Physiotherapy March 2001/vol 87/no 3

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Physio-Tek Ltd, 57 High Street, Rode, Bath, SomersetBA3 6PB2000. Illus. Video 90 min, manual 106 pages

By Jenny Conway £125 including postageThis is the author’s first venture into open learning materialpublication which is never an easy task and The Spine is thefirst in a planned series of learning packages designed forboth physiotherapists and student physiotherapists.

The author herself is an experienced musculoskeletalphysiotherapist and is to be congratulated on developingsuch a package which has potential for future developmentas a learning medium in the discipline. The author is praisedfor the professional appearance of the package (the text andthe video are contained in purpose-developed ring-binderpackaging for ease of use).

As an open learning package, the style is appropriate withconsiderable white space, the dialogue written in the secondperson, the use of bullets to highlight important points, and icons to indicate when readers should refer to videomaterial. Missing from the text however is an introductionon how to use the package. This could be viewed as a missedopportunity.

The package aims to bridge the gap between the formallearning setting, ie postgraduate teaching courses, and theindividual’s clinical setting. As such it offers attractive writtenand video material. The video is technically well producedand techniques included are clearly demonstratedthroughout, though on occasions the operator positioncould have been improved. The video is interspersed withaccompanying graphics and music which complement the package well.

The text itself consists of 15 sections covered in just over100 pages. These sections cover an introduction to theexamination, the subjective examination, planning theobjective examination, the objective examination, initialtreatment plan. These sections are unsupported by videomaterial. Then follows a series of sections which areregionally oriented; the cervical spine, vertebral arterytesting, thoracic and lumbar spines, the sacroiliac joints,neurodynamic examination, the abdominals and homeexercises, which are all supported by video footage. The lasttwo sections are devoted to posture and spinal syndromes.

In terms of content the fact that such a large number oftopics are covered in just over 100 pages indicates that thetext should be largely regarded as a manual. As such thereare a number of obvious omissions in some sections.

The majority of the package is unreferenced although atwo-page reference list forms the last section of the text.Some references which appear in the text do not appear in

the reference list and vice versa. Because of the lack ofreferencing it would be difficult for uninitiated readers toknow where to go to increase their depth of knowledge interms of primary texts and key papers in the field.

The regional sections, for example the cervical spine,make brief reference to the anatomy of the region, offer asmall paragraph on the symptoms and then proceed todescribe in outline the objective/physical examination,including range of movements, testing, overpressures,quadrants, neurological testing, palpation, accessorymovements and passive physiological movements. Thesection on the sacroiliac joint however is more complex andincludes also a range of treatment techniques. Thereforethere is some variation in continuity in terms of contentwithin the regional sections. In the main the package isprescriptive and does not promote the use of broad-basedexamination and treatment principles.

The stated aim of ‘the course’ is to identify an effectivetreatment plan for spinal patients and to create an awarenessof reflective practice and the importance of clinicalreasoning. It is our opinion that these aims are not achieved.

Throughout the examination sections of the spine bothactive movements with overpressure and neurodynamic testsmake no reference to the requirement of the therapist to identify the patient’s pain response, which could bepotentially harmful and misses an important aim of mostclinical examinations

The section on home exercises contains a list of exercisessupported by video footage as to how they should be carriedout. What is missing from the video-supported sections is anexplanation as to why certain techniques might or might notbe used. This could be a missed opportunity in terms ofdeveloping clinical reasoning skills.

The video footage supporting all sections is very wellproduced and readers will find the video useful as areminder of how examination techniques can be applied.There are however one or two places where theoperator/patient position could have been modified toenhance effectiveness.

The sections on posture and syndromes are unsupportedby video material and are very brief. They do however offera survival pack for physiotherapists who have already hadsome induction into these areas.

The package may be useful to those physiotherapists whohave already attended a specific course in the area and whohave been thoroughly inducted into the main conceptualphilosophies within the discipline for revision of basictechniques. We cannot recommend the package for use byundergraduate students.

Ann Moore PhD GradDipPhys FCSP DipTP CertEd MMACP

Nikki Petty MSc MCSP GradDipManTher MMACP

The SpineVideo and manual package

Video review