Maitland's Vertebral Manipulation

500 Pages·2005·66.43 MB·English

by  Geoff Maitland

ijI,lET,I,·TEE"~A"Q/·R:"n,
.. mmmJ I
MAITLAND'S
Vertebral
MANIPULATION
Edited by
GEOFF MAITLAND
ELLY HENGEVELD
KEVIN BANKS
KAY ENGLISH
SEVENTH EDITION
Maitland's Vertebral
Manipulation
Seventh Edition
Geoffrey DMaitland MSE.AUA. FCSP.TACP.SASPMapplsc
Editedby
Elly Hengeveld MSc, BPT. PTOMT. SVOMP, IMTAMemb"
SellPorltac~r;Int~rMrionolMaitlandT~chcr'sAsS<.lcior'on.Obcrcntfcldcn,Swiller/and
Kevin Banks SA. MMACP.MCSP.SRP.IMTAMemb"
Cho~~Ph~or~rop;slROlherlJom,UK
Kay English DipTech (Physio),GradDip(AdvMn.MMPAA,MAPA
PrivottProc1itiOflcr.Mtdind;t,SouthAuwoll(r.Australia
ELSEVIER
fIlrrn;RWORTH
IlU"u.,...""
EOINBURGl-1 LONDON NEWYORK OXFORD PHILADELPHIA STlOUIS SYDNEY TORONTO 2005
ELSEVIER
",;,r:~~~~"
Tho:liz""of("oooff~D1>bitbnd.ElI~'lenre-illM\inB~-.IK~)~Ibh10
"" 'ml'''''''"i-..Jiu....ofltu,..url_~a>-..d~'""....I.~'"..·itb
!bec ~~"'n.udIWM,"'...1'1Sll
N<>pon(lilbl'puNoac_....)bc~"''''<'OlI~~'<UOC\'".~>&tra...
~'k..d,....)" o.-by-.y.-.........-.-,.n.........oal......~in¥-
mxonlillJIJI"~i"" i!hoa.tilhttwprior1""""'1;'"(Iid>epubIi!ber;....a
llCe1IClOpcmuu,nf1'<>ln<Icd...",Y'~CInIbr:t:nnodK,"' IWICd~doe
Cop)~'rJlIl'OC~"IA~""'.9OT..'..........CounIt."""I \\IT-tlP
J'fllo".."",'rna)he......,Illd,"""1)r"""E1.....'....,Ikalth~Ri1"'"
OcrwtrnmtinPIoit.lc1phia.USA.pboDo,(+1,~13~39J.llO-t.fax'I+J):13~39
:,1,1,,0·5b.,,c,··m,~ai,lh.ehcI'aJ.l.l..l.r'c.pa.m.i''"''"''iI"'''"g"e~ctl...,...I.'·'iJc"'..r.o.m·.....-,I,..,.."..'mc..aryo~m1)",,1r»-o"m'p''k'''1''.''1)":"','W'Cp<pfIo'<n'"
.00ronllCt'""""lCfI'C"I')"l'h,an,JPennl"IOn-
b""l"'~h"'l(d1%-1
Sc<......"Jedlll<)lll%S
Thinlo<li",,,,IQ7:1
hlu"hc~""H' 1«77
hnhc~il",," I~I>
~i"h<.~lllj..n2ml
St"ell,hrdilion1QCY.1
II.cl"'"lc<.l2006.2007(1"';"'<)
1581\-13, 97~)"'15lJt>-.Sll(l(l...1
15111'1lIr (I'SOb-8!1Ub-ll
Bn.15lILlbl'lll')'C.tlIloeuin,inli'.u"bl.k..a..t.ionData
A......"""'"~r....1bi<boo/,. I.fn"n,hefln,c'"bllrary
I.lbnlf)·014.:_11.__Ca'OII"'J'llnitInl'utlllc:o'ionI)a••
A.c.a.l.Ilus""=-Idlf«1!u>booI..I>" ....lmlcfn\lllthe1Al<..,.orCon:='
"
'kdiall.-Iodaeis.coa<UI>'l;",*"",pnJ.AJ......"ll~bccomn",-:aibble.
dTh..e...s.r-,"."n'",rc_.ol"..,.....ppuroNcc''d''u''f''c.I<o.a~\rp~m<n_t."1"0"d"o"e".".'.",,olifldtnlIooct'".,.f..o..r.n...w.i~onp.""
",.bO,.""i.~~..,I0"""'.Hau.'"''''",aJCf-.~<tron~.....i>ed1O
conr.....~~\he"110...,,......c->pccw~..,Ih~k>dnI&...~••..".,p;,;,.,,'nhIhc
...~Iq,<LoI...._~ofpl'x"c..
Workinglog~ther10grow
...l..ib-ru.r.i.<":"~.in.t1_c.\"<""c-l-o''p''-ingcounttic~... ...
--~-...
