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Preventing back pain at work
Clinical Biomechanics
1989; 4: 126-127
Book reviews Diagnosing musculoskeletal
problems
Fredk G Lippert III and Carol C Teitz
Williams&Wilkins, USA, 1987,15Spp, f16 This 155page paperback aims to improve readers’ skills in diagnosing musculoskeletal problems, using clinical problem solving strategies. The introductory chapter sets out the philosophy of problem solving and introduces the reader to the six cognitive levels and their respective intellectual activities as adapted from Blooms Taxonomy of Education Objectives (1956). Subsequent chapters consist of exercises relating to a specific symptom followed by a number of case histories. The examples taken are hip pain, the red, warm and swollen knee, leg pain, ankle pain, foot pain, low back pain, shoulder pain, elbow pain and hand tingling/numbness. The history, physical examination and laboratory finding of each presenting symptom is given, followed by a number of questions that guide the student through the problem solving process. This is followed by a discussion of the same history, in which the key information is given in bold type followed by an explanation of its relevance in coming to a definitive diagnosis. Each chapter aiso contains a table showing a number of diagnoses which present with the symptom under discussion and giving the key findings. key tests, natural history if untreated, treatment and expected outcome with treatment. The authors state that the clinician must have a working knowledge of both the diagnostic and treatment process; the emphasis in this book is on developing expertise in the diagnostic part of the problem solving process. The book is aimed at helping the student rather than the experienced clinician reach a definitive diagnosis. It introduces concepts such as vectoring and pattern recognition; methods which most experienced clinicians will already have developed in their approach to diagnosis. The clinical problem solving approach has only relatively recently become accepted in the health educational sphere, although the concept has been around for many years. It is an approach suited to the field of medicine, and for those readers who are not familiar with the concept this book is a good one with which to start. It is not intended to be a profound thesis on medical diagnosis; it is clearly what it says it is-a practical guide to diagnosing musculoskeletal problems. As such, it is well worth reading. However, beware: it falls to pieces very easily. C EO’D The lumbar spine and back pain edited by MIV Jayson
Churchill Livingstone, UK, 1987,3rd edn. 463pp, f65 When a biomedical book reaches its third edition, it is not uncommon to find that little has changed since the previous version(s). This is only acceptable if the subject under consideration is fully explored and understood; clearly this is not the case for back trouble. Happily, the third edition of Malcolm Jayson’s collection is not simply a minor ‘editing’ of an earlier edition, but is more or less a new book. In a developing field researchers appear with new ideas and approaches whilst others retire from the arena, though some respected authorities remain to guide, as it were, the course of scientific endeavour. The list of contributors to the present edition (some 35 in all) displays many familiar names in the field, but also recognizes the contribution of a number of workers not featured in previous editions. 0 1989 Butterworth & Co (Publishers) Ltd 0268XNJ33/89/020126-02 $03.00
The format is as before, a collection of invited review papers intended to cover the major aspects of the problem of low back trouble. To a large extent it succeeds admirably, though some aspects of the field are inadequately discussed; an inevitable consequence of invited monographs, perhaps. However, of interest to readers of this journal is the greatly increased representation of biomechanics and an obvious desire to recognize the contribution to our understanding of low back trouble made by workers in this field. The book is particularly well produced, though the Vancouver style of references (sequential numbering in the text) may not be appropriate in a book which will, for many, be a reference volume; one chapter, by Barry Wyke, overcomes this problem by providing an alphabetical bibliography-could not the publishers repeat this for all chapters in future editions? The major advantage of the book is its multidisciplinary approach. No matter how dedicated, the average researcher simply cannot keep pace with the important developments outside his particular sphere, and the busy clinician is at even greater disadvantage. A book, because of its gestation period, is necessarily somewhat out of date on publication, but this one provides what is probably the most comprehensive picture of contemporary knowledge and opinion in the field of low back trouble. This edition should be seen as a replacement, and really should occupy the shelves of any clinician or scientist in this complex and challenging field. KB Preventing back pain at work E M Bunker and J O’Sullivan
Ergonomics Applied, The National Safety Council of Australia, Queensland Division. 1987, 81 pp. $14.95 This book differs from the majority of books dealing with back pain as it points out different working environments and their ergonomic impact on back pain. The book is divided into three chapters and four appendices are added. Each chapter is sub-divided into well illustrated sections. The references should be very useful for more in-depth studies. Chapter 1 deals with origin of pain and explains in a very clear way the anatomy of the trunk, pain biomechanics and back pain. It also points out psychosomatic pain as a cause of back pain. Chapter 11 describes causes of back pain in different workplaces (due to posture and movements) in well illustrated pictures. Chapter III gives some useful guidelines for the prevention strategies and stresses the importance of imposing those aspects of, for example, the work environment which might otherwise contribute to the risk of back pain. Appendix I shows an anthropometric table. whilst Appendices II and III stress the importance of fitness and give good advice on exercises starting with ‘on the job warm-ups’ to useful pain relief exercises. In Appendix IV, the manual handling audit supplies the reader with a very good checklist on how to analyse a specific task. This book describes very clearly the cause of back pain and how it could be prevented by using an ergonomic approach. It is highly recommended to those who have a responsibility for teaching or advising in this area, i.e. occupational health units, and to those back pain sufferers who wish to take a more active interest in preventing further episodes. This book has been produced as a significant component of the Queensland Industrial Ergonomic Project, which is partly funded by the Workers’ Compensation Board of Queensland. PB
