June, 1970 R H Y S I O.T.H E R A P Y Page 9 right side. In this case too, it was noted that the descending branch o f the fourth lumbar nerve was stretched and angulated over the enlarged transverse process o f the fifth lumbar vertebra. In partial sacralisations then it would appear that back­ ache could be due to either the pain o f the pseudarthrosis or direct nerve involvement. Disc degeneration has been adequately described by other workers. However, other soft tissue features were noted. In fat subjects, intermuscular deposits o f fat are found between the muscle segments, around the apophyseal joints and large extra articular deposits on the posterior aspects of the superior articular bearing facets o f the sacrum, the fifth and fourth lumbar vertebrae (an accumulation o f fat in front o f the sacrum, on superior and inferior surfaces o f the pelvic diaphragm could be o f gynaecological importance). Degenerations o f the interspinous ligaments were fre­ quently noted. These are frequently associated with joint like cavities between closely approximated spinous proces­ ses. The apophyseal joints vary considerably in shape, size and inclination. The articular facets are seldom symmetrical and even in fresh specimens do not articulate accurately. Asymmetry o f articular facets is often associated with osteo- arthritic changes o f vertebral bodies and apophyseal joints. The apophyseal joint capsules are usually thickened inferiorly and extend backwards to blend with the inter­ spinous ligaments. A- meniscoidal intra-articular synovial fringe encompasses the periphery o f the intra-articular facets. In osteoarthritis o f the apophyseal joints this synovial fringe enlarges so that in severely affected joints it extends as a ragged curtain across the joint. Nipping of this fringe could possibly account for sudden spasms o f backache. Enlargement o f the intra- and extra- vertebral venous plexuses is often found at osteo-arthritic levels o f the vertebral column as a whole. This may well be related to diminished intervertebral movement. The intervertebral foramen transmits the nerve root, two small arteries and three or more venous connections between intra- and extra- vertebral venous plexuses. Its boundaries consist of inter­ vertebral disc and adjacent vertebral bodies anteriorly, the superior vertebral notch inferiorly, the larger inferior verte­ bral notch superiorly and the ligamentum flavum covering the apophyseal joint posteriorly. Loose connective tissue and fat surrounds the nerves, arteries and veins. Intervertebral movement affects the size and shape o f the intervertebral foramen. In flexion all diameters o f the foramen are increased while extension caused a diminution o f these diameters. Intervertebral movement obviously subjects the emerging veins to alterations o f shape and pressure and conceivably causes a pumping effect assisting venous refum. These features suggest that adequate intervertebral move­ ment is essential for a pain free back. Clinical experience shows that backache is most frequent among office workers, housewives and the less active individuals. In contrast the African population is generally free o f backache and in fact only suffer from backache when “Westernised”. SUGG ESTED R E A D IN G FOR ANTE-AND POSTNATAL TEACHING By ROSEMARY HARTE, M .C S.P. , There are so many books available relating to the subject h 1 somet*mes at a loss to know which will be most nelpful Many I have read, and there must be as many again not readily available in this country with which I am un- J 1!aJ\^'or *he purpose o f clarity I have grouped books thp k j ve most meaningful' in my own work into ne Droad categories o f Teaching, Womanhood, Obstetrics, exercises, Relaxation and General. anrl if !° •*3e remembered that we are teaching the laywoman acrncc Slmply t.reat*ng her. Depending on our ability to put H e re in r ° r subJect follows the measure o f our success, n lies an answer why so many o f our ranks succeed in their work and so many, equally knowledgeable, somehow fail. I am sure that a good book on the technique o f teaching is invaluable. There are many on the market and I offer: The Art o f Teaching by Gilbert Highet (University Paper­ backs), Working With Groups by Josephine Klein (Hut­ chinson University Library). More specifically: An Approach to Antenatal Teaching by Sheila Kitzinger (National Child­ birth Trust). A highly commendable booklet. The approach is largely psychological, an aspect insufficiently stressed in physiotherapy training. Methods o f teaching are sound and well explained, and there is an excellent bibliography at the back for those wishing further reading, under specified headings. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Page 10 P H Y S I O T H E R A P Y June, 1970 By implication the teacher should understand the pupil— Woman. The Second Sex by Simone de Beauvoir (Jonathan Cape), is a veritable milestone in the study o f womanhood. The perception, analysis and frank commentary by a controversial and courageous character makes this an invaluable work. A greater knowledge o f obstetrics is required than that afforded by most physiotherapy trainings. Berkeley’s Pic­ torial Midwifery, revised by D . M. Stem (Bailli6re, Tindall & Cox) is text-wise brief and pictorially most informative. A Pocket Obstetrics by Arthur C. H. Bell (Churchill). In order to meet the physical demands put upon a woman in carrying her baby with minimum strain, delivering it with maximum efficiency, and returning to her physiological norm as soon after birth as possible, a sound physical condition is desirable. This is