~
,,".,.~
--1-"
Contents
Prl'fac~10theseventhedition vii 11. Thoracicspme 301
Prdacetolhefirstedition i~
12. lumbarspine 337
Biography ~I
Glcssary J('( 13. Silcroiliacregion;sacroiliacjei...I,
syml'hysispUbis 401
14. Sacrococcygealandintercoccygeal
1. Introduction 1
rcgioos 411
2. ThelIoctor'sroleindiagnosisand referralfor
15. Examplesoftn:atmcnt 413
manipulaliW'phyo;iolherapy 17
O.A.B,e~rtOt1 Apptndi~1.MovclMnldiagramtheoryand
J. Communication 23 compilingar!lOYf'mcntdiagram 445
wiehQcontributionl:IyJ.Graham Apptndi~2.ClinicalC:lilmplesof~mtflt
4. AnesSmtnl 53 diagf1lllTll; 459
AppendIX3.Examirution,dinem~tsand
5.. PrognosIs 85
moYelTl(ntdillgf1llms 46S
6. Eumin.tion 97
wirh0conui/)cjtiOllbraCfdwunJs Appendix4.Oinicallips 469
Appendix5.Physiot~rlIpyforanimals 475
7. Principlesofttthniq~s 111 with0contributionbyr1.Ahrm
8. ~lccljonoftechniques 183 Bibliography 481
9. Applicationoftcchniqu($ 213 Index 487
willi0('OIIw!JutioobyB.C.Edwards
10. CCr'IIica!spine 229
vii
Preface to the seventh edition
PhyS'Olh(-r~pislS..rebeingcalii'duponII1creasmglyII... Wh,lslle,lbookscanne\'d"~titutethe-rcal-timo.'
medic..lpraet;1I0nerstot•..-Ip I''''..,n" llUI\"erfrom acquisitionoflIlo1I1ipu1l.h\"CskU]",they<anact'"asian·
t>pi!iOd,os of uncompliCil.loo l>I" ~ln'rle/rnechanic.>J. dard and a rl.ltlio<rn from which the dirnci.ln can
~pinal d,sonl,.,... Manipu"'li,·.. Ml)'liiotherapy, il is contmuet"impro",' \',ithllu~InmInd.theIl!'l!O'.od
de-.u,lusanImportantroletopta\Wllmn!herecm'~ 7thI'd·bOnofl-Crt..i>l;M:\bllI~~J.uW>" althoughhal'ing
andT~kNbaib'lbitlya1t0iiodnepnroticfeysoa>n-d"leal"Ithsr,,,,,1s..--grnent.>! ncxuawct~h\hie....1T~M't~et<illlasnJ*d>dotcossrr'n.lppll'oiosnanodfaIl.D'dmVkDJsuheo-,wis
mobili!) U!V"inncnl,ni!UlOOyn.utuCd)'Sfuncti<I>and ing\id«IdIpsoraUrdc\OUII!I,'Chrnques_1lusshoukJ
musoele,mlxlL1nc{',for.,...mple,"-'quiresfinelyhml-'<i hdpthen'ilderI"seeandappl~mon·d.:arl}asf"-'Cbof
sk,lls04dlnlCilI ",",minahon,duucaJ n~and '-"'<:hl...Jmiquesucft....sWrtln"~'lJun>,1oc.l.l"""lIon01
t<-'duuc..l1va<:(uraleanddl,'Ctivetft'aUTlCllttechniques. lom'!Iand"pphc;d>onoffum",
"Th.cr.t:"itlandCoocepth.>sbl.'t.'ll0I1Coflhecon"-.,- II th""" dmamK additions allow srud''nb of
ston<:SofrnQ<I.,mmarupuL'IJ'eph}<IOIh<-npy.Those m,lOipw3tin'ph}>iothc.apy \{)enhance ,heirskills
whof\.wl'beenpnvilcgedl'll'-"'gl,IO;l<."c.....,f{M.lUbnJ Mlde>:perls10checkandrefinctheirskillsandinhun
"Iw(>r\(will"nl""howmUch1)1{)UI~ht"nddetailgoes appl),suchskillsclinicallytohelpmaximi'"p.ltie"t
mlO Ii~'.\pplication ofeachindividual k'Chniqueof ",'Co"I'<)',thentheaimofthi~rev;.;ededitionwillha'"e
examll1ation,rllQbilisatiollor",a'u!'u]atic'11,H,wingthp oc'\'n"crue'00.
npporlunityt(lSeolandpra<:ll<X'!C'dlniq"""JX-..-furTTl<.'£1
inano.pcrlwa...'canonl}sen"CInhdpan}clinician10
un<l~aJ>d and appl}' n",mplllat"e phnio!heTapl ElhI-k'llge,eld-Obrre.,f,'/J("fl.5"~I;:nIa",f
methnd~mon'dfocb,"el~II'lhecluuc.lsetlIng Ke-"inBank$-RI>rnm""fl.Uk
;.
