Lower back pain is taken seriously as a disease symptom by this in-depth medical treatise.
Fernando and Nelson, both professors and specialists in physical therapy, decry a tendency to treat lower back pain as a nonspecific catchall, psychological problem or malingerer’s crutch; they insist that it arises from specific disorders affecting the lumbar vertebrae and that precise diagnosis and targeted therapies are required to effectively treat it. Their thorough, scientifically grounded account starts with an extensive discussion of the anatomy of the lumbar and sacral vertebrae, the shock-absorbing cartilage disks between them, the spinal nerves they protect and the muscles and ligaments—including abdominal muscles—that stabilize the spinal column. They then describe the mechanical processes that can weaken, damage or displace these structures to cause back pain. The latter part of the book comprises a manual for diagnosing pathological conditions, from strains and sprains in muscles and ligaments to damaged and herniated disks and spondylolisthesis. The guide includes detailed instructions, complete with diagrams, on taking patient histories and performing physical exams, as well as tables of key symptoms that permit differential diagnoses. The authors’ conservative treatment approach shies away from surgery in most cases and focuses on noninvasive physical therapies, including heat and icing, exercises, therapeutic positions and traction to relieve disk pressure and nerve compression, along with a few higher-tech therapies like ultrasound, laser therapy and the application of mild electric currents. Stuffed with charts, statistics, citations from medical literature and Latinate terminology, this book is for medical professionals, not self-treating laypeople. The authors address controversies forthrightly and take strong stands against the McKenzie technique and various diagnostic protocols that they regard as inadequate; they issue an “urgent plea” against the use of therapy balls to treat spinal instabilities. Despite the low production values—sketchy line drawings instead of color illustrations—and loose organization of the book, doctors and therapists will find here a clear-headed, comprehensive guide to evaluating and treating the millions of patients who suffer from lumbar ailments.
A useful primer for medical practitioners that dispels the mystery surrounding back pain.