Maitland Concept®

ImtaIn Orthopaedic Manual Therapy the MAITLAND® CONCEPT, a specific concept of clinical reasoning and treatment, is consolidated as one of its most significant trends.

The IMTA is an international association of dedicated postgraduate teachers of manual therapy. It is committed to the standardization, development and promotion of manual therapy according to the Maitland Concept as well as to the training of the therapists applying it.

At KenZen Formacion/ESINFIS, IMTA tutors, the most distinguished as well as with the biggest number of publications on the Maitland concept, educate physiotherapists in comprehensive problem-solving and management of patients with neuromusculoskeletal disorders of the movement system based on the principles of the Maitland Concep: Renate Wiesner, Pieter WeiterHuis, Harry J. M von Piekartz, Hugo Stam.

Further information will be provided at the International Maitland Teachers Association site.

IMTA Postgraduate Educational Programm: Assesment, examination and treatment of neuromusculoskeletal disorders based on principles of Maitland® Concept

IMTA offers an eleven week curriculum (440 hours) of postgraduate courses divided into 4 Modules, which are considered as “fundamentals” for clinical practice of the Maitland® concept.

IMTA courses provide the basis for the Orthopaedic Manual Therapy qualification at IFOMT level (International Federation of Orthopaedic Manipulative Therapists) in several European countries. It is the highest international qualification which one might be possible to achieve in Manual Therapy.
IMTA postgraduate courses in manual therapy according to the Maitland® Concept aim to improve the skills of their participants in the treatment of movement dysfunction and thereby to contribute to the improvement of the management of patients with neuromusculoskeletal problems.

Maitland® Concept

The Maitland Concept is referred to as a’ concept’. Emphasis is placed not on the technique of treatment but on a basic philosophy- a thought and decision making process, involving analytical examination and assessment on which treatment decisions are based.

Present day Manual Therapy no longer concentrates exclusively on the articular components of movement but also encompasses the assessment and treatment of the function and mechanical sensitivity or mobility of the neural system and the function of the muscular system.

The main force of Maitland ® concept is found in the thoroughness of its endless re-evaluation. It is a lively concept in continuous development, due to the integration of the common scientific obviousness.

Manual Therapy is relevant in a broad spectrum of specialist areas including conservative Orthopedics, post-operative Orthopedics, Sports Therapy and rheumatological conditions.

The integration of pain physiology´s modern concepts has aided in designing customized treatments and specific basis, depending on patient.

Info for patients

From MAITLAND® Concept educational basis, each patient is different, with his own varying problems. The examination and tests are therefore also individually tailored to each patient.

The first part of the therapy always begins with a detailed interview about the present problem and how it affects your daily life. The description of the problem from the your perspective is very important to the therapist. A thorough physical examination will follow to identify the cause of the problem. In the case of a shoulder problem, for example, the neck, ribs and thorax may also need to be examined to pinpoint the exact nature of the problem.

The findings from the interview, tests and examinations are the basis for the treatment that follows. The movement problem identified will be treated with the most appropriate treatment method, as per example:

Manual joint mobilization.
Techniques to improve the mobility and function of neural tissue.
Stretching and/or strengthening of muscle.
Explanation of the mechanisms of the problem and advice to help ensure the long term success of your treatment.
Training in posture and everyday movements and preferred sports.
Exercises and advice to promote self-management.

Throughout the therapy the physiotherapist will continually monitor the progress made to make certain that the most effective methods are used to bring about an improvement as quickly as possible.

Manual Therapy can be effective in the treatment of:

Back pain and disc problems.
Neck pain and sinal problems of the neck region.
Arthritis – pain and stiffness for example of the hips, knees and back.
Facial pain, headaches and jaw pain.
Nerve irritation causing for example numbness or tingling in the fingers or sciatica.
Knee pain caused by for example ligament and meniscus problems.
Elbow problems such as Tennis or Golfers elbow.
Problems in the wrist and hand for example broken bones, carpal tunnel syndrome, sprains and strains.
Foot and ankle problems for example ligament and tendon tears.
Prevention and treatment of pain and wounds caused in sports activities.
Prevention and treatment of pain and of problems caused by a bad position in working situations.

Info for Physios

The coming on of the Maitland Concept belongs to the most important developments in Manual Therapy.
Maitland® Concept emphasis is placed not on the technique of treatment but on a basic philosophy- a thought and decision making process, involving analytical examination and assessment on which treatment decisions are based..

Present day Manual Therapy no longer concentrates exclusively on the articular components of movement but also encompasses the assessment and treatment of the function and mechanical sensitivity or mobility of the neural system and the function of the muscular system.

When knowledge of current concepts of pain physiology is also integrated into therapeutic decision making, a specific treatment regime can be planned for each individual. This enables the physiotherapist to improve and broaden clinical practice in the following ways:

Through the use of precise procedures of assessment.
By the application of a specific thought process model that facilitates the analysis of patient problems on a theoretical and clinical level.
Through the integration of the ICF in examination and treatment.
By the use of manual examination and treatment techniques of the vertebral column and peripheral joints.
By the use of examination and treatment techniques of neural structures.
Through the analysis of muscular imbalance.
Through instruction and advice relating to movement, posture and self-management.