Preface to the first edition
M"l>ipu!Jtion(Itthespi"ei>,aS6(ld:llrosooft""with eachcol><c,Th"wayl~thenprcp"""lforfurth"rde"'<,\
fa~diagnosisat\Cl 'hitorml~"methods0;bruh' opmentinlolhemdr"for<:l'fulnu.nipulativepl'OC't"d
force.~a!i§OCiJll{l11Sh.a,·crnulk'<linthe",,,Iu"on urcs arod their application. Guiding pnnclpb uf
of"",,,,puLah'"treatmentfromrourinephY5'cal""-,,h· ,reatmt'flliollowand~thenapplied10:<op<riflCCilSe
eine.Ilwcaul;0U5anda~\catt,tudelownds hisrorie>inthefinal(Npl(>r.IIshouldbeundet"5l00d
thist....atment..oul.lbelargely~;minated ifil"'~ tNt..II~a!ml.'nlinmisboo!<whendOllll."b)physio
r\.'Cognizedthatrl'll)Slpatient<;canberelie\'edbrthe thc-..arbt,is.,ruyC"amedoutonrrw!dicaln-il'rral
gl.'flt!erprocedun"'<. Tothem.mypropl.."00M."l"contributed00mudl
Thef-eMem'owar-;oflIMImpulallngthec~;ous roward,Ih...finalpreo;enlalionoflhisIloool:I.:1munabl.
p..~lknl.11lefirst,bo.oU",rthoughtofasmobilQ,lnon,i, lu"~pressm~grahl\lJ..i1dequatdy.Will'"ulthecon_
thegentl",C(~l"LngofamOYCml'TIlbyp"",i,-"m}th .Iruct",~helpoftho,;,:co,><:emrowilhtheIypin!l",>(1
mk,lloscillationsperformoowithinoratthelimit(If po,i0!lforIhedi,'gr~ms,mywork\\,,,,,1<.1h"veD..--Cn
therange;thesc<:ood;sthefmcinl;of.1 mOn'..""nl muchmoredifficult
(romthelimitofU....rangebya.uddcnthrustThedif P"rhculJlpeopleWell'asked10undertake1hI't",1:
ferencebetween~1"'0technique-IN.)"'"l'eIJll"ll'7'ili ofmildmgandmliazingthem"nu""riplmd..ta,l.so
siMI'"·!-....comp;oring..stronglvapphl."dmoblli/..lhOfl lhatilmighlm<'t'111,IlNn}"aspo:s,.iblclhe1lC'C'd,.fur
...lha GOOtle manipulative thrwot, but ~i!; an w!tichIIWasundl'ft.llen,andIam!>Urethatthe}"'ill
Importantd1h~_"Thepatient("In..lw...~"SIt;,bllt1<' booabl<'1O>ol'ChowiJ'\,ah..bletheir,,-utdancehasbeen.
mobil17..ltioo1ifIt,"",>uldberometoopainful,wht'n'.lS In partlCUl,u I"'1Sh to"~Pll'SSmy ";n<:....-c ltunl<s
tho-suddenr>rSSoftheforcrlutmilmpulahonpreo....,,15 lo )lbi \I J. H"mmOl1d, ,\UA, MC5r [Teachers
any(()Iltrolbythep,'l",nl C"rt.), Mis, 1·-\1 Gam~, MCSI' rr"..chers eerl),
TI,eprncli<:alappru.~chluth"",..,ofm~njpub,jonis ~!I.\oSM.Marhn-Jonl::>,MC5P(T"ache....C""I.).DrAw.
I"rdatetreatm""1toIh"patj~nl'.~symptomsandsiilns l:"Hlwl!.DPh}.Med.M",H.S.Cul,h"w.8",DipEd.
ratherIhantodia"noses,Suchaplan"Yoid,bolhthe MrLansellBonnin,MCh(Orth),FlK5,1I1dDrBry,ln
amfusion,,",u§«!brdiagno5ticlitl~callingtomind Gandella.\10,BS(1.ldbl,\iRACP{Consult.ilntEditor.
dilkrenl5~mplums10d,f{("l\'ntpeople,andme(on Austr~Ii4.11/('1...11I1ofPll'l"-ii.'l/lffllpll).T"hcsI'personsby
troHr5y..........pathology.lmieN,11i5oftenimpos..-.ib.... theirindi'idualcommentsandcrillos.rn!>~....ronsod
10In...... ..-NttheIn1<'patholog).;, AI60" "Illbe erab~ guid.aoceconammgd,ff~""1~ofthe
a~lh.atund.....,.theumbrellaofonedlo1gnosticti:lt>. work.oarnt.~Jtht'tcadungofph}"-';lOtherap}>tuoi<'n!,
fol'('XiImp....,'disc~ion',<vmptomsandsi~ma~ medlnl.K'Cq)IoInceandcompos'llun.\t) lhank",al'l'
'ill)•.,del}"andn!qu,,,,diffi'l'l'nllrealrnl...ts. du..abotOutr,,-ife..hosopairblilklOglyrrnducoJall
Only th... spinal Ioint>; from I"" occiput to thl" thedr,l,,'iog"-
,,;,crUZllarCdiscU5!ledinthis1xx,1:.""d!hI'k~thM I;lmmostgratdulforthemurt~y\·~tendedtome
beenplannedlu111"d Ihereaderinlogical<t.'<jllCncC durin,!;••=ent.tud}lUI"inGrealUrit,lin.lhcUnitl"(l
frum thecXil11l111alionofIl,edifferentinlcnerkbroll 5t.llesofAmencaandCm\,.da
le'clstotheIer:hnique$ofmobili/.ationapplocabl"in Adelaide G.D.Maitland
Biography
Geoffrey Douglas Maitland
MBE,AUA,FCSP,FACP{Monographl.
