Reviews

By Keith Innes, DC, Dean of the MPI Faculty

Title:       Topics in Clinical Chiropractic
Category:    Journal
Editor:      Robert Mootz, DC, DABCO
Published:   Quarterly, $58 per year
Publisher:   Aspen

Chiropractic Now Has Three Journals

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 doctor filling the role of associate editor becomes, in a rotating order, the editor for the next issue. Volume 1 Number 1 was edited by Dr. Mootz; Volume 1 Number 2 was edited by Dr. Souza.

The first issue, March 1994, focused on "the changing nature of chiropractic clinical assessment." It contained seven articles all of which were consistent with the concept of clinical excellence. All of 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 is 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, spotlighted "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 as 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, if a new graduate reads this material for the first time, and is later exposed to state-of-the-art examination and adjustments of the foot, he or she might not give this journal a second chance. That's a luxury the journal 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.

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

Steven Savoie, DC

In this updated 1994 version, Drs. Schafer and Sportelli once again provide the profession with an excellent recruiting tool. This book provides the reader with a wonderful overview of the chiropractic profession and its viability as a health career.

The book covers many topics relating to the practice of chiropractic. There is a concise discussion of chiropractic's position in the overall scheme of health care. The conservative, holistic approach of chiropractic is discussed in everyday language.

The authors present an overview of the history of spinal manipulation, including its origins in ancient times, leading up to its rediscovery by D.D. Palmer in 1895. The historical segment concludes with the current educational standards of the profession.

The remaining section of the book provides more in-depth coverage of the role of the chiropractor, and the educational process preparatory to and through chiropractic college. The book also offers a description of a typical chiropractor. An updated discussion of the cost-effectiveness of chiropractic care includes information from the recently released Manga report.

The section that I feel is the most important is, "Chiropractic as a Professional Career." This outlines the various aspects and options for chiropractic practice including care of children, sports injuries, and the role of women in chiropractic. Chiropractic practice options outside of the United States are also presented.

Overall, the book is an excellent presentation of our profession. It provides the uninitiated reader with a wonderful grasp of what a career in chiropractic can be.

The only negative comment I can make would be the book excludes mention of any professional associations other than the ACA. I think prospective chiropractic students should be provided with all sources of information to help them make this most important career decision.

Savoie Rating: 9.5