'Essential reading': Nick Worth on 'A Practical Approach to Musculoskeletal Medicine' (5th edition)

A Practical Approach to Musculoskeletal Medicine: Assessment, diagnosis and treatment

Authors: Elaine Atkins, Emily Goodlad and Sharon Chan-Braddock

Edition: Fifth

Publisher: Elsevier

ISBN: 9780702084089 (paperback); eBook ISBN: 9780702084096

This book is the fifth edition of the well-established and excellent text that accompanies the Society of Musculoskeletal Medicine (SOMM) foundation and advanced module courses.

The book and the courses offered by SOMM build on the work of Dr James Cyriax. The original concepts of the ‘Cyriax’ method of examination and treatment are still evident but combined with modern philosophies and research that have evolved in recent years.

This new edition brings some interesting new concepts to the book and updates that reflects the changing nature of musculoskeletal medicine within the UK. It will have a familiar feel to those who have read a previous edition but the addition of many colour photographs does improve the readability and details some of the areas where confusion has been regarding techniques or a particular therapist's handling positions.

While not unique to this new edition, there are online resources that can be accessed via a code within the book to enhance the learning. These include tests to assess knowledge and videos that demonstrate specific techniques outlined in the book.

Other new aspects are the case studies that appear periodically throughout the text. These help with putting the theory into a practical context that the reader can assess their understanding of the concepts described.

Criticism often levied at the ‘Cyriax’ method of examination and treatment is that is simplistic and based around transverse friction massage and injection therapy. I feel that, personally, some of this criticism is reasonable, but the new edition of this book tries to evolve from this by adding in updated references and description of rehabilitation ideas. The principles contained in this text are still logical and can form the firm basis on which a therapist can add in their own personal experiences and knowledge to complement the method of musculoskeletal (MSK) assessment and treatment.

In the current world of first contact practitioners and advanced practice, this text is essential reading as the assessment and diagnosis methods lend themselves to time-limited appointments within primary care

Developing a 'clear diagnosis'

The SOMM method of assessment and development of a diagnosis is still its main strength. It forms a logical pathway to follow through a subjective and objective assessment that is eliminatory in its nature. Every question is included for a reason and every objective test leads the therapist a little further down a pathway to arriving at a clear diagnosis.

While the treatment options within the book are straightforward and clear, an area for consideration would be the development of rehabilitation exercises to demonstrate the journey from injury, through assessment and treatment towards full recovery.

There remains an ongoing debate about manual therapy and the use of steroid injections in musculoskeletal medicine and the authors discuss the controversies, giving a balanced opinion and attempt to back these up with current evidence and research. The debate will continue to rage with proponents for and against manual therapy and injection therapy choosing to accept or reject research to reaffirm their own opinion. This particular controversy looks likely to rumble on for the foreseeable future!

This book is a great option for students, newly qualified or experienced MSK practitioners alike as there is a comprehensive reference list that demonstrates the evidence base behind the methods.

In the current world of first contact practitioners and advanced practice, this text is essential reading as the assessment and diagnosis methods lend themselves to time-limited appointments within primary care.

The book demonstrates the evolving world of MSK medicine and would be a good text to have within reach in an MSK clinic.

Nick Worth runs a physiotherapy clinic in Bolton and is the chair of the Society of Musculoskeletal Medicine (SOMM). 

To read a PhysioUpdate Q&A with Nick, click here 

Twitter: @Nickworthphysio