Maitland's Vertebral Manipulation Management of

Neuromusculoskeletal Disorders Volume 1, 8th Edition

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Maitland's Vertebral Manipulation

Management of Neuromusculoskeletal
Disorders Volume 1

EIGHTH EDITION

Edited by

Elly Hengeveld MSc BPT OMTsvomp Clin

Spec fisioswiss/MSK IMTA Member
Oberentfelden, Switzerland
Kevin Banks BA MMACP MCSP SRP IMTA Member
Chartered Physiotherapist, Rotherham, UK
Consulting Editor

Matthew Newton HPC Reg, MCSP,

MMACP, MIMTA
Teacher, International Maitland Teachers' Association
Orthopaedic Physiotherapy Practitioner, Doncaster, UK

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Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto
2014
Content Strategist: Rita Demetriou-Swanwick
Content Development Specialist: Sheila Black
Project Manager: Anne Collett
Designer: Christian Bilbow
Illustration Manager: Jennifer Rose

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Table of Contents

Cover image

Title Page

Dedication

Copyright

Contributors

Biography
Geoffrey Douglas Maitland MBE AUA FCSP FACP (Monograph), FACP (Specialist Manipulative
Physiotherapist) MAppSc (Physiotherapy)

Preface

Acknowledgements

In Memoriam: Kevin Banks (1959–2012)

Glossary
Chapter 1 The Maitland Concept: assessment, examination and treatment of movement
impairments by passive movement

Chapter 2 Clinical reasoning: from the Maitland Concept and beyond

Chapter 3 Communication and the therapeutic relationship

Chapter 4 Management of cervical spine disorders: a neuro-orthopaedic perspective

Chapter 5 Management of thoracic spine disorders

Chapter 6 Management of lumbar spine disorders

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 Chapter 7 Management of sacroiliac and pelvic disorders

Chapter 8 Sustaining movement capacity and performance

Appendix 4 Recording

References

1 The Maitland Concept

A personal commitment to the patient

A mode of thinking: the primacy of clinical evidence

Techniques

Examination

Assessment

Conclusion

References

2 Clinical reasoning
Introduction

Clinical reasoning and evidence-based practice

Critical thinking and clinical reasoning

Importance of skilled clinical reasoning to expert practice

Clinical reasoning and the bio-psychosocial model of health and disability

Clinical reasoning as a hypothesis-oriented and collaborative process

Clinical reasoning and knowledge

Clinical reasoning and cognition/metacognition

Skilled questioning important to critical thinking and learning

Skilled questioning important to clinical practice

Facilitating application of bio-psychosocial practice: clinical reasoning strategies and hypothesis

categories

Hypothesis categories

Pattern recognition

Complexity of clinical reasoning

Errors of clinical reasoning

Improving clinical reasoning: learning through clinical reasoning

We are all imposters

References

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3 Communication and the therapeutic relationship
Introduction

Therapeutic relationship

Communication and interaction

The process of collaborative goal setting

Critical phases of the therapeutic process

Verbatim examples

Conclusion

References

4 Management of cervical spine disorders

Introduction

Epidemiology of neck, head and facial pain

Common syndromes of the cervical region and their presentations

Clinical reasoning and the bio-psychosocial model

A definition for pain

Pain mechanisms

Input dominant mechanisms

Pain associated with changes in the nervous system

Centrally mediated mechanisms

The brain and pain

Output mechanisms

Examination of the cervical region

Physical examination

Palpation of peripheral nerves

Neurodynamic testing

Pre-cervical spine treatment screening – implications for examination

The treatment of the cervical region

Treatment with reference to neurodynamics

References

5 Management of thoracic spine disorders

Introduction: thoracic spine and the Maitland Concept

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 Clues in the subjective examination to thoracic spine involvement

Improvement of signs and symptoms in areas remote from the thoracic spine after passive
mobilization of the mid-thoracic spine region

Thoracic mobilization/manipulation: when to incorporate techniques to directly address

neurodynamic signs/symptoms in the healing process of a lumbar disc lesion

Analysis of role of detailed examination in determining when to use thoracic passive mobilization
techniques and associated interventions

Examination and treatment techniques

References

6 Management of lumbar spine disorders

Introduction

Demedicalization and conceptualization of NSLBP

Scope of practice of physiotherapists regarding NSLBP

Clinical reasoning

Examination of the lumbar spine: subjective examination

Physical examination

Passive accessory intervertebral movements (PAIVMs)

Examination of motor control impairment

Mobilization and manipulation treatment techniques

Case studies

References

7 Management of sacroiliac and pelvic disorders

Introduction

Applied theory and evidence supporting practice

Clinical reasoning

Subjective examination

Planning of the physical examination (‘structured reflection’)

Physical examination

Treatment

Common clinical presentations

References

8 Sustaining functional capacity and performance

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 Introduction

Role of passive movement in promotion of active movement and physical activity

Functional restoration programmes and self-management

Cognitive behavioural principles

Conclusion

References

1 The maitland concept

2 Clinical reasoning

3 Communication and the therapeutic relationship

4 Management of cervical spine disorders

5 Management of thoracic spine disorders

6 Management of lumbar spine disorders

7 Management of sacroiliac and pelvic disorders

8 Sustaining functional capacity and performance

Peripheral manipulation

Appendix 1 Movement diagram theory and compiling a movement diagram

A contemporary perspective on defining resistance, grades of mobilization and depicting movement
diagrams

