Rehabilitation of the Spine: A Practitioner's Manual [Hardcover]

This is one of the most comprehensive texts for rehabilitation of the spine I have seen in over 10 years of practice. As a physical therapist, I've learned that spine rehabilitation requires a broad knowledge of techniques, since every spine patient is different. The modern practitioner needs to have an ecelctic approach to rehabilitation since no 2 patients are alike, even with the same diagnosis. Dr. Liebenson has done a great job in providing the scientific and clinical application of a variety of spine rehabilitation principles with a multidisciplinary approach including a virtual "who's who" of physicians, chiropractors, physical therapists, and researchers from around the world. Of particular interest to me is the Czech approach to spinal rehabilitation based on contributions from legendary physicians Vladimir Janda and Karel Lewit. Top researchers including Bogduk, McGill, and Hodges also present the latest evidence-based interventions. I was quite pleased to see the amount of photographs and diagrams illustrating specific techniques and exercises, which is even further enhanced with videos on the enclosed DVD. Long gone (I hope) are the days of "hot packs, ultrasound and massage" as the treatment of choice for low back pain. We know that exercise is the most important component in back rehabilitation, but we must first be able to accurately assess the patient and prepare the tissues for exercise programs specific to the patient needs and goals. Dr. Liebenson and his contributors have given us the tools do do just that... they have captured a virtual paradigm shift in the way we approach the assessment and rehabilitation of the spine. I highly recommend this textbook for any healthcare professional treating spine patients.

Liebenson, Craig. Rehabilitation of the Spine: A Practitioner's Manual, 2nd edition. 2007.

By Ron LeFebvre, DC, Dean of Clinical Education, Western States Chiropractic College.

Because busy practitioners often rapidly skim articles, especially book reviews, let me start with the bottom line. Dr. Liebenson's second edition of Rehabilitation of the Spine is a "must" book. Any practitioner or student interested in physical rehabilitation of the spine must own and must read this book. The contributing authors represent an impressive array of some of the most notable experts across multiple disciplines, including Nikolai Bogduk, Paul Hodges, Vladimir Janda, Gwendolen Jull, Karel Lewit, Steven Linton, Stuart McGill, Robin McKenzie, Don Murphy, Vert Mooney, John Triano, and Howard Vernon. The cast is much larger yet, is international in reach, and represents some of the most important schools of thought in rehabilitation today. The second edition significantly improves upon the first, which was itself, a watershed document. Every chapter has been re-written and updated. The basic science chapters offer an exceptional overview for the clinical practitioner of what we have learned about the mechanics of the spine over the last 10 years. It re-establishes the foundation upon which so much of our practical rehabilitation lies. It also gives us a lens through which to judge both old and new approaches and techniques. But above all, this is a practitioner's manual, replete with a level of detail that is essential for actual application. In many of the chapters, one can almost hear the voice of an experienced workshop instructor correcting common errors in technique and imparting expert advice. The inclusion of the DVD-ROM is a huge leap forward, taking a lot of the guesswork out of trying to interpret what is written on the printed page. It also has the potential to standardize at least some procedures across multiple disciplines. This could have positive implications for co-treatment within or across professions and could provide a common therapeutic and assessment language for research.

The lay out of the book re-enforces the clinical strategy espoused, having sections devoted first to assessment, then the first 4 weeks of acute care, followed by later recovery care. Then the whole strategy is again re-packaged by region.

Having a keen interest in the field myself, I specifically perused the book for a few specific "bell weather" indicators. I was pleased to see a chapter devoted to manipulation of the spine, an omission which I thought was a weakness in the first edition. For those steeped in some of the current controversies in lumbar stabilization, I found it very interesting to compare the arguments posited by McGill and Hodges regarding the relative value of teaching patients to perform abdominal bracing versus abdominal hollowing. I was pleased to see that the simple and elegant three question Patient Specific Functional Scale was contained in the chapter on Outcome Assessment. And that DeFranca's section on pre-manipulation procedures for the cervical spine abandoned the recommendation to perform DeKleyn's maneuver and or any other extreme positioning of the neck--procedures which have a good sold base of evidence holding them to be worthless. I also noted that Janda's interpretation of the muscle firing pattern associated with hip extension has been abandoned (because of subsequent research findings).

The book also has welcome additions in the arena a neuromobilization, a much improved chapter on breathing, and many interesting additions from the Czech school of rehabilitation. Although not all of these schools of thought work together in complete harmony and although there are often significant differences in practical application, Dr. Liebenson has a real knack for organizing them into a coherent organization that suggests more agreement than disagreement in their overall strategies. The three great strategic pillars support the grand "unifying theory" behind the manual: a variety of approaches to hands-on manual therapy, specific low tech exercise prescription, and focused activity modification for the patient.

--- Note: This review is for the 2nd edition only. ---

Craig Liebenson has accomplished a monumental task with this 972 page tome that covers back rehab from A to Z. In the first 90 pages he exhaustively covers the back pain rehab literature with a special focus on Low Back Pain (LBN.) With 100's of references per chapter, (279 for Chapter One alone!) he convincingly shows the failure of conventional approaches and the new hope for LBN sufferers offered by the latest soft tissue techniques combined with patient reeducation and exercise prescription.

Then he turns the book over to a host of guest experts including Stuart McGill and the Czech pioneers Vladimir Janda and Karel Lewit. They fully cover assessment and treatment for acute and chronic recovery management of back pain with multiple soft tissue modalities fully explained.

This is $100 bucks extremely well spent. If you're a back pain professional who wants to see patients get out of pain, you can't afford not to buy this book.

Chronic back pain CAN be resolved. But only if you're willing to learn something new. This is a GREAT place to start!