THE PELVIC GIRDLE, 3rd edition
Review by Peter Huijbregts, editor for the Journal of Manual & Manipulative Therapy
Since the second edition of this book appeared in 1999, there has been a staggering amount of research related to the lumbopelvic region, most notably on the function of the local and global lumbopelvic stabilizing muscle systems. With this third edition, Diane Lee (with contributions by Linda-Joy Lee, Jackie Whittaker, and Jim Meadows) has succeeded in summarizing and integrating this new material into a comprehensive and clinically useful approach to the examination, evaluation, and management of patients with lumbopelvic and hip region dysfunction.
This book consists of ten chapters, of which chapters five to ten are brand new to this edition. Chapter one is a brief history of the development of our knowledge of anatomy, biomechanics, and dysfunction of the pelvic girdle. Chapter two discusses pelvic girdle comparative anatomy and phylogenesis. Chapter three describes the ontogenesis of the sacroiliac joint and pubic symphysis from the embryo to the elderly. Chapter four discusses relevant soft tissue and bony anatomy. Chapter five introduces the integrated model of function with a discussion of the role that form and force closure, motor control, and emotions play in (dys) function of the lumbopelvic-hip region. It is this model upon which the evaluation and management approach discussed in this book is based. Chapter six discusses the biomechanics of both the relevant individual joints and of all those joints integrated within the lumbopelvic-hip complex with a separate discussion of lifting and the effects of pregnancy. Chapter seven addresses the topics of pain, dysfunction, disability, and soft-tissue healing. Chapter eight introduces a comprehensive examination format with brief attention to the subjective examination and an extensive description of objective examination tests and real-time ultrasound imaging. Chapter nine introduces a classification model useful for the clinical diagnosis of lumbopelvic-hip dysfunction. Chapter ten is the largest chapter of this book. It describes the management approach for patients with lumbopelvic-hip dysfunction based on the integrated model of function with detailed descriptions of joint mobilization and manipulation techniques, mobilizing home exercises, the use of sacroiliac belts and taping, indications for prolotherapy referral, dry needling of hyperactive global muscles, and exercise intervention and progression. The description of exercise intervention and progression with the extensive use of imagery and manual cueing to increase mind-body awareness is reminiscent of the Feldenkrais approach and is certainly a unique and worthwhile addition to this third edition.
The 280 line drawings, imaging studies, and photographs enhance the text and make the at times complex concepts better to understand. The book is extremely well referenced with very up-to-date referencing throughout. Where available, research references are provided on reliability and validity of the diagnostic tests described. Of course, as the author admits, in many areas research evidence is as of yet lacking. The author has successfully integrated clinician expertise, pathophysiologic and pathobiomechanical rationale, and relevant research evidence consistent with the currently predominant evidence-based practice paradigm. In my opinion, this text provides the most comprehensive and research-based approach available to evaluation and management of patients with lumbopelvic-hip dysfunction and, therefore, this text will likely be of great interest to any clinician providing care for this patient population.
Peter Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT
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