FACP(SJ>e{'ialistManipulativePhysiotherapist!.MAppSc(Physiotherapy)
G.DMaidand(19U-J,\\0lSb(lminAdel.lIde,A....trallol. correspondedwithinIhI>p.-..cl'ding\~",rs.InLondon.
tTaiN'dasa pfl)1o.otheraplSlfrom19-J6to1949..fleT Groffh.>J,"~tin$;lunchtimt'climea!SleSiSionsand
5CT\'U'1gintheRAAFduringtheM'Cond~\orldW,]TIn d~ionsWithJamesC","""..noJhi~staff Fromthis
Grt'~lImlain. tour G D, \-laltlilnd ~"blishcd a friendship with
Hisfi~tjob"'MallheRoyalAdclaid"Ilosp,t,,1and GregoryP Gri..,",~tron11110..UK.Theyhadt'~tens",,,
tl'leAdelaideChildren'sHospital.withilm~ininte~1 correspondenceaboutIheirdmic,11 ('xpctiencl'sand
onIll\,trealm('nt01orlhopi>l.,licandneurologicaldis thisconh"u<'dfor!l1,.nyy"ars
ordl'N;.Laterheoonlinuroworkingpart-timemthe \-faitlandd~1i\e,,::dap.lper.in1962.10IhePhysio
hospitalandp"r1-hmeonhIS0....."pri'"lccllnic.After.. therapySocIetyofAUSlraliaenlliled'"TheProbIMru.of
fe....)~'il~heb«-a"l-.eaparNIm<'pri'at"practitioner Tmdting\'t'tkbral Manipulation',inwhich hep"'"
andpart-timeclinICaltutorattheSchoolofI'h~~o­ .....nl<'<Iadendifh.'Tt'Illiilllonbchn.....manipulation
lh<.'ra~inIhcSouthA..slr"JWl(nst1luleofT~'Chnolng~~ ,JIlt!mobilizanonandMarneastrongadvocaleofthe
nOWtheUn;"('I"S,I) ofSouth AuslralJ.. liecontinu uscofgenii...p.lssin,mon'menlinthe1"",1"",-,,1of
ouslystud""l,,"Jspent"',IfadayNehw''''killthe pain,inaddition10themOreITad,I,ona]forcelullech·
Barr-Smilh tibrMj'and theexceU"nl library011 the niqu<'Su",'<iloincR.'a,;('r,lngenf"1ol,,,n.lnIhiscon\('xt
Ml"dic,llSchooloftheUni""n.ilyofAdel~id" itmaybesuilable10quol"Jam<."SC:yriax,af,,\lt1dcrof
Heimmediatdyshowed",nintere;lincarefuldm orthop.ll!dicmediCIneandofmajOrinfluenceonthe
ICaI{':\.aminalional'ldas;es;m....'IltofpatJenbWIth""",m dC\'elopmenl of rrwnlpulali\'e therllpy pro\'ick'<1 by
m,~dtSttdeTs.lntha;edil}''5~and physlOlhl'rapi5ts;
tr'eo1tJn('n1byli"X'fw:p""'in~movementS"'~""un<k...
A.'f"\'S""lto.'<IinphySiotherApypractK\'.G D\-faillo1nd ""'"rrr....ll.v.\Iol'IJ.U1J••pIrysa."~Fl>tJrom
I..amt~dI~fromOSloop.1lhic,dllropr",clicand A"SlmJiIl,/fa-Mne1frpl~/1g"J'I.°III~thru~'"oJj
bonesetterboo"s.l5well"'Slrommedicalbookssuch J/'<M'r/millmcy!mlll'I/lrmart','rr'lglhMindII~'",.
"" thusc of M"r)in, jo;;te.., Jilll\~'S B. lI-fl'f11'l'1l.Jrlhn TI1eI/a"olloti,lemiclI/l.·itllIII<'/lwb,!i;:msI.-.:IIIII'/,I<'S
McMillan "kl\fldl, Alan Stoddud, lI.ob<!rt ,~l"igne, tlmlO,I"Il/Mlh,,,1i,.WHlf'IIrlicoll,rlro,i",I10rlireIlory
Edg..,rC\·n.L~,)am("<;erriaxandmanl'olher<;, rt.'jrrkvIIchiro"rllclol'l"I'''-s..<l''.....11"',1:"'111"jrlue
As,lIoxtun.....h"ernp~LUdclinicdlt'>:amino1lilm rffl.1l/l/afulsWorKis-,~tfWmJlimHchJJsfMl
anda~~1Heslirnula~SiudentstoWn:elIeal· 1'J1kf,:dr:fIllSm.1n1l'ld.zlii'f"/tOlll/qur'S;11/''''cull,/rto
Ill(.'ntraordsfromthe"e-rybt'ginning..ashe-fetl1....1 dJim.;tlafhl'rQIlIOflWlir-tffrd'/lOttmlllJl'yQrI'''
'oneOf'('ded wcomnutOt'I\.'jlolf10p;lpet'toan.al~-e poirt.1,t'II tndtni.J"got<au!OJhI)"""Iolar-'.
