Book Review  |   June 2009
Musculoskeletal Manual Medicine: Diagnosis and Treatment
Author Affiliations
  • Eileen L. DiGiovanna, DO
    Former Professor and Chairperson of the Stanley Schiowitz Department of Osteopathic Manipulative Medicine, New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury
    Associate Dean Emerita
Article Information
Book Review   |   June 2009
Musculoskeletal Manual Medicine: Diagnosis and Treatment
The Journal of the American Osteopathic Association, June 2009, Vol. 109, 293-294. doi:
The Journal of the American Osteopathic Association, June 2009, Vol. 109, 293-294. doi:
After years of collaboration, Jiří Dvořák, MD, and his international team of coauthors have produced Musculoskeletal Manual Medicine: Diagnosis and Treatment, a truly remarkable textbook with a surprisingly vast scope that is analogous to Foundations of Osteopathic Medicine by Robert C. Ward, DO, et al. 
The fascinating evolution of this book from its earliest edition—published in Germany 25 years ago as Manual Medicine: Diagnostics—is detailed in the preface. The authors describe the work they did after the publication of the first version, such as visiting chiropractic schools accredited by the Swiss health system and colleges of osteopathic medicine in the United States. 
The book opens with a history of how manual medicine developed in Europe and the United States. The authors discuss questions regarding the efficacy of manual medicine in its various forms, emphasizing the importance of future research in the field. 
In subsequent chapters, the authors do not focus solely on diagnosis and treatment of somatic dysfunction. They also discuss a full range of neuromusculoskeletal problems, including neurologic, orthopedic, muscular, rheumatologic, and functional conditions as well as the forms of acute and chronic pain associated with each. The dynamic interaction of body, mind, and spirit is made very apparent in discussions of diagnosis and treatment with manual techniques. 
Chapter 3, titled “Biomechanical Principles of the Spine and Joints,” contains detailed information on how and why manual techniques work—information useful to any osteopathic physician (DO). In addition, dissection photographs are very helpful for reviewing musculoskeletal anatomy and understanding functional diagnosis and pathologic processes. For example, this chapter includes a series of three photographs illustrating age-related degenerative processes as seen in the sacroiliac joint. 
Physicians who treat patients with chronic pain will find chapter 5, “The Pharmacologic and Psychologic Treatment of Chronic Pain,” relevant. The chapter provides a broad discussion of chronic pain and its association with common problems related to the musculoskeletal system. The authors also present information regarding the psychological effects of chronic pain in a clear and useful format. In addition, the chapter discusses the use of pharmacologic agents in conjunction with manipulative medicine—information physicians will find important when developing a comprehensive treatment plan for patients. 
Other interesting chapters cover topics such as neurophysiology of joints and muscles and myofascial trigger point diagnosis and treatment—complete with clear illustrations of referral patterns. The chapters discussing imaging studies and their value in diagnosing and managing neuromusculoskeletal conditions are clear and comprehensive. The tables in chapter 9 that provide guidance on how to minimize risks, complications, and side effects of manual medicine are also essential for any manual medicine practitioner to heed. 
Throughout Musculoskeletal Manual Medicine: Diagnosis and Treatment, readers will find a plethora of tables, black and white diagrams, colored diagrams, gray-tone and colored photographs, and assessment forms. As previously mentioned, colored photographs of anatomic dissection are very helpful. Other particularly outstanding images include radiographic images, computerized tomography scans, and magnetic resonance images. All 1313 high-quality prints contribute to reader comprehension. 
Because Musculoskeletal Manual Medicine is a cross-national compilation of manual medicine techniques, DOs from the United States may not immediately recognize many of the foreign descriptions and terms. For example, a large number of the manual techniques illustrated for each segment of the spine, pelvis, and extremities will be unfamiliar to DOs as a result of differences in terminology and manual techniques used in Europe. However, practicing osteopathic physicians who desire to advance their skills and knowledge will find this book practical once they have mastered the terminology used by the authors. While osteopathic terminology used in the United States differs in many cases from that of European manual medicine practitioners, the authors have explained those differences quite well. 
Whereas the textbook touches on many technical areas that are probably beyond the scope of curriculum for first- and second-year osteopathic medical students, this textbook would be beneficial to faculty members of osteopathic manipulative medicine departments and undergraduate teaching fellows. In addition, I believe it should be required reading for physicians training in neuromusculoskeletal residency programs. Manual Medicine will provide these osteopathic medical professionals the opportunity to learn and practice techniques that may be unfamiliar to DOs. It not only serves as a supplement to US osteopathic education, but it will also serve as a reference when searching for new techniques to address difficult problems. 
While the book's size may be daunting for physicians in a busy practice, reading it in small sections might prove very useful because techniques are presented in a step-by-step manner for ease of understanding. 
Overall, Manual Medicine: Diagnosis and Treatment is a well-organized, comprehensive book that provides the tools for DOs to both understand and integrate European practices and manual methods into osteopathic manipulative medicine. The authors studied American osteopathic forms of diagnosis and treatment. By developing this book, they have given us the opportunity to reciprocate the learning process. 
 By Jiří Dvořák, MD; Václav Dvořák, MD; Wolfgang Gilliar, DO; Werner Schneider, MD; Hans Spring, MD; and Thomas Tritschler. 788 pages, $169.95. ISBN: 978-1-5889-0243-6. Stuttgart, Germany: Georg Thieme Verlag; 2008.