1989; 4: 126-127
Book reviews Diagnosing musculoskeletal
problems
Fredk G Lippert III and Carol C Teitz
Williams&Wilkins, USA, 1987,15Spp, f16 This 155page paperback aims to improve readers’ skills in diagnosing musculoskeletal problems, using clinical problem solving strategies. The introductory chapter sets out the philosophy of problem solving and introduces the reader to the six cognitive levels and their respective intellectual activities as adapted from Blooms Taxonomy of Education Objectives (1956). Subsequent chapters consist of exercises relating to a specific symptom followed by a number of case histories. The examples taken are hip pain, the red, warm and swollen knee, leg pain, ankle pain, foot pain, low back pain, shoulder pain, elbow pain and hand tingling/numbness. The history, physical examination and laboratory finding of each presenting symptom is given, followed by a number of questions that guide the student through the problem solving process. This is followed by a discussion of the same history, in which the key information is given in bold type followed by an explanation of its relevance in coming to a definitive diagnosis. Each chapter aiso contains a table showing a number of diagnoses which present with the symptom under discussion and giving the key findings. key tests, natural history if untreated, treatment and expected outcome with treatment. The authors state that the clinician must have a working knowledge of both the diagnostic and treatment process; the emphasis in this book is on developing expertise in the diagnostic part of the problem solving process. The book is aimed at helping the student rather than the experienced clinician reach a definitive diagnosis. It introduces concepts such as vectoring and pattern recognition; methods which most experienced clinicians will already have developed in their approach to diagnosis. The clinical problem solving approach has only relatively recently become accepted in the health educational sphere, although the concept has been around for many years. It is an approach suited to the field of medicine, and for those readers who are not familiar with the concept this book is a good one with which to start. It is not intended to be a profound thesis on medical diagnosis; it is clearly what it says it is-a practical guide to diagnosing musculoskeletal problems. As such, it is well worth reading. However, beware: it falls to pieces very easily. C EO’D The lumbar spine and back pain edited by MIV Jayson
Churchill Livingstone, UK, 1987,3rd edn. 463pp, f65 When a biomedical book reaches its third edition, it is not uncommon to find that little has changed since the previous version(s). This is only acceptable if the subject under consideration is fully explored and understood; clearly this is not the case for back trouble. Happily, the third edition of Malcolm Jayson’s collection is not simply a minor ‘editing’ of an earlier edition, but is more or less a new book. In a developing field researchers appear with new ideas and approaches whilst others retire from the arena, though some respected authorities remain to guide, as it were, the course of scientific endeavour. The list of contributors to the present edition (some 35 in all) displays many familiar names in the field, but also recognizes the contribution of a number of workers not featured in previous editions. 0 1989 Butterworth & Co (Publishers) Ltd 0268XNJ33/89/020126-02 $03.00
The format is as before, a collection of invited review papers intended to cover the major aspects of the problem of low back trouble. To a large extent it succeeds admirably, though some aspects of the field are inadequately discussed; an inevitable consequence of invited monographs, perhaps. However, of interest to readers of this journal is the greatly increased representation of biomechanics and an obvious desire to recognize the contribution to our understanding of low back trouble made by workers in this field. The book is particularly well produced, though the Vancouver style of references (sequential numbering in the text) may not be appropriate in a book which will, for many, be a reference volume; one chapter, by Barry Wyke, overcomes this problem by providing an alphabetical bibliography-could not the publishers repeat this for all chapters in future editions? The major advantage of the book is its multidisciplinary approach. No matter how dedicated, the average researcher simply cannot keep pace with the important developments outside his particular sphere, and the busy clinician is at even greater disadvantage. A book, because of its gestation period, is necessarily somewhat out of date on publication, but this one provides what is probably the most comprehensive picture of contemporary knowledge and opinion in the field of low back trouble. This edition should be seen as a replacement, and really should occupy the shelves of any clinician or scientist in this complex and challenging field. KB Preventing back pain at work E M Bunker and J O’Sullivan
Ergonomics Applied, The National Safety Council of Australia, Queensland Division. 1987, 81 pp. $14.95 This book differs from the majority of books dealing with back pain as it points out different working environments and their ergonomic impact on back pain. The book is divided into three chapters and four appendices are added. Each chapter is sub-divided into well illustrated sections. The references should be very useful for more in-depth studies. Chapter 1 deals with origin of pain and explains in a very clear way the anatomy of the trunk, pain biomechanics and back pain. It also points out psychosomatic pain as a cause of back pain. Chapter 11 describes causes of back pain in different workplaces (due to posture and movements) in well illustrated pictures. Chapter III gives some useful guidelines for the prevention strategies and stresses the importance of imposing those aspects of, for example, the work environment which might otherwise contribute to the risk of back pain. Appendix I shows an anthropometric table. whilst Appendices II and III stress the importance of fitness and give good advice on exercises starting with ‘on the job warm-ups’ to useful pain relief exercises. In Appendix IV, the manual handling audit supplies the reader with a very good checklist on how to analyse a specific task. This book describes very clearly the cause of back pain and how it could be prevented by using an ergonomic approach. It is highly recommended to those who have a responsibility for teaching or advising in this area, i.e. occupational health units, and to those back pain sufferers who wish to take a more active interest in preventing further episodes. This book has been produced as a significant component of the Queensland Industrial Ergonomic Project, which is partly funded by the Workers’ Compensation Board of Queensland. PB