WMIoneisdOIng' In1954he-~lartedwithmampula· 11r..",.ttml.'Su"""lslIlld'''''',,1><11,11..prllrlical
theIhc.apyleachjnG<e:>sion~. rffi>rtofmalllp"lat'Oll 11r,'""IWIIj,ex<>mi"",f
I"1%1he~e'\"l'<!.an",,,,m;fromaSpl'Ci,llstudlClo rrlfrrqumli/1lff"iwl,dHr;'l~Ill/'1il'S.'lClIl,t(Jf"~H~Ih,'
fund, which"""bled hj",at1d hi,wifeA"t1c 10!il1 llUwjlm/alnr1<1a,><,:;Stit"n':'l1ll'111i,trcnlmC/I1
O\ers<-",s for a studr tour. 1'1ll1' 'lSlb•...J 06teopaths, 50~r.Heron/m,,'"orallershi,lce/""''Ilain
chin'pr<>ctors, mecbcal doctors .,nd phvsiotherap\ IXcordfllCt'll'i/Il,h,remlsr,INa/J«'ICfO!dl/lll,l:f,
fflileagues"'homthe)'lwdhelIrdandreadaboutand lklcdeJ~",ohJ~J<mScJCQrlyp"",i,k1M
':~~-'-'-",-"-'-'''1i-'d-'''-;'-'''-'-fu-'_--''i----''-"d-'ho~'-n-"'-~-'-"P-"-"-"-"-P-"-"-.-""'-"-'-P-Y-(,-k-OO-"
r
MtllOpanlicftlnf""lJ~a",I-I"'ft,'I'~fjll,u'ill,.OJ wh.."" howlInd whl~h k..,h"iqll~'S topcrfonn.nnd
;"Irrxf"c/i<mII),I,nll.Sll~smIJ,rmifi<t<'llC<'f"'''' a,J~ptth.-'SCtotileind'inv'idualsituationofthepatient')
MillS.~...,tI~IJWI"""""'",,,,d.if/I'"C"""""po",I, and..total(ommitm.. toIhepatient.
8\'11 ,..Yl1-«IiIWfurtl'" M.liUal1d1\.;>5held" ~.md""h...ui...·comm,t-
C.ria~1/19'4)T.....lbooL01Orthop.K'dic "...",llo,..riou:;prnfCffiion.,1lIS.'lOO.1hOf>S:
~foo..:..""PariII-Treatl1\l"111b\
Manipulalil....'\fitSSolgt'.nd1njt.."C~ Austrnlian1"Y"'oolh".aM'A-.ci.Jlioo{APMwhcft,
11thEd,U<m. he"-015onIheSlatebranchcomnunecfor2~\'t.\1J'li
(1l.>IIicn.~nn;Jall,umdon.P"S'"-10-11) in\..OOu5cap.1Citi<.."ilndiIStat..OI,"-,*,t"to
Fed!'ra!(",neiliorIIye,lrs.Incuuf"nclion....ith
G.D,MaitlandI:>o!c.",.,..subst"",i,,1contributor10th.. "thers.hewasrcspon..'ibkforthe"",,-,ion01the
AII!>/",t.",j'lIlr>l1l1<"fPI'Y'J",/IWl1lj'll..s...,,11a~toother stitu!ionofAP/\in1~1%~InIm,hepul
m..-di<:lolan.!ptl\'5olothe1ap\ joumab""OfW"id.. On fo.ward.submi:>sionf>?golrdingSp«ulizahOllin
theinstigationofMonicaM<l,tin-JOIWS06E.aIead... \I.""puLtt"el'hysicothefilf";a<.V<'lC'q)r..-hich......
oBfnltah,en.CMlw':ltIc''m'''''t''Swoadseta\~1oo:fedl'h1y0,...pouCbhlOer<ah~~In.C.."rOel.i<ll, .l,n..abu>geUqula.,lml'l<yeasclrd<">"ptlc01dUin",nA>o""d,iufJaeldialnonCnoIkogcof
which"-",ult..,,jInth<.·fi~t,-od,tlonof\hlrl>/lllMIl"'I"" Ph\~oIh<:rar"t:sfors")'''U"Sanda"....-mlx....o/lhe
Inrumin1%-1.whIchw~s10110\\,('(1byJ!'oC<ond,-.,j,lioo Cl.,,,ncilforafurth<....s;",p,"''S.
io1968.Tf\cfir>1c'dihon(IfI'c~'wh,'ralMo"ip"lalio"WM Membero(tI~Ph)"'iOlhl'rap~'~cl>l.lrallonUoord
published in1970,in"hid..thefamVIb'm"'eml.....r of500.lthA~trill;"fur22Wilrs
di.lgram' wi\S inlrodw;OO..." ..a,lic...co-producrion Chairman,>Irhe&pt'MI'aneffor1'h~l'i<.>IMilpy
..-ilhMs}ennikrIliddiflsIII1965_ forAusl...I~",Examini"lCCoullCllrorD-..........s
0.''-'' all tho:' rursof Ift:turing"nd publb.h.in~ I"'}.......therapbt5IAECOP)lor11)'Nf$.