The movement diagram: a teaching aid, a means of communication and self-learning

Pain

Resistance (free of muscle spasm/motor responses)

Muscle spasm/motor responses

Modification

Compiling a movement diagram

Example – range limited by 50%

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 Clinical example – hypermobility

Treatment

References

Appendix 2 Clinical examples of movement diagrams

Hypermobility

Scheuermann's disease

The spondylitic cervical spine

Reference

Appendix 3 Examination refinements and movement diagrams

Varied inclinations and contact points

Sagittal posteroanterior movements in combined positions

Diagrams of different movements on a patient with one disorder

Appendix 4 Recording
Introduction

Asterisks

Conditions

Some remarks with regards to recording

Recording of subjective examination findings

Recording of physical examination findings

Active movements

Passive movements

Recording of treatment interventions

Information, instructions, exercises, warning at the end of a session

Recording of follow-up sessions

Retrospective assessment

Written records by the patient

Conclusion

References

Index

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Dedication

This book is dedicated to the memory of Geoff and Anne Maitland

and the legacy they have left for us to nurture and evolve

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Copyright

© 2014 Elsevier Ltd. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by

any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without permission in writing from
the publisher. Details on how to seek permission, further information about the
Publisher's permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing Agency, can be
found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).

First edition 1964

Second edition 1968
Third edition 1973
Fourth edition 1977
Fifth edition 1986
Sixth edition 2001
Seventh edition 2005
Eighth edition 2014

ISBN 978-0-7020-4066-5

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress

Notices
Knowledge and best practice in this field are constantly changing. As new
research and experience broaden our understanding, changes in research
methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and

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knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they
should be mindful of their own safety and the safety of others, including parties
for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are
advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to
verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners,
relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors,
contributors, or editors, assume any liability for any injury and/or damage to
persons or property as a matter of products liability, negligence or otherwise, or
from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Printed in China

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Contributors
Kevin Banks BA MMACP MCSP SRP IMTA Member, Chartered
Physiotherapist, Rotherham, UK

Tim Beames MSc BSc(Hons) MCSP, Chartered Physiotherapist; Instructor

Neuro Orthopaedic Institute, London, UK

Robin Blake MCSP DipTP, Chartered Physiotherapist in Private Practice,

Kirkby Malzeard, UK

Elly Hengeveld MSc BPT OMTsvomp Clin Spec fisioswiss/MSK IMTA

Member, Senior teacher IMTA, Oberentfelden, Switzerland

Mark A. Jones BSc(Psych) PT MAppSc

Program Director, Master of Musculoskeletal and Sports Physiotherapy,
School of Health Sciences, University of South Australia, Australia

Elaine Maheu BSc PT Grad Dip Manip Ther(SA) FCAMPT IMTA

CGIMS, Manipulative Physiotherapist (Clinical Practice), Montreal;
Instructor and Chief Examiner for the Orthopaedic Division of the Canadian
Physiotherapy Association, St Laurent, Quebec, Canada

The late, Geoffrey D. Maitland MBE AUA FCSP FACP, Specialist

Manipulative Physiotherapist, MAppSc [Physiotherapy], Adelaide, Australia

Peter Wells BA DipTP FCSP FMACP, Senior Teacher, International

Maitland Teachers Association (IMTA); Formerly Physiotherapy Clinician and
Teacher, London, UK

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Biography

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Geoffrey Douglas Maitland MBE AUA FCSP
FACP (Monograph), FACP (Specialist
Manipulative Physiotherapist) MAppSc
(Physiotherapy)

G.D. Maitland (1924–2010), who was born in Adelaide, Australia, trained as a

physiotherapist from 1946 to 1949 after serving in the RAAF during the Second
World War in Great Britain.
Geoff Maitland worked initially at the Royal Adelaide Hospital and the
Adelaide Children's Hospital, with a main interest in the treatment of
orthopaedic and neurological disorders. Later he became a part-time private
practitioner and part-time clinical tutor at the School of Physiotherapy at 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.
He immediately showed an interest in careful clinical examination and
assessment of patients with neuromusculoskeletal disorders. In those days
assessment and treatment by specific passive movements were under-
represented in physiotherapy practice. G.D. Maitland learned techniques from
osteopathic, chiropractic and bonesetter books as well as from medical books
such as those of Marlin, Jostes, James B. Mennell, John McMillan Mennell, Alan
Stoddard, Robert Maigne, Edgar Cyriax, James Cyriax and many others. He
maintained an extensive correspondence with numerous authors worldwide,
who published work on passive mobilizations, manipulation and related topics
as for example MacNab from Canada and Alf Breig from Sweden.
As a lecturer, he emphasized clinical examination and assessment. He
stimulated students to write treatment records from the very beginning, as he

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