Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management. J Dommerholt and P Huijbregts. Boston, MA: Jones and Bartlett Publishing; 2011. Soft cover, 294 pages, $53.95.
Both the authors are long-time experts in the field of orthopedic manual therapy, well-respected, and published. They have done an excellent job of pulling together the current knowledge in myofascial trigger points. The majority of this text is a collection of previously published articles and modifications of previously published articles or book chapters.
Several times in the text the authors point out that typical orthopedic manual therapy has not recognized myofascial dysfunction. In my teaching experience, I believe, most women's health physical therapists (PTs) do understand the importance of fascia. There seems to be a need for more research that might convince PTs that they should evaluate and treat myofascial dysfunction.
The text is divided into 4 parts: pathophysiology, diagnosis, management, and future research directions. Part 1 goes into exquisite detail about the chemical reactions thought to relate to the occurrence of trigger points. It also includes a very valuable update on the nutritional and metabolic factors in trigger points. Part 2 (diagnostics) looks at the reliability of palpation of trigger points. Management is reviewed in chapter 3 with a systematic review of noninvasive treatments and a section on dry needling.
This book is fully focused on the current evidence and research. This unfortunately means that there are more questions than answers. It is not a book on how to treat myofascial trigger points. I would suggest this book for all women's health PTs who use manual techniques to treat trigger points. We must understand the evidence and be able to apply it to patient treatments. It is extremely helpful to have all these papers in a clear order in one place.
Beth Shelly, PT, DPT, WCS, BCB-PMD, Moline, IL
Hold It Sister: The Confident Girl's Guide to a Leak Free Life (2nd ed). M. O'Dwyer. Queensland, Australia: RedSok Publishing; 2010. Soft cover, 175 pages, US $19.95.
This is a revised edition of the book My Pelvic Flaw first published in 2007. It is written for the general female population. The author's stated intention is to help women understand and deal with pelvic floor dysfunction. Ms O'Dwyer, a physiotherapist with more than 30 years of experience in women's health and a senior teaching fellow at Bond University, acknowledges that the book would be helpful to therapists who treat patients with pelvic floor muscles (PFM) dysfunction and indeed, she frequently indicates when the reader should seek PT assistance and guidance.
There are 37 short chapters that cover topics such as the nature of the pelvic floor dysfunction; instruction to find, control, and train the PFM; the role of proper pelvic stabilization as part of a pelvic floor rehab program; and pelvic floor dysfunctions throughout the lifespan. The book deals with incontinence; prolapse, prenatal/postpartum, and aging issues; and pelvic pain. The author includes short patient case scenarios that help the lay reader relate to and understand the information.
The author does an excellent job of explaining clearly how and when the pelvic floor functions, and the ramifications of weakness, pain, etc. Some of the instructions for finding the PFMs are a little confusing, but she provides a variety of ways to find the correct structures. There is also excellent practical advice on learning the correct way to do a PFM contraction, and then engaging the transversus abdominis without overflow or substitution. She also addresses the need for correct PFM relaxation. There are many practical hints that PTs can use with their patients such as correct toileting techniques and positions and postural changes that can influence PFM function.
The text is illustrated with line drawings that help the reader easily envision the anatomy and function of the pelvic floor area. Photographs illustrate pelvic stabilization exercises to use with PFM contractions in a variety of positions that show a reasonable and functional progression. Throughout the book, the author references 79 current sources of primary literature that support her statements. The last chapter entitled "Taking Action" includes a simple pelvic floor patient self "assessment" questionnaire, bladder and bowel diary forms, and a log for writing goals and plans for change. She also includes a short glossary of medical terms at the end of the book, although she explains most terms within the text of the various chapters.
I would definitely recommend this book both to my PT colleagues and patients. It is an excellent resource during and after PT is completed. The author offers a companion Web site that offers a blog and a newsletter for ongoing support and information.
Linda A Steiner, PT, DPT, MS, OCS, Boston, MA
Painful Yarns: Metaphors and Stories to Help Understand the Biology of Pain. G. Lorimer Moseley. Minneapolis, MN: OPTP Publishing; 2007. Soft cover, 113 pages, US $19.95.
Painful Yarns, by Lorimer Moseley, is a collection of short stories and metaphors to help patients gain a better understanding of the biology of pain. This book was created as a companion to Dr Moseley's first book, Explain Pain, which strives to educate clinicians and patients on the biological mechanisms of pain. Dr Moseley is a physiotherapist working at Oxford University in the UK, where he is Nuffield Medical Research Fellow in the Department of Physiology. Dr Moseley has a PhD in Pain Science from the University of Sydney, Australia, and his high-quality research has been published in many peer-reviewed clinical and basic science journals.