M...tLmdkepitINtingpatientsill>thtoclmical"OJ~ Austrilhand,4"'!l"1etoIfO\tTforfi\e)·""<5aOOa
",mallledhl~m.l1nSOU=oflearnIng..ndadaptu'8 m<."n'lbcrofl~aCJd"mic"bndardscommitf('('for
0id\-e'""•.Geofftre"tlodpati('JllSinhispri"M"prM'h«1for .111".herfil'er"MS
~yean;Jlllialthoughh"doscdhi,pr"clI,,'111
1965.""r<:maintdJcti,'eintreatingp.lti"nt>unt;119'I~ ForhlJ;workhew~shon.)u.......Jwilh.,.,\er~1aWilrd~
tlhhceIranhpd1>9p6S50c,1hoo~noehloSf0ouM..t..h....JAlCb=.n..d.I..r'.aj..i..i'Y.w.,.niHshIenei',\,sdulCuolaIf!m.''e!ohhfe1T1P.e.ch;hHWnloiot!h · MPFethlJm)o."..>i"o,-'t,;h'he'ipr'il.~.p"OtsIrt~sdeb~ryU.I--.1i<".1>n!h<h..>.egnrB..CpriobllilsiehngE1e9mu7fp0i,......-iiIIn11a91\1.
O1'Sh~)'."a"n.ud..t'hI.l.'pS)'o.u..t~htAiusol1n'lI,li<t'IhneBfirNantditlreol.f'ItThUeA\lh"s"tOrOaUhIa'llnl.' fIuiorlo"o"r,"aJF}e'l~lore"o-".h-'ipubfyMsapse'cl'WroizfAAtpiopnlieind159c6t-e1ncc
onM"llIpu!.>tlQnoftll..Spi...•wasn..ldInAdeLudc.In inI'hysioU\('r~py1m",Ill<:University"fSouth
197~ thiscvur.;ed",e]"I"-,<1 IntotneOil"ye,lrp<.n>t· AI.l~traTi~'"1986_
sr..duatl'oo""ativll'postgr,;Ju.Ill'diplom...inmarupu' tiooorilryrdlowofth"Ck;'r1"n..xlSerlet}'0(
br;v"phy<iulhc....p~'atlill'SouthAUStralianInstltut" Phvsi<.>therapy(CD)
01Technology,no....a:\loOSkn~<OUt'5<.'..Ithe J-iorIor~ryII(e...emb"nlll!",uitheSe.•J1hAhirnn
Uni"'~r5"tyof50ll,hAlblrall3. !'oc~'"Phr"lCJtho,np~.includingtheGroup01
H..WlISON'nf Ih<-co-Iouod....-s.. III 1974..ofI..... \bnipulab..,('Phy-srotl\eQp~~M......pulab\'t'
Inr.........rional f-edcr..hon 01 OrthoJ'al.'dic M,}Jlu,,1 rhv.wthc..apyAssociationorAustQ.l1.(~1PAA),
1ll<'.apy(IFOMT),abranch<.>itheWorklConf.xl.....• Sw,ssA""'-'Ci~linno{\1anlj>ulatiwI'hysioth"r.lpy
at,,,,,ofl'hysi"llwlOlpy(wei'll (SVO:\lPl,(;(>nlla"A,..)('iMi,mof"1anunlTh<:mpy
Onlyin197~,,,hilctl'achingoneoihi!;fi,."t""uN'S (OVMf)andIh"Americanl't1ySiC.l1The,apy
incuuhnentalEuropeinB"dIl:aga~,S",uerldI1od,llid A»ociation(APTA).
he ~, through d~on ....·ilh Dr £Inn. tw"",.,.n.,J...,a\"".dlromIFOJ.,ITinapp"",;"tlQn
lJ'm>o:tor01!heMedKillCli.....andtheP<Jo"IgradUoll<' 01hl$.......-~;u>dI..~dcf'shipfrom;1$foun,btion
StudvCenl",inD.ldRag.oz.tlutinf.."lC1IUsworkand \llIdredOwnAwardb\IheWorldConkdcT-atioJ'l
itk>..s......"..,iIspecUJ(:COllCl'PiofIhooghland<'CIi<>n 01Ph\"Sica111'lo:"<~py(Wc:rnforhislife'sworkin
~atherthanamethQd<.>fappl)lnglJIolnlpulatkelech· 19'95' -
ruq\ll-'S.T.....MaitlM'IdC<'>llccptof\lallipulati\'ePhys.o
thcr,lpy'ISil!x-eame!.:nownemphiiSILCSa"P"Cifi<w,ly in 1M'" Zur.wch, Swlt~l'rbnd,the 11l1"m.,tional
(II Ihmking, cQT1rinl>Ousc\'ah",li"" ..nd i1,;,;e,.~ml"'" MullandT,"..d....-no'A'>SOC;i1l1on(l:\IT,\).....asfound...,j,
810graphy xiii
of....hkhG.D.\laitl,mdisafoundingmemberand Eatii"rin1987,TImml'\'.ha\'1n~"uHb'CSledMaitlaoo
inauguralPresident ~tlO\Ild,,'rill'abouthISWfItnbuhOfls.ud:
A1Ithisw(If'kw(>uldf!NM\el>eenpo;>;oJl>le"linout
thekwinS~uppnn01 IllswifeAnne.thl..rnotheTof /11myl'ito1'.thl'A-1JJit..llIdtq:pnlIlfIllOlll'flll'lt'T"
IhcirIwochikf"-....john..ndWench:Annedidmostof di'frrsfron'"t~,"di>1tI",IntdldPll('Siffl.