particularly pertinent in our 20th Century, technological Western civilisation, and spe­ cifically in this country. In spite o f an increasing tendency overseas not to stress the “number and vigour o f the exercises taught” * prenatally, it is my experience that only very isolated cases react adversely compared with the vast majority who appear to derive great benefit. However, the question is conjectural and in my opinion a project for further research. The value o f postnatal rehabilitation exercise is not held in question. By definition and training, the physiotherapist is highly equipped to evolve exercises suitable for the needs o f the individual or group. For this reason I am disinclined to suggest any specific books on exercise techniques, though Ballet, Yoga, Modern Dance Drama etc., all help to augment the repertoire, contingent on pertinent analysis. The Principles o f Exercise Therapy by M. Dena Gardiner (G. Bell & Sons) is an excellent book for revision, and for further reference: Human Kinetics and Analysing Body Movements by T. McClurg Anderson. Strange that mention is not made o f the pleasurable and beneficial effects o f using music to induce rhythm and reduce tension and resultant fatigue! Relaxation is such a profound and subtle discipline, com­ pounded as it is o f the physical and the mental, the sensory and the emotional, that the teaching o f it, particularly for use under stress, can be highly problematic, and must, o f necessity be very individual. These books are recommended: Progressive Relaxation by Edmund Jacobson, M .D. (McGraw-Hill Book Co.). You M ust Relax by Edmund Jacobson, M .D . (University o f Chicago Press). Release from Nervous Tension by D . H. Fink, M .D. (Unwin Books). Physiological Relaxation by Voluntary Control by Laura Mitchell, M.C.S.P. A gramophone record o f a lesson demonstrating this method may be obtained from Recorded Sound Ltd., 27 Bryanston St., London, W .l. Sense Relaxation by Bernard Gunther (Macdonald). A New Way to Relax by Karin Roon. Finally we come to the welter o f books aimed at informing the laywoman on methods o f training for childbirth. The similarity between most o f them is often so marked that one wonders what moved each subsequent writer to add yet another volume to the already loaded list. Systems vary various stages o f labour; facts are often far from accurate; chiefly only in the types o f breathing recommended for the and very little original thought and up to date research seems evident. However! A t Your Best fo r Birth and Later by Eileen Montgomery, M.C.S.P. is a little book which I highly recommend. It is packed full o f sound information, well tabulated and illustrated. It refrains from the tendency to ooze sickly sentiment, and the thought processes are very much up to the moment. Equally suitable for laywoman or physiotherapist. The Experience o f Childbirth by Sheila Kitzinger (Penguin Books) is, in my opinion, a valuable contribution. The author is an artist in expressing herself with a lively humour, and a metaphysical awareness. Psychology-orientated, she explores the psycho-sexual implications o f pregnancy and birth in the widest sense, and not just as an isolated incident in the life , o f a woman. She understands the need for a woman to come to terms with her own body before delivery, and to be able to know and̂ feel the responses o f her muscles, thereby facilitating the required control. In this era o f low incidence o f breast­ feeding, her chapter on this subject is excellent. I f some feel that her idealistic involvement o f the husband is a little unrealistic, that must remain their personal opinion. I found a holism in the knowledge derived from this and the previous book. The Know-How o f Pregnancy and Labour by Sylvia Close (John Wright & Sons Ltd.), a very comprehensive little book written in the question-and-answer form, it covers the ground briefly, fully and efficiently. Sex Develop­ ment and M aternity by Dr. Pierre Vellay (Hutchinson, 1968), a new and interesting publication. Becoming a Mother by Theodor R. Seidman, M .D. and Marvin H . Albert (Fawcett Publications Inc.). Clear, concise and straightforward. It does not aim at recommending any particular “system”, but discusses several o f them; Korperschulung Wdhrend Schwangerschaft und Riickbildung by Frau Dr. Dagmar Liechtivon Brasch, Frau Edith Risch and Frau Ines Bitterli is o f Swiss origin, written in German pending an English translation. It presents some slight but interesting variations on the usual breathing techniques for labour, and some good and well illustrated exercises. Maternal Breathing in Labour by Dr. R. St.J. Buxton is a 1 very much up to date research booklet put out for the O.A.C.P., and has been reviewed elsewhere in this journal. In conclusion, it will be noted that most o f my recom­ mendations are comparatively recent publications. I am aware o f the import o f the early contributions o f such well known exponents o f the discipline under discussion at Lamaze, Grantly Dick Read, Minnie Randall, Helen Heardman and many others. Without their inspiration, research and writings we could not have attained the position enjoyed today. Implicit in present day writing is a knowledge o f the works o f these men and women, and we owe them a tremendous debt for having prepared the soil for the second generation to analyse and cultivate. * Recent Advances in Ante- and Postnatal Physiotherapy by Margaret Williams, M.C.S.P., T.M.A.O.T., and J. Odoni, M.C.S.P. Also A Conservative View o f Antenatal Training by P. E. Kennedy, M.C.S.P. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )