|
It
is always a pleasure to write a review about a book with which you are
in almost total agreement. The only upsetting feature is that you wish
you had put in that extra effort and written it first!
This book should form the ‘backbone’ of
treatment. Back pain sufferers should be encouraged to read it from cover
to cover, and possibly even more importantly, it should become mandatory
reading for all GPs and Orthopaedic Surgeons.
The forward from Prince Charles is very
supportive, but wrong in one important aspect. Virtually all the changes
in the understanding and treatment of back pain has happened in the last
30 years. This has been as a direct result of research from the physiotherapy
profession – world-wide. In my 28 years as a chartered physiotherapist
there has been an enormous revolution in the way we, as a profession treat
patients with back pain. I cannot speak for doctors, but within physiotherapy
we have the sacro-pelvic dynamics from the USA, we have all the muscle
imbalance work and stabilizer rehabilitation techniques from Australia
and we have the bio-psycho-social model with advanced understanding of
patients and pain mechanisms from the UK.
The chapters are self explanatory but worthy
of comment for all readers.
1. Why is back pain so common?
Good explanation with simple anatomy
descriptions and diagrams. Sarah has a very good turn of phrase that describes
the problem in everyday terms. The right messages are all there.
I would suggest that the Association of
Chartered Physiotherapists in Animal Therapy with their extensive post
graduate training alongside the Royal Veterinary College requirements
deserve a mention as well as ‘equine osteopaths’!
2. Back to basics
Again, she has got to the nub of the
matter and includes what can go wrong in ways that should help dispel
the all too common fear factor that only serves to increase the pain.
3. Diagnosing the problem
This is an excellent discussion about
how a good, low tech, clinical examination is in fact far more valuable
than X rays or even scans that can only take snapshots of the spine. As
Sarah says – a photograph of a door hinge will not tell you whether it
works or not!
My only disagreement with the content is
in the area of the sacro-iliac joints. There is a huge, researched, growing
body of evidence that demonstrates the dynamic sacro-pelvic dysfunctions.
Dynamic ultrasound scanning is also providing hard evidence of what happens
during movement of any joint, not just the spine.
4. A choice of treatments
Sarah covers the times to mobilize
and the times to manipulate very well. There is now a lot of supporting
evidence for the possible mechanism of acupuncture, which does fit in
well with manual therapy techniques. It is obvious that Sarah doesn’t
use electrotherapy of any kind but these have been a mainstay of physiotherapy
for the best part of 100 years now and most of them have been superseded
by the development of the manual therapy techniques. Treatments such as
Interferential Therapy and Ultrasound have been shown to increase the
healing rate of tissues and serve to reduce the soreness that can be associated
with manipulation etc. While Sarah has every right to treat in her way,
prospective patients should not feel concerned if their local physiotherapist
uses electrotherapy as part of the whole programme.
Sarah also deals effectively with patients’
common fears about injections and operations.
5. Benefits of mobilisation and manipulation
It is so refreshing to find a publication
that clearly explains the differences between mobilizations and manipulation
in simple terms. The more our patients can understand about their condition
and treatments the better. The term manipulation is being misunderstood
by patients to mean any treatment that includes ‘hands on’.
6. Exercises for a back problem
As physiotherapists, we have our own
pet exercises, but they are designed to achieve the same result. The physiotherapy
skill is being able to put together a specific recipe for the individual
patient with their individual clinical condition. There is no universal
exercise ‘aspirin’ dose, but the exercises Sarah describes here are an
excellent basic series.
7. Sport and the back
There is always the question of which
sport is best, and Sarah deals with this aspect well. I must agree that
swimming is not the universal panacea, and there is a good discussion
about some of the most common sporting activities and their relative values.
8. Other factors that influence a back
problem
This chapter deals with a wide range
of other considerations which are common questions asked by patients,
from tension and depression to long distance travel.
9. Your other questions answered
This is the follow-on Q and A series
to cover those other aspects such as postural considerations to sex and
housework!
10. A daily self-treatment plan
Again this is a very good series of
activities to work to prevent back pain as well as maintain improvement
after treatment. Sarah includes my personal favourite – squatting, which
also links in with sacropelvic dysfunctions.
11. Back with optimism
There is great hope for back sufferers.
What is not generally understood is that the manual therapists who spend
virtually all their working lives treating people with back pain are the
real back specialists. They are like Olympic athletes in that every day
they are honing skills, learning new techniques and treatments for the
benefit of the patient. They are the specialists in joint dysfunctions
where the doctors are specialists in disease. Sarah has shown this clearly
and with this book, makes the case for the patient’s choice.
Sarah suggests that world-wide there is
a relatively small band of physiotherapists who specialize as manual therapists.
In the UK, there are over 3000 members of PhysioFirst (The Organisation
of Chartered Physiotherapists in Private Practice). Over 80% of these
members specialize as manual therapists. There are 2300 osteopaths and
1200 chiropractors. All this is before we consider the NHS – and waiting
lists.
As a small additional point, references
would have been a useful addition, as there are many people now who want
to look up research papers etc on the Internet. It also allows professionals
to source Sarah’s comments and explanations, and it gives recognition
and testament to the growing army of physiotherapy researchers who are
providing us the clinicians with the evidence that everyone demands.
About the Reviewer
Wendy Emberson MCSP SRP has been a
chartered physiotherapist for 28 years – the last 20 have been in independent
practice in Bishops Stortford, Hertfordshire, specializing in orthopaedic
medicine, manual therapy and Interferential Therapy. She is Public Relations
Officer for PhysioFirst; Tel: 01327 354441; www.physiofirst.org.uk
|
