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[This chapter is dedicated to the memory of Geoffrey Douglas Maitland (1924–2010)]
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Chapter Objectives
At the conclusion of this chapter, the reader will be able to:
Identify the major influences leading to the development of the Australian approach to orthopaedic manual physical therapy (OMPT).
Understand the value of using compartmental thinking when interacting with patients.
Conduct an interrogation with empathy when performing a subjective examination.
Emphasize the relationship between pain and stiffness when assessing range of motion (ROM).
Understand the importance of the comparable sign in guiding intervention.
Appreciate the myriad of ways in which motion may be tested within this approach and how overpressure may be implemented.
Use the findings from the ROM examination and slump testing to reach a differential diagnosis.
Interpret the Maitland movement diagram.
Understand the emphasis placed on analytical assessment in leading to one of four diagnostic classification groupings.
Understand the system used for grading of mobilization and how the therapist's choice may be guided by the diagnostic classification.
Appreciate the differentiating characteristics of this approach and to what extent the current best evidence supports it.
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HISTORICAL PERSPECTIVES
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The development of the Australian approach to orthopaedic manual physical therapy (OMPT) has long been attributed to the work of Geoffrey Maitland. Geoffrey Douglas Maitland was born in Adelaide, Australia, in 1924. After serving in the Second World War in Great Britain, he trained as a physical therapist from 1946 to 1949. While working part-time at the Royal Adelaide Hospital and part-time as a private practitioner, Maitland rapidly developed a keen interest in the management of patients suffering from neuromuscular disorders. His strict attention to detail served him well as he labored over the works of James and John Mennell, Alan Stoddard, Robert Maigne, and Edgar and James Cyriax. Maitland's interest in the detailed examination and evaluation of patients with neuromuscular disorders was innovative and became the primary focus of his teaching endeavors in manual therapy at the University of South Australia, where he began as an instructor in 1954.
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Development and Collaboration
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In 1961, Maitland received a grant to study overseas. During his study tour through London, Maitland had the opportunity to interact with many of the leaders of his day in the area of manual therapy. It was during this collaborative venture, that he began to further refine his approach to manual physical therapy. Gregory Grieve and James Cyriax were among those to have the greatest impact on the development of Maitland's concepts. In 1962, Maitland presented a paper to the Physiotherapy Society of Australia in which he advocated the use of gentle passive mobilization techniques as opposed to the more forceful manipulation techniques that were traditionally being used at that time. The culmination of Maitland's work was realized in 1964 with the first edition of his text ...