Positive Health Online

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 basicsAgain, 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 problemThis 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 treatmentsSarah 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 manipulationIt 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 problemAs 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 backThere 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 problemThis 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 answeredThis 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 planAgain 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 optimismThere 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 ReviewerWendy 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