and function must surely come anomalies, particular- ly of symmetry between sides.

There’s a lot of them about. For example, an X-ray of the normal female pelvis in the current (38th) edition of Gray’s Anatomy (page 685) depicts a degree of sacral scoliosis as well as public asym- metry; likewise the pelvis of a seven-year-old boy (page 670). It follows that the sacro-tuberous and sacro-spinous ligaments must also be asymmetrical, like all other

paired soft-tissue structures attach- ed to the sacrum; for example the muscles of the pelvic floor.

How then can we justify treat- ment of pelvic joint problems solely from the standpoint of bilateral symmetry being the norm, as many still seem to do?

Bogduk provides an interesting summary of the confusion surround- ing innervation of the sacro-iliac joint, and clarifies the vexed question of its movement, which transpires as ‘feeble in magnitude and irregular in direction’. This dose of corrective science is long overdue. The irregularity of move- ment-direction may have more to do with anomalous structure than it is possible yet to show.

In passing, it is interesting that internal disc disruption can now be diagnosed by magnetic resonance imaging. The book is a very good E20 worth. Up-to-date therapists cannot afford to be without it.

Gregory P Grieve FCSP DipTP MMACP

Physiotherapy - A Psychosocial Approach edited by Sally French. Buftetwotth Heine- mann, Oxford, 1997, 2nd edn (ISBN 0 7506 2608 9). 438 pages. f22.50.

The revised and up-dated edition of this book draws on a wide range of topics from psychology and sociology and discusses their application t o physiotherapy practice. It aims to be informative, analytical and stimu- lating. I t is written for physio- therapists, although most topics are relevant t o other health care workers. Over half of the 17 con- tributors to the 28 chapters are physiotherapists and all are experts in their field.

The behavioural aspect of physio- therapy is now accepted as an important component of practice yet there are still relatively few text- books available. This book provides a concise overview of many issues of clinical practice with a particular focus on disability. Chapters are logically divided into four sections. The first gives a background t o psychosocial influences on health

care such as the changing nature of illness; inequalities on health; insti- tutional and community living. New chapters take a comprehensive look at health care for ethnic minorities and a t attitudes of health profes- sionals towards disabled people.

The second section examines the experience of illness and disability, including pain, stress and death and dying. A revised chapter on age- related cognitive change is very relevant to work with older people. A new chapter on dimensions of impairment and disability chal- lenges the nature of health care interactions although it fails t o address the associated concept of handicap. The third section, on communication in physiotherapy practice, offers new chapters on ‘interpersonal communication’, and ‘counselling and the use of coun- selling skills’, which are well applied to physiotherapy.

The last section, on psychosocial aspects of physiotherapy practice, tackles complex issues of ethics and moral decision-making in physio- therapy, definitions of disability, and sexuality and disability, as well as changing roles in learning disability, psychological aspects of child development and of treatment, and health and health education.

There are few tables or figures but illustrative case material and verbatim quotes are used with great effect in many chapters and full reference lists are given in each. The book is commendable for encouraging physiotherapists to consider a wider role in health care which takes into account the psychosocial dimensions of their practice, and for promoting a critical approach which can identify areas for physiotherapy research.

This new edition is very readable and remains good value in both price and quality. It deserves to be kept on the booklist of all under- graduate physiotherapy courses and many postgraduate students and practising physiotherapists will find it a useful source and reference book as well.

Barbara Richardson PhD MSc MCSP

Physiotherapy, September 1997, vol83, no 9