The medical diagnosis includes information which mainly concerns the effected structure, its relevant pathology and vital information to the therapist with regards to contra-indications and possible necessary precautions. The physiotherapist is dependent on this information in order to make an accurate assessment of the movement dysfunction and to decide on the range and emphasis of treatment suitable for any particular patient.

Subsequently those are some conditions where Manual Therapy is applicably:

Acute and chronic vertebral conditions including radicular syndromes.
Craniofacial dysfunction (Temporomandibular joint problems, headaches).
Degenerative joint diseases of peripheral joints.
Soft tissue conditions of the peripheral joints (Tennis elbow, rotator cuff disorders, Achilles tendon disorders).
Peripheral nerve impingement (Carpal tunnel syndrome, Tarsal tunnel syndrome).
Post-operative conditions following joint replacement, Osteotomy, Osteo-synthesis, ligament repair, surgery to the vertebral column.

It is imperative that the treatment sessions are clearly understood by the patient, only then is the physiotherapist able to motivate the patient to take responsibility for their own condition. Teaching the patient to become aware of his body and make necessary changes to the way he carries out activities of daily life and how he participates in his social environment is as important as the specific manual techniques used in the treatment sessions.

Geoffrey D. Maitland

Geoffrey Douglas Maitland was born in Adelaide Australia in 1924. He trained as a physiotherapist from 1946 to 1949 after serving in the RAAF (Royal Australian Airforce) during the second World War.

His first job was at the Royal Adelaide Hospital and the Adelaide Children’s Hospital, with a main interest in the treatment of orthopedic and neurological disorders. Later he continued working part time in the hospital and part time in his own private clinic. After a few years he became a part time private practitioner and part time clinical tutor at the School of Physiotherapy in the Southern Australian Institute of Technology, now the University of South Australia. He continuously studied and spent half a day each week in the Barr-Smith Library and the excellent Library at the Medical School of the University of Adelaide.

As a lecturer, he emphasized clinical examination and assessment. He stimulated his students to write treatment records from the very beginning, as he felt that “one needed to commit ones self to paper to analyze what one was doing”. In 1954 he started with manipulative therapy teaching sessions.

In 1961 he received an award from a special studies fund, which enabled him and his wife Anne to go overseas for a study tour. They visited osteopaths, chiropractors, medical doctors and physiotherapy colleagues whom they had heard and read about and corresponded with in the previous years. In London, Geoff had interesting lunchtime clinical sessions with James Cyriax and his staff. During this tour Geoff Maitland established a friendship with Gregory P. Grieve from the UK. They had extensive correspondence about their clinical experiences and this continued for many years.

In 1962 Geoff Maitland delivered a paper to the Physiotherapy Society of Australia entitled “The Problems of Teaching Vertebral Manipulation” in which he presented a clear differentiation between manipulation and mobilization and became a strong advocate of the use of gentle passive movement in the treatment of pain, in addition to the more forceful techniques used to increase range of motion.

Geoff Maitland became a substantial contributor to the “Australian Journal of Physiotherapy” as well as to other medical and physiotherapy journals world wide. In 1964 his work was published in the first edition Vertebral Manipulation which followed by a second edition in1968. The first edition of Peripheral Manipulation was published in 1970.

Over all the years of lecturing and publishing, Maitland continued to treat patients as the clinical work remained the main source of learning and adapting ideas.

In 1965 one of Geoff Maitland’s wishes came true and the first three months course on Manipulation of the Spine was held at Adelaide. This course has developed into today’s Masters degree course at the University of Adelaide.

He was one of the cofounders, in 1974, of the International Federation of Orthopedic Manipulative Therapists (IFOMT), a branch of the World Confederation of Physiotherapy (WCPT).

It was only in 1978, while teaching one of his first courses in continental Europe in Bad Ragaz, Switzerland, that he recognized, through discussion with Dr Zinn, Director of the Medical Clinic and the Postgraduate Study Centre in Bad Ragaz, that in fact his work and ideas were a specific concept of thought and action rather than a method of applying manipulative techniques.

The Maitland Concept of Manipulative Physiotherapy as it became to be known, emphasizes a specific way of thinking, continuous evaluation and assessment and the art of manipulative physiotherapy (“know when, how and which techniques to perform, and adapt these to the individual Patient”) and a total commitment to the patient.

Geoff Maitland is a member of many professional organizations and has been honored with several awards.

In 1992 in Zurzach, Switzerland, the International Maitland Teachers Association (IMTA) was founded of which Geoff Maitland is founding member and inaugural President.

All his work would not have been possible without the loving support of his wife Anne, the mother of their two children John and Wendy. Anne did most of the graphic arts for his publications, kept notes, made manuscripts and videotaped may of his courses. Their continuous feedback discipline is one of the very strengths of the Maitlands, who are practically inseparable since they met in England during the second World War.

Geoff Maitland’s work has laid the foundation for the development of contemporary definitions and descriptions of the physiotherapy process. The great strength of the Maitland Concept lies in the disciplined and continual feedback. It is a concept that is still alive and continues to develop and extend.

Adapted from Maitland’s Vertebral Manipulation, Maitland G.D., Hengeveld E., Banks K., English K., Butterworth, Heinemannn, Oxford, 2001.