LOGO

Maitland’s Concept
of
Peripheral Manual
Therapy
 Introduction to the Maitland
 A tribute to Geoffrey Douglas Maitland

MBE, AUA, FCSP, FACP, MAppSc

 1924 to Fri 20 Feb 2010

 GD Maitland born in 1924 in Adelaide, Australia, was trained

as physiotherapist from 1946 to 1949
 First job at Royal Adelaide Hospital, (main interest was
treatment of orthopedic and neurological conditions)
 Part time tutor at School of physiotherapy in South Australian
Institute of Technology, now University of South Australia
 He used to spend half day each week in barr-smith library and
excellent library at Medical School of the University of the
Adelaide
 He became interested in learning clinical examination and
assessment

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 Introduction to the Maitland Cont…
 He has studied the techniques from osteopath, chiropractor, bonesetter books as well as
from medical books such as those of Marlin, Joster, James B. Mennell, John Mc Millan
Mennell, Alan stoddard, Robert Maignee, Edgar Cyriax, James Cyriax, and many others
available
 1954, He started teaching manipulative therapy sessions

 1961, He was awarded with special scholarship for overseas study tour, he visited James
Cyriax, and Georgy P. Grieve in UK along with others
 1962, he wrote an article of “the problems of teaching vertebral manipulation”
 1964, first edition of vertebral manipulation (Latest 7 th Edition 2005)

 1970, first edition of peripheral manipulation (Latest 4 th Edition 2005)

 He remained in working practice till 1995

 He died on 20th Feb 2010

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 Fundamental components of the Maitland’s
Concept

A. The patient centered approach to dealing with movement disorders

B. The brick wall approach and the primacy of clinical evidence

C. The paradigm of identifying and maximizing movement potential

D. The science and art of assessment

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 A. The patient centered approach to dealing with movement
disorders

 Personal commitment to the patient

1. Concentration
 What it is
 How it can be improved
2. Prepared to revisit
 Follow up
3. Non judgmental
 why
4. Verbal and non verbal communication
 Communication error? Who will be responsible for it?
5. Patients own terminology
 Physiotherapist’s duty to explore and modify accordingly
6. Patients frame of reference
 Put yourself in patients shoes to have true idea
7. Therapeutic relationship
 Environment should be comfortable, trusting

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B. The brick wall approach and the primacy of clinical
evidence

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 C. The paradigm of identifying and maximizing movement
potential

Physiotherapist is concerned with identifying and

maximizing movement potential within the spheres
of promotion, prevention, treatment and
rehabilitation.

(WCPT,1999)

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 C. The paradigm of identifying and maximizing
movement potential

THE MAITLAND CONCEPT with attention to detail in the

analysis of
QUANTITY AND QUALITY OF HUMAN MOVEMENT

AND

with MOBILIZATION/MANIPULATION techniques designed

to restore movements to their pain free ideal state, is well
placed to contributes to the realization of such a paradigm

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 C. The paradigm of identifying and maximizing movement
potential

 The Physical Examination – Maitland Concept emphasized on

 Present Pain
 Observation
 Functional movement assessment (functionally reproducing movements)
 Re-enacting the injuring movement
 Differentiation tests
 Brief Appraisal Tests
 Pain response to
 Accessory movements
 Physiological movements
 Combined movements
 Physiological and accessory movement with joint surfaces compressed together
 Over pressure
 Movements
 Palpation
 Isometric Testing
 Neurological Examination and Neurodynamic Testing
 Division of Tests in Different Positions (Supine, Side lying(L,R), Prone, Sitting)

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 D. The science and art of assessment
 Science of assessment
 Cause of the problem
 The structures at fault
 Pathobiological mechanisms

 Art of Assessment
 Repeated assessment and ongoing analytical assessment
 Clinical decision making about treatment strategies (selection and
application of the techniques)

It is open-mindedness, mental agility and mental discipline linked

with a logical and methodical process of assessing cause and effect
which are the demands of the concept
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 Assessment
 Analytical Assessment at 1st consultation
 Pretreatment Assessment
 Assessment and Reassessment during and immediately
after each treatment session
 Progressive assessment
 3rd to 4th session
 Retrospective assessment
 After a planned break from treatment
 Like 2 weeks on and 2 weeks off
 Final Analytical Assessment

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THE MAITLAND’S CONCEPT
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Basic Definitions from
Maitland’s Concept

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 Mobilization

It is passive movement performed in such a manner

and speed that all the times it is within the control of
the patient so that the movement can be prevented if
patient chooses so

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 Manipulation

A passive movement consisting of a high velocity, small

amplitude thurst within the joint’s anatomical limit, performed
at such a speed that renders the patient powerless to prevent it
MUA (Manipulation Under Anaesthsia)
is a medical procedure, performed under anaesthesia, and is
used to stretch a periarticular and intraarticular joint structures
to restore a full range of movement by breaking adhesions.
The procedure is not sudden forceful thurst, but it is done as
steady controlled stretch, and also termed as manipulation
if any break down (sudden) of adhesions during mobilization
technique may be classified as manipulation even though a
sudden thurst has not been used

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 Passive Movement

 Any movement of any part of one person which is

performed on that person by another person or piece of
equipment
 Physiological and Accessory Movements are two types
of passive Movements

 It is important to restore both physiological and

accessory movements to restore normal joint
mobility

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 Passive Movements

Physiological movements are those movements

that patients can perform actively by themselves
Accessory movements are those that the
individual can not perform actively but which can be
performed on them by another person.

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 Grades of Mobilization
Grading based on amplitude of movement & where within
available ROM the force is applied.
 Grade I
 Small amplitude rhythmic oscillating movement at the beginning of
range of movement
 Manage pain and spasm

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 Grades of Mobilization
 Grade II
 Large amplitude rhythmic oscillating movement within midrange of
movement
 Manage pain and spasm
 Grades I & II – often used before & after treatment with
grades III & IV

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 Grades of Mobilization
Grade III
 Large amplitude rhythmic oscillating movement up to
point of limitation (PL) in range of movement
 Used to gain motion within the joint
 Stretches capsule & CT structures

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 Grades of Mobilization

Grade IV
 Small amplitude rhythmic oscillating movement at very
end range of movement
 Used to gain motion within the joint
 Used when resistance limits movement in absence of pain

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 Grades of Mobilization

 Grade V – (thrust technique) - Manipulation

 Small amplitude, quick thrust at end of range
 Accompanied by popping sound (manipulation)
 Velocity vs. force
 Requires training

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 Example of grades

The best way to learn is to practice, practice and practice……

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