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Physical therapies in sport and exercise
  1. D B Kenneally

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    Edited by G S Kolt, L Snyder-Mackler. Published by Churchill Livingstone, 2003, £60.00, hardcover, pp 623. ISBN 0443071543

    Physical therapies in sports and exercise, as the name suggests, is sports medicine from a physical therapy perspective. As with all of these types of book, it tries to cover everything, draws on clinicians and researchers from around the globe, and succeeds well in giving a general guide. It is a mix of strong and concise anatomical review, general concepts within sports and exercise, regional injury management, other active groups, and a section on medical issues.

    The editors make the point early on that there is a dearth of evidence for the techniques and approaches we use in physical therapies within sport. The stated aim is to “provide a logical approach to the management of sport and exercise injuries that considers the available evidence for the efficacy of a variety of management approaches.” This book tries to use supporting evidence to develop the ideas presented, but despite this, often draws on the anecdotal clinical experience of the authors. How else would they get the notion that short runners tend to overstride (p 250)? If the book had stuck to the stated aim of evidence based statements, we would only have a book half the size and a lot more short athletes with facet joint problems.

    This approach is demonstrated beautifully in the chapter on patellofemoral pain syndrome (PFPS). Sections outlining the theory, evidence, and practice of this condition provide a well structured layout. The authors of this chapter are able, in this way, to present the anecdotal evidence, the clinical findings, and acknowledge where further research needs to be done. It highlights that the evidence based techniques we now use for PFPS are the same techniques we used in our clinics 5–10 years ago which were then not evidence based! Without wishing to delve too much into the debate of “evidence based sports medicine”, I found that this chapter, in general, rides the line well between providing the evidence for the management and acknowledging that other areas used within the overall program need to be further investigated.

    There was quite a discrepancy in the layout and structure of the other chapters. It was difficult to know the focus. The clinician looking for prescriptive rehabilitation techniques and programmes would do well to look in the elbow chapter, but if looking for similar protocols for hamstring injuries, the clinician would be disappointed.

    Similarly, the amount of space allocated to a region was inconsistent, and this was probably due to how much evidence was available or the interest/knowledge of the author. Whereas there were 20 pages devoted to patellofemoral joint pain, there was a page and a half on groin pain in its entirety, including just a few paragraphs on osteitis pubis. The multifactorial nature of hamstring pain and the management of this condition were given cursory consideration, despite the fact that these conditions often present the biggest challenge to the practitioner.

    The last chapter makes an interesting read and attempts valiantly to roll years of academic and clinical sports physician training into a few short pages. Within sports medicine, it is all too easy to get caught up in addressing the musculoskeletal issues, and forget the impact of common (and not so common) medical issues on the elite athlete. As primary contact practitioners, we have to ensure we have a strong multidisciplinary team around us. I would have liked to see a bit more attention paid to the multidisciplinary team and the physical therapists role within it.

    There is some really useful information and up to date evidence based thinking within this text. For the primary clinician on the field of play, however, to rely on the knowledge in this book as the sum total of his/her arsenal would be to be left wanting. On balance, I can recommend Physical therapies in sport and exercise as an invaluable adjunct to the sports clinician’s library.

    Analysis

    • Presentation 17/20

    • Comprehensiveness 14/20

    • Readability 18/20

    • Relevance 18/20

    • Evidence basis 16/20

    • Total 83/100

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