Reviews

Title: Topics in Clinical Chiropractic

Category: Journal (quarterly, $58 per year)

Editor:    Robert Mootz, DC, DABCO
Publisher: Aspen (7201 McKinley Circle, Frederick, Maryland 21701)
Tele: 1-800-234-1660

Chiropractic Now Has Three Journals

The purpose of this journal is, and I quote: "... a peer-reviewed journal that provides practitioners with relevant, practical information that fosters clinical excellence." The clinical excellence point will be dealt with later in this review.

The editor of Topics in Clinical Chiropractic is Robert Mootz, DC, DABCO. Dr. Mootz is an associate medical director for chiropractic, state of Washington (Olympia), Department of Labor and Industries.

The journal has four associate editors: Drs. Linda Bowers, Daniel Hansen, Kevin McCarthy, and Thomas Souza. The role of the associate editor is to become, in a rotating order, the editor for the next issue. Vol. 1 Number 1 was edited by Dr. Mootz; Vol. 1 Number 2 was edited by Dr. Souza.

The first issue, March 1994, had its focus on, "The changing nature of chiropractic clinical assessment." It contained seven articles all of which were consistent with the concept of clinical excellence. All the articles were superb, but two need special mention: "Back to basics: Differentiating mechanical pain from visceral pain," by Dr. T. Souza; and "Somatization: Psychologic considerations in chiropractic practice," by Dr. T. Milus.

A "Special Feature" section, that I sincerely hope continues to be a part of this journal, is prepared by Linda Bowers, DC, a diplomate in just about everything. The first feature, "Clinical Pearls," contains pearls of wisdom that every DC should know. This short section if fabulous.

Each journal has a section, "Appendixes," which contains some of the best algorithms and forms that I have seen for many years. Each article tends to have an algorithm to go with it, thereby providing an extremely quick reference guide to the busy doctor. What is not clear is whether or not these algorithms and other forms/histories can be reproduced for clinical use by the reader.

Volume 1, Number 2, June 1994, had its focus on "The clinical importance of the extremity." Consistent with the previous issue, this second attempt also contained seven articles, ranging from x-ray analysis (a very good article), to PNF techniques, orthotics and orthopedic conditions of the lower limb. However, unlike the first issue where the quality was first class, we find coach class material in this issue.

If this journal is to survive, and I hope it does, the editors must not look upon this review as negative, but rather an opportunity to catch potential problems early in its genesis. For example, in the article, "Evaluation of soft tissue pain," Dr. R. Henninger states: "In the spine however, tight muscles will be painful and make more specific ligamentous palpation difficult." This prompts the following questions: Is Dr. Henninger saying that he can palpate ligaments or is he subscribing to the old out-of-date ligamentous theory of fixation. And where do we find the references for this specific palpatory skill. It is not contained in the provided list of reference material. Either way, this is not something that fosters clinical excellence, or am I just missing something?

Dr. Souza was brilliant in the first issue, however in this issue he states that the cuboid is usually restricted on dorsal movement. Well, when you consider this statement one can only assume that the author is not aware of the shape of the articular surfaces, as the cuboid with respect to the calcaneus is concave on a convex calcaneus, and therefore pure dorsal movement is not possible. The movement is compound in nature and includes glide-roll and a translatoric motion that is 90 degrees to the IAR being in the concave partner.

In the section on the navicular, Dr. Souza states: "The navicular drop test is not an indicator of subluxation, I agree, but illustrates that adjustment of the navicular must also be supported with a medial arch support..." The navicular, although anatomically part of the midfoot actually functions as part of the subtalar joint, the talo-calcanconavicular joint, and must be evaluated both in open and closed kinetic chain postures of the subtalar joint. Ground reactive forces and dysfunction of the windlass effect will compromise the function of the first ray complex and result in a false positive navicular drop test. Therefore an orthotic device may not be indicated for this patient, rather an adjustment to the cause and not the compensatory area is a logical place to start. Once again, this article displays thoughts and concepts that are not clinically excellent.

I realize that these are picky little points, however to a new graduate reading this material for the first time, and after being exposed to state of the art examination and adjustments of the foot, he or she might not give it a second chance: a luxury you can ill afford.

I would like to reiterate my statement about the authors not taking this personally or in a negative vain. The task you have undertaken is monumental and you are to be applauded for your efforts. The journal is wonderful and I am a subscriber as well.

Keith Innes, DC, Head of the MPI Faculty

Innes rating: I rate this journal, regardless of how one interprets my comments, as a 9.5 and will recommend it to my colleagues.

Title:       Therapeutic Stretching for Athletes
Author:      William Moreau, DC, DACBFP, Brian Nook, DC, DACBFP
Category:    DC education, as well as athletes, coaches, etc.
Publication: Videotape, 45 minutes, $40.00
Publisher:   Northwestern College of Chiropractic, 1993
phone: (612) 885-5446

"Therapeutic Stretching for Athletes" is a much welcomed compendium of therapeutic and potentially preventative stretching regimens targeting athletes of major team sports: football, baseball, softball, basketball, volleyball, wrestling, swimming, and track and field. The developers of this video, Drs. Moreau and Nook, proffer the hope that pre and post workout stretches will increase the flexibility of the athlete and prevent injury. As they note in the videotape postscript, athletes are far more aware of (and compliant with) strength training in physical performance than the necessity for adequate muscle lengthening and flexibility.

Following a brief introduction regarding the utilization of the stretching regimen, the videotape is divided into a 20-minute section of "core" stretches for athletes involved in all sports, and another segment of equal length of "sport-specific" routines for the individual sports cited above. All therapeutic routines consist of PNF stretches and antagonist contraction. "Core" stretches include all major extremity muscle groups (such as groin/adductor, buttock/piriformis and anterior leg and shin), as well as the chest and neck. The stretches highlighted are all performed with the aide of an assistant or trainer.

The "sport-specific" regimens include the basic core exercises with the addition of stretches for areas particularly stressed in a particular sport, such as the triceps and posterior shoulder in baseball or softball, and the recommendation against anterior shoulder stretches in the swimmer.

The only drawbacks noted were a tendency toward extraneous background noises, especially in the beginning, and the question of necessity in demonstrating each exercise for the entirety of its recommended "8-count" and 3-repetitions. At the end of the videotape I was left wishing for more: golf, racket sports, even bowling, for the advisement of my patients involved in more individualized sports. Hopefully, there will be a "Volume II" in the near future.

Drs. Moreau and Nook have aspirations for use of this tape in physical education classes and team training. I would loudly applaud the application of this tape in this manner. It would make a superlative donation to or presentation for a high school or college athletic department. Now, if we could only get coaches to use it, we might all see fewer injuries young athletes.