The Pelvic Girdle: An Integration of Clinical Expertise and Research, 4th edition. D. Lee with L. J. Lee. New York: Churchill Livingston; 2011. Hard cover, 434 pages, $90.00.
Diane Lee has done an outstanding and meticulously comprehensive job of pulling together the current research in the area of musculoskeletal pelvic function and dysfunction. The fourth edition is almost twice as long as the third edition and includes an online resource with more than 240 video clips of Diane and Linda Joy Lee performing and narrating the tests and treatments.
The text begins with a 1-page historical perspective. However, the Web site has much more about this. Chapter 2 addresses myths and facts about the pelvic girdle and is similar with only a small amount in the text. The Web site answers 6 very common questions (like "can we reliably detect motion at the sacroiliac joint?") with a significant amount of research evidence. As in previous editions there is a great deal of detail on anatomy and normal functional movement of the pelvic structures. The author notes that chapters 4 and 5 (normal and abnormal function) were the most difficult to update as there is much confusion and conflict in the current literature. The text is very clear on the lack of research and the difficulty in interpreting the research we have to make it relevant for clinical use. Specific issues of pregnancy are covered in chapter 6.
Chapter 7 addresses the issue of pain origin, influences to pain, and clinical predicative rules. Assessment of lumbopelvic-hip complex is covered in chapter 8 (81 pages). Treatment is covered in chapters 9 to 12 (153 pages). Treatment is divided into several categories: clinical reasoning and treatment planning, releasing and relaxing structures, facilitating and strengthening muscles, training posture, and movement. These sections are supported by video clips on the Web site.
Case studies are used to demonstrate clinical reasoning including a case study of a postpartum woman with pelvic girdle pain and urinary incontinence. The anatomy, function, and dysfunction of the pelvic floor muscle are very well covered throughout the text. However, the assessment and treatment techniques in this book are all external. The ischiococcygeus/coccygeus muscle is listed as 1 of 4 muscles that can compress the sacroiliac joint when hypertonic (no reference given). Dry needling of posterior pelvic floor and deep hip rotators (and many other muscles) is described. Assessment of the pelvic floor is performed by imaging ultrasound only, although there is 1 note that internal assessment and treatment may be helpful. Normalizing pelvic floor muscle activation is completed with the imaging ultrasound, and good instructions are given on how to help the patient learn the proper contraction and relaxation. Very little attention is given to the actual exercise program. Referral to a specialized therapist is suggested.
The text is very well referenced and well organized. It is impossible to convey in a short book review the immense detail and complexity of this text. Along with a good text on evidence-based pelvic floor assessment and treatment, it is a must for all physical therapists who treat patients with pelvic floor problems (even if you have a previous version).
Beth Shelly, PT, DPT, WCS, BCB-PMD
Moline, Illinois