t.....graphicart;.if!MdJlbn..l·sput.licdlion",l"J'I""te<, I«J",iqlli'.M,Ir,~111TIIIIF,1lJ11"TWdllcIll.'IVUrIll
rrnoau<rJst.&.mTalwnl1lroc<onnptbinuaonudsfcn!dIdcboatadp;deid"",-Jp11\dinnytisoofnth'oi_f aiil'ldtThJnisO.lI'di,rlatK'i'IT''1l,!4Irr"/,'T1C1I'NlIr"olllI.Ill",-Jllrrra..fpftm}flNlllin~"I/oJtilkl"t'l"liiln
m.,\"'"str~fll;th,>oftheM...itlands,whoan'pracl1t' pI'lf"lUl/fl>mzl"f/uw/l'(iic';"..UVrlllspclllll;(01/1
:a;lalyunildlStW"poarraldbleWSU,lflC\:AInI.n-')emweilSlinawE"n,rgdlacnddmd.u:-ripnrugloc ill<1t/J1'(f'l{d'mdr-lk.:'lV,;,;.1<'tf1i:"lfl)U'0111''1''.if_'rmll
I"'less of the Dutch As5ociation of Orthop.-.cd1C IIJldImlTr'lml;
M..nipul.1I"·...Ther-..py('VO~Il). tIl'llT1'~!;tm<1'('II",,,,,,Jfi.",tJ.lI.1I<'oflolsK
M"itbnd'swork,<'!lpeciall\ throughI"'"mod..or bioIogiculb,.~~·/.,,f;(...;
thinkinglind thepl'OCt.~ofconlinuo",",l5'ieSo""-'rlt, iI,e'r«rs':;llffo,l,i;;11I.·."",t!slil/.
hasl<lidthefoundationforthe,.k·n~lopm\'r'tnfcon· tr,,·n.'t1ulumrftl/f","'....pto.IIJIJmllw,,'t:'I"
k'11lpordrydehrntlon~aOOd\'SCriptiollsofthephysio .¥""fllllyJrn'/0I".J /"" I~IflinusIIJI"';.
therapyproct'SS. d'"1~IOJ'i"lI""Jnkll.l",s;
Withinthisconl<'~titS('\'mssuitable10conclude II",IJff,'S,illffi" .Id'Iilt'di'.m'IIIJ1,III""mIdforthe
with a q""h.' f""n1 Pn.J(~wr L,nce Twom~', Vice I'.",m""diOl'l/m'I"'ml/r".....mmilwlio'IIII'I''''''r!'
seihly,"o'cfdTleo<r:,hnPorlotfllYr,e~l'ri'orlfhI,'tAlyu"smtrtahleiar:apy,CurtLllUJ1I'l'r 1Tt..I.,.·i<,1utN,,·'./I11i.<'11'11"'C.11il1i<~t'ol,rell','"S(''"y..I!<'',','''lmf'/iI,.I1,'im11Nl1,,'I'I1l1.rI'"lIriOlI
Mail/mld'_,'IJII,lwsi'PH;'Cry.arefuland
Ci''''I'I'f'llrJ'5il'<'""'mllma/i,m1~lIdi'lg10111"I"''l:i"" 1\\T.ml'\·,L1.~ndT~\'lor,j,K(1987)11,1'M~illand
1i1ll!'II'lII~,,n7Jtb"yJJlI'i'ffllrl_(l<1rl<mS"M,,1'J!bIyoJm:l0/;1,''t'!'m(.'mf:<ll1onfldl~flolJlolr'/"li O>bnynI''pats::;Ai,'sc:;~elssom\'lC'fmlcl'l.IEl>..E.1dD~\inPaiII.Il0f.l''ilm,.l1nTdIKT'n"lI,'YalomfeIIn..t.
"""'("Intlll011tiN'pilllt'lll./Vl''''lire!J:J,,,,{iJ,Ille Lou...,BurkChurchillLi"ingslone
n.uffllriillieo/IIPI'roWell,TillSbl'robIlbly'hdlN'I' t'JI}'H{'flge,·etd
1Iu',;n,~11'6cnll'lhcJ11>''''po1>;,/['/1'u·;thintiltdi,fi(nJ Ka)En~
,..odin'c{Jt/:l/~IC'l/IIh/'raI'Yulld...~""IfmMrl1'll' Ke\inBanI.,.
oil,"~1«Uf/llmbofII.'prP//'5<ifpll.