This humorous, easy-to-read collection of stories is divided into 11 chapters, each telling a short story that helps illustrate a component of pain. The wording Dr Moseley uses throughout this book is candid and casual, making this book an easy read. Of note, there is occasional foul language in his writing, which may be offensive to some readers. The illustrations in each chapter include photographs and sketches that support the stories he tells. His concepts are research-based, but he lists only 6 references. An additional reading list is provided at the end of the book for those wanting further information regarding the science of pain. Overall, Dr Moseley has an excellent way of writing to keep a reader's attention and will have you laughing out loud as you are reading his stories.
He uses down-to-earth stories of cars, thirst, snakebites, traumatic injuries, fast-food restaurants, and music that make it easy for patients to identify with. Concepts include the role nociception plays in informing people of threat to their bodies, the role previous experience and beliefs play, and the impact chronic pain can have on a person over time.
I especially loved his chapter titled, "Seeing is Believing," in which he uses optical illusions to demonstrate how perception of pain is outside conscious awareness. In this chapter, he takes well-known optical illusions, such as lines of the same length with opposite arrows on the end that make it look different or shaded pictures that are really the same color, and explains how the brain gives meaning to the sensation of vision to create conscious awareness of the image seen. Making the point that vision (and nociception) can be interpreted differently, I was impressed at the way in which he breaks down complex concepts into simple stories that can improve understanding of both patients and clinicians alike.
Both Explain Pain and Painful Yarns are invaluable to clinicians who treat patients with chronic pain. Personally, I have used stories from Painful Yarns to help my patients with chronic pelvic pain and fibromyalgia better understand the biology of pain and have found it to be an excellent adjunct to treatment. Overall, I strongly recommend Painful Yarns as a resource to both PTs and other health care providers.
Jessica N. Powley, PT, DPT, Greenville, SC
Walk Tall!! An Exercise Program for the Prevention and Treatment of Back Pain, Osteoporosis and the Postural Changes of Aging (2nd ed). Sara Meeks. Gainesville, FL: Triad Publishing Company; 2010. Spiral-bound paperback, 160 pages and 130 drawings, $24.95.
Sara Meeks, PT, MS, GCS is a PT who has worked with patients who have low bone mass for over 25 years. She is a geriatric-certified specialist and founder of the Special Interest Group on Osteoporosis of the Section on Geriatrics. She was also the 2001 recipient of the Award for Excellence in Clinical Practice. She has been teaching PTs about osteoporosis treatment for many years.
Walk Tall!! is written for the general public to use as a home-based exercise program but can also be an excellent resource for PTs in the clinic. This book can help individuals gain an understanding of appropriate exercises as well as extensive tips for daily living to reduce stress on the spine and reduce the chance of sustaining a fracture. Exercise principles to protect the spine and improve core musculature are well-supported by referenced literature.
Multiple pictures throughout the book help the reader understand correct techniques to maximize benefits of the exercises. The pictures are simple, yet complete, often showing the start and end position for an exercise. The pictures on the "core strengthening" page are helpful to cue the correct actions of isometric abdominal strengthening using arrows to indicate the direction of muscle contraction. The addition of similar pictures for the "pelvic floor exercises" would greatly enhance understanding of these particular isometric exercises.
Suggested routines help individuals choose to work toward a particular goal or in a specific situation, including the following: A. M. Waker-Upper, Around the House or Office Break, Core, Arm/Leg Strengtheners, Back Strengtheners, Flexibility, Wall Exercises, On the Airplane (seated, standing), and In the Car (driver, passenger, at rest stop).
The author includes several sections to explain functional ways to prevent unnecessary stress on the spine including Weight-Bearing Exercise, Safer Sitting, Breathing and Relaxation, and Balance. The Weight-Bearing section mostly discusses walking, treadmills, stair steppers, ellipticals, and other activities. Ms Meeks recommends walking as one of the best weight-bearing activities to improve bone health and explains how to improve the effectiveness of walking for exercise.
Finally, a section of Activities of Daily Living like carrying and housework is included as well as several other specific suggestions one can apply to functional movements around the house. Walk Tall!! second edition is an excellent resource that is applicable to daily life.
Meghan Swenck, PT, Richmond, VA