Furt-""ordin~f'!'haUS{'K&Gass[
(1995)MJ,<cItlo4r!tIO!l'h!,-"",IIImII"'·
But!('fWorth-lleinemann.O\fcrd Pag"IX
Glossary
ACCESSOIO'MOVEMENTS. (a)[>~ssi\"eae<riSOrv <.ot,1"Cl".'ofsymptoms "'hen rnO"" Ihan onejointor
mh·"crtL~)r.llmm,,--menls,I'AIVM;(b)Pa:;:;i,'"intc; "truclureisul\"oh'ooinamO\'\!lJll'f\1
costaln'o,"errw.'flIS,PAICM. DISORDERS. Beca~aSpe"CirKdiagnosisISana~
ASSESS\1£N'T ThistermIw;threedefllUliorIs: ofd"lo>nninationwhichisIn!<lu=tly,""rydilr.cuJIto
!YUle,thed.,,;criplin·IL'1"m~<lS'thepatienl'sd....
1. A!i5CS6mmt01thelindmg;;oilhl!eummilbonofa order'15usedinmanypl.>o:-..mtheledofIhisbolllk.
lp'la."llJUelnn!ld"1IeU)drnl.:agIo;c,-..a...d1ihacgnLo">"iusl..iSneormleilt(-Oi\n.Ifllotrrime!;alu.,s.e, T[<h)eIe.."...,-.....otntwfOJ",.u,_amd.g".s'.ucnhuInItderfmTt"iesdtocl"ibbs=olrb~,tthISem~;,>,lnt
theterm[V,\I.UATIO:-.lf;;wIhl>aspo.'Ct oSsmtl..lsofthe"""""",tedIL':l.1 The..tlen1ati'eis!II
ta,kindIagnostictenl'll>.bUIItuscanoc'COmecounter
2. AsseSismmtofthechange..wtuchlakepLoc..as.. prodUCII'!,b)"cloudinglhe,mpocloflherelatLodlext
!>!Suitoftheus.:ofat«hnlqU",toprO'cIheclfed thu"losinSthekeyofIhalrel,'IOOle~1
ofthete.:hniqueontil<'d,>oroL""al"" todC'lcrmi""
Ihe<"fll'CloftheIrcalm,,'" hxhr"qul'Sandth..treat [VALUATION, Thistermisnotu:>ed inIlle1".\1of
menlSl.'SSiOll>onthedisonk•. Ihisbook.but it ;sunderstood tomean a form 01
A~So.'S<->menl(seeA,se-smt'nll
3. dAuNriAn)L;"YITr(I>CilAlmLe"atsSo<r'Sil,tntKh~lelroj,n,t,l"usili-o<",,o«fmte~nllmemTa1dte. GRADESOFMOVEMENT, 5.,...M.,"e"'''T1t
Ittake!;intoacrountalld.-t;ubofth,-patient'spil.S1 HYPERMOBILITY.SeclT1stabllity.Hyper-mOOlhl)"I~
ilndpre5Cll1history.IN.>di.1l:n.l<!lcrle\.il,lsandthe ,In ~,"-""S".. rang~ of mCl\emC'1lt (e>."mples bein!;
hrei,s.p..0,ns<5tothed,ffert.'fllI",..Imentswhich...i11 hype"",IL'1lSiooofth....lbo"Of~..,)forwhichthe....is
beenadminisll"nXl.ThISmllecbonofmfor· romp"'temUSClJLuronlrolthu~prO\idmg~tabilitv"
",,"honISanalysedsoa'10alkn.'under!;taJ\dmgof
thehkt"lyfuwwoithep..I;......'Sdisorder li\STA8IlITY.ThislennisUSt'donl) 10meao<In
ncl5SI'"" rangeof "b0()l'lTl.11 mOH'm.'.Il1 for "hlCh
ASTDUSKS.Theuseat~;1'!hen=rdingof lho.'n.'''noprole<:II,..mU>oCulolrrontrol.
eachpalll!flise.=UnabOf'lfindmgs<lndIlUItmenl~ IRRITABILITY. Irril1bi!J~'meanslhatabtll..acti.·")
hasonh'on..erurpose;itisto/''S'''lSlrlIhemilu'riements causes"lotofpainthatt.ake;.arelalL.-...I}'longbn...
found.n.cul$'savesrecordinglim<>,,00m.o"-othe toOl'1lle"Inmill')"casesthisisanlndk"tionthai<:iIU
thl'filPlStquickly...........of....senlIilJromts...h8lmilkirf; Iioo ;~ T\.'quired dUTlng......,lUllolhon and t.-mIn"",1
~_
p-~
COMPRESSION.ThisisIh"al'l'r<)~Im.ltionofOPpoli 1. Its5usc'-'plibi]jl}10becomi!p.1i"fuL
ing;oi"l sUr!:t<es,either in a positiun orduri"g.1 2. HowpainfulIIoc'l:ome<.
m<)"eml~lll,10asse,sthe.>ourceof'1'1l1plornsandtoIJ" 3. Thl.'k'T1gthoftiml.'this1"'"'takL'S10reco"L'"
usedasalreatmc~11!<-'Chni,!ue ($<~'J"'1gesS.116-117).
DtFFEKENTIATION. This arplkos to examination JOtNT. Thiswordrd'-'n>toalllllolintra-articularslrue·
p~uresIh"lassesswhichjointor~lruClu",isIhe tur('<;,tilt-capsule,,00allIll..nOl'-eOT1lraclit"t!.'>,UC5